PT  - JOURNAL ARTICLE
AU  - Mark Fan
AU  - Dorothy Tscheng
AU  - Michael Hamilton
AU  - Patricia Trbovich
TI  - Opioid losses in terms of dosage and value, January 2012 to September 2017: a retrospective analysis of Health Canada data
AID  - 10.9778/cmajo.20190112
DP  - 2020 Jan 01
TA  - CMAJ Open
PG  - E113--E119
VI  - 8
IP  - 1
4099  - http://www.cmajopen.ca/content/8/1/E113.short
4100  - http://www.cmajopen.ca/content/8/1/E113.full
SO  - CMAJ2020 Jan 01; 8
AB  - Background: Canadian health care facilities must report losses or thefts of opioids to Health Canada. To broaden the understanding of opioid loss in Canada, we analyzed data describing these losses to estimate the amount of opioid lost, estimate the wholesale and street value, compare the distribution of loss types between facility types and compare loss trends.Methods: We analyzed Health Canada records of losses of codeine, fentanyl, hydromorphone, morphine and oxycodone reported by Canadian facilities from January 2012 to September 2017. We conducted descriptive analyses of the opioid losses by calculating milligrams of drug lost, oral morphine equivalents, daily defined doses, approximate wholesale value and approximate street value, and compared loss trends when counted by incidents, dosage units or milligrams.Results: There were 64 963 reports of loss of codeine, fentanyl, hydromorphone, morphine or oxycodone over the study period. Over 112 kg of opioids were lost, an estimated $8.7 million in wholesale cost and $136 million in street value. The dominant loss categories varied by facility type: armed robbery (30.9 kg [31.1%]) for community pharmacies, unexplained losses (6.4 kg [55.8%]) for companies and pilferage (0.8 kg [57.4%]) for hospitals. Loss trends over the study period varied by reporting metric and facility type: community pharmacy losses increased when measured by dosage units and incidents of loss, and remained stable when measured by milligrams; hospital losses increased when measured by milligrams and showed no clear trend when measured by dosage units and incidents of loss. Companies showed no clear loss trend with any reporting metric.Interpretation: Large quantities of opioids were lost or stolen from community pharmacies, companies and hospitals over the study period, and these losses are valued in millions of dollars. Publishing milligrams of opioids lost annually alongside metrics such as dosage units and incidents of loss would help characterize the economic cost and the magnitude of drug losses.