Opioid poisoning and availability of specialized medical care in Ontario, 2002-2006

The prescription of opioid analgesics has risen sharply in North America over the past two decades. This increase has been accompanied by a rise in overdoses. The present study draws on administrative data collected from emergency department contacts to describe the epidemiology of opioid overdose in Ontario b~tween 2002 and 2006 and to examine the role of regional variation in availability of specialist care. The number of poisonings increased from 1250 (10.9 per 100,000) in FY2002 to 1816 (15.2 per 100,000) in FY2005. Local concentration of specialist physicians was significantly associated with the incidence of opioid overdose, inversely at most levels of availability, but positively at very high levels. Regional variation in incidence was also associated with demographics, median family income, and the rate of other drug poisonings. Policy options for limiting opioid-related harms are limited, but improvements in monitoring and clinical management may prove valuable.

Handwritten sheet of paper detailing the cost of transporting boxes containing the Gravatt’s level

Handwritten sheet of paper detailing the cost of transporting boxes containing the Gravatt’s level from London to St. Catharines, April 1847.

Handwritten sheet of paper detailing the cost of transporting boxes containing the Gravatt’s level

Handwritten sheet of paper detailing the cost of transporting boxes containing the Gravatt’s level from London to St. Catharines. This sheet is signed by S.D. Woodruff, Jan. 11, 1847.

Approximate cost of completing the railway from Port Dalhousie to St. Catharines and an estimate of the cost of the piers at Port Dalhousie signed by William Hamilton Merritt

Approximate cost of completing the railway from Port Dalhousie to St. Catharines and an estimate of the cost of the piers at Port Dalhousie signed by William Hamilton Merritt (5 pages, handwritten), July 8, 1854.

Approximate estimate of the cost of completing the Port Dalhousie Railway to the Grand Central Railway Station at Lock 12

Approximate estimate of the cost of completing the Port Dalhousie Railway to the Grand Central Railway Station at Lock 12. This document is badly torn and burned but most of the text is legible, July 14, 1854.

Estimated cost of the Port Dalhousie and Thorold Railway sent to George Rykert by S.D. Woodruff

Estimated cost of the Port Dalhousie and Thorold Railway sent to George Rykert by S.D. Woodruff, Aug. 5, 1854.

Approximate estimate of the cost of constructing and completing the Port Dalhousie and Thorold Railway to St. Catharines

Approximate estimate of the cost of constructing and completing the Port Dalhousie and Thorold Railway to St. Catharines signed by S.D. Woodruff (2 pages, handwritten), Jan. 8, 1855.

Cost of the railway from Port Dalhousie to St. Catharines

Cost of the railway from Port Dalhousie to St. Catharines (1 page, handwritten), Jan. 11, 1855.

Approximate estimate of the cost of extending the Port Dalhousie and Thorold Railway from Geneva Street to the Great Western Railway Station at Lock no. 12

Approximate estimate of the cost of extending the Port Dalhousie and Thorold Railway from Geneva Street to the Great Western Railway Station at Lock no. 12 (2 copies) [one appears to be a rough copy] (2 pages, handwritten), Feb. 2, 1855.

Letter of estimate sent to S.D. Woodruff for the total cost of construction and equipment of the extension of the line to Port Colborne

Letter of estimate sent to S.D. Woodruff for the total cost of construction and equipment of the extension of the line to Port Colborne [this is unsigned]. There is an envelope with this letter that suggests that it is from Mr. Shanly, Mar. 12, 1857.

Chart of estimate of cost of Port Dalhousie and Thorold Railway extension Line no. 1

Chart of estimate of cost of Port Dalhousie and Thorold Railway extension Line no. 1 signed by Mr. Shanly, Mar. 12, 1857.

Chart of the estimated cost of Line no. 1

Chart of the estimated cost of Line no. 1, n.d.

Chart outlining Port Dalhousie and Thorold Railway cost of planks, bridge, railway crossing and approaches thereto

Chart outlining Port Dalhousie and Thorold Railway cost of planks, bridge, railway crossing and approaches thereto, n.d.

Approximate estimate of the cost of macadamizing, grading, bridging and putting in culverts from Hurst’s Bridge above Thorold to Port Robinson

Approximate estimate of the cost of macadamizing, grading, bridging and putting in culverts from Hurst’s Bridge above Thorold to Port Robinson (2 pages, handwritten), n.d.

List of abstracts (2 pages, handwritten) stating the cost of S.D. Woodruff dwelling and barns

List of abstracts (2 pages, handwritten) stating the cost of S.D. Woodruff dwelling and barns, January, 1878.