PHC Opioid Response Initiative Data to support zone planning February 14, 2018
Prepared by: Knowledge, Performance & Integrated Planning, Provincial Addiction & Mental Health
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Information requested by: Jean Jacque Lovely, Director PHC Integration and Innovation
Information requested for: Zone planning for PHC Opioid Response Initiative
Description of information: High level overview of information requested
Prepared by: Knowledge, Performance & Integrated Planning, Provincial Addiction & Mental Health
Phone: 780-641-9559
This is confidential information and is intended solely for the individual(s) requesting the information and may only be used for the purpose(s) identified in the request. Please do not distribute or use in any other context without prior agreement. PHC Opioid Response Initiative: Data for planning - 3
Opioid Death Data.
• In 2017, there are now on average, 1.5 apparent accidental drug poisoning deaths related to fentanyl per day, compared to 1.0 death per day in 2016 in the province.
Table 1: Number of apparent accidental opioid toxicity deaths related to any opioid by quarter.
Total
South Zone 6 4 10 12 5 8 45
Calgary Zone 46 53 57 66 71 79 372
Central Zone 18 17 13 24 12 16 100
Edmonton Zone 40 48 61 50 50 57 306
North Zone 12 15 7 10 20 21 85 908
Alberta 122 137 148 162 158 181
Q12016 Q22016 Q32016 Q42016 Q12017 Q22017
Figure 2: Number of apparent accidental fentanyl toxicity deaths, by Zone (based on place of death) and quarter. Jan. 1, 2016 to Sept. 30, 2017.
160 North 800 Edmonton 140 700 Central 120 Calgary 600 South
100 Cumulative total 500
related deaths related - 80 400
Fentanyl 60 300
40 200 deaths total Cumlative
20 100
0 0 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
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Table 2: Number of apparent accidental fentanyl toxicity deaths by quarter. Total
South Zone 3 1 5 6 5 6 10 36 Calgary Zone 30 34 41 52 57 62 68 344
Central Zone 11 6 5 17 6 11 13 69 Edmonton Zone 17 27 33 37 42 39 39 234
North Zone 8 13 3 8 16 13 13 74
Alberta 69 81 87 120 126 131 143 757
Q22016 Q32016 Q42016 Q12017 Q22017 Q32017 Q12016
Table 3: Rate (per 100,000 person years) and number of apparent accidental drug toxicity deaths related to fentanyl, by Zone (based on place of death). Jan. 1, 2016 to Sept. 30, 2017.
2016 2017 YTD* Count Rate Count Rate
South Zone 15 4.9 21 9.2
Calgary Zone 157 9.7 187 15.3
Central Zone 39 8.1 30 8.3
Edmonton Zone 114 8.4 120 11.7
North Zone 32 6.5 42 11.4
Alberta 357 8.4 400 12.4
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Table 4: Rate (per 100,000 person years) and number of apparent accidental drug toxicity deaths related to fentanyl, by city (based on place of death). Jan. 1, 2016 to Sept. 30, 2017.
2016 2017 YTD* Count Rate Count Rate
Lethbridge 10 10.3 13 18.3
Medicine Hat 2 2.9 4 7.8
Calgary 150 11.3 170 17.2
Red Deer 23 21.0 16 19.3
Edmonton 100 10.2 94 12.8
Fort McMurray 9 11.0 9 15.0
Grande Prairie 10 13.4 18 31.2
Total 304 11.1 324 15.9
Figure 3: Number of apparent accidental drug toxicity deaths related to an opioid other than fentanyl, by Zone (based on place of death) and quarter. Jan. 1, 2016 to Jun. 30, 2017.
70 North 350 Edmonton Central 60 Calgary 300 South Cumulative total 50 250
40 200
30 150
fentanyl opioid related deaths related opioid fentanyl -
20 100 deaths total Cumlative Non
10 50
0 0 Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017
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Table 5: Number of apparent accidental drug toxicity deaths related to an opioid other than fentanyl by quarter. Total
South Zone 3 3 5 6 0 2 19 Calgary Zone 16 19 16 14 14 17 96 Central Zone 7 11 8 7 6 5 44 Edmonton Zone 23 21 28 13 8 18 111 North Zone 4 2 4 2 4 8 24
Alberta 53 56 61 42 32 50 294
Q12016 Q22016 Q32016 Q42016 Q12017 Q22017
Table 6: Rate (per 100,000 person years) and number of apparent accidental drug toxicity deaths related to an opioid other than fentanyl, by Zone (based on place of death). Jan. 1, 2016 to Jun. 30, 2017
2016 2017 YTD* Count Rate Count Rate
South Zone 17 5.6 2 1.3
Calgary Zone 79 4.9 31 3.8
Central Zone 39 8.1 11 4.5
Edmonton Zone 93 6.9 26 3.8
North Zone 16 3.3 12 4.9
Alberta 244 5.7 82 3.8
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Table 7: Rate (per 100,000 person years) and number of apparent accidental drug toxicity deaths related to an opioid other than fentanyl, by city (based on place of death). Jan. 1, 2016 to Jun. 30, 2017
2016 2017 YTD* Count Rate Count Rate Lethbridge 4 4.1 0 0.0
Medicine Hat 5 7.3 1 2.9
Calgary 49 3.7 28 4.2
Red Deer 12 11.0 3 5.4
Edmonton 69 7.1 24 4.9
Fort McMurray 1 1.2 2 5.0
Grande Prairie 1 1.3 3 7.8
Total 141 5.2 61 4.5
*YTD = Jan. 1, 2017 to Jun. 30, 2017
Figure 4 Narrative: Edmonton average: 14.5 per 100,000 person years (n = 104)
Within the City of Edmonton, the LGAs with higher or significantly higher rates of apparent accidental drug toxicity deaths related to an opioid (including fentanyl) compared to the city average were Eastwood and Abbottsfield. However, 71 per cent of the total deaths occurred in LGAs outside of these areas.
