Edmonton opioid-related EMS calls increase 299% since 2018

Mom warns about stigma over opioid deaths An Edmonton mother says victims of opioid overdoses are not who you would expect. Nahreman Issa has her story.

Data released by the province shows the number of opioid events EMS attended in Edmonton has been growing year over year.

In 2020, the number of events EMS responded to more than doubled. A total of 1,909 incidents made for a 109 per cent increase.

That trend continued in 2021 when the numbers more than doubled again.

Between the 1,060 events in 2018 and the 4,227 in 2021, Edmonton saw an increase of 299 per cent.

To date, EMS has responded to 1,396 events in the city, meaning 33 per cent of last year’s total has been reached as of May 1, 2022.

“We’ll call it an epidemic, pandemic, I don’t know what you want to call it anymore, but the opioid crisis exists, it’s real, and it’s killing Albertans,” said Mike Parker, Health Sciences Association of Alberta president.

The soaring number of opioid responses happening at the same time as the COVID-19 pandemic has been taking a toll on the health-care system, as the impacts are felt by paramedics and hospital staff, with crews often driving across the entire city to get to a high priority call.

“(On April 29) in downtown Edmonton, it took 17 minutes for the first paramedics to get on scene of a drug overdose with CPR in progress. That’s what’s going on out there," Parker said.

“There is no surge capacity in the EMS system in Alberta. So anytime we get high levels of calls we end up stacking them. Twenty or 30 in Edmonton, 30 or 40 in Calgary. This is normal today.

Alberta Health Services confirmed that Edmonton is experiencing high call volumes while also seeing an increase in hospital admissions, with the number of calls up by 30 per cent since August 2021.

Kerry Williamson, AHS spokesperson, told CTV News Edmonton that additional paramedics and ambulances have been brought online.

"EMS is also working closely with hospital teams to ensure timely flow through our emergency departments," Williamson said in a statement.

"EMS is offering overtime to staff who are willing. EMS staff are working extremely hard to provide timely care to Alberta patients and we thank them for their tireless service.”

Parker said the crisis' impact on paramedics and society as a whole has been devastating.

“Our system has failed, our paramedics are exhausted and nobody’s listening."

INSIDE THE HOSPITAL

Opioid-related visits to Edmonton zone emergency departments increased in 2020 and 2021.

Previously, visits to emergency remained below 3,000 a year, but it crossed that mark in 2020. In 2021, there were a total of 5,457 visits, representing a 157 per cent increase from 2016. Opioid-related hospitalizations have gone up for the last five years in a row, making for a 121 per cent increase since 2016.

Dr. Darren Markland, a physician at the Royal Alexandra Hospital, has been practicing ICU medicine for 20 years. He works with patients who have overdosed on various substances, including opioids.

“Those people come in dead," Markland said.

"They are literally found without a pulse and some bystander performed CPR on them, and then they’re brought into the emergency department dead and resuscitated. Then what I typically do is spend three days waiting for them to wake up.”

He said a major component of today’s drug supply is Carfentanil – a very potent form of synthetic narcotic similar to Fentanyl but much stronger.

“If you make a one per cent maladjustment to the dilution, you can increase the potency by 10 times," he said. "That’s enough to turn someone from being happy and loose to being unconscious and not breathing."

In Edmonton last year, Carfentanil was listed as the primary or one of the drugs causing death on 204 death certificates.

People not knowing what dangerous substances might be in the drugs they are consuming is a significant issue, according to Markland.

“That’s our problem, we have no way of regulating supply; we have no way of knowing what’s in the supply.”

IN THE COMMUNITY

Opioid-related deaths in Edmonton have risen significantly in the last two years. In Edmonton, 624 people died during 2021, an increase of 278 per cent when compared to the 165 deaths that happened in 2016.

The number of deaths in public places has also increased. On average, 22 per cent of deaths in the Edmonton Zone in 2021 occurred in public places, an 11 per cent increase from the average three years ago.

