Study: Understanding opioid overdoses in Simcoe Muskoka, Ontario, 2018 and 2019
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Released: 2021-07-15
As the lives of Canadians continue to be impacted by the COVID-19 pandemic, the opioid epidemic persists in having deadly consequences for thousands of Canadians.
Since March 2020, excess mortality among older ages has been largely attributable to COVID-19. However, overdoses have played a larger role in contributing to excess mortality among those in younger age groups.
Fatal and non-fatal opioid overdoses occur across all demographic and socioeconomic groups. However, it remains critical to understand the characteristics of those who experienced opioid overdoses in order to inform tailored intervention programs. It is also important to identify whether people made contact with public and private systems before their overdose occurred. These points of contact provide opportunities for public health to offer programs to mitigate the risks of substance use.
To identify the social, economic and health factors that precede an overdose, Statistics Canada led a pilot study of people who experienced opioid overdoses in Simcoe Muskoka, Ontario between January 1, 2018 and December 31, 2019, by combining records of overdoses from health care, justice, employment and social assistance.
This area is of particular concern for opioid overdoses, as data from the Local Health Integration Network of North Simcoe Muskoka (population 464,406 as of the 2016 Census) indicate that emergency department visits for opioid overdoses were at least 57% higher per capita in this region than in the rest of Ontario in 2018 and 2019.
Although the overdoses in this study occurred before the COVID-19 pandemic, these data provide a profile of those who experienced an overdose, as well as a baseline for examining harms related to opioid use before the COVID-19 pandemic. This may be important since recent work by the Public Health Agency of Canada indicates that opioid deaths have increased during the COVID-19 pandemic.
Males and young adults accounted for the majority of those who experienced opioid overdoses
In the Simcoe Muskoka region, the study recorded 1,257 individuals who experienced one or more opioid overdoses in 2018 and 2019. Nearly one in five (19%) experienced more than one overdose, for a total of 1,746 opioid overdoses over this period.
More than half (53%) of those who experienced opioid overdoses were 25 to 44 years old—more than twice the proportion of that age group in Simcoe Muskoka. Males accounted for 60% of those experiencing overdoses. Males more frequently experienced an opioid overdose than females in every age group, except those aged 65 and older, where females experienced overdoses almost twice as often as males.
Just over 1 in 10 (13%) of those who experienced an overdose died, although this percentage was higher for males (15%) than for females (9%). Among those who experienced an overdose, adults aged 45 to 64 experienced a fatal overdose twice as often (22%) as those under the age of 35 (8% to 9%) (Table 1).
Health care: the most frequent point of contact
In framing overdose prevention strategies, it is helpful to identify whether those who experienced opioid overdoses interacted with different public and private institutions and organizations. These points of contact can offer opportunities to provide support for substance risk mitigation.
The health care system was the most common point of contact in the two years leading up to an overdose, with 86% of those who experienced an overdose passing through an emergency department or being hospitalized. Females and those aged 55 and older had contact with the health care system most often.
During the year before the first overdose, just over two-thirds (69%) of those who experienced an overdose had visited an emergency department at least once, while one-third (36%) had visited three or more times. Females more frequently visited an emergency room at least once (77%) than males (63%).
Nearly half of those who visited an emergency department in the year before an overdose did so for injuries or (non-opioid) poisonings (Chart 1). These findings mirror those from a similar study in British Columbia. While it is possible that some of these injuries and conditions may have resulted in an initial opioid prescription, many of those who experienced an opioid overdose were never prescribed them. For example, more than half (54%) of those in the previous British Columbia study were not prescribed opioids in the year before an overdose.
Chart 1
Reason for emergency department (ED) visit in the year prior to an overdose, among Simcoe Muskoka Opioid Overdose Cohort subjects who visited an ED (n=866, or 68% of cohort)
Other common reasons for emergency department visits in the year preceding the overdose included mental health conditions other than substance use (21%) or non-opioid substance use condition (26%). Fewer than 1 in 10 people (7%) who experienced an overdose had visited an emergency room for an opioid overdose in the prior year.
Employment and social assistance: viable contact points for intervention strategies
Employers and social assistance programs remain viable contact points for intervention strategies prior to an opioid overdose. In the two years before an overdose, 47% of people in the study were in contact with an employer and 56% with a social assistance program. While the percentage in contact with social assistance was similar across sex and age groups, employers were more frequently a contact point for males and young adults.
In the year leading up to an overdose, over one-third of those who experienced an overdose were employed (38%), with males more often employed (43%) than females (32%) (Table 2).
