Half of Opioid Deaths in Ontario Interacted with Healthcare System in Previous Month: Study

Half of the Ontarians who died from an opioid overdose in the early stages of the pandemic had interacted with the health system in the month before their deaths, a new report shows.

And one in four had seen a doctor, been in an emergency room, or been discharged from hospital just a week prior, the study shows.

“This represents such an important missed opportunity for us to ensure our healthcare system meets the needs of people who use drugs and helps connect them to the services they need to prevent these fatal overdoses.” said Dr. Tara Gomes, an epidemiologist at Unity Health and a researcher at the Ontario Drug Policy Research Network, who co-authored the study.

The report, titled “Patterns of Medication and Healthcare Use Among People Who Died of an Opioid-Related Toxicity during the COVID-19 Pandemic in Ontario,” was released Tuesday by Unity Health and the Ontario Drug Policy Research Network. Public Health Ontario, the Chief Coroner’s Office and ICES, the non-profit health research organization, contributed to the report.

The authors call for safer drug supply, expanded access to accessible healthcare treatment, affordable, supportive housing, and more harm reduction services and monitored sites of consumption, especially outside of cities.

“The loss of life due to opioid toxicity in Ontario has only increased during the COVID-19 pandemic,” said Dr. Dirk Huyer, the chief coroner for Ontario, in a statement.

“Understanding how people interact with healthcare providers, support systems and harm reduction services will help inform strategies aimed at preventing further opioid-related deaths.”

The vast majority of deaths recorded between March and December 2020 – 89 percent – are related to non-prescription opioids, almost exclusively fentanyl, according to the report.

Gomes said two out of every three deaths occurred in people with evidence of an opioid use disorder. That means about a third of people had no evidence of a substance use disorder.

“It’s likely that many of these people use drugs only occasionally,” she said.

“And they might actually be a demographic at higher risk of overdosing from this really unpredictable drug supply because they haven’t developed the same level of tolerance to these really powerful drugs.”

The study follows work by the group published in May that showed fatal opioid overdoses in Ontario rose more than 75 percent from March to December 2020 compared to the same period last year.

There were 2,050 people who died from an opioid-related overdose in about 10 months, compared with 1,162 from March to December 2019.

The researchers were able to link the vast majority of these deaths to other health data to better understand some of the circumstances.

Increasingly volatile drug supplies appear to be linked to the surge, Gomes said.

“Although the role of prescription opioids has historically been considered a major contributor to the overdose crisis, the report shows that the unregulated drug supply is primarily responsible for fatal drug overdoses, with deaths primarily attributed to fentanyl,” the report said.

Researchers found a five-fold increase in non-pharmaceutical benzodiazepine use in fatal opioid overdoses during the pandemic.

“It’s not that people are being prescribed drugs for anxiety, it’s that the unregulated drug supply is really being polluted by benzodiazepines,” Gomes said.

The addition of benzodiazepines further complicated the response to an overdose and subsequent treatment, she said.

“We’re hearing people who are so heavily sedated because of the benzodiazepines in the drug supply that they can’t be awakened for hours even after being given naloxone because it just reverses the opioid effects,” Gomes said.

She said opioids mixed with benzodiazepines “have been shown to increase respiratory depression and sedation so it can increase the chances of an overdose and a serious overdose because you’re still heavily sedated and you know your breathing is still going on is slowed down.

The researchers also found that the opioid overdose death rate in northern Ontario was almost three times higher than in southern Ontario when the population is taken into account.

Meanwhile, researchers delved into a deeper understanding of why the opioid crisis was hitting the homeless much harder than other populations, after their previous report found that one in six people who died from an opioid overdose during the pandemic had no home.

The researchers found that in the days and weeks leading up to their death, the population interacted with the healthcare system at a similar rate to the rest of the population, but were much more likely to seek help from an emergency room than outpatient care, such as a visit to a family doctor.

Gomes said they see high levels of mental health diagnoses among the homeless who have died from an opioid overdose.

“Given rising overdose rates among people affected by homelessness during the pandemic, the expansion of supervised consumption services in shelters and easily accessible treatment options is warranted,” the researchers wrote.

This report from The Canadian Press was first published on January 18, 2022.

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