“Unmonitored use when we’re dealing with a toxic supply means lots of down time. So the longer someone is down, if they do have contaminated drugs, the more likely they are to be experiencing a very severe poisoning event," said Dr. Ginetta Salvalaggio, University of Alberta associate professor in family medicine and a former member of the Edmonton Zone Medical Staff Associations Opioid Poisoning Committee.

“Within supervised consumption sites, there’s never been a death because they’ve been able to manage things so proactively and quickly,” she said.

In the first three months of 2020, more than 18,000 visits were made to the supervised consumption sites in Edmonton, the highest number yet. However, that number fell by more than half in the next quarter, a time frame directly overlapping the start of the COVID-19 pandemic. People are returning to the sites and the numbers have been increasing over time, but the same number of visitors had not returned by the end of 2021.

The overall decline has been caused, in part, by the closure of sites and a recent change that requires ID to acess a site, according to Salvalaggio.

"They’re worried about privacy," Salvalaggio said. "It used to be that you could access services and it didn’t matter if it was on an anonymous or quasi-anonymous basis."

THE SOLUTION

Parker said he would like to see more supervised consumption sites and wraparound services for people with addictions.

Having supervised consumption sites is an added layer of prevention which he believes can lower call volumes.

“We need to be ensuring that our folks that are most vulnerable are assisted so that they don’t end up in a back alley, they don’t end up in your parents' basement desperately needing paramedics to come rolling in,” Parker said.

Dr. Markland agreed supervised consumption sites are necessary to prevent deaths and buy people the time they need to get help.

But along with an increase in sites, there needs to be a certain understanding, he added.

“We need a stronger community, we need more mental health supports, and we need the realization that this type of treatment doesn’t happen overnight so you’re not going to see instant changes.”

Dr. Salvalaggio believes decriminalization and removing barriers to supervised consumption sites is a big part of the solution, as well as increasing services in the downtown core. But what she would really like to see is government-supplied data that could be used to help people in the short term.

“I just wish we knew more about what was going on. We’re missing out on that neighbourhood-level data to be able to know exactly where to pivot and where to help people.”

WHAT IS BEING DONE

Edmonton has three supervised consumption sites: The Royal Alexandra Hospital that is only accessible to inpatients, the Boyle McCauley Health Centre and the George Spady Centre.

The supervised consumption site at Boyle Street Community Services was opened in 2018 but was redirected to the Tipinawâw shelter at the Edmonton Convention Centre in the fall of 2020. When the shelter closed on April 30, 2021, so did the site.

The press secretary for Mental Health and Addiction, Eric Engler, said the government is building the Alberta Model of recovery-orientated addiction and mental health care to help Albertans pursue long-term recovery but that “services that reduce harm, such as supervised consumption services, can be an important part of this comprehensive system.”

Engler also confirmed the planning of another supervised consumption site in Edmonton is underway.

“Alberta’s government continues to work with Boyle Street Community Services to explore opportunities for supervised consumption services in the Strathcona area of Edmonton," Engler said.

Opioid-related EMS events is one of the most frequently updated statistics on the Alberta Substance Use Surveillance System (ASUSS), however acute death data is updated less often.

In June of 2021, CTV News was told by then Press Secretary Justin Marshall “the data provided in ASUSS related to overdose deaths and EMS responses is updated monthly, however it takes about six to eight weeks after the relevant month ends to allow for the validation of data by the Office of the Chief Medical Examiner’s Office (OCME), AHS and Alberta Health. Alberta’s government will only publish verified information from the OCME.”

When asked if the government plans to start releasing more precise locations of EMS responses in Edmonton, Engler said Alberta has the "most comprehensive reporting" in Canada.

"This platform is updated regularly with the most up to date information possible,” Engler said.

As of publication, the Alberta substance use surveillance system had not been updated to reflect acute deaths past January of 2022.