Copy
View this email in your browser

May 2019 Report


Paramedic services calls
 
29
May 2019
calls for suspected opioid overdose responded to by Halton Region Paramedic Services in May 2019.
 

118
Year to date

calls for suspected opioid overdose between January 1 and May 31, 2019, which is higher than the same period in 2018 (54 calls). 

 
Figure 1 shows the density of calls for suspected opioid overdose responded to by Halton Region Paramedic Services over the last 12 months. This map includes pickups for anyone experiencing an overdose within Halton, even if they do not normally reside in Halton, but excludes any pickups outside Halton boundaries. Many calls occurred within the area of Milton that contains the Maplehurst Correctional Complex and the Vanier Centre for Women.

Table 1 shows the number of calls over the last 12 months by municipality.
 
Municipality Number of calls
Burlington 57
Oakville 75
Milton 56
Halton Hills 20
Total 208
Figure 1 (density) & Table 1 (counts): Paramedic services calls for suspected opioid overdose, by patient pickup location, ages 10 and up, Halton Region Paramedic Services, Jun. 2018-May 2019.
Data source: electronic Patient Care Report (ePCR), Halton Paramedic Services.

Emergency department visits
 
14
May 2019

visits by Halton residents to an emergency department in Ontario for a confirmed opioid overdose in May 2019.

 
61
Year to date
visits by Halton residents to an emergency department in Ontario for a confirmed opioid overdose between January 1 and May 31, 2019. This is lower than the same period in 2018 (68 visits).
Figure 2: Number of emergency department visits for confirmed opioid overdose, by hospital, ages 10 and up, Halton Region, Oct. 2017-Sep. 2018.
Data source: National Ambulatory Care Reporting System (NACRS), IntelliHEALTH, Ministry of Health and Long-Term Care (MOHLTC).
Figure 2 shows the number of emergency department visits for confirmed opioid overdose presenting to each Halton hospital over the last 12 months of data for which breakdowns by hospital are possible (October 2017 to September 2018). During this time period, Joseph Brant Hospital received the greatest number of visits, although capacity of the hospitals and size of the population served has not been taken into account. This graph includes visits to Halton hospitals by anyone, even those who do not live in Halton.

Naloxone distribution and use
 
28
naloxone kits were distributed in May 2019
18 by the Halton harm reduction program
10 by community agencies in Halton

 
13 administrations of naloxone by a first responder occurred in May 2019
8 by Halton Region Paramedic Services
by Halton Regional Police Service
by Oakville Fire
0 by St. John Ambulance in Halton
Figure 3: Number of naloxone kits distributed (new and refill), by municipality, Halton harm reduction program, Jun. 2018-May 2019
Data source: Halton harm reduction program naloxone database.
Figure 3 shows that the Halton harm reduction program directly distributed 223 naloxone kits over the last 12 months. The most kits were distributed in Oakville, followed by Burlington. 138 (62%) of the kits distributed were refill kits. Among refill encounters for which the reason was known, 71% occurred because the client said they had used their original kit(s) for overdoses (not shown). Pharmacies in Halton also distribute naloxone kits. The most recent data indicate that 145 kits were distributed by Halton pharmacies in January 2019 alone (not shown).
Opioid-related deaths
 
40*
Jan-Dec 2018
opioid-related deaths occurred among Halton residents between January and December 2018 (the most recent time period for which data are available)
 
Age group 2014 2015 2016 2017 2018 Total
0 to 14 0 0 0 0 0 0
15 to 24 2 3 3 7 8 23
25 to 44 5 4 14 20 20 63
45 to 64 4 7 9 12 7 39
65+ 1 1 0 1 1 4
Total 12 15 26 40 40* 133
Table 2: Number of opioid-related deaths, by age group, Halton residents, 2014-2018

Data source: Office of the Chief Coroner of Ontario, via the Opioid-related morbidity and mortality in Ontario tool and the Coroner's Opioid Investigative Aid.

*Of the 40 deaths in 2018, four are probable deaths that have not yet been confirmed.
There are estimated to have been 40 opioid-related deaths among Halton residents in 2018, which is the same as the previous year. Please note that the counts by age in 2018 do not sum to the total for 2018, as sex and age are unknown for four probable deaths with investigations that are not yet complete. The numbers for 2018 are subject to change pending further investigation by the Office of the Chief Coroner of Ontario.

