High SCS usage linked to low deaths and EMS responses

Yesterday, the Alberta government announced the Alberta Substance Use Surveillance System.

The online dashboard will present data on substance use in the province, such deaths, EMS responses, supervised consumption site usage, and hospitalizations. Data is sortable by health zone and municipality.

It’ll replace the old system of quarterly reports, allowing users to access monthly data as soon as it’s updated.

The most recent complete data appears to be September 2020; although there is some data for October, which is a month more than we would’ve received had we received only the third quarter report this month as scheduled.

Since it was available, I thought I’d breakdown stats for Lethbridge (see my previous coverage for Q1 2020 and Q2 2020).

Deaths

Lethbridge saw 46 substance-related deaths this year, as of October. This is the highest annual number the city has seen since 2016. The next highest was 2018, when the SCS opened; we saw 37 that year.

According to the new system, these deaths include only those certified by the medical examiner. They don’t include “apparent fentanyl deaths”, which are deaths where fentanyl was present in the system of the person who died and “initial circumstances point to a likely drug poisoning death”.

It’s quite possible that Lethbridge has seen even more than 46 deaths related to substance use.

Calgary and Edmonton had, by far, more total deaths this year, putting Lethbridge at the third highest number of total deaths related to substance use. Red Deer was next at 42.

However, when we account for population, Lethbridge has the highest death rate per 100,000 person years of the 7 communities included in the data.

Lethbridge’s 2020 death rate so far is 55.7, its highest rate since at least 2016. The next highest was in 2018, when it was 37.7 per 100,000.

Red Deer had the second highest death rate, at 45.6 per 100,000 person years, followed by Edmonton (39.7) and Grande Prairie (38.2).

Here’s how the deaths break down by substance. Keep in mind that some of the people who died had multiple substances in their system, so these numbers add up to more than 46.

Substance	Deaths
Non-pharmaceutical opioids	40
Pharmaceutical opioids	7
Methamphetamine	18
Cocaine	9
Alcohol	10
Benzodiazepines	2

The 10 months of 2020 reported so far saw an average of 4.6 deaths per month and a median of 4 deaths per month. Here’s what 2020 looks like compared to other years:

	Average deaths	Median deaths	# months 0 deaths
2016	1.50	1	2
2017	1.75	2	3
2018	3.08	3	1
2019	1.75	1.5	2
2020	4.60	4	0

2020, so far, has been the only year in the reporting period that has reported substance-related deaths every month.

The highest month this year was June, which saw 10 deaths. That also happens to be the highest number of deaths in a single month in Lethbridge since at least January 2016.

The supervised consumption site operated by Lethbridge ARCHES shut down at the end of August. (See below for more on supervised consumption data.)

In the two months following the SCS closure, Lethbridge saw 6 deaths (3 each). Since 2016, there has been only 1 year where at least one of those months saw 3 or more deaths: October 2018 saw 3 deaths. So, even with the previous SCS closed, we’re seeing more deaths for this time of year than normal.

Plus, September and October weren’t even the lowest months of 2020: February and March were, before COVID-19 restrictions drastically reduced SCS utilization. Both had 2 deaths, the lowest number of deaths in a month so far this year.

Hospitalizations

The new system doesn’t delineate hospitalization data by city, so the following information is based on data for the South Zone at large, which includes Lethbridge, as well as Medicine Hat.

The South Zone had the second highest rate of substance-related emergency department visits in the province during the third quarter, at 2,143 per 100,000. The North Zone had the highest, at 2,322 per 100,000.

July through September this year, the South Zone saw its third highest rate of substance-related ER visits of any quarter in the last 5 years.

As far as general hospitalization goes, the South Zone had the highest hospitalization rate in the province, at 773 per 100,000. The next highest was the North Zone, at 171.

The third quarter hospitalization rate for 2020 was the highest hospitalization rate of any quarter in the entire reporting period. The next highest quarter was the second quarter of 2016—2 years before the Lethbridge SCS opened—when the South Zone saw 663 per 100,000 substance-related hospitalizations.

The South Zone hospitalization rate for the third quarter had increased to 773 from 706 in the second quarter, which itself was higher than the rate of 606 reported in the first quarter of this year.

EMS responses

Lethbridge saw 2,981 EMS responses to opioid-related events in 2020 to date. This is higher than the 2,361 we saw last year, but not as high as the 4,114 we saw in 2018. We saw a drop of 42.6% in EMS responses in 2019 compared to 2018, but an increase of 26.3% in EMS responses so far this year compared to last year.

Lethbridge had the highest EMS response rate in the province in this year’s third quarter. Local EMS responded to 452 opioid-related events per 100,000 between July and September 2020. The next highest community was Edmonton, at 243.

This was also Lethbridge’s second highest quarter during the 5-year reporting period. The only quarter higher was the second quarter of 2018, when it was at a rate of 461 EMS responses per 100,000.

This past July was the month Lethbridge saw the highest EMS response rate since 2016: 691. EMS responses have dropped since then, with August at 400, September at 267, and October at 206.

Lethbridge’s average EMS response rate this year was 298.1 per month. Its median rate was 236.5. The average last year was 196.8 per month and the median was 181 per month. In 2018, the average was 342.8 and the median was 343.

