Starting April 1, Ontario hospitals will begin tracking opioid overdoses in the province on a weekly basis for the first time in an effort to gain a near real-time look at the growing crisis, according to a letter from the provincial health minister obtained by Global News.
After extensive reporting by Global News on the issue, Ontario Health Minister Dr. Eric Hoskins and provincial overdose coordinator Dr. David Williams sent the mandate to hospitals with emergency departments across Ontario on Feb. 13, in response to the rise in opioid overdoses in the province over the last five years.
“Understanding and addressing opioid addiction and the incidence of morbidity and mortality associated with opioid use/misuse is an important public health priority,” the letter stated.
“Improving monitoring of emergency department visits and outcomes related to opioid overdoses will assist the entire health care system to better understand the burden and distribution of opioid-related patient morbidity and mortality on our health care system.”
“Reporting opioid overdose events from hospitals will assist us in ensuring that … preventive initiatives are being carried out effectively where needed.”
In 2010, there were 421 fatal opioid overdoses in Ontario, with 93 of those being opioid and alcohol-related.
That number rose dramatically to 551 with 159 deaths related to alcohol and opioids in 2015, according to the latest available preliminary data from the Chief Coroner for Ontario’s office released Tuesday. Eighty six of those deaths were caused by fentanyl in 2010, with five related to alcohol, which almost doubled to 167 in 2015 and 37 related to alcohol.
In total, 710 Ontarians are believed to have died from opioid-related deaths in 2015.
In September, Hoskins repeatedly denied there was a lack of comprehensive real-time data to track the opioid overdose death crisis in the province. Ontario Premier Kathleen Wynne later admitted that more information was needed to track the growing problem.
“We do have real time surveillance and data that comes from more than 100 hospitals around the province,” Dr. Eric Hoskins told Global News on Sept. 22, in response to questions about whether enough was being done to track opioid overdose deaths in Ontario.
But when Wynne was asked the same question Sept. 26, her response was much different.
“It’s time to make sure we have all the information in the most timely way possible,” she said at the time. “We don’t have that at this point and so whether it’s appointing someone or whether it’s doing something else, we need to have that information in a timely way.”
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The province then appointed Williams, its chief medical officer of health, as its first provincial overdose coordinator on Oct. 12 to better track patients who overdose on opioids such as fentanyl as part of its “comprehensive opioid strategy.”
But until now, little has been done to address the lack of real-time data.
Hoskins had repeatedly said the province did have a real-time system to track opioid overdose deaths but that program, the Acute Care Enhanced Surveillance System, received data from just 118 of 145 public hospitals in Ontario and had information on opioid-related emergency department visits — but not specifically on overdose deaths.
“We are taking action to address Ontario’s opioid crisis. Recognizing there are those struggling with abuse and addiction, we have already taken major steps to ensure Ontarians get the help they need when and where they need it,” Hoskins said in a statement Tuesday.
“Beginning April 1st, we’ll take another step forward by ensuring hospital opioid overdose data is tracked and shared in near real-time updates. Every hospital and public health unit will have access to the near real-time data, giving experts a more comprehensive understanding of what’s happening on the ground.”
Hoskins said this would “strengthen surveillance initiatives” and may also be used to “inform harm reduction initiatives.”
“This enhanced data collection also builds on earlier commitments to modernize prescribing and dispensing practices and connect patients with high-quality addiction treatment services,” he said.
“While we know these new measures are a big step forward and will help save lives, more can be done and we look forward to working collaboratively with our partners over the coming months to determine further solutions.”
The call for better tracking of the issue has been echoed by experts and health officials, with Toronto Public Health (TPH) calling for more real-time tracking of fatal drug overdoses in the city Monday amid growing concerns over fentanyl and opioid abuse.
Dr. Barbara Yaffe, the city’s acting medical officer of health, said the city has seen a 73 per cent increase in reported drug overdose deaths in the last 10 years, but the latest statistics they have to address the problem are from 2015.
“It was showing an increase and it was also showing an increased role for the opioids like heroin and fentanyl, which is of concern,” she said, adding that opioids accounted for about 66 per cent of all overdose deaths that year.
“They’re playing a larger part and in particular fentanyl is going up and again [the data] is out of date now and anecdotally we are hearing about overdose deaths so we need to get better data.”
To address the lack of data, Yaffe has formed a group to develop an “early warning system” to bring together the limited data available from police, paramedics, coroners and harm reduction workers to get a better scope of the problem until better data is available.
“I think all levels of government are very interested right now in developing real time data and I know the province of Ontario is working on it,” she said.
“So we’re hoping to have some information from hospital emergency rooms and so on so we can get a better picture of what’s going on, what drugs are causing the overdoses and even where they’re happening would be very helpful so we can help direct our prevention and response activities.”
As part of its Toronto Overdose Action Plan being presented to the Board of Health on March 20, TPH is also calling for more widespread availability of naloxone kits, the lifesaving overdose antidote medication, and for the exploring of the use of prescription heroin in the future.
“[TPH] is correct, you need real-time monitoring to design the interventions that will save lives and reduce injuries, if not to actually respond to clusters of overdoses,” Michael Parkinson, a drug strategy specialist with the Waterloo Region Crime Prevention Council, said.
“What’s happening around Ontario is municipalities are scrambling to cobble together overdose monitoring systems … It’s frustrating because we’re watching a predicted and preventable crisis unfold. We called for real-time monitoring nine years ago and here we are in 2017.”
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Parkinson said there is a desperate need for a “consistent monitoring system” across the province, as opposed to different municipalities being forced to pull together their own opioid overdose surveillance system with “inconsistent standards and a real lack of resources.”
“But if all hospitals comply [with the minister’s letter], there’s a tremendous amount of subjectivity at the local level,” he added.
“[Overdoses] are reportable within a week up to the ministry level and then at some point in the future it comes back down. So my point is, don’t be fooled into thinking it’s real-time monitoring.”
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