Opioid Crisis is Much More Than a Local Crisis

The opioid crisis is causing havoc on families and communities across North America. It is not simply a Guelph problem.

The solution needs national, provincial, and local changes to end the thousands of lives cut short by both prescription drug abuse, and illegal drug abuse. Studies reveal that while opioid poisoning hospitalization rates vary across Canada, they are increasing in all jurisdictions.

How did this happen? Why the rise of deaths, ED visits, and crime-related incidences the past 3 years?

Too Little Too Late

OxyContin added to Ontario Formulary in 2000. Canadian Guidelines released in April 2010 came too little too late.

November 2011, Ontario’s NSAA came into force. Its key initiatives were for collection, use and data gathering related to prescribing and dispensing monitored drugs. This combined with the Narcotics Monitoring System in March 2012 improved issues relating to double doctoring and polypharmacy, and other concerns.

In February 2012 TD LA Oxycodone became available in Canada. Generic OxyContin became available in Canada on December 2012.

It is now a national public health emergency. The growth in legal prescriptions of OxyContin has increased its availability in Canada, and a greater amount of the drug diverted to street users. Major sources of oxycodone for sale on the black market include:

• Forged prescriptions
• Polypharmacy
• ‘Doctor-shopping’ to obtain prescriptions; double doctoring
• Pharmacy break-ins and robberies
• Diversion by unethical medical professionals

The widespread availability both in prescriptions and on the black-market lead to the significantly increased risk of medical complications and overdoses from the drug, and new street drugs.

National Public Health Crisis

This is not a problem restricted to persons who use illegal or street drugs. This is a national public health crisis that affects all of us, in communities across Canada. It does not discriminate against age or socioeconomic groups. Rates of opioid poisoning have increased across the age board, with seniors 65 and older and adults aged 45 to 64 keeping the highest rates.

The stigma is divisive and is obstructing the recovery of this crisis. Many people who are addicted have no history of drug abuse and did not set out with the intention of becoming addicted.

Opiates are powerful. Those prescribed them are unaware of what is happening until it is too late. There are incredible numbers of people who walk out with a prescription for pain, and from surgery who end up addicted. For some, the opioid crisis begins with an innocent visit to their trusted family doctor. Patients go in with intentions to get better and end up with life-threatening addiction.

Illegal and prescription opioid use is rapidly growing in Canada, with fentanyl and analogs seeming to fuel the rise in opioid-related deaths. The crisis is a devastating impact on the health and safety of families and communities across Canada. Western Canada (BC and Alberta) and the Northern territories (Yukon and Northwest Territories) have the highest burden.

Canada Health reports that 63% of the unintentional poisonings occurred in people aged 65 years and older, while intentional poisonings are common and rising in ages 15 to 24 years and adults 25 to 44 becoming the fastest growing hospitalization rates.

Both western Canada (BC and Alberta) and northern Canada have the highest rates. 50% of the spikes in both required hospital care and ED visits have occurred during the last three years.

Since 2013, opioid-related ED visits for Ontario have increased close to 50%. The greatest increase in rates has been males, with a 65% jump, versus women at a 30% increase. Although the highest age group of over 65 accounts for 85% of ED visits, the largest increase is within the age group 25 to 45 years. The spike has occurred in the past three years. 2011 Canadian population statistic is the reference year.

The age groups using and prescribed opioids locally are comparative to provincial numbers.

Data from the Hospital Morbidity Database and the National Ambulatory Care Reporting System show that hospitalizations at 15.6 per 100,000 population in 2016/2017. However, Ontario and Alberta are the only two provinces that collect emergency department data at the level dictated for these studies. There is a necessity for Canada-wide surveillance of opioid-related harm, and evidence-based policies to reduce this crisis.

Sixteen hospitalizations in Canada daily attributed to opioid poisonings, with 11 emergency department visits daily in Alberta and 13 in Ontario.

The lack of Pan-Canadian Real-world Health Data Network (PRHDN) data is holding back the solutions to recover from this crisis. Data on Canadians who experienced nonfatal opioid-related harms is sparse. Pan-Canadian measures provide a better understanding of the harms associated with opioids, including hospitalizations and emergency department visits, and must be a high priority.

