Opioid Deaths Doubling Across Canada After Pandemic – Medscape Achi-News

Premature opioid-related deaths in Canada doubled after the COVID-19 pandemic began, and more than one in four deaths occurred in young adults, a new study suggests.

“The intersection of the COVID-19 pandemic with the drug toxicity crisis in Canada has created an urgent need to better understand patterns of opioid-related deaths across the country to inform targeted public health responses,” the study authors wrote.

Some Canadian provinces were disproportionately affected by the crisis, they noted. For example, in Alberta, almost half of all deaths among people aged 20-39 were related to opioids.

“While the finding that early life loss increases over time was expected, I was surprised by the magnitude of this burden across Canada,” said lead author Shaleesa Ledlie, MPH, a PhD candidate in the Leslie Dan Faculty of Pharmacy at the University of Toronto. , Toronto, Ontario, Canada, by Medscape Medical News.

In addition to the increase in Alberta, he said, “in Manitoba, opioid-related death rates and the associated years of life lost increased almost fivefold between 2019 and 2021. This really reinforces the urgency of this issue across Canada and identifies regions where there is a focus that may need attention.”

The study was published online on April 15 at Journal of the Canadian Medical Association.

Significant Progress

Researchers conducted a repeated cross-sectional analysis of accidental opioid-related deaths from 2019 to 2021 in nine Canadian provinces and territories. All provinces and territories for which age and sex-stratified data were available at the time of the study included: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, and the Northwest Territories . These areas represent 98% of the Canadian population.

Deaths were determined to be accidental or intentional by the coroner or medical examiner in each state or territory that investigated the death, according to Ledlie.

The primary outcome was the burden of opioid-related premature deaths, measured by potential years of life lost (YLL). The secondary outcome was the proportion of deaths attributable to opioids.

Overall, the annual YLL of opioid-related deaths doubled during the study period, from 3.5 YLL per 1000 population in 2019 to 7.0 YLL per 1000 in 2021.

In 2021, the highest death burdens were seen among men (9.9 YLL per 1000) and young adults aged 20-29 (12.8 YLL per 1000) and 30-39 years (16.5 YLL per 1000).

More than 70% of all opioid-related deaths occurred in men each year (73.9% in 2021), and about 25% of deaths occurred in people between the ages of 30 and 39 (29.5% in 2021).

Geographical Variation

The annual increase by age and gender in each state and territory was generally consistent with the overall analysis. However, the observed changes in YLL over time varied geographically. They ranged from a decrease of 0.8 times in Nova Scotia (1581 YLL in 2019 to 1324 YLL in 2021) to an increase of 4.7 times in Manitoba (2434 YLL in 2019 to 11,543 YLL in 2021).

In 2021, the YLL rate ranged from a low of 1.4 per 1000 in Nova Scotia to a high of 15.6 per 1000 in Alberta, while the absolute number of YLL ranged from 93 in the Northwest Territories to 111,633 in Ontario.

Between 2019 and 2021, the average percentage of all deaths attributed to opioids increased in all age groups. In 2019, 1.7% of deaths among people under the age of 85 were related to opioids. This proportion increased to 3.2% of deaths in 2021.

The greatest relative increase between 2019 and 2021 (50.3%) was among young people. Opioid-attributable deaths increased from 19.3% to 29.0% among those aged 30-39. This change was followed by an increase of 48.0% among those aged 20-29 from 19.8% to 29.3%.

The authors noted that the study was limited by their inability to examine four states and territories in which the number of opioid-related deaths was suppressed due to small counts (ie, <5). However, sensitivity analyzes suggested that the demographic distribution of these deaths followed a similar pattern to that of the overall results.

Need More Information

Commenting on the study for Medscape Medical News, S. Monty Ghosh, MD, MPH, assistant professor at the University of Alberta, clinical assistant professor at the University of Calgary, and co-medical lead of the Alberta Health Services Rapid Access Addiction Medicine program in Calgary, “The study was fairly robust in her evaluation. Their approach is statistically sound and makes sense, given the quality of the data they obtained.” Ghosh did not participate in the analysis.

It would be important to know if the premature deaths were related to several substances, he noted. “More nuanced data in Alberta showed that most of the deaths were related to poly-substance use on top of fentanyl. This includes alcohol, meth, as well as substance contaminants such as benzodiazepines, and more recently (outside the research phase), xylazine.

Furthermore, Ghosh added, “It would be good to see more demographic information about Alberta’s youth. For example, were they housed or homeless? Are they Indigenous? Anecdotally, we know that blue collar workers, especially those in Alberta who work in construction and oil rigs, have a disproportionate rate of substance use and at times substance death. This was seen in British Columbia and Ontario.”

What Is Being Done

The Alberta government is responding to these data, Ghosh said. For example, in 2022, specialist funding was provided to enable young adults to access gold standard opioid agonist treatment. Treatment was delivered through the Alberta Virtual Opioid Addiction Program (VODP) and other community-based addiction programs. “This [program] there still needs to be more focus on homeless young people, however, they may not have access to technology or other resources.”

In addition, the government recently announced a $1.55-billion plan to continue building the Alberta Recovery model, he said. “This is the biggest investment seen in our province. Safer delivery or prescribed alternatives are very controversial in Alberta and therefore not an option available to this population.”

In addition, he said, the Ministry of Older People and Community Social Services recently “started coordinated work with other ministries to support vulnerable populations and who deserve equity around this issue, including the creation of navigation centers for housing, subsidy ​​income, and access to treatment through the VODP.”

Ledlie noted that various policies and programs have been developed in response to the ongoing drug toxicity crisis. Some were included in a recent review her team conducted to summarize the evidence for Canada’s safer opioid delivery programs. “We found that these programs generally had positive effects on clients, including lower rates of opioid toxicity and improvements in quality of life.”

“Because most health care is coordinated at the provincial or territorial level, the investments into and access to harm reduction services tend to vary across Canada,” he said. “Even in regions where these programs exist, we know they are not always accessible for various reasons, such as a lack of resources preventing widespread expansion and geographic barriers in more remote and rural regions.”

“One example of a simple but life-saving harm reduction measure that has been implemented effectively by most provincial and territorial governments is the availability of publicly funded naloxone kits,” he added. “Given the broad social impacts of opioid toxicity described in our study, we believe it is critical for all levels of government to coordinate to ensure equitable access to evidence-based services across the country, while continuing to provide the opportunity to tailor and modify those responses. to the unique needs of local communities.”

The study was supported by grants from the Ontario Ministry of Health and the Canadian Institutes of Health Research. Ledlie is supported by an Ontario Graduate Scholarship and a Health Systems Improvement Network Trainee Award. Ledlie and Ghosh declared no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.