December 2018 — Dr. Jeff Eppler doesn’t need to see a chart or a graph to understand the impact of Canada’s deadly opioid crisis in his B.C. community.
“It was nothing like this 5 or 6 years ago,” said Eppler, an emergency department doctor at Kelowna General Hospital for the past 24 years.
Opioids — such as fentanyl, oxycodone, morphine and codeine — can be obtained with a prescription or illegally. In both cases, they can lead to unexpected consequences, including addiction, poisoning and death.
I’ve treated more overdoses in the past year or 2 than I treated in the 20 before that combined.
— Dr. Jeff Eppler
The numbers in a new CIHI analysis certainly reflect what Eppler is experiencing. Kelowna had one of the highest rates of opioid poisoning hospitalizations in Canada in 2017.
Smaller Canadian communities are experiencing opioid poisoning hospitalization rates that are more than double those in Canada’s largest cities. For example, in 2017, Brantford’s opioid poisoning hospitalization rate was more than 3.5 times the Ontario average.
“We did observe a spike from 2016 to 2017,” said Tin Vo, a health planner with the Brant County Health Unit. “In 2018, we’re seeing a drop-off in terms of opioid poisonings and in what our emergency medical services are seeing.”
CIHI’s analysis shows an overall Canada-wide decrease in opioid-related hospitalizations for the last 3 months of 2017 and the first 3 months of 2018, although it’s too early to know if the trend will continue.
Here’s a look at some of the key findings from CIHI’s latest analysis of the opioid epidemic:
Opioid poisonings are affecting Canadians across the country. CIHI’s analysis shows that while hospitalization rates varied across the provinces and territories, communities with between 50,000 and 99,999 people saw some of the highest rates of opioid poisonings.
“Up until recently, it was completely different,” said Eppler. “You’d see the odd person who needed naloxone (which can counteract the effects of opioid poisoning), but now it’s become a daily thing, if not multiple cases a day.
“The challenge is when people want some help and want to get off opioids. We haven’t had the best access to addiction services, but that’s improved. I’m really hopeful.”
Although the number of opioids being prescribed is going down, the harms associated with their use are on the rise.
“I’m shocked that the numbers just keep going up despite the number of people who have died already,” Eppler said.
In 2017, an estimated 3,996 Canadians died because of an opioid overdose,Référence1 and hospitalization rates for opioid poisonings were up 8% from the year before. Between 2013 and 2017, opioid poisoning hospitalization rates went up 27%.
Between 2016 and 2017, rates of opioid poisoning emergency department visits in Ontario and Alberta rose. Both provinces currently supply CIHI with the level of detail needed for this analysis.
Eppler noted that the rise in emergency department visits is a major concern, and a variety of approaches are needed to begin addressing it.
“You’ve got a whole cohort of people who have opioid addiction, and you have to take care of those people because they’re really at risk,” Eppler said. “That may mean all kinds of radical things like substitution therapy, safe consumption sites, take-home naloxone, maybe even prescription heroin, as well as improved access to treatment of mental health disorders.”
Between 2016 and 2017, men age 25 to 44 had the fastest-growing rates of hospitalization, with an increase of 30%.
Vo noted that trends in Brantford were similar to the Canadian ones.
“The majority of calls emergency medical services are responding to and what we’re seeing in the hospital is in the 20 to 39 age group here,” he said. “Almost 60% to 70% fall within that group.”
Although opioids play an important role in pain management for many Canadians, they can cause harm even when taken as prescribed. When this happens, it is referred to as an adverse drug reaction.
For the first time, CIHI looked at hospitalizations for opioid-related adverse drug reactions. Between 2013 and 2017, Canada saw a 6% decrease in these hospitalizations. Initiatives like new Canada-wide guidelines for opioid prescribing, enhanced education on opioid prescribing and provincial prescription monitoring programs have helped raise awareness and shift opioid prescribing practices.
CIHI will continue to play a role in reporting on Canada’s opioid crisis. Learn more by visiting our Opioids in Canada page.
Read the report
Read the full report on opioid-related harms in Canada