Rising hospitalizations due to opioid crisis puts a burden on Canada's health system: report

The last decade has seen hospital admissions for opioid poisonings jump 53 per cent, with more than 40 per cent of that increase occurring in the last three years, researchers found.

Thestar.com
Sept. 14, 2017
By Sheryl Ubelacker

At least 2,816 Canadians died from opioid-related causes in 2016 and that number "will almost certainly" surpass 3,000 in 2017, the country's chief public health officer predicted Thursday, as officials outlined the growing scope of the epidemic.

While the western provinces have been hardest-hit - there were 978 illicit drug overdose deaths in B.C. and 586 apparently opioid-related deaths in Alberta in 2016 - the numbers of people dying in Eastern Canada are also rising. For example, Ontario had 865 deaths last year and Nova Scotia had 53 as a result of opioid-related toxicity.

"No area of Canada is necessarily safe from this crisis," Dr. Theresa Tam told a media briefing from Ottawa.

Canadians aged 30 to 39 accounted for the highest proportion of deaths related to the potent narcotics, at 28 per cent overall, although the figures varied widely across the country.

"We are beginning to get a better picture of the kinds of drugs that are fuelling this epidemic," said Tam, noting that illicit synthetic fentanyl and fentanyl-like drugs are a major driver of overdose deaths in the hardest-hit areas of the country.

Deaths involving fentanyl more than doubled in the first three months of 2017 compared to the same period in 2016, she said.

"We're also seeing that this is not a crisis involving only opioids. Many of the overdoses involved a mix of substances. In fact, 84 per cent of apparent opioid-related deaths also involved a substance that was not an opioid, adding to the complexity in addressing the crisis."

Those substances include alcohol, cocaine and benzodiazepines, a class of anti-anxiety drugs that includes Valium (diazepam) and Ativan (lorazepam).

Dr. Robert Strang, Nova Scotia's chief public health officer, said the number of deaths from illicit opioid use varied widely across the country: in Alberta, 64 per cent involved fentanyl, while only 15 per cent of deaths in Nova Scotia were linked to the powerful drug.

"This data illustrated to us that we are facing two different but overlapping issues," Strang said. "First, overdose deaths from prescription opioids and second, overdose deaths from illicit drugs laced with fentanyl or other synthetic opioids."

In Atlantic Canada, most deaths were related to prescribed opioids, some of which may have been diverted to the black market from legitimate users with acute or chronic pain.

"But we are starting to see in 2016 that we had our first small number of deaths ... where illicit fentanyl was part of the picture," he said of Nova Scotia.

In a report released earlier Thursday, the Canadian Institute for Health Information (CIHI) warned the opioid crisis is having a significant impact on the health system as a growing number of Canadians seek emergency hospital care for overdoses

In 2016-17, 16 Canadians a day were admitted to hospital for opioid toxicity, up from 13 per day two years earlier - a rise of almost 20 per cent.

That one-year hospitalization rate translates into more than 5,800 Canadians needing treatment.

The last decade has seen hospital admissions for opioid poisonings jump 53 per cent, with more than 40 per cent of that increase occurring in the last three years, CIHI found.

"We found rates varied across the country, but interestingly they were generally lower in the largest cities, such as Toronto, Montreal and Vancouver," said Michael Gaucher, director of pharmaceuticals and health workforce information services at CIHI.

That finding may reflect a different demographic in smaller urban centres such as Hamilton, Saskatoon and Victoria, where a higher proportion of residents may be seniors taking prescription opioids and where there may be greater availability of the drugs on the street, he said.

The CIHI report showed adults aged 45 to 64 and seniors 65 and older had the highest rates of hospital admissions for opioid toxicity over the last 10 years, but the fastest-growing rate was for youth and young adults aged 15 to 24.

About half of those admissions were due to accidental opioid poisonings; about one-third were intentional; and the cause of the remainder are unknown.

"With seniors, you seem to see higher rates of accidental poisonings, perhaps related to multiple medications that they may be on," Brent Diverty, CIHI's vice-president of programs, said in an earlier interview. "So they simply take the wrong dose.

"We see higher rates of intentional self-harm in younger folks."

CIHI found intentional opioid overdoses were most prevalent among young people aged 15 to 24, accounting for 44 per cent of hospitalizations.

Still, the researchers also found escalating rates of accidental overdoses among younger people, which Diverty said may be linked to recreational use of illicit drugs, some of which may be laced with a synthetic opioid like fentanyl.

"We have a supply that is completely unpredictable in terms of exactly what is included in what is being purchased and the quantity," Matthew Young, a senior research and policy analyst at the Canadian Centre for Substance Abuse, said in an interview from Ottawa.

"It really comes down to how in the last few years, there's just been this injection of these new compounds that are making the illicit opioid market incredibly volatile," he said.

"And nobody really knows what they're purchasing and what they're using."

In data from Alberta, CIHI found emergency department visits related to heroin and synthetic opioid overdoses soared almost 10-fold over the last five years.

In Ontario, emergency department visits for heroin poisoning rose almost four-fold, while visits for synthetic opioids more than doubled.

While CIHI doesn't have a dollar figure for the cost to the health-care system, Diverty said people admitted for an opioid overdose spend longer than average in hospital and there are downstream costs for continuing treatment of complications.

"So it will be important for us to monitor these rates over the foreseeable future to see both how this issue is progressing across the country, but also how various types of interventions that are taking place may be helping to stem the tide."