Considering the industries in which employed individuals worked, over a third of employed males who experienced overdoses worked in construction (34%), twice the percentage of employed males in Simcoe Muskoka who worked in that industry in 2016 (17%). Overrepresentation in the construction sector was also identified in a British Columbia study of illicit overdose deaths.
Administration and support, waste management and remediation services was the second most common industry in which employed males in the study worked (17%, versus 14% for the general male population in 2016).
Females in the study were most often employed in accommodation and food services (24%) or retail trade (14%), while more broadly in the Simcoe Muskoka region, only 15% of females were employed in accommodation and food services and 10% in retail trade.
Turning to income support programs, over half (52%) of those who experienced an overdose received social assistance in the year before the overdose. Approximately two-thirds of the cohort (62%) were not employed during the year before overdose. When considering the five years prior to overdose, over one-third (38%) were not employed during any of that period.
Justice: a common point of contact for young adults
Almost half of those who experienced an overdose (46%) in the region came into contact with the justice system in the two years leading to an overdose, either through interactions with police leading to an offence (44%) or through formal contact with the criminal court system (31%). Young adults aged 25 to 34 were more likely to come into contact with the justice system (60%) than other age groups.
Of those who had an interaction with police leading to an offence, 70% were male, and a little over half (54%) had three or more police interactions over the two years leading to the overdose. In addition, 80% of those who had contact with the police did so within one year of their opioid overdose, while 29% were most recently in contact with the police within one month of their opioid overdose.
Of those in contact with police, 33% were issued administration of justice offences (e.g., breach of probation), 24% were issued property offences, 18% were issued violent offences, and 12% were issued drug offences in their last police interaction before an overdose (Table 3). Although the percentage of violent offences was similar to the rest of Ontario, there was a lower percentage of property offences and a higher percentage of administration of justice and drug offences in this group compared with Ontario.
Contact with multiple systems
One of the strengths of this study was that it was possible to track points of contact across multiple systems before an opioid overdose occurred. In the two years prior to an opioid overdose, almost one in five (19%) of those who experienced an overdose in Simcoe Muskoka had contact with the health care, justice, and social assistance systems, while 2% had no contact at all.
Among those who succumbed to a fatal overdose, about one in six (17%) had made contact with the health care and social assistance systems over the two previous years.
This study highlighted the concurrent roles of health care (e.g., emergency department visits, hospitalizations), employment, social assistance, and justice (e.g., police, courts) in providing opportunities for contact points for intervention strategies. Since opioid overdoses occur broadly across different demographic and socioeconomic groups, considering multiple points of contact affords a more inclusive approach to intervention.
Note to readers
The Simcoe Muskoka Opioid Overdose Cohort combined records of overdoses and points of contact with a range of different systems through partnerships with the Simcoe County Paramedic Services, select police services from the region, the Canadian Institute for Health Information (hospitalizations from the Discharge Abstract Database and emergency department visits from the National Ambulatory Care Reporting System), Statistics Canada's Canadian Coroner and Medical Examiners Database (Ontario unnatural deaths having closed investigations), and Canada Revenue Agency tax data (employment and social assistance records). Cohort creation and data linkage was conducted within Statistics Canada's secure Social Data Linkage Environment.
One limitation in the cohort is that it only included overdoses that were captured by formal interactions with some types of health care services, police, paramedics, or coroners. Therefore, overdoses not recorded by one of these systems would not have been included. As a result, the overdoses in the cohort likely represent an underestimate of non-fatal opioid overdoses that occurred in the Simcoe Muskoka region during the study period. Notably, some of the data sources only included opioid overdoses within the Local Health Integration Network number 12 - North Simcoe Muskoka; therefore, not all areas of Simcoe County were represented by the cohort. It is also acknowledged that the first overdose during the study observation period may not have been the first overdose for the cohort member.
Another limitation of this study was that the data available was unable to capture all types of contacts with formal systems. For instance, police interactions that did not result in an offence (e.g., where the person was the complainant or victim), and health care interactions other than acute care hospital or emergency department visits (e.g., visits to a family doctor) were not documented in this study. Prescription records were not included in this study, so it was not possible to distinguish sources of the opioid. Disaggregated sociodemographic data, other than age, sex and income, were largely unavailable. As well, the study did not examine deaths due to causes other than opioid overdoses that may have also occurred during the study period.
Products
The infographic "Understanding opioid overdoses in Simcoe Muskoka, Ontario" is now available in the series Statistics Canada - Infographics (Catalogue number 11-627-M).
Contact information
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