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A report released Wednesday on opioid-poisoning hospital visits tells only part of the story for Nova Scotians dealing with addiction, an expert says.
The overall provincial rate of opioid poisoning hospitalizations and emergency department visits in 2017 was 8.4 per 100,000, the lowest in the country, and a slight decrease compared to 2016, according to a report by the Canadian Institute of Health Information.
Halifax had the lowest rate for larger urban areas in the country with 20 hospitalizations, or 4.6 per 100,000, in 2017. But in Cape Breton there were 27 hospitalizations linked to opioid poisoning, said the CIHI report called Opioid Related Harms in Canada.
That translates into 27.9 per 100,000, the highest rate in the Atlantic provinces after the cities of Moncton and St. John’s. The CIHI researchers found that hospital visits related to opioid poisoning were often much higher in smaller communities across the the country.
Opioids are narcotic pain relief drugs such as codeine, fentanyl and hydrocodone.
“While I’m glad Halifax does have the lowest rate of opioid-poisoning related hospitalizations in the CIHI report, I do want to stress that opioid-poisoning related hospitalizations are a really specific health outcome (related to severe, but non-fatal overdose, generally from fentanyl or fentanyl analogues),” said Dr. Thomas Brothers, a Halifax internal medicine specialist and an advocate for marginalized populations such as people grappling with drug addiction.
“(The stats) does not reflect our unfortunately relatively high rates of opioid overdose death and our new HIV outbreak among people who inject drugs, among many other issues related to the overdose death crisis in our province,” Brothers said in an email in response to the CIHI report.
While hospital/opioid rates dipped overall in Nova Scotia, the number of opioid-related deaths jumped to 63 in 2017 compared to the 53 deaths the previous year.
As of Nov. 1, there have been 33 confirmed and 13 probable opioid toxicity deaths in 2018, according to provincial Health Department statistics.
Brothers said because hydromorphones such as Dilaudid are being prescribed less frequently in Nova Scotia, “drug users are seeing more limited availability of prescribed (and therefore safely dosed) hydromorphone and increasing availability of fentanyl (being sold as heroin) taking its place.
“To combat these issues we do urgently need funding for services that are the standard of care in other provinces, including safe consumption sites in the community and in the hospital; take-home naloxone distribution from emergency departments and hospitals; and availability of buprenorphine in the emergency department for people who survive overdose and are interested in treatment.”
A spokeswoman for Dr. Robert Strang, Nova Scotia’s chief medical officer and co-chair of the Pan-Canadian Public Health Network’s special advisory committee on the epidemic of opioid overdoses, said Thursday that he wouldn’t comment until he had a chance for “greater review” of the CIHI report.
In October, the Health Department said it’s seeking “safer consumption/overdose prevention” models that will work in urban and rural Nova Scotia. The province has distributed 5,000 take-home naloxone kits to at-risk Nova Scotians and their families. Naloxone is a life-saving medication that can stop or reverse an opioid overdose.
“One reason we may not have had as many opioid-poisoning related hospitalizations is that our illicit drug supply in Halifax does not seem to be as widely contaminated with fentanyl as other provinces,” said Brothers, who recently received the Dr. Jock Murray Award for resident leadership in global health.
The CIHI report shows a trend of opioid-poisoning related hospital visits starting highest in the western Canada and decreasing as you move east. That mirrors the statistics on the overdose death rate from fentanyl, Brothers noted.
“People who use illicit opioids in Nova Scotia have traditionally used diverted (and therefore safely dosed) prescription opioids like hydromorphone, rather than heroin (which has generally been replaced with fentanyl all across Canada).”
Brothers also pointed out that most opioid-poisoning patients are seen at the emergency department and discharged rather than being hospitalized.
“The reasons that we would admit someone to hospital related to opioid poisoning are the complications of a severe, non-overdose, and not simply the complications of opioid use itself,” he said. “Often this would be when an overdose is so severe it requires a continuous naloxone infusion, or if someone has had a seizure, a cardiac arrest, a brain injury from lack of oxygen, or a pneumonia from aspirating vomit into their lungs.
“These are far more likely with accidental fentanyl overdose than they are with prescription (and therefore safely dosed) opioids like hydromorphone.”