Tangled web of prescription bottles and syringes symbolizing the opioid crisis, with a ray of hope shining through.

Beyond Prescriptions: Unmasking the Real Drivers of Opioid Overdoses

Theo Raines in Health & Wellness December 2025 • 5 min read.

"A groundbreaking study reveals surprising insights into the complex factors behind opioid-related overdoses in British Columbia, challenging common assumptions about prescription drug use."

The opioid crisis in North America has been a devastating epidemic, with a recent surge in overdose deaths linked to the powerful synthetic opioid, fentanyl, infiltrating the illegal drug supply. British Columbia (BC), Canada, has been particularly hard hit, prompting a public health emergency declaration in 2016. While prescription opioids have long been considered a major driver of the crisis, a new study sheds light on the complex factors at play, revealing surprising insights that challenge conventional wisdom.

A common approach to combatting the overdose crisis has been to restrict and regulate clinicians' prescribing of opioids, with the aim of reducing the availability of these drugs. However, a recent study conducted in British Columbia questions this approach. The study uses a large linked administrative dataset to examine the prevalence and past history of use of a range of prescription medications among men and women who experienced an opioid-related drug overdose in BC.

This article delves into the findings of this important research, exploring the prescribing histories of individuals who experienced opioid-related overdoses and comparing them to a control group. By understanding the patterns of prescription drug use among those who overdose, we can gain valuable insights into the true drivers of the crisis and develop more effective strategies for prevention and intervention.

Unveiling the Unexpected: Prescription History vs. Overdose Reality

Tangled web of prescription bottles and syringes symbolizing the opioid crisis, with a ray of hope shining through.

The study, conducted in British Columbia, Canada, analyzed administrative data from 2015 to 2016, a period marked by a rapid increase in opioid-related deaths. Researchers examined the prescription histories of nearly 10,000 individuals who experienced an opioid-related overdose, comparing them to a control group of over 49,000 matched individuals. The analysis focused on a wide range of prescription medications, including opioids for pain, opioid agonist therapy (OAT), benzodiazepines, antidepressants, and other psychotropic substances.

One of the most striking findings was the low prevalence of active prescriptions for opioids for pain at the time of overdose. The research indicated that the majority of overdose cases, approximately 92% of men and 86% of women, did not have an active prescription for opioid pain medication at the time of the overdose. In fact, approximately half of the individuals had not even filled an opioid prescription in the past five years. This suggests that while prescription opioid use may have played a role in the past, it is not the primary driver of the current crisis.

Overdose cases were more likely to have been prescribed opioids for pain in the past compared to controls.
Long-term use of prescription opioids was also more common among overdose cases.
Those who overdosed tended to have more prescriptions for psychotropic substances than controls, suggesting a link between mental health issues and overdose risk.
Fewer than 10% of cases had an active prescription for opioid agonist therapy (OAT), highlighting a gap in treatment access.

The study also revealed that individuals who overdosed were more likely to have a history of mental health conditions, such as substance use disorders, anxiety, and depression. This suggests that mental health plays a significant role in the opioid crisis. Additionally, the data indicated a high prevalence of injection drug use among overdose cases, further emphasizing the importance of harm reduction strategies and access to treatment for addiction.

Reconsidering Our Approach: A Path Forward

The findings of this study have significant implications for addressing the opioid crisis. While regulating opioid prescribing may be a necessary step in curbing the flow of prescription drugs, it is not a sufficient solution on its own. The study suggests that focusing solely on prescription opioids may have a limited short-term impact on the current crisis, which is largely driven by the contamination of the illegal drug supply with fentanyl.

A more comprehensive approach is needed, one that addresses the underlying factors that contribute to opioid use and overdose. This includes expanding access to mental health services, providing comprehensive addiction treatment, and implementing harm reduction strategies, such as safe consumption sites and naloxone distribution. By addressing the complex needs of individuals at risk, we can reduce the demand for illicit opioids and prevent overdose deaths.

Ultimately, solving the opioid crisis requires a multifaceted approach that goes beyond simply restricting prescription opioids. We need to focus on prevention, treatment, harm reduction, and addressing the underlying social and economic factors that contribute to addiction. By working together, we can create a healthier and safer community for all.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.drugalcdep.2018.09.019, Alternate LINK

Title: Patterns And History Of Prescription Drug Use Among Opioid-Related Drug Overdose Cases In British Columbia, Canada, 2015–2016

Subject: Pharmacology (medical)

Journal: Drug and Alcohol Dependence

Publisher: Elsevier BV

Authors: Kate Smolina, Alexis Crabtree, Mei Chong, Bin Zhao, Mina Park, Christopher Mill, Christian G. Schütz

Published: 2019-01-01

Everything You Need To Know

Does having a current prescription for opioids for pain directly cause most opioid overdoses?

Research in British Columbia indicates that the majority of individuals who experienced opioid-related overdoses, specifically around 92% of men and 86% of women, did not have an active prescription for opioids for pain at the time of their overdose. In fact, about half had not filled an opioid prescription in the past five years. This suggests that factors beyond current prescriptions, like the contamination of the illegal drug supply with fentanyl, are major drivers of the crisis.

Besides prescription drug use, what other factors contribute to opioid overdoses?

The study in British Columbia revealed several key risk factors. Those who overdosed were more likely to have a history of mental health conditions, such as substance use disorders, anxiety, and depression. Additionally, a significant number of overdose cases involved injection drug use. While past prescriptions for opioids for pain and long-term opioid use were more common among overdose cases, the lack of current prescriptions suggests a shift in the primary drivers of the crisis.

What is opioid agonist therapy (OAT), and how does its use relate to overdose rates?

Opioid agonist therapy (OAT) is a treatment that uses medications like methadone or buprenorphine to help individuals manage opioid dependence and reduce the risk of overdose. The British Columbia study found that fewer than 10% of overdose cases had an active prescription for opioid agonist therapy, indicating a significant gap in access to this potentially life-saving treatment. Addressing this gap could involve expanding access to OAT programs, reducing barriers to entry, and increasing awareness of the benefits of OAT among both patients and healthcare providers.

If prescription opioid regulation isn't enough, what other strategies should be part of addressing the opioid crisis?

The British Columbia study suggests that focusing solely on restricting prescriptions for opioids for pain may have a limited impact on the current overdose crisis. While responsible prescribing practices are important, the study highlights the need for a more comprehensive approach that addresses the underlying issues driving the crisis, such as mental health conditions, substance use disorders, and the contamination of the illegal drug supply with fentanyl. Harm reduction strategies, increased access to treatment, and addressing social determinants of health are also crucial components of an effective response.

With the rise of fentanyl, what are the implications and next steps for tackling opioid overdoses?

The surge in opioid-related deaths in British Columbia, particularly those linked to fentanyl, underscores the urgent need for multifaceted interventions. The study's findings call for increased resources and focus on harm reduction strategies, such as supervised consumption sites and naloxone distribution, to prevent immediate deaths. Addressing mental health and substance use disorders through integrated treatment programs is crucial. Furthermore, strategies to disrupt the illegal drug supply and reduce the availability of fentanyl are essential to curbing the crisis and saving lives.