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Lethbridge drug crisis worsens

In the second quarter of 2020, Lethbridge had the highest fentanyl death rate in the province and had doubled ER visits and EMS responses.

Yesterday, the Alberta government released their Opioid Response Surveillance Report for the second quarter of 2020. Here’s a summary of how Lethbridge fares regarding the ongoing drug crisis.

Fentanyl deaths

According to the report, Lethbridge has the highest death rate for fentanyl related deaths of the 7 municipalities reported on.

Rate (per 100,000 person years) and number of apparent accidental drug poisoning deaths related to fentanyl, by municipality (based on place of death). January 1, 2016 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 11.

In the above table, we see that at 42.4, Lethbridge’s rate for fentanyl related deaths year to date is significantly higher than all the others and the highest it’s ever been since at least January 2016. It’s 2.6 times higher than it was in 2019 and 69% higher than the next highest year, 2018.

Non-fentanyl deaths

Lethbridge’s rate for non-fentanyl opioid deaths for the first half of 2020 was 1, tied with Fort McMurray for the second lowest rate in the province. This continues a downward trend in the non-fentanyl opioid death rate in Lethbridge.

Rate (per 100,000 person years) and number of apparent accidental drug poisoning deaths related to an opioid other than fentanyl, by municipality (based on place of death). January 1, 2016 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 14.

ER visits

Lethbridge’s Chinook Regional Hospital saw the 9th highest number of emergency visits related to drug use, at 1,784 visits between 1 January 2016 and 30 June 2020. That’s an increase of 155 since the first quarter of 2020 and accounted for 4% of all ER visits. The first quarter saw 82 ER visits related to drug use.

Top 10 ED facilities utilized for emergency visits related to opioids and other drug use, January 1, 2016 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 21.

The South Zone as a whole continued to have the highest emergency department visit rate of all the health zones during every quarter of this 4.5-year period. The second quarter of 20202, the South Zone ED visit rate for drug usage was 11% higher than the provincial average.

Rate of emergency department (ED) visits related to opioids and other drug use, by quarter and Zone, per 100,000 person years. January 1, 2016 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 21.

Hospitalizations

The rate of hospitalizations related to drug usage, on the other hand was the third highest in the last quarter for the South Zone. In fact, it was the highest in that zone for 13 of the 18 quarters during this 4.5-year period.

Rate of hospitalizations related to opioids and other drug use, by quarter and Zone, per 100,000 person years. January 1, 2016 to December 31, 2019. Alberta Opioid Response Surveillance Report: Q2 2020, p. 22.

Chinook Regional Hospital itself had the 7th highest number of hospitalizations related to harm associated with drug usage, which accounted for 4% of all hospital stays. In the previous quarter, it was 8th highest and accounted for 3% of all stays.

Top 10 facilities utilized for hospitalizations related to harm associated with opioids and other drug use, January 1, 2016 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 22.

This was an increase of over 100 hospitalizations since the first quarter.

Dispensation

Given the prevalence of death and hospitalization related to drug usage in the South zone, it shouldn’t be that surprising that South Zone has the highest rate of methadone dispensation from community pharmacies. That has been the case for every quarter in that 4-year period, as well as in the second quarter of 2020, when the rate was 185% higher than the provincial average.

Rate of unique individuals dispensed methadone indicated for opioid dependence from community pharmacies per 100,000 person years, by quarter and Zone. January 1, 2016 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 23.

This is also the case with naloxone, with a dispensing rate increasing every quarter of the 4-year period, except this most recent quarter, where it finally dropped slightly. Even so, we still saw a naloxone dispensing rate that was nearly 200% higher than the provincial average.

Rate of unique individuals dispensed buprenorphine/naloxone (generic brands and SuboxoneTM) indicated for opioid dependence from community pharmacies per 100,000 person years, by quarter and Zone. January 1, 2016 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 23.

The South Zone also had the highest rate of individuals being dispensed an opioid from community pharmacies, although this rate has been consistently dropping during nearly the entire reporting period. Even so, the dispensing rate for the second quarter of 2020 was 40% higher than the provincial dispensing average.

Rate of unique individuals dispensed an opioid from a community pharmacy per 1,000 person years, by Zone and quarter. January 1, 2016 to March 31, 2020. Alberta Opioid Response Surveillance Report: Q1 2020, p. 25.

EMS responses

Other than the first two quarters of 2019, Lethbridge has seen the highest rate of EMS responses to opioid-related events. Interestingly, Lethbridge data is ungraphed for 2016 and 2017. Despite its higher EMS response rates, Lethbridge rates have dropped nearly every quarter since the peak in early 2018.

