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1 Supplementary Online Content Gomes T, Redelmeier DA, Juurlink DN, et al. Opiod dose and risk of road trauma in Canada: a populationbased study. JAMA Intern Med. Published online January 14, doi: /2013.jamainternmed.733. etable 1. Place of occurrence codes used to identify road trauma in emergency departments. etable 2. Components of disease risk score used to match cases to controls etable 3. Characteristics of all cases and potential controls efigure. Association between opioid dose and road trauma among all cases and potential controls This supplementary material has been provided by the authors to give readers additional information about their work.

2 etable 1. Place of occurrence codes used to identify road trauma in emergency departments Place of Occurrence, ICD 10 Code Suffix Patient Position Vehicle Involved V01 V09 All Pedestrian Various vehicles V10 V19 All Miscellaneous Pedal bicycle V20 V29 0, 2, 3, 4, 6, 8, 9 Driver Motorcycle V20 V29 1, 5 Passenger Motorcycle V30 V39 0, 3, 4, 5, 8, 9 Driver All terrain vehicle V30 V39 1, 6 Passenger All terrain vehicle V30 V39 2, 7 Pedestrian All terrain vehicle V40 V49 0, 3, 4, 5, 8, 9 Driver Automobile V40 V49 1, 6 Passenger Automobile V40 V49 2, 7 Pedestrian Automobile V50 V59 0, 3, 4, 5, 8, 9 Driver Small truck V50 V59 1, 6 Passenger Small truck V50 V59 2, 7 Pedestrian Small truck V60 V69 0, 3, 4, 5, 8, 9 Driver Big truck V60 V69 1, 6 Passenger Big truck V60 V69 2, 7 Pedestrian Big truck V70 V79 0, 5 Driver Bus V70 V79 1, 3, 4, 6, 8, 9 Passenger Bus V70 V79 2, 7 Pedestrian Bus V80 All Miscellaneous Animal rider V81 V82 All Passenger Train or Streetcar V83 V86 0, 3, 4, 5, 9 Driver Industrial V83 V86 1, 6 Passenger Industrial V83 V86 2, 7 Pedestrian Industrial V87 V89 All Miscellaneous Uncertain Abbreviation: ICD 10, International Statistical Classification of Diseases, 10th Revision.

3 etable 2. Components of disease risk score used to match cases to controls Variable ICD-9 Diagnosis Code ICD-10 Diagnosis Code OHIP Diagnosis Code Demographic Characteristics (measured on index date) Age Sex Estimated residential income Neighborhood income quintile based on location of residence on index quintile date Residence in a long-term care Based on LTC flag on most recent ODB prescription in past 1 year facility Rurality of principal residence Rural community defined as community with 10,000 residents Medical disorders (measured by presence in 3 years before index date) Acute myocardial infarction 410 I21 410, 413 Alcohol abuse V113, 291, 303.0, 303.9, F10, G31.2, G62.1, G72.1, 291, , 357.5, 425.5, 535.3, 571.0, 571.1, 571.3, 790.3, I42.6, I70.0, K29.2, K70.1, K70.4, K70.9, K86.0, R78.0, T51.0, X65, Y15, Y91, Z50.1, Z71.4, Z86.40 Atherosclerotic disease 414.0, 440 I251, I Chronic lung disease 490.0, 491, 492.0, 494.0, J40-J44, J47 491, 492, Dementia 290, 331.0, 331.1, 331.2, 797 F00, F01, F02.0, F02.1, F03, F05.1, G30, G31.0, G31.1, R54 Diabetes mellitus index date Dyslipidemia , E78.0-E78.6, E78.9, E88.1, H02.6 Gastrointestinal tract hemorrhage 494, , 331, 797 Defined as diagnosis date in Ontario Diabetes Database that precedes the 531.0, 531.2, 531.4, 531.6, 532.0, 532.2, 532.4, 532.6, 533.0, 533.2, 533.4, 533.6, 534.0, 534.2, 534.4, 534.6, 578.0, 578.1, K25.0, K25.2, K25.4, K25.6, K26.0, K26.2, K26.4, K26.6, K27.0, K27.2, K27.4, K27.6, K28.0, K28.2, K28.4, K28.6, K92.0, K92.1, K92.2 Glaucoma 365 H40, H Gout 274 M Heart failure 428 I Hypothyroidism 244.1, 244.3, 244.8, E01.8, E02, E03.2, E03.3, E03.5, E03.8, E03.9, E89.0 Injury other than poisoning 8XX, S* T00-T35 Osteoarthritis 715 M15.0-M15.2, M15.4, M M19, M89.41-M89.43, M89.45-M89.46, M89.48 Other coronary heart disease 411.0, 412.0, 413.0, I20, I24.0, I24.8, I24.9, I25.1, , 414.8, I25.2, I25.5, I25.6, I25.8, I25.9 Parkinson s disease G20, G21.1, G21.2, G21.3, 332 G21.8, G21.9, G22 272