Clearly, this year had a lot more responses, but not as many as 2018.

Since the SCS closed down, Lethbridge has seen fewer EMS responses: 267 in September and 206 in October. However, EMS responses are higher than they were during the first 4 months of the year, which varied between 97 and 194.

Supervised consumption

Supervised consumption in Lethbridge was down significantly in the third quarter of this year.

The Lethbridge SCS saw 5,640 visits in the third quarter from 237 unique visitors: a rate of 23.8 visits per visitor in the quarter, or an average of 7.9 visits per visitor per month.

The Lethbridge Overdose Prevention Site reported 1,309 visits in the same quarter, from 119 unique visitors: a rate of 11 visits per visitor. It opened on 17 August 2020, which gives it a monthly visit rate of about 7.3 per visitor.

The SCS saw 12,101 visits in the second quarter of 2020 and 58,719 visits in the first, from 255 and 439 visitors, respectively. Compare these numbers to the other quarters it was operational.

	Visits	Visitors	Quarter rate	Monthly rate
Q1 2018	2,375	237	10.0	3.3
Q2 2018	24,464	380	64.4	21.5
Q3 2018	42,450	447	95.0	31.7
Q4 2018	56,562	440	128.6	42.9
Q1 2019	60,260	418	144.2	48.1
Q2 2019	59,901	431	139.0	46.3
Q3 2019	59,781	452	132.3	44.1
Q4 2019	66,168	446	148.4	49.5
Q1 2020	58,719	439	133.8	44.6
Q2 2020	12,101	255	47.5	15.8
Q3 2020	5,604	237	23.6	11.8

We see that during 2019 and the first quarter of 2020, visits per visitor rate was fairly consistent, varying between 130 and 145 visits per person per quarter, or 45–50 visits per month. That’s only 1–2 times per day per person.

Even though the quarterly rate was a bit lower in the last quarter of 2018, the monthly rate was similar. The first 3 quarters of 2018 were pretty low, which makes sense, given that the SCS operated for only a month in the first quarter, and it would’ve taken some time for usage to increase as people come to trust the service.

What I do find interesting is the numbers for the second and third quarters of this year.

We already knew that the COVID-19 pandemic restrictions seriously reduced the number of visits to the SCS, which we can see in the visits column and in the visitor column. However, it wasn’t just the number of visits and visitors that dropped during that period. The number of visits per visitor dropped as well.

The SCS went from a consistent visits per visitor rate of 130–145 per quarter (45–50 per month) during 2019 and beginning of 2020 to a rate of only 47.5 in the second quarter. During the lockdown, visitors were visiting the SCS at 35.5% the rate they did prior to the lockdown.

And the visit per visitor rate dropped even more in the third quarter this year, which is the quarter when the provincial government announced they were defunding the SCS. It’s also the quarter when the SCS closed.

The visit per visitor rate in the final quarter of the SCS being opened was half that of the previous quarter and only 17.6% that of the first quarter of 2020.

So, not only were the number of visits and visitors down at the SCS for most of 2020, but how often the average visitor used the SCS was also down.

SCS usage and harm reduction

Now that we have the data on SCS usage, I thought I’d chart the SCS usage between 2018 and 2020 with both deaths and EMS responses to see if there was a relationship between them.

Here’s the number of deaths:

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Here’s the number of EMS responses:

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What we see in all 6 charts is that the more used the Lethbridge SCS was, the fewer substance-related deaths and EMS responses there were in Lethbridge.

The higher the number of visits to the Lethbridge supervised consumption site, the lower the number of deaths and EMS responses. And the reverse is also true: as visits dropped, deaths and EMS responses increased.

Same goes for the number of visitors: more visitors, fewer deaths and EMS responses. And vice versa.

Even the frequency the average visitor used the SCS had an inverse relationship with both death and EMS responses. The more often the average visitor used the SCS, the lower the number of deaths and EMS responses, and like the other two usage stats, the reverse was also true.

While the data in these 6 charts covers only usage, death, and EMS responses for when the SCS was open because quarter 4 data is not complete yet. However, we do know that the visit frequency for the AHS OPS is down compared to the SCS.

As I mentioned above, the OPS had a rate of 11 visits per visitor in the 3rd quarter, about half of the rate of the final quarter of the SCS and 8.2% the rate of the SCS at the beginning of the year. The OPS’s monthly visit rate was about 7.3 per visitor. There’s no OPS data for October.

I couldn’t compare hospitalization and ER rates: the new system shows only health zone data, not city data, which means it would include the entire South Zone. There would be too many variables for us to see whether SCS usage in Lethbridge affected hospital use in Lethbridge, given that the zone data includes all hospitals in the zone, not just the Chinook Regional Hospital.

Clearly, supervised consumption sites save lives. They reduce demand on our health care system.

In 2019, the only year when the SCS was open for all 12 months of a year, Lethbridge saw:

• 2nd lowest number of substance-related deaths
• 2nd lowest median number of deaths per month
• 2nd lowest average number of deaths per month
• Lowest number of EMS responses
  • Absolute numbers
  • Monthly average
  • Monthly median

Plus crime also dropped.

Cancelling funding for the SCS was an irresponsible move on the UCP government’s part.