Why we fight fentanyl with flawed information
Detailed new stats on Ontario’s opioid problem from the provincial government are months behind and still probably about the best we’re going to get.
The new provincial figures that Public Health Ontario released Wednesday show emergencyroom visits, hospitalizations and deaths by overdoses of drugs like heroin and fentanyl, broken down by sex, age group and geography.
They’re are reliable and detailed ... so they’re late. The most recent data, on emergencyroom visits and hospitalizations, ends last September and data on deaths ends three months before that. In a worsening epidemic, that’s ancient.
But it’s what there is. Collecting, filtering and cross-checking data, to “scrub” it of noise to make sure it’s as solid as can be, takes months.
On Thursday, a working group of Canada’s big-city mayors demanded more drug-treatment money and awareness efforts from the federal government. It also renewed a call for a national standard for gathering and sharing data on opioid abuse and harm, which, unbelievably, we don’t have.
“Any additional data point to us is welcome and we’re happy to see it,” says Andrew Hendriks, the Ottawa health unit’s manager of clinical services and the chair of the region’s anti-opioids task force.
Deaths from overdoses are always the headline stat, but gathering data on non-fatal ODs is really useful for understanding who’s taking drugs and where.
Relying on months-old figures to deal with opioids is like grappling with a bear in the dark. They’re better than nothing, but there’s a lot we don’t know.
We want reliability, detail and speed in our public-health statistics. The trouble is, we can’t have them all at once.
Ottawa’s health unit releases monthly data on overdoses generally, which shows a steady increase in patients turning up in hospital emergency rooms in the city. Thursday, the health unit shared the information from April. It shows that we’re on pace for 1,269 overdose patients in ERs this year, an increase from 1,122 in all of 2016.
But wait — that’s all drug overdoses, not just ODs from opioids. There’s no way it’s good news, obviously, but it’s limited in its usefulness.
The rawest data from emergency rooms is collected when a patient arrives, when nurses and doctors have other things on their minds.
“In the emergency-room (records) system, it might just say ‘addictions’ or ‘methadone,’ or it might just say ‘overdose,’ ” Hendriks says. “And that doesn’t tell us whether it’s an overdose from Tylenol or alcohol.”
Patients show up with multiple drugs in their systems, with suspected overdoses that turn out to be something else.
A patient who dies from an opioid overdose might be taking opioids to self-medicate for a mental illness, to feed an addiction, to treat an underlying health problem like cancer, or all of the above. Each case is its own story.
Over-reading the stats can even take you to dangerous conclusions.
For instance, the provincial statistics show that Ottawa has an unusually high rate of hospital treatment for opioid overdoses among women between the ages of 15 and 24, or at least it did in 2015. Middle-aged men are the most likely to die of overdoses, but young women are the most likely to go to an ER.
That’s alarming, but maybe it’s not precisely an opioid problem, because even the rock-solid provincial numbers combine accidental and intentional opioid overdoses. Breaking those apart, if it could even be done, would delay the releases even longer.
“We know from looking at self-harm that one of the leading causes of morbidity (illness and injury) in young women is selfharm,” says Cameron McDermaid, a health-unit epidemiologist. “So I think when we look at the provincial data, that’s some of what we’re seeing.”
Accidental overdoses and suicide attempts are problems to tackle very differently.
To try to make sense of the figures, the health unit relies on police (who share information on busts and seizures), school boards (which pass on anecdotal information from teens) and drug users (who are often the first to find out about overpowered or tainted drugs, and share what they know when they visit clinics and needle exchanges).
“The qualitative side of things is just as important as the quantitative side, the numbers and those types of things,” Hendriks says.
Health authorities are accustomed to dealing with this sort of problem when it comes to the flu, which comes around on a reliable schedule every fall. First the coughs and fevers show up in the emergency rooms and doctors’ offices. Then lab tests confirm that the influenza virus is what’s making people sick. Then further tests tell us what strains we’re dealing with and how well the year’s vaccine matches the bug that’s actually out there. Then, as the annual outbreak spreads, we can see who’s most at risk from serious complications.
The combination of information tells authorities where to focus their efforts — on getting more kids vaccinated, for instance, or on controlling outbreaks in nursing homes. They can compare this year to last year, the year before, and years before that.
Opioids are like a moving, changing, unpredictable, maybe permanent flu season.
“This scenario is fairly new,” McDermaid says. “Historically, we deal with things that end. You look at flu, the season ends. We know when that’s going to happen with some degree of certainty.”
There’s no reason to think fentanyl and its cousins are going away.
“What will happen, probably, is this will still be with us next year,” McDermaid says. “It’s not anything somebody can flick a magic switch and it’ll be gone.”
Patients show up with multiple drugs in their systems, with suspected overdoses that turn out to be something else.