The Waterloo Dufferin Guelph Public Health October 2018 Opioid Surveillance update states “Although the proportion of people being dispensed opioids is highest within the 65+ age range, the largest number of opioids dispensed to treat pain are being dispensed to males between the ages of 45-64. Individuals aged 45 and older are receiving 85% of the total amount of opioid medication dispensed in the WDG region. Locally opioid dispensing and prescribing resemble that of the Province of Ontario as a whole.”

The update further clarifies that “in WDG the amount of dispensed opioid medications has decreased by 20% from 2013 to 2017, following a similar decrease of 26% for the province of Ontario.” This is a sign that collaborative groups are being successful in their efforts to curb this crisis.

The study compared the rate per 100,000 Residents of Opioid-Related ED Visits in Wellington County, Dufferin County, and the City of Guelph to those of all between 2003-2017. They found that “Shelburne and Guelph have higher than average rates of ED visits for opioid-related harms when compared to the province (74 vs. 55 ED visits per 100,000 residents). All other areas within WDG are comparable to the provincial average.”

Guelph

To bring clarity to Guelph 2017 ED rates the WDG visits by neighborhoods. This data omits those who use emergency medical services and centers on actual ED visits, with a greater concentration of visits in downtown Guelph and area.

This could be because of accessibility, downtown is closer to the Guelph General Hospital. It could be causally related to the success of the nine collaborative groups who are on the opioid crisis frontlines, as the locations are downtown. I would suggest that the rise in ED stats is causally related to the accessibility of the location of emergency services, rather than a reflection we are not addressing the crisis head-on.

The study suppresses data on much of the city. Data from Old University, Hales Barton, Hanlon Creek, Clairfields, June Avenue, St. George’s Parkway and Parkwood Gardens are. This is for privacy reasons in neighborhoods where there are less than 5 ED visits.

The areas included in the study are Waverley, Two Rivers, Exhibition Park, Downtown Sunny Acres, West Willow Woods, and Onward Willow. These areas have the highest ED visits in the study. They are also closer to residential areas in dense manufacturing areas, and it is simple logic that the stats point to residential city location as a cause.

There is a collaboration in Guelph between ARCH, Sanguine Health Centre, Guelph Community Health Centre, Public Health, Hope House, The DropIn Centre, Wyndham House, Specialized Outreach Services and Family and Children’s Services.

Guelph is working towards a solution. As a community, we should rally behind these organizations to resolve this epidemic. We are suffering locally, yet it is a national crisis.

Guelph’s opioid data is average to rates across Canada, other than the spike in ED visits, which are much more than overall Ontario being 20% more compared to overall Ontario data.

Health Canada Funding

Funding from Health Canada’s Substance Use and Addictions Program (SUAP) is significantly less for Guelph outreach such as ARCH who received just over $200,000, to the rest of Canada. The Family Health team, ARCH, and Community Health Services work collaboratively on this community crisis. It would be hopeful that once the temporary site is a Supervised Permanent site by the Federal government, that levels of federal funding will increase.

Note, the WDG study does not include homeless numbers due to no residential address. The study does state that, “strategies, such as Supervised Consumption Sites, tend to engage people who are more likely to be experiencing unstable living arrangements or homelessness, mental health concerns and/or chronic substance use.” Their move to make the temporary site permanent is a step towards addressing the needs of this group.

This is causally related to the success of front-line responders and to the nine collaborative groups mentioned above, who are there to reduce deaths resulting from the opioid crisis. It shows that the City of Guelph has a positive coalition organized with community centers and it is working.

This is not the time to end the safe injection site found on Wyndham Street North, close to downtown. Next term council can work with community partners to tackle this crisis.

Municipal Election Issue

Crime levels and community safety is causally related to the national opioid crisis, and it is a municipal election issue. Candidates have issued public statements on how they intend to address the crisis if elected to the council. Some recommend more police presence, which would address the causal connection with local crime.

This article is meant to take the fear out of stats on the local level and give credit to the community for responding to this in a meaningful and proactive way.

That the City of Guelph opioid stats is comparative in every area, other than emergency visits are a sign of what we are doing as a community is working.

We must continue this path.

We must respond with compassion, rather than stigmatization and fear.

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