4 Pneumonia J10-J Poisoning or drug toxicity T36-T Rheumatoid arthritis , M05, M06, M08.0, M M08.4, M08.8, M08.9, M09, M12.0 Seizure disorder 780.3, 345 R56.0, R56.8, G40, G Sepsis 038 A40, A41 Stroke I60, I61, I62, I63, I64, G45 Urinary incontinence N39.3, N39.4, R32 Psychiatric disorders (measured by presence in 3 years before index date) Affective disorder 296 F30, F31, F32.2, F32.3, F32.8, F33, F34.8, F34.9, F38, F39 Anxiety or sleep disorders 300 F32.0, F34.1, F40-F42, F44, Psychoses, agitation, and related disorders 292, 293.0, 293.8, 294, 295, 297.1, 297.3, 297.8, 297.9, 299 All other mental disorders 301, , , 304.9, , 305.9, 306.4, 306.5, 306.8, 306.9, 307, 308.3, 308.9, 309.0, 309.2, 309.8, 310.1, 310.2, 310.8, 310.9, 311.0, , 312.8, 312.9, 313.0, 313.2, 313.3, 313.8, 313.9, 314.0, 314.2, 314.8, 314.9, 315, Other variables Suicide attempt in 3 years before index date Number of visits to a physician in the past 1 year before index date Care by a psychiatrist in 1 year before index date Days in hospital during 1 year before index date X60-X84 F45.0-F45.2, F48, F68.0, F99 F02.2-F02.4, F02.8, F04, F05.0, F05.8, F05.9, F06.0- F06.6, F06.8, F06.9, F09, F11.0, F11.3-F11.9, F12.0, F12.3-F12.9, F13.0, F13.3-F13.9, F14.0, F14.3-F14.9, F15.0, F15.3-F15.9, F16.0, F16.3-F16.9, F17.0, F17.3-F17.9, F18.0, F18.3-F18.9, F19.0, F19.3-F19.9, F20-F22, F23.2, F24, F25, F53.1, F84 F06.7, F07, F11.1, F11.2, F12.1, F12.2 F13.1, F13.2, F14.1, F14.2 F15.1, F15.2, F16.1, F16.2 F17.1, F17.2, F18.1, F18.2 F19.1, F19.2, F32.9, F43, F45.3, F45.4, F45.8, F45.9, F50, F51, F52, F53.0, F54-F59, F60-F66, F68.1, F68.8, F69, F80-F83, F88-F95, F98, G44.2 Count only one OHIP claim per person per physician per day. Main specialty in IPDB = psychiatry , , 302, 304, 305, Defined as sum of total length of stay of all hospitalizations discharged in prior year

5 Abbreviations: ICD 9, International Classification of Diseases, Ninth Revision; ICD 10, International Statistical Classification of Diseases, 10th Revision; IPDB, Institute for Clinical Evaluative Sciences Physician Database; LTC, longterm care; ODB, Ontario Drug Benefit; OHIP, Ontario Health Insurance Plan.