Over the past five years, the most deaths have occurred among people aged 25 to 44. There have been more deaths among males than females in every year with sex information except 2015 (not shown).
Halton compared to Ontario



 
Rate of
emergency department
visits
In 2017, the rate of emergency department visits for confirmed opioid overdose among residents of any age was 30 visits per 100,000 in Halton and 55 visits per 100,000 in Ontario. From 2013 to 2017, the rate of opioid-related ED visits has increased in both Halton and Ontario. From 2013 to 2017, the rate of ED visits for opioid overdose has consistently been higher in Ontario compared to Halton.

Data source: Opioid-related morbidity and mortality in Ontario tool, Public Health Ontario.
 
Rate of
opioid-related deaths
In 2017, the rate of opioid-related deaths among residents of any age was 7 deaths per 100,000 in Halton and 9 deaths per 100,000 in Ontario. From 2013 to 2017, the rate of opioid-related deaths has increased in both Halton and Ontario. The rate of opioid-related deaths has been consistently higher in Ontario compared to Halton Region over this time period.

Data source: Opioid-related morbidity and mortality in Ontario tool, Public Health Ontario.
For more information on opioids in Halton, please see the Halton Region Opioid Report.
For information on opioids in Ontario, please see Public Health Ontario’s Opioid-related morbidity and mortality in Ontario tool.
For information on opioids in Canada, please see the Government of Canada’s Opioids data, surveillance and research page.

Data Notes

Please note that the recency of data varies by source. Important considerations for each data source are explained below.

Paramedic services calls

A “paramedic services call for suspect opioid overdose” is defined as a call for service made to the Halton Region Paramedic Services for patients aged 10 or older where naloxone was administered (by paramedics or others), or where naloxone was not administered but the patient was thought to have overdosed on one or more opioid drugs. No drug testing has been performed; it is possible that the patient was not overdosing, or was overdosing on a non-opioid drug. Intentional overdoses are included. Patients responded to by Halton paramedics may not necessarily reside in Halton. It is possible that some overdoses in Halton were responded to by neighbouring paramedic services, and therefore are not captured here. Individuals may have made more than one call at separate times, and therefore the number of calls should not be interpreted as the number of distinct individuals. Single points have been removed from the heat map in figure 1 to avoid identifying individual callers. Please note that for the May 2019 report, paramedics data were extracted early in the day on May 31, so any calls occurring later on May 31 have not been captured.

Emergency department visits

An “emergency department visit for confirmed opioid overdose” is defined as an unscheduled visit made to any emergency department in Ontario that was coded as T40.0 (poisoning by opium), T40.1 (poisoning by heroin), T40.2 (poisoning by other opioids), T40.3 (poisoning by methadone), T40.4 (poisoning by other synthetic narcotics), or T40.6 (poisoning by other and unspecified narcotics). For data from April 1, 2018 onwards, the following codes are also included: T40.20 (poisoning by codeine and derivatives), T40.21 (poisoning by morphine), T40.22 (poisoning by hydromorphone), T40.23 (poisoning by oxycodone), T40.28 (poisoning by other opioids, not elsewhere classified), T40.40 (poisoning by fentanyl and derivatives), T40.41 (poisoning by tramadol), T40.48 (poisoning by other synthetic narcotics, not elsewhere classified). 

Monthly and year to date counts reflect patients who were residents of Halton of any age at any hospital in Ontario, while counts by hospital in Figure 2 include visits made by anyone to a hospital in Halton who was 10 years of age or older, regardless of residence. As final data are not available beyond June 2018 from NACRS, tentative values from the Ministry of Health and Long-Term Care (MOHLTC) fitting the aforementioned diagnosis codes have been used for July 2018 onwards. As the MOHLTC data are preliminarily reported by hospitals, they are subject to change, and they are not broken down by hospital.

Query diagnoses, and overdoses known to be intentional or due to therapeutic adverse effects, have been excluded from all emergency department visit data. Each visit has been captured only once, even if multiple opioids were involved. However, individuals may have made more than one visit on different occasions, and therefore the number of visits should not be interpreted as the number of distinct individuals. Individuals who overdosed but who did not access an emergency department are not captured.

