Opioid emergency room visits in Hamilton at highest level in 14 years

Emergency room visits for opioid overdoseshave climbed to their highest level since the city started tracking those numbers, and are likely at their peak since at least 2003.

Amid those stark statistics, the province has told the city it willprovide $250,000 in funding to support local drug response initiatives.

In a letter addressed to the mayor and the local board of health, provincial Minister of Health and Long Term Care Dr. Eric Hoskins says the funding will be for staff positions to support opioid response initiatives, like distribution of lifesaving naloxone kits and for early warning and surveillance of opioid overdoses.

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The latest data from the city shows that emergency room visits for opioid overdose and misuse jumped in March to 48 incidents, up from 39 in February. When compared to the province's opioid statistic tracking numbers, that's the most on record.

Lesa Irish, manager of alternative justice programs and an addictions services worker with Mission Services, told CBC News that the landscape for drug use in Hamilton has radically changed in recent years. Opioids have become much more common than ever before, alongside other drugs like crystal meth and crack cocaine.

"We're hearing about more people dying," she said. "For some people, it seems like fentanyl is just calling their name."

But it can be difficult to track exact numbers when it comes to emergency room visits. The city's numbersand the province's numbers draw from two slightly different data sets.

The city gets its statistics directly from Hamilton's hospitals, and it measures anyone who visits an emergency room in the city, regardless of where they're from.

The province, by contrast, tracks Hamilton residents, wherever they are. So if a Hamiltonian ends up in a Sudbury hospital after overdosing, that counts as a Hamilton hospital visitin the province's numbers (which are only available up to the end of 2016).

A steep rise

This means the two sets of numbers are slightly different at times, though they do show a similar upward trend.

It's a patternthat has been emerging since October of 2016, when emergency department visits started rising in Hamilton. While there were peaks and valleys in those numbers over the course of 2015, since then they have been staying high at around 40 a month, and not dropping back down. By comparison, there were only 24 emergency room visits for overdoses last September.

"Between October 2016 and March 2017, Hamilton hospitals have seen a sustained increase in opioid poisoning emergency department visits compared to previous months," said public health spokesperson Aisling Higgins.

And people are dying. There were 24 opioid overdose deaths in Hamilton in the first half of last year alone, the latest period for which those numbers are available. The city's opioid-related death rate is higher than the rest of the province, at a rate of 8.3 per cent per 100,000 people, compared to 5.3 per cent for the rest of the province.

911 calls are spiking, too.According to statistics from the city, there were 32 opioid-related 911 calls in Hamilton in June alone, up from 20 in May.

Both the city and police have issued numerous alerts in recent years, mostly focusing on powerful prescription painkillers like fentanyl.

Then at the end of 2016, the city issued a warning about carfentanil, a drug that is 100 times more toxic than the already extremely powerful prescription painkiller.

"It will cause more overdoses and deaths," reads an ominous post from the city's warning.

Irish also listed carfentanilas one of the lethal drugs on the streets right now. "It's just so unpredictable," she said. "You never really know what it is you're going to get.

In March, the city issued another warning about a drug called "takeover" or "dirty fentanyl," which is crack cocaine laced with fentanyl.

Irish said "popcorn fentanyl," which is another version of the drug, is a huge problem right now, too.

Getting naloxone to the people who need it

In an effort to save lives, public health has been distributing hundreds of naloxone kits an opioid antagonist that can help reverse an overdose if injected, in a similar way to an Epipen being used on someone having an extreme allergic reaction.

But distribution of those kits has slowed. In March, 181 naloxone kits were given to the public, with the city saying that 30 of those were used to revive someone who wasoverdosing.

The number of kits distributed to the public has dropped each month since, down to 60 in June.

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Higgins said the city doesn't yet have enough data to fully understand those numbers yet.

"It is likely there are many factors that influence Public Health's naloxone distribution such as such as increased awareness through media [and the] community," she said in an email.

"Another potential factor might be client demand being met during that peak period (January toMarch) and refills not needed as much recently due to the high uptake earlier this year."

The numbers on the city's website don't include naloxone that was used by Hamilton paramedics or other agencies,so the number of times the life-saving kits are used locally is likely higher.

adam.carter@cbc.ca