The opioid crisis in Canada is putting increasing pressure on the country’s health care systems, as new data from the Canadian Institute for Health Information (CIHI) shows that the number of emergency department visits and hospitalizations continues to rise.
“If you just look at the numbers, you can see the impact of the opioid crisis is increasing,” says David O’Toole, president and CEO of CIHI. “There are more patients being seen in emergency departments, more patients being hospitalized, and the lengths of stay for hospitalizations are quite long — it all adds to the burden.
“When you look at the numbers and think of the resources required to treat all those people, I would say the impact is quite significant — and it’s growing.”
Opioids include commonly known types such as fentanyl, oxycodone, morphine, codeine and heroin. Certain opioids are prescribed to treat pain, and they can often be obtained illegally. They can also create a feeling of euphoria, are highly addictive and too often are deadly.
“This is a major public health crisis in Canada,” says Dr. Theresa Tam, Canada’s chief public health officer. “Tragically, in 2016, there were more than 2,800 apparent opioid-related deaths in Canada, which is greater than the number of Canadians who died at the height of the HIV epidemic in 1995.”
New data from the Public Health Agency of Canada (PHAC) shows that from January to March 2017, there were at least 602 apparent opioid-related deaths across the country; it is expected that this count will rise as additional data becomes available.
The new CIHI data supports the public health surveillance of opioids by measuring the impact of opioid harm across Canada. Here are some of the key findings of CIHI’s report on the subject:
Opioid poisonings resulted in an average of 16 hospitalizations a day in 2016–2017, the CIHI report finds. This is a 19% increase from the daily hospitalization rate in 2014–2015.
“It’s a dramatic increase,” says Michael Gaucher, director of Pharmaceuticals and Health Workforce Information Services at CIHI.
“The rate of hospitalizations over the past few years is very troubling and points to the deepening of the opioid crisis across Canada.”
Hospitalization rates varied across the provinces and territories overall, with Northern and Western Canada having generally higher rates than Eastern Canada.
Between 2007–2008 and 2016–2017, the rate of hospitalizations due to opioid poisoning increased 53%. More than 40% of the increase occurred over the past 3 years.
Concerns about the impact of illicit drugs and opioids were first raised in Western Canada, but we’ve seen hospitalization rates increase across most of the country.
“We cannot say how many hospitalizations are due to prescribed opioids or illegally produced opioids, but the people being hospitalized reflect all of Canadian society. Opioids have the potential to cause significant harm, especially when not taken as directed by a health care provider,” says Gaucher.
Adults age 45 to 64 and seniors age 65 and older had the highest rates of hospitalizations due to opioid poisoning over the past 10 years, but the fastest-growing rates were for those age 15 to 24.
“Young people are increasingly being prescribed opioids, but this also reflects the impact of the illegal market,” says Gaucher.
“Counterfeit opioids are more prevalent now in cities, suburbs and rural communities, and they’re much more potent than what was available 10 years ago. People need to understand that significant harm — or even death — can occur, especially for first-time users.”
The number of emergency department visits in Alberta related to heroin and for synthetic narcotic poisoning, which includes opioids, rose by almost 10 times over the past 5 years.
In Ontario, emergency department visits related to heroin poisoning increased by almost 4 times, while visits for synthetic narcotic poisonings more than doubled.
Albertans age 15 to 24 had the highest and fastest-growing rates of emergency department visits related to opioid poisoning, tripling over the past 5 years.
In Ontario, adults age 25 to 44 had the highest and fastest-growing rates of emergency department visits related to opioid poisoning over the past 5 years, increasing by 85%.
The majority of the increase in both provinces — the only 2 that currently provide CIHI with data regarding emergency department visits related to opioid poisoning — occurred over the past 3 years.
Purposely self-inflicted harm, which includes suicide attempts, led to 31% of opioid poisonings in Canada last year, while more than half of poisonings were considered accidental. Intentional poisonings were most prevalent for youth age 15 to 24, accounting for 44% of hospitalizations.
“This is a concerning trend,” says Tam.
“We know that mental health challenges and trauma are significant public health issues in Canada and are key root causes contributing to problematic opioid use and a significant number of intentional poisonings.”
The report shows that 63% of opioid poisonings among Canadians age 65 and older in 2016–2017 were accidental, while 16% were intentional and 21% were of unknown reason.
“It’s very important for patients to notify their health care providers about all medications they are taking — whether prescribed or not — as drug interactions can have very harmful effects. This is particularly true for seniors, who are more likely to have multiple prescriptions. Failing to take medication as prescribed can have very significant consequences,” says Gaucher.