There have been more opioid-related deaths in the Hamilton LHIN over a five-year period than anywhere else in the province, according to a new study out of the Institute for Clinical Evaluative Sciences.

The report also shows that the Hamilton LHIN (which includes Niagara, Haldimand and Brant) had the highest number of opioid-related hospital admissions and emergency department visits in the entire province in 2014.

It all adds up to a stark picture of a region that is suffering through an opioid epidemic that has claimed hundreds of lives in recent years.

"This suggests there is something different happening in the region with issues of addiction and overdose," said Tara Gomes, a scientist at St. Michael's Hospital.

"It really highlights the fact that there are pockets in the province that are having issues."

'I'm not sure people appreciate how pervasive this is. It crosses all socioeconomic structures, all genders and age groups.'

- Tara Gomes, scientist

According to the report, there were 444 opioid-related deaths in the Hamilton LHIN from 2009 to 2013 — that's 138 more than the nearest area, statistically. In 2013 alone there were 96 deaths, which is the highest in the province and well above the Ontario average.

Provincially, the study found that rates of opioid overdose deaths increased a staggering 242 per cent between 1991 and 2010.

(LHIN stands for Local Health Integration Network. In each region of the province, the local LHIN is the authority responsible for regional administration of public healthcare services.)

A strain on the medical system

The problem is taking a toll on hospitals, too. In 2014, there were 587 opioid-related emergency department visits in the region, which is 179 more than the next highest region, and well above the provincial average.

That same year, the Hamilton region saw 266 hospital admissions, which again, is the highest in the province in that time.

This comes as Hamilton's hospitals and paramedics say they are slammed, and feeling the weight of an onslaught of patients.

"The issue certainly puts a burden on emergency departments and hospitals," Gomes said. There exists a misconception in the general public that these issues only affect people who would be "substance abusers anyway," Gomes said, but really, that is not the case.

"I'm not sure people appreciate how pervasive this is. It crosses all socioeconomic structures, all genders and age groups."

How does it feel to be hooked on opioids?3:57

While Hamilton has the highest overall number of deaths and hospital visits, other regions have slightly higher numbers per capita when population is factored in.

The Hamilton LHIN is just slightly under the North East Region for emergency department visits per capita, and just below a couple of regions on hospital admissions in 2014.

When looking at the death rate rate per 10,000 people, Hamilton's LHIN comes in at fourth in the province over a five-year period, but still well over the provincial average.

Fentanyl a definite concern

All of this alarm has not gone unnoticed. Cities across the country have noted fentanyl as a particular concern as deaths begin to mount.

The painkiller is often used for cancer patients or people with chronic, searing pain — but it's also much stronger than even heroin.

Police and community groups have been warning of a looming crisis involving so-called "bootleg" versions of the drug. Hamilton police claimed to have found the first liquid fentanyl seizure in Canada in an announcement last week, though Health Canada subsequently debunked that claim.

An advisory released in August by the Ontario Association of Chiefs of Police warned that 2016 has been a record year for overdose alerts and seizures of bootleg fentanyl. That refers to drugs that are not prescribed by doctors, but produced synthetically and sold on the black market, usually mixed in with other substances.

Then there's carfentanil, a synthetic opioid that is 100 times stronger than even fentanyl itself. That drug was originally designed to immobilize large animals such as moose and elephants, where injections become difficult or impossible.

As the number of overdoses rise, Hamilton is considering the implementation of safer injection sites, which have been shown to lower deaths.

However, Hamilton is still years away from one of these sites — if the city gets one at all — which has some critics bemoaning the fact that in the meantime, more people will die.

adam.carter@cbc.ca