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Disclosure:
Gomes reports that outside of the study, he has received grants from the Ontario Department of Health, as well as student grants from the Ontario Department of Health and the Canadian Institutes of Health Research. Your colleagues do not report any relevant financial information.
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The US isn’t the only country to see an increase in opioid-related deaths in the era of COVID-19.
A Canadian study found that the number of opioid-related deaths in Ontario rose from 766 in the 6 months before the pandemic to 1,237 from March 2020 to September 2020.
“Measures required by a pandemic, including health care changes to accommodate physical distancing and increased social isolation, may increase the risk of harm to people who use drugs,” said Tara Gomes, PhD, MHSc, Epidemiologist, Principal Investigator for Ontario Drug Policy Research Network and a scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital in Toronto, Ontario and colleagues wrote. “For example, reduced opening hours of health services (e.g. pharmacies and ambulances) and harm reduction services (e.g. drug control programs and monitored consumption points) have created additional barriers to the care of people with opioid use disorders.”
Gomes and colleagues conducted a cross-sectional study to assess weekly fatal opioid overdoses that occurred in Ontario between January 1, 2018 and September 20, 2020 in people aged 15 years or older – the first 6 months after a state of emergency was declared – from March 16, 2020 to September 15, 2020 – with the same period of the previous year as well as the 6 months before COVID-19 from September 14, 2019 to March 15, 2020.
In the period from March 16, 2020 to September 15, 2020, 1,237 people died of opioid-related causes, for a total of 49,155 years of life lost. In contrast, in the same period last year there were 766 opioid-related deaths, corresponding to 30,286 years of life lost, and 771 deaths in the previous 6 months, corresponding to 31,312 years of life lost.
In addition, fentanyl (1,056 vs. 586; P <0.001) and stimulants (880 vs. 485; P <0.001) were detected more frequently in people who died of an opioid overdose after a state of emergency was declared versus months immediately before, according to Gomes and Colleagues.
Overall, the weekly number of opioid-related deaths increased by 135%, with 2,774 people (73.4% men; ages 35 to 54 years, 47.2%) dying from an opioid-related cause in all three periods of interest. Weekly deaths among those under the age of 35 rose 320%, which is the largest increase. Conversely, in the US, Healio previously reported that adults ages 35 to 44 appeared to have a higher risk of overdose.
“The rising harm rates among young adults and the increased contribution of fentanyl and stimulants to these deaths underscore the urgent need for barrier-free access to evidence-based harm reduction and treatment services for opioid use disorders in all jurisdictions dealing with the COVID-19 overdose syndrome” wrote the researchers.
In a comment published in The Lancet, Richard Horton, FRCP, FRCPCH, FMedSci, the magazine’s editor-in-chief, stated that syndemes “are characterized by biological and social interactions between states and states, interactions that increase a person’s susceptibility to harm or health outcomes worsen. “
The term comes from medical anthropologist Merrill Singer, PhD, who postulated that studying phenomena through this lens “reveals biological and social interactions that are important to prognosis, treatment, and health policy,” Horton wrote.
In the case of COVID-19, previous research has shown racial differences in COVID-19 diagnosis and hospital admissions, including among pediatric populations, and complications in cardiovascular disease, among other things. Experts said that COVID-19 has exacerbated existing health inequalities caused by structural racism and that these inequalities need to be addressed.
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