Hasan Sheikh is an emergency and addictions physician and a lecturer at the University of Toronto. Edward Xie and Jennifer Hulme are emergency physicians and assistant professors at the University of Toronto.
Imagine you are lying in a hallway stretcher of an emergency department. You’ve just had a heart attack – the pain is gone, but part of your heart muscle has stopped working. You’re scared. Anxious. Wondering what this means for your health.
Then, as you lay there worrying, you’re abruptly told that once you’re up and walking, you can leave.
If this happened to you, you’d be understandably horrified.
But this is similar to what is happening in emergency departments across Ontario. Without realizing it, we are discharging people with a nearly 1 in 10 chance of death without a clear plan for managing their severe illness.
What is this deadly affliction? A harmful dependence on alcohol.
As practising emergency physicians, we’ve become accustomed and even desensitized to looking after intoxicated patients. We watch them for a few hours while they sober up and then send them out – back to the same conditions that foster a vicious and deadly cycle.
These visits often seem simple. We usually give them little thought. We see the same faces from day-to-day. Their faces slip from our minds when they stop coming.
So with a team of researchers, we asked a simple question: What happens to them?
Our team looked at data on individuals who visited an Ontario emergency department for alcohol-related reasons more than once in a year. The results were alarming: Despite repeated contact with the health care system, 1 in 20 people died in the year after their visits.
For those with five or more visits in a year – the most familiar faces in our emergency departments – the risk is closer to 1 in 10. That’s similar to the risk of dying after being admitted to hospital for a heart attack.
These results tell a story of people living with a dangerous illness, who regularly flow through the health care system at tremendous costs but are not getting the support they need.
This is not a failure of our emergency services. People are not routinely dying of intoxication. They are dying from accidents and injuries, from toxic damage to the body’s vital organs, and from alcohol’s ability to darken depression and thoughts of self-harm.
This is a societal failure. Alcohol competes with tobacco as a leading cause of disability and premature death. These harms cost roughly $15-billion a year in Canada in lost productivity, health care and criminal justice costs.
Problematic alcohol use is common, and getting worse. One in five Canadians will struggle with alcohol overuse at some point in their lives, and a recent Nanos poll found that stress – not enjoyment – was a common reason for increased drinking during the COVID-19 pandemic.
This is a societal problem, and it requires societal solutions.
Some of those efforts will be within the health care system, including support for low-barrier addiction-medicine clinics, managed alcohol programs and sobering centres. Medical detoxification centres, where people can more safely stop drinking when they are ready, are woefully limited and underfunded.
But crucial and underappreciated work needs to occur before someone even makes that first ER visit. There is clear evidence that public policies on the density of alcohol stores, purchasing hours and minimum alcohol pricing have a significant impact on alcohol-related harms. The easy access to alcohol that we enjoy is a matter of convenience for most, but it is a matter of life and death for those with severe alcohol use disorder.
For the period of our study, Ontario had the top-ranked alcohol policies in Canada – earning a “C” Grade from the Canada Alcohol Policy Evaluation project – but has since made changes that will lead to more alcohol-related harms.
If we can be responsible drinkers, we need our governments to be responsible policymakers.
We don’t send people home with heart attacks. Instead, we have cardiac centres of excellence throughout the province. Those struggling with severely harmful alcohol use face a similar risk of death, yet we don’t offer similarly comprehensive care, policies that work or the preventative social infrastructure that is desperately needed.
Now that we know the risks, inaction is no longer an option.
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