Opioid deaths more likely illicit use
City’s death rate among the highest
An Ontario report warns Hamilton shows signs of having among the highest illicit opioid use in the province.
It also flags a potential lack of addiction treatment services here compared to the high death rates found by the Ontario Drug Policy Research Network.
Its alert comes at the same time that city data shows July had the highest number of opioid-related 911 calls so far this year.
“Hamilton has stood out as having one of the higher death rates in the province,” said Tara Gomes, a scientist at St. Michael’s Hospital and the lead author of the report.
“But what is interesting is that the rate of prescribing for pain is not particularly high. I think it does suggest that perhaps the prescribed opioids are playing less of a role and perhaps illicit drugs are leading to more of those opioid-related deaths.”
Hamilton had the 10th-highest death rate in the province with nearly eight opioid-related deaths per 100,000 population in 2016. To compare, the provincial average was just over five. Halton Region’s rate is around three, which was the third-lowest in Ontario.
But Hamilton was 23rd out of 36 public health units when it comes to the number of residents filling opioid prescriptions for pain. The city was slightly over the provincial average with nearly 14 per cent of the population dispensed an opioid for pain. Halton was third lowest at 10 per cent.
“In areas where there are higher rates of opioid-related deaths, there is not the association that we might expect with higher rates of
opioid prescribing,” said Jason Busse, McMaster associate professor in the department of anesthesia and main editor of the 2017 Canadian Guideline for Opioids for Chronic Non-Cancer Pain.
“It’s important in terms of understanding how we can affect this crisis,” Busse said. “To what degree, if we focus on the issue of over-prescribing opioids, can we hope to see a decrease in fatal overdoses and to what degree are we going to have to ensure there is equal attention paid to the issues of diversion and illicit use?”
Hamilton was the only urban centre to have high deaths coupled with lower prescribing. The others were Renfrew County and Simcoe Muskoka.
Despite the high death rates, Hamilton ranked merely average for treatment in the report published Aug. 22.
“I think in Hamilton, there likely is more of a gap in terms of access to some of these harm reduction services and treatment for addiction,” Gomes said. “How easy is it for people to access methadone or suboxone? Are there plans for supervised injection sites and how quickly can those get up and running? How easily are people able to access naloxone? Is it available at community health centres, harm reduction centres and those types of areas where people who use drugs might be able to access them and learn how to administer them?”
Hamilton public health is studying the feasibility of a supervised injection site and is expected to make a recommendation to city council by the end of the year.
In 2016, public health distributed 462 naloxone kits with 192 people being revived by them. It is already well above that number this year at 889 kits distributed and 219 people revived.
However, the number of kits distributed each month has been declining since March.
Busse says the report highlights the need for more detailed data on overdose deaths that would distinguish how the user got the drugs.
“You hear a lot about the fatal opioid overdoses but it’s often difficult to drill down to understand was this someone who was taking prescription opioids prescribed for them, or is this someone who got their hands on someone else’s prescription opioids, or is this someone who simply went out to the street and got illicit fentanyl and carfentanil?” Busse said. “If that kind of information could be acquired, then it’s going to give a much better idea of where the main targets for change are going to be.”
Perhaps illicit drugs are leading to more of those opioid-related deaths TARA GOMES ST. MICHAEL’S HOSPITAL