Naloxone distribution and use

A “naloxone kit distributed by the Halton harm reduction program” refers to a naloxone kit containing two doses of naloxone nasal spray given out by a Halton Region Health Department harm reduction worker during outreach or at a clinic site. “New kits” are kits given to a client after completing the necessary naloxone training, while "refill kits" are kits given to repeat clients who have already completed the training. Reasons for obtaining a refill kit include having used the previous kit for an overdose, having given the kit to a friend, or having the lost or damaged the kit. Since clients obtaining refill kits are repeat clients, the number of kits distributed should not be interpreted as the number of unique recipients. Clients may not obtain kits where they live, and they may obtain more than one kit per encounter.

A “naloxone kit distributed by a community agency” refers to a naloxone kit containing two doses of naloxone nasal spray given out by a qualifying agency located in Halton. Such agencies have signed legal agreements to receive naloxone kits from the Halton Region Health Department and distribute them to their clients, after the client has completed the necessary naloxone training.

A “naloxone kit distributed by a Halton pharmacy” refers to a kit with injectable or intra-nasal naloxone given out by a pharmacy located within Halton Region as part of the Ontario Naloxone Program for Pharmacies, as defined by the Ministry of Health and Long-Term Care.

Administrations of naloxone by a first responder refers to occasions when a Halton paramedic, Halton police officer, St. John ambulance responder in Halton, or a firefighter with one of the participating fire services in Halton (currently Burlington and Oakville Fire only) has administered one or more doses of naloxone to a person suspected of experiencing an opioid overdose. It does not include instances when a client responded to by a paramedic, police officer, St. John ambulance responder, or firefighter had naloxone administered to them by a civilian prior to the arrival of first responders, unless one or more doses was also subsequently administered by a first responder. The number of doses is not shown. Administrations of naloxone within the community (for example by a private citizen to a friend) are also not captured. Please note that in the May 2019 report, the number of doses administered by Burlington Fire is not shown due to lack of available data.

Opioid-related deaths

An “opioid-related death” refers to a death where opioid poisoning was considered to have contributed to the cause of death, regardless of whether the death was accidental or intentional. Death data for 2018 are preliminary and subject to change with future updates as remaining cases are closed by the Office of the Chief Coroner of Ontario. Sex and age are unknown for four decedents in 2018 as their investigations are incomplete; therefore the counts by age do not sum to the total. Death data were geocoded to the health unit using the decedent's postal code, so most cases are Halton residents; however, if postal code of residence was unavailable, the postal code reflects the location of the death.

Halton compared to Ontario

The rates presented include emergency department visits and deaths for residents of any age (including very young children), and include accidental and intentional overdoses. The rates are crude, which means that differences observed could reflect differences in the age structure of the populations being compared, although preliminary investigation shows only minor differences between the crude and age-standardized rates for opioid-related emergency department visits and deaths in both Halton and Ontario.

Data Source

Paramedic services calls: electronic Patient Care Report (ePCR), Halton Region Paramedic Services, extracted May 31, 2019.

Emergency department visits, Halton only: National Ambulatory Care Reporting System (NACRS), IntelliHEALTH, Ministry of Health and Long-Term Care (MOHLTC), extracted Feb. 12, 2019; MOHTLC, Weekly emergency department visits for opioid overdose report, received Jun. 11, 2019.

Naloxone kits, Halton harm reduction program: Naloxone EpiInfo database, extracted on May 31, 2019.

Naloxone kits, Halton pharmacies: Not available for month of May 2019. The most recent data shows 145 kits were distributed by Halton pharmacies in January 2019.

Deaths: Opioid-related morbidity and mortality in Ontario [2014-2017 data], Public Health Ontario, extracted Dec. 13, 2018; Coroner's Opioid Investigative Aid [2018 data], May 2017 to December 2018, Office of the Chief Coroner for Ontario, received May 21, 2019.

Emergency department visits, Halton compared to Ontario: Opioid-related morbidity and mortality in Ontario, Public Health Ontario, extracted Sep. 2018.

Last updated: Thursday, June 13, 2019

Copyright © 2019 Halton Region Health Department, All rights reserved.


Want to change how you receive these emails?
You can update your preferences or unsubscribe from this list.