Until now.

After trending down for 8 quarters, EMS responses jumped sharply in the second quarter of 2020, more than doubling the response rate of the first quarter.

Rate (per 100,000 person years) of Emergency Medical Services (EMS) responses to opioid related events, by quarter and municipality. January 1, 2016 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 24.

Naloxone kits

All that being said, the South Zone has seen the third highest number of naloxone kits being distributed of all the health zones, with a total of 37,542 kits distributed in 2016, 2017, 2018, 2019, and the first half of 2020.

Naloxone kits dispensed by community pharmacies, by Zone and month. January 1, 2016 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 28.

For the second quarter of 2020, the South Zone had the highest dispensing rate, double that of the provincial average.

Supervised consumption

Regarding supervised consumption, for the first time since it opened, Lethbridge’s supervised consumption site was not the highest used in the province.

The Lethbridge SCS went from an average of over 54,000 visits per quarter since the second quarter of 2018 to just 12,101 visit in the second quarter of 2020.

Even with that nearly 80% drop in usage last quarter, Lethbridge had seen nearly 445,000 visits at its SCS during the entire reporting period. That’s more than all the other sites combined.

Number of visits per quarter and site. January 1, 2018 to June 30, 2020. Alberta Opioid Response Surveillance Report: Q2 2020, p. 29.

For the first time since the first full quarter after its opening, Lethbridge’s supervised consumption site didn’t see the most attended adverse events than any other location. It had the third most attended adverse events, which isn’t surprising given the massive drop in usage.

Total number of attended adverse events* per quarter and site. January 1, 2018 to March 31, 2020. Alberta Opioid Response Surveillance Report: Q1 2020, p. 29.

Adverse events are so-called “drug poisoning events” requiring intervention, including oxygen or naloxone or requesting medical assistance. None of those adverse events resulted in death.

Here’s a summary between the first and second quarters of 2020:

  • Went from second highest fentanyl death rate to highest
  • Nearly doubled drug-related ER visits
  • Chinook Regional went from 8th highest in drug-related hospitalization to 7th highest
  • Lower naloxone distribution
  • Opioid dispensing rate went from 32% higher than provincial average to 40% higher
  • EMS responses more than doubled
  • Went from highest SCS usage to 3rd highest
  • Went from most attended adverse events to third most attended

None of this is surprising.

With public gathering restrictions implemented because of COVID-19 and a March SCS report that made users of the site think the Lethbridge SCS was shutting down, it makes sense that SCS usage was down significantly last quarter.

But just because SCS usage was down, it doesn’t mean that drug usage as a whole was down in Lethbridge. And that’s clear by the jump in fentanyl death rate, EMS responses, ER visits, and hospitalizations.

After all, if the SCS had had no deaths and medical staff on site were able to attend to most adverse events without EMS intervention, then it seems to me that it was saving lives and easing the burden on the local public health system.

Given that the provincial government announced at the beginning of the third quarter that they were defunding the SCS—leaving people with the impression that it had already shut down—and that it actually shut down halfway through the third quarter, I don’t expect the third quarter update to look any better.

And the UCP government finally admitted this. From page 1 of this second quarter report:

Beginning in March 2020, the number of harms associated with opioid use began to increase significantly, reaching record levels not previously seen. This sharp rise was in conjunction with a decrease in the utilization of treatment and harm reduction services.

Maybe now that they finally admit that harm reduction reduces harm, we will see more harm reduction services in the province. Right?

The drug crisis is still here. It had never left. And I’m not sure the 50 treatment beds that are supposed to be funded at an undetermined point in the future will make a dent in these numbers.

Oh, one more thing.

The report included maps for each city, showing where opioid-related deaths occurred during the first quarter of 2020. Here’s Lethbridge.

Notice that the deaths happened in various locations throughout the city, not just near the SCS.

Compare that to the map for the first quarter. Now there are deaths happening in locations where we didn’t see them in the first quarter. Including Galt Gardens.

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By Kim Siever

I live in Lethbridge with my spouse and 5 of our 6 children. I’m a writer, focusing on political news, social issues, and the occasional poem. My politics are radically left. I recently finished writing a book debunking several capitalism myths. My newest book writing project is on the labour history of Lethbridge.

I’m also dichotomally Mormon. And I’m a functional vegetarian: I have a blog post about that somewhere around here. My pronouns are he/him, and I’m queer.

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