TORONTO — Powerful opioid drugs are killing people in the northern city of Thunder Bay at a higher rate than anywhere else in Ontario, a new report states.
In addition, the report finds the rate of visits to district emergency departments or hospital admissions because of opioid overdoses are almost double the provincial average.
Over the past 12 years, according to the study, 220 people in the Thunder Bay district died from overdoses. The worst year appears to have been 2014, which saw 17.4 deaths per 100,000 people, compared to the Ontario rate of 4.9 deaths per 100,000.
The report by a task force comprising health-care providers, first responders and academics finds several factors play a role in the higher rates.
“Poverty, unemployment, accessibility of services, and housing costs are barriers to achieving good health outcomes,” the report states. “Community partners who provide services to people who use drugs indicate that there is a lack of safe, affordable housing for their clients.”
Opioids, such as codeine, morphine, oxycodone, fentanyl, methadone, and buprenorphine, are commonly prescribed for management of physical pain. Some people use or abuse them to get high or to cope with emotional or psychological trauma. While some are highly addictive, others can be used to treat addictions by easing withdrawal symptoms.
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The drugs should generally be used for no more than three days to treat acute pain, but the report says almost half of new prescriptions in Ontario in 2016 were for more than seven days — increasing the risk of withdrawal symptoms and potential addiction. Higher prescribing rates are also closely associated with higher opioid-related fatalities.
According to the report, almost one in five residents in the Thunder Bay district were prescribed opioids in 2016. The vast majority of prescriptions were for treatment of pain, while a small number were for treating addictions.
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All opioid users risk potentially fatal poisoning — a particularly acute problem with the synthetic fentanyl, responsible for overdose deaths that have soared into the thousands a year in Canada and tens of thousands in the U.S.
While most fatal overdoses in Ontario are attributable to fentanyl, the main killer in Thunder Bay is methadone, the report says. The reason is likely due to both appropriate and excessive prescription of methadone to treat addictions to other drugs, or due to inappropriate diversion of the drug to the streets.
While men aged 25 to 44 make up the largest group heading to Ontario emergency departments for overdose treatment, it is women in that age group who make the most ER visits in Thunder Bay.
Overall, the report says, the rate of emergency room visits in Thunder Bay for opioid overdoses has jumped dramatically from 32.9 per 100,000 people in 2005 to 53.4 per 100,000 people in 2016. Well over half of overdoses are accidental, but almost one quarter last year were intentional, the report says.
“Social exclusion and traumatic events are strongly predictive of problematic drug use,” the report states. “Risk factors for overdose include poverty and lack of housing, depression, use of alcohol or benzodiazepines, administration of drugs by injection, previous overdose, contaminated drug supply — e.g., with fentanyl analogues — and periods of abstinence.”
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To try to deal with the problem, the community has increased distribution of naloxone, which can save lives by countering the lethal effects of opioid overdoses. The district is also setting up places where users can take drugs under supervision and addiction-medicine clinic that is quickly accessible.
The Thunder Bay report concludes that solid information provided by opioid users themselves is still needed, as is more information from those around them.
“The location of services and supports presents significant challenges to those who must travel great distances to access health-care, and mental-health and addictions services,” the report states.