Opioids - What is the situation?

London has multiple overlapping drug-related crises.

Opioid-related deaths

Opioid-related death rates have been fluctuating in Middlesex-London since 2005. In Ontario the death rate had been slowly increasing until 2017 where it jumped significantly. Middlesex-London did not see the same increase in 2017 and reported 31 deaths, similar to 2016. However, preliminary estimates for 2018 indicate higher rates than in the past.

Data Source: Ontario Opioid-Related Death database, Office of the Chief Coroner for Ontario
Accessible on the Public Health Ontario Interactive Opioid Tool

Opioid-related Emergency Department Visits

Middlesex-London Emergency Department visits rates have been increasing since 2014. The most dramatic increase was seen from 2016 to 2017 where the count jumped from 188 visits to 316. Rates have generally been higher in Middlesex-London than the province since 2003.

Data Source: National Ambulatory Care Reporting System (NACRS), 2003‒2017, Ontario Ministry of Health and Long-Term Care, IntelliHealth Ontario
Accessible on the Public Health Ontario Interactive Opioid Tool

Opioid-related Hospitalizations

Hospitalizations for opioid toxicity have been increasing generally over time in both Middlesex-London and Ontario. In recent years, the rate in Middlesex-London has been increasing at a higher pace and is significantly higher than the provincial rate. Despite the dip seen between 2016 and 2017, the hospitalization rate has not significantly decreased.

Data Source: Discharge Abstract Database (DAD), 2003‒2017, Ontario Ministry of Health and Long-Term Care, IntelliHealth Ontario
Accessible on the Public Health Ontario Interactive Opioid Tool

Opioid-related morbidity and deaths

Monthly ED visits, hospitalization and death data provide a picture of the variability seen across the past few years. An increase in number of ED visits was seen starting in April, 2017 and there has since been variation in the number of monthly visits. In the first 6 months of 2018 there were 33 deaths compared to 31 in all of 2017. Data from January to March 2018 show a higher monthly rate of death but the rates from April to June were lower.

Note: Data sources change for deaths after 2018-03 and ED visits after 2018-06. Death data for 2018 is preliminary and subject to change.

Data Source:
Ontario Opioid-Related Death database, Office of the Chief Coroner for Ontario
Discharge Abstract Database (DAD), Ontario Ministry of Health and Long-Term Care, IntelliHealth Ontario
National Ambulatory Care Reporting System (NACRS), Ontario Ministry of Health and Long-Term Care, IntelliHealth Ontario
Accessible on the Public Health Ontario Interactive Opioid Tool

Naloxone

The number of naloxone kits distributed in Middlesex-London has steadily increased since 2014. After the number of kits distributed leveled off in 2018 there was an increase seen throughout 2019, with more than 1,000 kits distributed in each quarter between April and December 2019. The number of overdose reversals reported continued to increase, with the greatest number reported to date between October and December 2019.

Data Source: Regional HIV/AIDS Connection and Middlesex-London Health Unit

Invasive Group A Streptococcal (iGAS) Infection

Invasive Group A Streptococcal (iGAS) infections are caused by the bacterium Streptococcus pyogenes. These bacteria are naturally found in the throat and on the skin of many people. However, when the bacteria get into parts of the body that are usually bacteria-free, like the bloodstream, it is called an invasive infection. Invasive infections can cause serious conditions like pneumonia, meningitis, necrotizing fasciitis, and streptococcal toxic shock syndrome.

Prior to 2016, iGAS rates in Middlesex-London were generally similar to the Ontario rate, except in 2008 and 2012 when local clusters of cases emerged. Since 2016, local rates have exceeded the provincial rate. Although the Middlesex-London rate decreased in 2018, the local rate was still nearly two times greater than the rate across the rest of Ontario.

Data source: Public Health Ontario Infectious Disease Query. Data current as of January 23, 2019 at 7:00 a.m.

HIV

Human Immunodeficiency Virus (HIV) is a virus that weakens a person’s immune system, leaving the body unable to fight other infections and illnesses. Some people have mild symptoms 2-6 weeks after becoming infected with HIV, but these symptoms go away after a few weeks. Most people do not develop symptoms until years after they have been infected with HIV.

Prior to 2014, HIV rates in Middlesex-London were lower than or similar to the Ontario rate. Between 2014 and 2016, local rates increased whereas the provincial rate was stable. In 2017 HIV rates in Middlesex-London began to decline, and in 2018, the local rate was more than 50% lower than at the peak of the outbreak in 2016.

In 2016, 74% of newly diagnosed HIV cases in Middlesex-London reported injection drug use as a risk factor. By 2018, the proportion had decreased to 52%. However, people who use injection drugs are still over-represented among local HIV cases. The Public Health Agency of Canada (2018) found that approximately 14% of HIV cases newly diagnosed across Canada in 2016 reported injection drug use as a risk factor.

Data source: Public Health Ontario Infectious Disease Query. Data current as of January 23, 2019 at 7:00 a.m.

Reference: Public Health Agency of Canada. Summary: Estimates of HIV Incidence, Prevalence and Canada’s Progress on Meeting the 90-90-90 HIV targets, 2016. Public Health Agency of Canada, 2018. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90/pub-eng.pdf. Accessed January 16, 2019.

Hepatitis C

Hepatitis C is an infection of the liver caused by the Hepatitis C virus. Many people infected with the Hepatitis C virus do not get sick, or they feel ill for only a short time. However, three out of four people infected with the Hepatitis C virus will carry it for years.

Since 2007, Hepatitis C rates have been consistently higher in Middlesex-London when compared to provincial rates. Injection drug use is a risk factor reported by many cases, and may contribute to the local rate being higher than the Ontario rate. For example, in 2018, 54% of Middlesex-London Hepatitis C cases reported current or previous injection drug use.

Data source: Public Health Ontario Infectious Disease Query. Data current as of January 23, 2019 at 7:00 a.m.

Endocarditis

Endocarditis which is also called infective endocarditis, is an infection and inflammation of the heart valves and the inner lining of the heart chambers. It can occur when infectious organisms, such as bacteria or fungi, enter the bloodstream and settle in the heart People who inject drugs are at high risk of acute endocarditis, because numerous needle punctures give bacteria many opportunities to enter the blood through broken skin. Re-using drug paraphernalia increases the risk. Endocarditis is treated through intravenous antibiotics and surgery may be required in some cases. If untreated, this form of endocarditis can be fatal in less than six weeks.

Needle Recovery

Each year in London, more than 3 million clean needles are distributed to people who inject drugs; of these, about 60% are recovered.

• Free and confidential needle exchange services are available at Regional HIV/AIDS Connection (RHAC), the Middlesex-London Health Unit and My Sister’s Place.
• Well-marked stationary needle disposal bins in several public areas collect discarded needles and syringes; they also assist with overall recovery of used injection drug equipment. See the list of stationary needle disposal bin locations and learn more about the safe handling and disposal of needles.

If needles are found on public property:
If needles are found on public property, please call 519-661-2489 ext. 4965. This phone line is answered 24 hours per day, 7 days per week.

Public drug use

People tend to use drugs in public areas, because they don’t otherwise have a safe location to do so. This public drug use can lead to unsafe consumption practices, which increase the risk of overdose and the spread of diseases, such as hepatitis C and HIV. In addition, discarded equipment, such as used needles, pose a potential risk of injury for those who use public spaces where people inject drugs.