Alcohol-linked hospitalizations stubbornly high in province
SASKATOON Saskatchewan has a drinking problem — at least compared to the rest of the country — and experts think the pandemic may be a good time to talk about it.
That’s the sobering take-away from the latest set of data from the Canadian Institute for Health Information (CIHI), which says 10 of the province’s 13 former health jurisdictions had rates of hospitalization caused wholly by alcohol that were above the national average in the 2018-19 fiscal year.
The three northernmost jurisdictions in Saskatchewan were hardest hit. The former Mamawetan Churchill River health region reported 2,199 hospitalizations per 100,000 people, more than eight times the national rate of 259 and the provincial rate of 347.
Those statistics only include hospitalizations for conditions like alcohol poisoning, not emergency room visits or hospitalizations related to drunk driving, among other associated harms.
“Not everybody spends time in a hospital bed for conditions like these,” CIHI population health manager Geoff Hynes said. “For every one hospitalization for alcohol, you may see maybe seven emergency department visits.”
Why so many people wind up in hospital is a complicated question.
Harold Johnson, a former Crown prosecutor and the force behind the province’s Northern Alcohol Strategy, believes much of it goes back to the normalization of alcohol, which gets less attention than opioids or methamphetamine but takes a greater toll on the average person’s health.
“We need to ask ourselves: why did the government keep the liquor stores open during COVID-19?” Johnson asked. “In what world is a daycare not essential but a liquor store is?”
Dr. Peter Butt is also wondering about that. The Saskatoon addictions specialist noted access to alcohol actually increased during the pandemic, since restaurants were able to include drinks with their takeout orders, even though a study from the University of Victoria’s Canadian Institute for Substance Use Research (CISUR) last year gave Saskatchewan an “F” grade for its lax availability rules around booze.
Saskatchewan also leads the country in charges laid for impaired driving.
“What we see in times of COVID when people are under stress and they’re self-isolating is actually an increase in the availability of alcohol,” Butt said.
What he believes is needed is a change to what he calls a “frontier” mentality around alcohol that is permissive toward binge drinking. Johnson and colleagues have already been pushing for that change in the north.
The Northern Alcohol Strategy debuted in La Ronge in 2017 as a community-based, voluntary partnership to reduce the harms associated with alcohol. Since then, liquor store and bar hours in La Ronge are shortened; alcohol-free community events are more common and emergency room visits caused by drinking are down. RCMP officers have a practice of “brief interventions” to refer people who spend a night in a drunk tank to health services.
The strategy is also used in La Loche, Creighton and English River First Nation.
Director Carla Frohaug said it takes bravery for communities to face the problem, noting alcohol abuse in First Nations and Métis communities is rooted in historic trauma, including the residential schools. The strategy tries to address alcohol use across a “spectrum of use” that ranges from abstinence to dependence.
“I think the harms from alcohol in communities are great. And they’re attached to some really challenging experiences of trauma, and of violence, and of harms,” Frohaug said.
“It’s not a conversation that is without emotion, and there are varying perspectives within that conversation that need to be respected.”
Beyond the cultural shift, Northern Health Services medical health officer Dr. James Irvine said other medical interventions are available. In 2017, the province added the anti-craving medications naltrexone and acamprosate, which can help manage alcohol use, to the provincial formulary. The Ministry of Health says 623 prescriptions for those medications were accepted under the provincial drug plan in the 2019-20 fiscal year compared to 343 prescriptions two years prior.
“It’s not a magic bullet. But it’s one of the tools that helps in the process of management,” Irvine said, adding he believes the “shift” he’s observing is promising.