6 etable 3. Characteristics of all CASES AND POTENTIAL CONTROLS Controls N = Cases N = 6006 Standard. Difference Age (mean, SD), y ± ± Sex (male) (45.9%) 3151 (52.5%) 0.13 Income quintile Missing 261 (0.6%) 39 (0.6%) < (42.7%) 2587 (43.1%) < (23.4%) 1440 (24.0%) (14.8%) 838 (14.0%) (11.1%) 644 (10.7%) (7.4%) 458 (7.6%) 0.01 Urban residence (84.1%) 5031 (83.8%) <0.01 ODB plan coverage Social assistance 7007 (16.0%) 1370 (22.8%) 0.18 Disability support (68.5%) 4059 (67.6%) 0.02 Other 6784 (15.5%) 577 (9.6%) 0.17 Charlson Comorbidity Index No hospitalization (65.4%) 3621 (60.3%) (18.1%) 1459 (24.3%) (6.9%) 437 (7.3%) or more 4210 (9.6%) 489 (8.1%) 0.05 Duration of opioid use 7.23 ± ± Comorbidity measures in past 1 year ED visit for alcohol abuse 757 (1.7%) 355 (5.9%) 0.28 ED visit for road trauma 404 (0.9%) 990 (16.5%) 0.99 ED visit for drug toxicity 809 (1.8%) 262 (4.4%) 0.17 Total number of ED visits (Mean, SD*) 1.59 ± ± Total number of physician visits (Median, IQR**) 18 (10-31) 22 (13-38) 0.20 Total number of visits to a family physician (median, IQR) 10 (5-17) 13 (7-21) 0.26 Visit to a psychiatrist 6779 (15.5%) 1209 (20.1%) 0.13 Medication ue in past 180 days Number of drugs dispensed (mean, SD) ± ± SSRI (35.8%) 2210 (36.8%) 0.02 Other antidepressant (34.5%) 2011 (33.5%) 0.02 Antipsychotic 6423 (14.7%) 1052 (17.5%) 0.08 Benzodiazepines (48.8%) 3158 (52.6%) 0.08 Other CNS depressants 2901 (6.6%) 381 (6.3%) 0.01 Comorbidity measures in past 3 years Hospitalization for poisoning or drug toxicity 6073 (13.9%) 1229 (20.5%) 0.19

7 Alcohol abuse 3576 (8.2%) 806 (13.4%) 0.19 Affective disorder 3946 (9.0%) 683 (11.4%) 0.08 Anxiety or sleep disorders (61.4%) 4234 (70.5%) 0.19 Psychoses 2482 (5.7%) 505 (8.4%) 0.12 Other mental disorders (47.8%) 3495 (58.2%) 0.21 Injury 1559 (3.6%) 425 (7.1%) 0.18 Osteoarthritis (36.5%) 2184 (36.4%) <0.01 Rheumatoid arthritis 2958 (6.8%) 362 (6.0%) 0.03 Abbreviations: CNS, central nervous system; ED, emergency department; IQR: Interquartile Range; ODB, Ontario Drug Benefit; SSRI, selective serotonin reuptake inhibitor.

8 efigure. Association between opioid dose and road trauma among all cases and potential controls, adjusted for age, sex, public drug plan, Charlson score, past hospitalization for alcoholism (3 years), past emergency department (ED) visit for alcoholism (1 year), number of ED visits in past 1 year, ED visit for road trauma (past 1 year), number of physician visits (past 1 year), number of visits to a family physician (past 1 year), visit to a psychiatrist (past 1 year), hospitalization for drug poisoning (past 1 year), ED visit for drug poisoning (past 1 year), duration of opioid use, medication use in past 180 days (selective serotonin reuptake inhibitors, other antidepressants, antipsychotics, benzodiazepines and other depressants of the central nervous system, separately), number of drugs dispensed in past 180 days, history of sleep disorders, psychoses, other mental disorders, or injury in the past 3 years.