Opioid deaths spike amid pandemic isolation
It's the other epidemic.
Opioid deaths in Windsor and Essex County surged 44 per cent during the first 15 weeks of the COVID-19 pandemic, according to a new study.
Across Ontario, deaths jumped 38 per cent. If this rate continues, the report released last week warns, 2,271 people will die of opioid overdoses by the end of the year. That's 50 per cent more people than the 1,512 who died last year. It's another record.
And, concluded the report, the striking increase was likely inadvertently caused by measures to protect people from COVID-19.
The report — by the Ontario Drug Policy Research Network, Office of the Chief Coroner for Ontario, Public Health Ontario and the Centre on Drug Policy Evaluation — compares opioid deaths during the 15 weeks before the province declared a state of emergency March 17 and the 15 weeks after.
There were 16 deaths in Windsor and Essex County between Dec. 1, 2019, and March 15, and 23 deaths between March 16 and June 30.
Across Ontario, there were 503 deaths before the pandemic and 695 deaths after — an average of 12 more people dying every week.
And it has continued with alerts about high numbers of overdoses.
There were nine opioid overdoses here between July 10 and July 12. Some required multiple doses of naloxone to reverse the effects. In all, 39 people were taken to Windsor Regional Hospital in July for overdoses.
Twenty-six people ended up in the emergency department here in August because of overdoses and another 27 in September.
There were 11 opioid overdoses in eight days here between Oct. 13 and Oct. 20. Nine of them happened within 24 hours.
Here and across Ontario and Canada, we're setting records that no one wants.
What had been an epidemic long before COVID-19 was initially lost amid the new and deadly pandemic.
“For sure, early on, all the effort was shifted toward the pandemic and rightly so,” said Patrick Kolowicz, mental health and addictions director at Hotel-dieu Grace Healthcare. “We've spent a lot of money on the pandemic. I think if we had a similar response around funding addiction we could do a lot more.
“But we're coming to a realization that now it's even more of a priority to tackle mental health and addiction. With the potential for a mental health and addiction wave following the pandemic, we need to make sure that the supports and resources are out there.”
Men between the ages of 25 and 44 die the most in Ontario. They also suffered the biggest increase in deaths during the pandemic, according to the report. But there was even an increase in those ages 65 and older.
Fentanyl contributed to 87 per cent of deaths during the pandemic, compared to 79 per cent before. Almost all of the overdoses in the spikes here in July and October involved fentanyl.
Cocaine contributed to 45 per cent of deaths during the pandemic, compared to 38 per cent before. And etizolam, similar to benzodiazepines, was detected in significantly more cases. Mixed with fentanyl, it can be lethal.
At the same time, the use of methadone as a treatment fell from 13 to nine per cent.
More people died alone, the report also noted, and there were fewer attempts to resuscitate or administer naloxone. Fewer people overdosed in indoor public places. More overdosed outside and in hotels.
All of this, the report deduces, is likely driven by more isolation, less access to supervised consumption sites, pharmaceutical-grade alternatives and treatment and resorting to illegal street drugs that are increasingly unpredictable and toxic because supply channels have been disrupted.
And all of those factors are likely the result of measures to contain the pandemic. For example, physical distancing is crucial to contain COVID-19, but the No. 1 rule for using drugs is never use alone.
“Despite the intention to reduce the impact of COVID-19, there is concern that these measures could lead to unintended harms,” the report says.
The same factors are cited here. “The added stressors, isolation and changes in the drug supply are all contributing factors to increased rates of substance use and overdose in our community over the past several months,” said medical officer of health Dr. Wajid Ahmed, who has warned of the pandemic's impact on substance use and mental health during public briefings.
Public health officials provided targeted support and mitigation strategies to high-risk populations like those served by the Downtown Mission.
But, said Kolowicz, “when the pandemic first started, there was fear of spread. A lot of programs changed to be virtual. Some temporarily closed. A number of addiction facilities operate in congregate settings. We had to really take a look at these programs to make sure all the measures were in place to take care of people safely. That decreased a lot of capacity.”
The health unit originally planned to submit an application for a consumption and treatment services site — a key part of the strategy to reduce opioid overdoses — to the government by September. But that deadline was extended to December because of COVID-19.
We need to understand what's happening, the report concludes, because we're still in the pandemic.
Supervised consumption sites “should be a priority,” it states. We need more treatment, more access to pharmaceutical-grade alternatives to fight toxic street drugs and more social supports.
“We've learned a lot more, so we've become much more skilled at how to preserve the services but still maintain the safety,” said Kolowicz. “In terms of closing everything down, I don't think you'll see that again.”
A lot more services are available virtually, he said. But that doesn't work for everyone, so in-person services will also be available.
This region's opioid strategy group, co-chaired by Ahmed, is also writing a letter to Ontario Health Minister Christine Elliott “advocating for the removal of barriers related to safer supply treatment options for practitioners.”
That could include pharmaceutical-grade opiates, said Kolowicz.
“We need to have all the tools in the tool box, especially now when COVID has created this scenario where people are isolating on their own,” he said.
As the report concludes, we need to act to stem the toll, not just from COVID-19, but from opioids. As Kolowicz suggested, we need to act like it's a crisis. Because it is.