Surge in opioid emergency visits
More than five-fold increase over the last 12 years
AREA EMERGENCY DEPARTMENT visits for opioid overdoses skyrocketed in 2017 to the highest rate in Ontario by far.
The worsening epidemic is taking a major toll on kids, with at least 25 per cent of the children’s aid society cases in Brant now involving parents with opioid addiction. Dozens of children — and rising — have been taken into care.
Hundreds of calls for help go unanswered every month because the beds are full at Men’s Addiction Service Hamilton and Womenkind Addiction Service.
“We feel like we’re in a fentanyl crisis here,” said Andrew Koster, executive director of Brant Family and Children’s Services. “It’s been pretty devastating. It’s a killer drug.”
Opioid-related emergency department (ED) visits hit 91.9 per 100,000 population in 2017 in the Hamilton Niagara Haldimand Brant Local Health Integration Network, which includes Burlington.
It’s a staggering jump from 53.4 the year before and dramatically off the provincial average of 54.6, shows data from Public Health Ontario.
In real numbers, it translates to 1,361 ED visits across the LHIN due to opioid overdoses in 2017, compared to 780 the year before and 244 in 2006.
“This is all preventable,” said Dr. Lori Regenstreif, interim lead physician with the Shelter Health Network. “This is what is so frustrating.”
In real numbers, it translates to 1,361 ED visits in this LHIN due to opioid overdoses in 2017 compared to 780 the year before and 244 in 2006.
“There is a huge backup of people waiting to go into detox. People go back home and keep using. They usually just relapse.”
DR. LORI REGENSTREIF
Interim lead physician, Shelter Health Network.
ED
VISITS have been rising steadily since 2011 to five times higher than the lowest point, which was in 2006 when there was 17.8 opioid-related ED visits per 100,000 population in this LHIN.
The crisis appears to be at its worst in Hamilton, Brant and Niagara, which are driving the LHIN’s high numbers of opioidoverdose ED visits.
Hamilton’s rate was 87.2 per 100,000 population in 2017, Niagara’s was 113.6 and Brant’s was an astonishing 141.4, which is the worst rate in the province by a long shot. Niagara’s is the third highest and Hamilton’s is sixth.
“They jump off the page at you,” Regenstreif said. “I don’t think those numbers mean as much as the people I see affected.”
Across the board, there was a jarring increase from 2016. In Hamilton, that equalled 200 more opioid-related ED visits from the year before for a total of 497.
The rest of the LHIN is closer to rates seen in other parts of Ontario, with Haldimand-Norfolk at 66.3 per 100,000 and Halton at 30.
The numbers are significant because they show a gap between the resources available to tackle the crisis and the need for help.
“If more people are getting worse, it means fewer people are able to access what they need,” said Regenstreif, who is assistant clinical professor of family medicine at McMaster University.
The team at St. Joseph’s Healthcare that provides consultations for people with addictions has seen its referrals go up by 40 per cent, with a significant number of those being for opioid use.
“One of the biggest needs in our city is definitely in withdrawal management,” said Holly Raymond, clinical director of general psychiatry and addiction service at St. Joseph’s. “We’re seeing an increasing number of patients ... with a primary opioid use disorder.”
One major problem is that withdrawal management wasn’t originally designed for opioids, which are “a very different beast” from other addictions, says Raymond. Patients need to be in observation beds for days with opioids compared to hours with other drugs. It causes major bottlenecks for those trying to get help. As a result, between 471 and 820 calls a month for help have been going unanswered since April because there are no beds at Men’s Addiction Service Hamilton. For women, 34 to 103 a month have been turned away since January at Womenkind Addiction Service.
“There is a huge backup of people waiting to go into detox,” Regenstreif said. “People go back home and keep using. They usually just relapse.”
The consequences of failing to address the opioid crisis are deadly, with 14.5 deaths per 100,000 population in this LHIN in 2017 compared to a rate of 8.2 the year before. The provincial average in 2017 was 8.9.
In real numbers, it means 214 people died of opioid overdoses in 2017 compared to 120 the year before. Of those, 88 were in Hamilton which had a rate of 15.4 opioid-overdose deaths per 100,000 population in 2017 — up from 21 deaths in 2006.
“Opioid use disorder still remains a very serious issue in Hamilton,” Raymond said. “The impact and the amount of opioids we see in Hamilton really speaks to the need for a consumption treatment site which combines both features of a supervised injection site with lots of connections for treatment as well.”
Hamilton’s downtown temporary overdose-prevention site, run by the Urban Core Community Health Centre, is in the midst of seeking an extension to continue operating beyond Nov. 30. It has received more than 1,000 visits since opening in June.
Organizations from across the city have come together to create one bid for a permanent consumption and treatment site — down from the original three applications — because of a provincial cap of 21 put in place by the Progressive Conservative government. The cap raises questions about whether the hardesthit communities such as Brant and Niagara will get a site at all.
“It’s going to be a competition at who is the fastest and best at writing an application,” Regenstreif said. “It’s not who needs it the most or who is going to benefit the most ... If they ask the right people. they will tell you the 21 worst places. On the other hand, we’ll also tell them 21 is not going to cut it.”
Hamilton Health Sciences forensic pathologist Dr. John Fernandes raised alarm bells earlier this month about the dramatic increase in the number of fentanyl deaths in this area saying it’s creating a “lost generation” of those age 24 to 45.
No where is that more evident than at Brant Family and Children’s Services (FACS) which is taking an increasing number of children into care at a time when its numbers should be decreasing (Six Nations now has its own children’s aid society).
Right now, Brant FACS has roughly 344 children in care compared to 294 last year.
“The overall numbers of children coming into care has really stretched our foster care system,” Koster said. “We’re putting a drive on for more foster homes and we’re actually having to use more expensive private operator placements on occasion which we wouldn’t have done before.”
There is some hope that multiple strategies like the wide distribution of the opioid antidote naloxone and Hamilton’s temporary overdose-prevention site are starting to make a difference.
“For opioid-related ED visits there’s been a drop since June,” Regenstreif said. “We don’t know yet what that represents, it’s too early too say and it’s a very short period of time. For all we know, it could go up over the winter or with the next influx of fentanyl. But for right now ... there’s been a moderate improvement.”