The place where the accidental drug toxicity death occurred was the same as the individual’s home address for 57 per cent of these deaths in Edmonton.
Note: Place of death was used as the place of the overdose, except in instances where the place of death occurred in a hospital. In instances where the death occurred in a hospital, if EMS had responded to the individual for an opioid related event within 24 hours of the death, the location of the EMS response was used as place of the overdose. If no EMS visit occurred within 24 hours, the hospital death was excluded. In Edmonton, a hospital was the place of death in 17 per cent of deaths.
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Figure 4: Rate (per 100,000 person years) and counts of apparent accidental drug toxicity deaths related to an opioid (including fentanyl), in the City of Edmonton, based on place of overdose, by LGA. Jan. 1, 2017 to Sept. 30, 2017.
Number in blue circle represents counts
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Figure 5: Rate (per 100,000 person years) and counts of apparent accidental drug toxicity deaths related to an opioid (including fentanyl), in the City of Calgary, based on place of overdose, by LGA. Jan. 1, 2017 to Sept. 30, 2017
Number in blue circle represents counts (numerator)
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Figure 5 Narrative: Calgary average: 17.8 per 100,000 person years (n = 172)
Within the City of Calgary, the LGAs with higher or significantly higher rates of apparent accidental drug toxicity deaths related to an opioid (including fentanyl) compared to the city average were Centre, Centre-North, East, Lower NE, West Bow, and Nosehill. However, 40 per cent of the total deaths occurred in LGAs outside of these areas.
The place where the overdose occurred was the same as the individual’s home address for 67 per cent of these deaths in Calgary. Note: Place of death was used as the place of the overdose, except in instances where the place of death occurred in a hospital. In instances where the death occurred in a hospital, if EMS had responded to the individual for an opioid related event within 24 hours of the death, the location of the EMS response was used as place of the overdose. If no EMS visit occurred within 24 hours, the hospital death was excluded. In Calgary, a hospital was the place of death in 20 per cent of deaths.
Figure 6 Narrative: The neighbourhoods with three or more apparent accidental opioid toxicity deaths included McCauley (5), Boyle Street (5), Alberta Avenue (4), and Central McDougall (3).
Opioid related drug overdose deaths were most likely to occur in neighbourhoods with a self- reported household median income of $30,000 to $39,999 (23 apparent accidental opioid toxicity deaths for every 10 neighbourhoods within this median household income range).
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Figure 6: Median household income of neighbourhood where individuals who died of apparent accidental opioid toxicity resided, and number of deaths occurring in neighbourhood, in the City of Edmonton. Jan.1, 2016 to Sept.30, 2017
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Figure 7: Median household income of neighbourhood where individuals who died of apparent accidental opioid toxicity resided, and number of deaths occurring in neighbourhood, in the City of Calgary. Jan. 1, 2017 to Sept. 30, 2017.
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Figure 7 Narrative: The neighbourhoods with more than five apparent accidental opioid toxicity deaths included Forest Lawn (9), Beltline (8), Downtown Commercial Core (6), and Sunalta (5). Opioid related drug overdose deaths were most likely to occur in neighbourhoods with a self-reported household income of $40,000 to $49,999 (28 apparent accidental opioid toxicity deaths for every 10 neighbourhoods within this median household income range).
