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As new statistics paint a clearer picture of Canada's opioid crisis, the Health Minister says better, more centralized tracking would help Canada to better monitor it and tackle the problem. Karen Howlett and Kelly Grant look behind the numbers

Health Minister Jane Philpott plans to address "huge gaps" in Canada's ability to monitor an epidemic of opioid abuse by creating a central clearing house that will track emergency department visits and overdose deaths.

A national report that said the number of admissions to Canadian hospitals for opioid poisoning increased by 42 per cent from 2007-08 to 2014-15 reveals that policy-makers need a much better statistical picture of the scope of the problem, Dr. Philpott told The Globe and Mail.

The new figures from the Canadian Institute for Health Information (CIHI) provide the most complete snapshot yet of how often opioid overdoses, accidental or deliberate, send people to hospitals across the country. Yet the picture is incomplete – for example, only Ontario and Alberta report emergency department visits as well as in-patient admissions to CIHI – and the report does not capture the full impact of bootleg fentanyl, which hit Canada's streets in earnest after the last year for which data were available.

"The CIHI report really highlights the fact that there are huge gaps in data and surveillance from all sorts of different perspectives," Dr. Philpott said. "We have not done a good job in recent years of gathering pan-Canadian data."

An ongoing investigation by The Globe has found that Canada lacks vital information needed to track and respond to a crisis that claimed 622 lives in British Columbia in the first 10 months of this year and 338 in Alberta between January and September. Unlike countries such as the United States and Australia, Canada has no mechanism for collecting and monitoring the number of people who die each year from opioids.

A Killer High

After the number of fentanyl deaths exploded in 2015, The Globe and Mail sought answers to what had gone wrong across the country. Read more in the series.

The investigation also found that Ottawa and the provinces have failed to take adequate steps to address the root of the problem: the overprescribing of prescription painkillers, whose risks are substantial and benefits uncertain.

"We've got disinterest, and that's what's standing in the way of the public interest," said Hakique Virani, an Edmonton-based public health and addiction-medicine specialist.

The CIHI report, which was co-authored by the Canadian Centre on Substance Abuse, illuminates the toll of the escalating opioid crisis on the health-care system. Hospitals across the country logged nearly 4,800 admissions for in-patient care related to opioid poisoning in 2014-15, up from 3,357 in 2007-08. Those patients stayed in hospital for an average of eight days – longer than patients recovering from heart attacks, pneumonia or hip replacements. The figures do not include people treated in emergency departments and sent home.

The report, released on Wednesday, comes as Dr. Philpott and Ontario Health Minister Eric Hoskins prepare to co-host a national summit in Ottawa on Friday and Saturday aimed at reducing opioid addiction and overdose deaths in Canada.

Dr. Philpott said she does not want to create a new agency to track deaths and emergency department visits. Rather, she said, she is looking at having two or three agencies form an alliance to do it.

British Columbia's experience underscores what is missed when emergency department visits are left out of the picture.

The province is one of eight whose hospitals do not submit enough information to CIHI to be included in its new analysis of opioid-related emergency visits. However, when B.C. Provincial Health Officer Perry Kendall declared a public health emergency in April in response to a spike in drug overdoses, he ordered ambulance services and hospital emergency departments to gather detailed information about overdose patients, including which drug they consumed and where the overdose occurred, and submit it to their regional health authorities.

Dr. Kendall said that, so far, the drug overdose patients who have been revived by paramedics or discharged from the emergency rooms look very different from those admitted to hospital and captured in the CIHI data up to 2014-15.

The report shows the proportion of opioid poisoning admissions was slightly higher among women than men. Patients over the age of 65 accounted for nearly a quarter of all opioid-related hospitalizations, and teens and young twentysomethings saw the sharpest increase in their rate.

"The gender difference was very different from what we see with illicit drug overdoses either dying or turning up in the emergency rooms, where it's four males for every one female," Dr. Kendall said.

At least two of B.C.'s regional health authorities are already making public some of what they've gathered through enhanced surveillance at their emergency departments.

Vancouver Coastal Health, which includes the city of Vancouver, reported that of more than 5,000 drug overdose cases seen at emergency rooms between Jan. 1 and Oct. 29, about a quarter were related to opioids, and the majority – 71 per cent – turned up at St. Paul's Hospital in downtown Vancouver. Nearly 70 per cent of the patients were male.

Interior Health, which includes the city of Kelowna, logged 207 opioid overdoses and suspected opioid overdoses through its enhanced emergency room surveillance between June 1 and Oct. 31. The health authority reported that 129 of the patients were male, that most of the overdoses occurred in a private residence, and that heroin was the drug patients most frequently admitted taking before their overdose.

In Alberta – another province hit hard by opioids – the government is also publishing detailed surveillance information on emergency department visits and overdose deaths. Among the interesting findings in the government's first report, dated Oct. 27, is that two thirds of the people who died of overdoses this year lived outside Calgary and Edmonton and another one quarter were homeless, said Karen Grimsrud, Alberta's Chief Medical Officer of Health.

"That points to a problem that will lead to quite different approaches," Dr. Grimsrud said. For homeless people addicted to opioids, she said, the province is looking at providing funding for safe injection sites. For those living outside major urban centres, the government will ensure they have access to the antidote naloxone, she said.

The report also reveals that a disproportionate share of the deaths linked to fentanyl were in Calgary. In Edmonton, by contrast, other opioids, including prescription painkillers, were responsible for most of the fatalities. Over all, half of the people in Alberta who died from other opioids had been prescribed painkillers in the 30 days before their death.

The province is also tracking the number of patients treated in hospital emergency departments and urgent care centres on a monthly basis. In January, 2003, there were just 64 visits. But the numbers began to ratchet up in mid-2012 – around the same time illicit fentanyl hit the streets – and peaked at 323 in June of this year.

Between Jan. 1, 2014, and June 30, 2016, Alberta had 17,690 emergency and urgent care visits related to opioid overdoses, the report says. One in five individuals visited emergency or urgent care more than once.

No single organization compiles this kind of data nationally. Jurgen Rehm, director of the Institute for Mental Health Policy Research at the Centre for Addiction and Mental Health (CAMH) in Toronto, said Canada's fractured health-care system is a "nightmare" for anyone who wants to analyze data of any kind, including data about overdose deaths.

"I cannot tell you, if you ask me, how many people died of opioid overdoses last year," he said. "We have different coroners who have different rules. I'm sorry, but in the year 2016, we should be able as a country to come up with one clear rule which every provincial coroner would apply, which gives us some kind of a statistic which is necessary for health-care planning and for political steps."


On the ground with Downtown Eastside firefighters battling opioid overdoses