Hospital stays for opioid overdoses on the rise, warn health researchers

About 13 people every day across Canada are admitted to hospital for overdoses of opioids like fentanyl, methadone and oxycodone, according to a new national study by the Canadian Centre on Substance Abuse and the Canadian Institute for Health Information.

Opioid overdose patients stay in hospital 8 days on average, study finds

Ottawa paramedic J.P. Trottier says he expects to see twice as many opioid-related 911 calls this year compared with last. (Steve Fischer)

Slow breathing. A lack of oxygen. Blue discoloration. For Ottawa paramedic JP Trottier, the telltale symptoms of an opioid overdose are becoming all too common.

"Our paramedics find the patient hypoxic, blue in colour … they're breathing at four or six breaths a minute, certainly not enough to maintain life," said Trottier.

This year Ottawa is on pace to see twice as many opioid-related 911 calls as the previous year, Trottier said. And they aren't the only emergency responders seeing a spike in recent years, if a study published Wednesday is any indication.

The rate of opioid overdoses requiring hospitalization is on the rise in nearly every province, according to a new national study by the Canadian Centre on Substance Abuse and the Canadian Institute for Health Information.

The centre's report on hospitalizations and emergency department visits found that in 2014-15, 4,779 people across Canada — or 13 a day — were hospitalized as a result of an opioid overdose.

That's up from 3,357 in 2007-08.

A look at hospitalization rates for opioid poisoning per 100,000 people by province. Saskatchewan had the highest rate among the provinces and territories, while Alberta had the highest increase (6.4 per cent) from 2007-08 to 2014-15. (Canadian Centre on Substance Abuse, Canadian Institute for Health Information)

That translates to an increase of more than 30 per cent in the same seven-year span, rising to 13.5 hospitalizations per 100,000 people from 10.2.

While Saskatchewan had the highest rate of opioid-related hospitalization rate (20 per 100,000 people), Alberta had the greatest increase in the seven years of the study. Only Prince Edward Island among the regions had a decline in the rate of overdose-related hospitalizations.

The report is an attempt by medical researchers to begin to piece together data on indicators of what they call the "costly and largely preventable harms" of opioid addiction and overdoses.

But the national and provincial numbers don't include overdoses where patients may have died before getting to a hospital, or overdoses where the people did not receive treatment.

"Therefore, these figures underestimate the number of Canadians experiencing opioid-related harms," the authors write.

Seniors and youth most at risk

Seniors age 65 and older had the highest rate of hospitalization, at 20 per 100,000 people, with the most common cause being "accidental" overdoses, due to confusion or misunderstanding about how to take prescribed drugs.

The next biggest age group was youth, age 15 to 24. They were hospitalized at a rate of 10 per 100,000, with more than 50 per cent of the cases categorized as "intentional," meaning the person admitted to using the drug to "self-harm."

But young people also had the biggest increase in hospital stays as a result of opioid poisoning, up 62 per cent compared with 2007-08.

While most opioid poisoning hospitalizations were accidental for children and seniors, 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)

"We find many who reported using opioids got it from their parents' medicine cabinet, so I think this points to the importance of prescription take-back days, safe storage of medication and disposal when it is no longer required," said Matthew Young with the Canadian Centre on Substance Abuse.

Many who reported using opioids  got it from their parents' medicine cabinet.- Matthew Young, CCSA

The national study also found that people admitted to hospital for opioid poisoning remain there longer than for many other medical conditions.

The average stay for opioid poisoning is eight days, longer than the average stay for a heart attack (5.1 days) pneumonia (6.9 days) and hip replacement surgery (7.3 days).

"When someone is poisoned by opioids, the area of the brain responsible for breathing stops, so there could be lingering brain damage, depending on how long the person has been without oxygen," said Young.

Matthew Young, a research scientist with the Canadian Centre on Substance Abuse, stresses the importance of the storing and disposing of prescription opioids. (Steve Fischer)
He said because opioids are so addictive, the person may also need to have an extended stay in hospital to get help with their dependency.

The study also looked at emergency room visits from 2010-11 to 2014-15 for Alberta and Ontario — the only two provinces where comprehensive data was available — and found an alarming rise in the number of heroin overdoses during the four years studied.

In 2010-11, heroin accounted for just one per cent of opioid poisoning emergency visits in Alberta and five per cent in Ontario. By 2014-15, those proportions had climbed to 14 per cent and 15 per cent, respectively.

With files from Paul Jay