Opioid poisoning puts Manitobans in hospital at a rate of 1 every 2 or 3 days, report says

Fewer Manitobans are going to hospital because of opioid use than in the rest of the country, a new report says, but experts say new data doesn't show the full picture.

Manitoba rate 2nd lowest in country, but doesn't include ER visits that don't end in hospital admission

Hospitalization for opioid poisoning in Manitoba is happening at a rate equivalent to one every two or three days. (CBC)

Fewer Manitobans are going to hospital because of opioid use than in the rest of the country, a report released Thursday says, but the new data doesn't show the full picture.

There were 138 Manitobans hospitalized in the 2016-17 fiscal year because of health concerns related to the use of opioids, including overdoses, says data from the Canadian Institute for Health Information that was made public Thursday. The opioids were taken both under prescription as painkillers and as illegally purchased street drugs.

The number works out to 10.8 hospitalizations a year per 100,000 Manitobans; that's one hospitalization every two or three days if they were evenly spread out over a year.

The national rate was 15.5 hospitalizations per 100,000 people. Among the provinces, Manitoba was second last, with only Quebec ranking lower at 9.4 hospitalizations per 100,000 people in 2015-16, the latest year for which data is available from that province.

"The numbers, compared to other provinces and Canada as a whole, are really favourable," said Michael Gaucher, director of pharmaceuticals and health workforce information services at CIHI. "Certainly that can be taken as a positive sign."

"That may be due to, certainly, some of the harm reduction strategies and measures that have been undertaken in the province to try to really address this. But I think, too, it's important to continue to monitor the situation and to really get the full picture."

Manitoba shows the second-lowest rate among provinces in this map of hospitalization rates for opioid poisonings per 100,000 people. (Canadian Centre on Substance Abuse, Canadian Institute for Health Information)

Numbers for Manitoba and every other province except for Ontario and Alberta were built using the national hospital morbidity database, which only captures people who were admitted to the hospital for opioid poisoning.

The Manitoba data leaves out opioid-caused deaths, and doesn't reflect treatment provided by ambulances or visits to emergency departments that don't end with admission to hospital. The latter are logged in the National Ambulatory Care Reporting System, or NACRS, but CIHI said submissions lacked enough detail to be useful for its analysis.

Gaucher said without that information, CIHI numbers don't capture all the harm opioids are doing in the province, but it's unclear how much of the picture is missing.

Alex Forrest, president of the United Fire Fighters of Winnipeg, said many of the people firefighter paramedics treat for opioid overdoses don't end up in the hospital. Crews can treat poisonings with naloxone, which reverses the effects of an opioid overdose, and after that, some people refuse to be taken in, he said.

"I can tell you that in Winnipeg, almost daily we give out naloxone … to avoid respiratory arrest and such from overdoses," Forrest said.

"We don't know how this impacts upon this study, because it only cites the number of hospitalization opiate overdoses."

The province has worked hard to educate the public about the dangers of misusing opioids, and the favourable numbers may be a reflection of that, he said.

But Forrest said he's still concerned about the number of opioid-related calls and the number of young people who are falling victim to the drugs.

People age 15 to 24 were most likely to be sent to hospital for intentional drug abuse. (Canadian Centre on Substance Abuse, Canadian Institute for Health Information)

Adults age 45 to 64 and age 65 and older had the highest rates of hospitalizations due to opioid poisoning in the CIHI data, but the fastest-growing rates were for youth age 15 to 24.

The rate of hospitalizations in Canada among those young people jumped from 6.5 per 100,000 in 2007-08 to 13.3 per 100,000 last year.

While the majority of the hospitalizations among children and seniors were due to accidental opioid poisonings, youth were just as likely to have been poisoned through intentional drug abuse.

Forrest said he's seen that borne out in fentanyl overdoses in Winnipeg.

"It's a very tragic drug, because the majority of the overdoses that we see on the street are young individuals between the ages of 14 and 22, 23 years old," he said.

"I don't think we can take the foot off the gas, and we need to keep working with the province trying to educate the public that this drug is out there and it is extremely dangerous, and unfortunately it kills far too many of our young individuals in Winnipeg."

'Things can change'

Provinces reporting relatively lower rates of hospitalizations now can't assume the lower rates will continue, Gaucher said.

"We've seen, you know, things can change," he said. "When you see what's been happening in some of the provinces, you know, traditionally they have been a little lower and they are increasing now."

In Winnipeg, Main Street Project executive director Rick Lees said he's seen a steady rise in street use of opioids since the introduction of Oxycontin in hospitals more than a decade ago.

"There is an increase generally in opiates. They're being mixed in with other drugs like crystal meth, so fentanyl is a favourite to mix in because it gives a fairly significant high," he said.

"There is a rise in the use of prescription pain medication, which is being ground into different forms, for use on the street."

Lees said CIHI data suggests to him that Manitoba hospitals are doing a better job than others of prescribing opioids to help fight pain, but he's still concerned about how the drugs are prescribed.

He said Manitobans should educate themselves about how the drugs can be abused.

"The public [should] be aware that there is an opiate issue, that it's largely behind the scenes, and it's not something that you generally see right in front of you," he said.
Fewer Manitobans are going to hospital because of opioid use than in the rest of the country, a report released Thursday says, but the new data doesn't show the full picture. 2:04