November 16, 2016 — Canada is faced with a public health crisis due to harms associated with opioids, and a new report now quantifies their impact on our health systems.

Hospitalizations and Emergency Department Visits Due to Opioid Poisoning in Canada, a joint report by the Canadian Institute for Health Information (CIHI) and the Canadian Centre on Substance Abuse (CCSA), found that between 2007–2008 and 2014–2015, the rate of hospitalizations due to opioid poisoning increased more than 30%.

Who is being hospitalized for opioid poisoning?

Seniors 65 and older accounted for nearly one-quarter of these hospitalizations, despite representing only 16% of Canada’s population. Seniors are at a greater risk for opioid-related harms because of multiple medication use and age-related changes to the body.i

“People don’t tend to think of seniors when they think about drug overdoses,” said Brent Diverty, vice president of Programs at CIHI. “So Canadians may be surprised to learn that the seniors age group has accounted for the highest rate of hospitalizations for opioid poisonings over the last 8 years. Although there are many reasons for these hospitalizations, this report shows that Canada’s seniors are particularly vulnerable and may benefit from focused interventions.”

While seniors consistently had the highest rates of hospitalizations, youth age 15 to 24 had the fastest rate of growth for hospitalizations, compared with other age groups — increasing by 62% over the study period.

What are the reasons people are being poisoned by opioids?

Reasons for poisonings varied significantly by age. The data shows that the majority (55%) of opioid poisonings among seniors were considered accidental, while most (52%) poisonings among youth age 15 to 24 were determined to be intentional self-inflicted harm.

The study also found that the number of opioid poisonings differed across the provinces and territories, with Saskatchewan, Alberta and British Columbia having the highest rates of hospitalizations.

Emergency department visits

The report also examined emergency department (ED) visits in Ontario and Alberta — the only 2 provinces that provide CIHI with enough detailed ED data to identify opioid poisonings over the study period.

Opioid poisonings resulted in 7 ED visits in Ontario and more than 3 ED visits in Alberta every day. The rate of ED visits increased steadily between 2010–2011 and 2014–2015 in both provinces (by 53% in Alberta and by 22% in Ontario).

“Over the last 5 years, emergency department visits for opioid poisoning increased dramatically in Ontario and Alberta,” said Diverty. “What’s worrisome is that these numbers don’t tell the full story, since some people die before reaching the hospital. This report is a great first step, but we still don’t have the complete picture on opioid poisonings in Canada.”

“This report is an invaluable contribution to the growing body of evidence, helping to form a response to the country’s opioid crisis,” said Rho Martin, deputy CEO at CCSA. “For the first time, we have national-level figures that speak to the harms associated with opioid poisoning. And, while these figures are alarming, they are likely an underestimate of the issue, as overdoses that did not receive treatment in a hospital or emergency setting are not represented.”

Facts and figures

  • Accidental poisonings accounted for 49% of opioid-related hospitalizations and intentional poisonings accounted for 33%, while 12% of hospitalizations were for unknown reasons and 6% were attributed to therapeutic poisonings (i.e., those that occurred when the drug was used as prescribed).
  • The average length of stay in the hospital for opioid poisoning was 8 days in 2014–2015. This number has remained relatively consistent since 2007–2008. In comparison, people who were hospitalized after a heart attack remained for an average of 5 days.
  • Rates of hospitalizations varied across the provinces and territories, from a high of 21 per 100,000 people in Saskatchewan to a low of 10 per 100,000 people in Quebec in 2014–2015.

“The opioid crisis has put a spotlight on the need for evidence to address pain management going forward, as well as for changes within the entire system of care for those suffering with an addiction to opioids and other substances. In addition to helping to develop more effective targeted interventions, the results of this report will also help to reduce the stigma surrounding opioid use and addiction, as it is clear from the data that those experiencing harms from opioids are our parents and grandparents, our colleagues and neighbours, and our young adults,” said Martin.

i. See CIHI’s report Drug Use Among Seniors on Public Drug Programs in Canada, 2012.