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Addiction Services
Wait times 1. AHS addiction outpatient service is a treatment delivered in a non-residential setting through counseling or medical appointments for clients’ use of substances (alcohol and other drugs) and/or gambling. 2. AHS addiction outpatient services includes walk in services at some sites. 3. Results reflect clients who have attended their first appointment in the time period specified. 4. Wait time for outpatient treatment is the time in days between service request or referral and first attended appointment. 5. 90th percentile wait time is the time period within which 90% of clients (new enrolments) attend the first appointments. 6. Trimmed Mean results exclude the records captured with the 0.1% longest wait times for each quarter and for all zones combined. PHC Opioid Response Initiative: Data for planning - 15
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Emergency department visits related to opioid overdose. Opioid-related emergency department (ED) visits involving overdoses attributed to opioids. Each visit is geographically allocated based on the postal code of the patient’s home residence.
Figure: The count of opioid overdose-related ED vists for the zones, from 2014 to 2017. 200 180 160 140 120 100 80
MonthlyCount 60 40 20 0
Calgary Edmonton Central North South
Figure: The monthly crude rate of opioid overdose-related ED visits for zones and the province, from 2014 to 2017. 18 16 14 12 10 8 6 4 2
0 Monthly Crude Rate (per 100 000)
Calgary Edmonton Central North South Alberta
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Figure: The count of opioid overdose-related ED vists for the zones in 2017. Data for January- November 2017.
768
1369
447
381
475 954
Calgary Edmonton Central North South Unknown
*Unknown indicates postal code of patient is missing, invalid, or out-of-province.
Figure: The average monthly crude rate of opioid overdose-related ED visits for the zones in 2017. Data for January-November 2017.
South 13
North 7
Central 8 Zone
Edmonton 6
Calgary 7
0 2 4 6 8 10 12 14 Monthly Crude Rate (per 100 000)
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Emergency department visits related to opioid use, with a local emphasis. All opioid-related emergency department (ED) visits are presented, which includes both overdoses attributed to opioids, and mental and behavioral disorders due to the use of opiods. An ED visit involving multiple diagnoses of opioid misuse is recorded only once. Each visit is geographically allocated based on the postal code of the patient’s home residence.
Figure: A count of all opioid-related ED visits by local geographic area (LGA), showing the top 20 LGAs by count. Data for January-November 2017.
Edmonton - West Jasper Place 94 Calgary - SE 98 Lethbridge - South 120 Lethbridge - North 125 Edmonton - NE 129 Medicine Hat 130 Edmonton - Woodcroft East 137 Calgary - Upper NE 141 Edmonton - North Gate 151 Fort McMurray 152 City of Grande Prairie 156 Calgary - Nose Hill 161 Calgary - Lower NW 173 Red Deer - SW 180 Calgary - Fish Creek 181 Cardston - Kainai 205 Edmonton - Bonnie Doon 216 Calgary - Centre 239 Calgary - East 295 Local Local Geographic Area Edmonton-Eastwood 356 0 50 100 150 200 250 300 350 400 Counts
Figure: The monthly crude rate of all opioid-related ED visits by LGA, showing the top 20 LGAs by monthly crude rate. Data for January-November 2017.
Peace River 24 Canmore 24 Boyle 24 Fox Creek 26 Slave Lake 28 St. Paul 30 Calgary - West Bow 30 Beaverlodge 31 Lethbridge - South 32 Starland County/Drumheller 35 Calgary - East 35 Calgary - Centre 35 Black Diamond 39 Wabasca 40 Lethbridge - North 41 Wood Buffalo 42 Fort MacLeod 42 Edmonton - Eastwood 43 Manning 47 Red Deer - SW 97 Local Local Geographic Area Cardston-Kainai 109 0 20 40 60 80 100 120 Monthly Crude Rate (per 100 000)
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The following data is geographically allocated based on the facility, rather than the patient’s postal code.
Figure: A count of all opioid-related ED and UCC (Urgent Care Centre) visits by facility, showing the top 3 facilities in each zone. Data for 2015.
Peter Lougheed Centre 698 Foothills Medical Centre 589 Rockyview General Hospital 532 Royal Alexandra Hospital 808 University of Alberta Hospital 463 Grey Nuns Community Hospital 278 Red Deer Regional Hospital Centre 338 Wetaskiwin Hospital and Care Centre 66
Lacombe Hospital and Care Centre 27 Facility Queen Elizabeth II Hospital 280 Northern Lights Regional Health Centre 216 Peace River Community Centre 33 Chinook Regional Hospital 247 Cardston Health Centre 182 Medicine Hat Regional Hospital 138 0 100 200 300 400 500 600 700 800 900 Count
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Take Home Naloxone Kits Dispensed.
Reporting date: February 15, 2018
Naloxone Kit Distribution Table: Number of kits # of Kits Distributed # of Reported Reversals distributed and reported overdose reversals, by zone, Alberta, 2016-2017 Zone South 4,070 365 Calgary 12,346 470 Central 6,720 1,059 Edmonton 9,366 537 North 5,146 208 Unknown** 137 216 Alberta 37,785 2,855
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Emergency Department visits related to mental and behavioral disorders due to use of opioids.