Last week, the Alberta government updated the data contained in its Alberta Substance Use Surveillance System for the first quarter of 2021
The online dashboard tracks various metrics related to substance use in the province, including deaths, EMS responses, supervised consumption site usage, and hospitalizations.
Since the updated data was available, I thought I’d breakdown stats for Lethbridge (see my previous coverage for Q1 2020, Q2 2020, Q3 2020, and Q4 2020).
Deaths
Lethbridge saw 16 substance-related deaths during the first 3 months of 2021, up from the 8 reported during the same period the year before, as well as up from the 11 reported in the final quarter of 2020.
In fact, this was the highest number of deaths seen during any first quarter between 2016 and 2021. The next highest was 2019, which saw 10.
January 2021 itself had 5 deaths. This was tied with 2016 for the second-highest death count in a January since 2016. The highest was January 2019, at 6.
February was tied for the highest February death count since 2016. The other year that saw 4 deaths in February was 2018.
March was, by far, the highest March on record, at 7 deaths. Until this year, no March during the previous 5 years saw more than 3 deaths.
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 16 deaths related to substance use.
Calgary and Edmonton had, of course, more total deaths this year, putting Lethbridge at the 3rd highest number of total deaths related to substance use. Grande Prairie was fourth at 14.
However, when we account for population, Lethbridge had the second highest death rate per 100,000 person years of the 7 communities included in the data.
Lethbridge’s death rate for the 3 months was 63.9, its highest rate since at least 2016. The next highest was in 2019, when the first 3 months of the year were at 40.2 per 100,000.
By comparison, Grande Prairie was highest, at 73.4.
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.
| Non-pharmaceutical opioids | 16 |
| Pharmaceutical opioids | 0 |
| Methamphetamine | 8 |
| Cocaine | 1 |
| Alcohol | 2 |
| Benzodiazepines | 1 |
Lethbridge saw an average of 4 deaths per month in the first quarter of 2021 and a median of 5 deaths per month. Here’s what 2021 looks like compared to other years:
| Total deaths | Average deaths | Median deaths | # months 0 deaths | |
|---|---|---|---|---|
| 2016 | 8 | 2.7 | 3 | 1 |
| 2017 | 5 | 1.7 | 2 | 1 |
| 2018 | 8 | 2.7 | 3 | 0 |
| 2019 | 10 | 3.3 | 2 | 0 |
| 2020 | 8 | 2.7 | 2 | 0 |
| 2021 | 16 | 5.3 | 5 | 0 |
This record number of deaths follows a record number of deaths for the previous 4 months. In the 4 months following the closure of the supervised consumption site (September–December), Lethbridge saw more opioid-related deaths than we saw in the same period in any of the 4 previous years:
| Sep | Oct | Nov | Dec | Total | Avg | |
|---|---|---|---|---|---|---|
| 2016 | 2 | 1 | 4 | 2 | 9 | 2.3 |
| 2017 | 0 | 2 | 2 | 2 | 6 | 1.5 |
| 2018 | 0 | 3 | 2 | 2 | 7 | 1.8 |
| 2019 | 1 | 2 | 0 | 1 | 4 | 1 |
| 2020 | 3 | 3 | 0 | 8 | 14 | 3.5 |
| 6 | 11 | 6 | 17 | 40 | 2.5 |
In fact, the monthly average for this 4-month period was the highest average for this period of any of the previous 4 years, even before the SCS opened.
If we add up all 7 months since the SCS closed, here’s how the number of deaths compares to the same 6-month period of previous years.
| Total | Median | Average | |
|---|---|---|---|
| Sep–Mar 2016–17 | 14 | 2.0 | 2 |
| Sep–Mar 2017–18 | 14 | 2.0 | 2 |
| Sep–Mar 2018–19 | 12 | 2.0 | 2.4 |
| Sep–Mar 2019–20 | 12 | 4.0 | 1.7 |
| Sep–Mar 2020–21 | 30 | 4.0 | 4.3 |
Before 2020–21, the average of this 7-month period among the previous 4 years was 13. The 2020–21 death count is more than double the previous average. As well, this most recent 7-month death count is so high, that it increased the average among all years to 16.4.
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 1st quarter, at 1,604 per 100,000. The North Zone had the highest, at 1,960 per 100,000.
January through March this year, the South Zone saw its third lowest 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 third highest hospitalization rate in the province, at 604 per 100,000. both the Central Zone and the North Zone were higher (613 and 619 respectively).
The 1st quarter hospitalization rate for 2021 was the third lowest hospitalization rate of any 1st quarter in the entire reporting period. The highest first quarter was in 2019, when the South Zone saw 618 per 100,000 substance-related hospitalizations.
The South Zone hospitalization rate for the 1st quarter had decreased to 604 from 638 in the previous 4th quarter, which itself was lower than the rate of 801 reported in the 3rd quarter of last year.
EMS responses
Lethbridge saw 71 EMS responses to opioid-related events during the first 3 months of 2021. This is the highest we’ve seen since the 72 we saw in 2016, before the SCS opened. We saw a drop of 44.1 % in EMS responses during the first quarter of 2020 compared to 2019, but an increase of 115.2% in EMS responses for 2021 compared to 2020.
Lethbridge had the highest EMS response rate in the province in the first quarter of 2021. Local EMS responded to 383 opioid-related events per 100,000 between January and March 2021. The next highest community was Red Deer, at 236.
Clearly, this year had a lot more responses—even though it’s only 3 months in—but not as many as 2018.
Since the SCS closed down, Lethbridge has seen lower EMS response rates: 267 in September, 206 in October, 291 in November, 192 in January, 276 in February, and 383 in March. By comparison, it was 557 last June, followed by 691 in July and 400 in August.
However, the EMS response rates are higher than they were during the previous 7-month period, 287.8 compared to 152.3. Also, at 400 responses, December saw the 6th highest response rate since January 2018.
Supervised consumption
Supervised consumption in Lethbridge was up slightly in the 1st quarter of 2021.
The Lethbridge SCS and the AHS mobile overdose prevention site saw a combined 6,949 visits in the 3rd quarter of 2020 from 356 unique visitors: a rate of 19.5 visits per visitor in the quarter, or an average of 6.5 visits per visitor per month.
In the 4th quarter—after the SCS closed down—the OPS saw 10,061 visits from 215 individuals. That comes to a rate of 46.8 visits per visitor, or an average of 15.6 per month.
In the 1st quarter of 2021, the OPS had 244 visitors make 10,327 visits, which brings their visit per person rate to 42.3 for the quarter, averaging 14.1 per month.
| 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 | 6,949 | 358 | 19.5 | 6.5 |
| Q4 2020 | 10,061 | 215 | 46.8 | 15.6 |
| Q1 2021 | 10,327 | 244 | 42.3 | 14.1 |
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 came to trust the service.
What I do find interesting is the numbers for the last 3 quarters of 2020 and the first quarter of 2021.
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 of last 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 visits per visitor rate increased in the final quarter, but was still lower than during the beginning of the pandemic, during early lockdown stages, and it’s still significantly lower than it was during normal operations of the SCS. And the first quarter of 2021 has the visits per visitor rate down by nearly 10%.
This is the second full quarter that the mobile OPS has been operating, and it has nowhere near the usage rate that the SCS had prior to the pandemic. Not in visits, not in visitors, and not in the rate of visits per visitors.
