Pubdate: Tue, 29 Aug 2017
Source: Hamilton Spectator (CN ON)
Copyright: 2017 The Hamilton Spectator
Author: Joanna Frketich
Page: A1


City's death rate among the highest

An Ontario report warns Hamilton shows signs of having among the
highest illicit opioid use in the province.

It also flags a potential lack of addiction treatment services here
compared to the high death rates found by the Ontario Drug Policy
Research Network.

Its alert comes at the same time that city data shows July had the
highest number of opioid-related 911 calls so far this year.

"Hamilton has stood out as having one of the higher death rates in the
province," said Tara Gomes, a scientist at St. Michael's Hospital and
the lead author of the report.

"But what is interesting is that the rate of prescribing for pain is
not particularly high. I think it does suggest that perhaps the
prescribed opioids are playing less of a role and perhaps illicit
drugs are leading to more of those opioid-related deaths."

Hamilton had the 10th-highest death rate in the province with nearly
eight opioid-related deaths per 100,000 population in 2016. To
compare, the provincial average was just over five. Halton Region's
rate is around three, which was the third-lowest in Ontario.

But Hamilton was 23rd out of 36 public health units when it comes to
the number of residents filling opioid prescriptions for pain. The
city was slightly over the provincial average with nearly 14 per cent
of the population dispensed an opioid for pain. Halton was third
lowest at 10 per cent.

"In areas where there are higher rates of opioid-related deaths, there
is not the association that we might expect with higher rates of
opioid prescribing," said Jason Busse, McMaster associate professor in
the department of anesthesia and main editor of the 2017 Canadian
Guideline for Opioids for Chronic Non-Cancer Pain.

"It's important in terms of understanding how we can affect this
crisis," Busse said. "To what degree, if we focus on the issue of
over-prescribing opioids, can we hope to see a decrease in fatal
overdoses and to what degree are we going to have to ensure there is
equal attention paid to the issues of diversion and illicit use?"

Hamilton was the only urban centre to have high deaths coupled with
lower prescribing. The others were Renfrew County and Simcoe Muskoka.

Despite the high death rates, Hamilton ranked merely average for
treatment in the report published Aug. 22.

"I think in Hamilton, there likely is more of a gap in terms of access
to some of these harm reduction services and treatment for addiction,"
Gomes said. "How easy is it for people to access methadone or
suboxone? Are there plans for supervised injection sites and how
quickly can those get up and running? How easily are people able to
access naloxone? Is it available at community health centres, harm
reduction centres and those types of areas where people who use drugs
might be able to access them and learn how to administer them?"

Hamilton public health is studying the feasibility of a supervised
injection site and is expected to make a recommendation to city
council by the end of the year.

In 2016, public health distributed 462 naloxone kits with 192 people
being revived by them. It is already well above that number this year
at 889 kits distributed and 219 people revived.

However, the number of kits distributed each month has been declining
since March.

Busse says the report highlights the need for more detailed data on
overdose deaths that would distinguish how the user got the drugs.

"You hear a lot about the fatal opioid overdoses but it's often
difficult to drill down to understand was this someone who was taking
prescription opioids prescribed for them, or is this someone who got
their hands on someone else's prescription opioids, or is this someone
who simply went out to the street and got illicit fentanyl and
carfentanil?" Busse said. "If that kind of information could be
acquired, then it's going to give a much better idea of where the main
targets for change are going to be."
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