Lethbridge saw record number of drug deaths in 1st half of 2021

Earlier this week, the Alberta government update the data contained in its Alberta Substance Use Surveillance System.

The new data includes EMS responses to opioid-related events up to the week ending 27 September 2021. Death data goes to the end of July, and hospitalization and SCS usage data goes to the end of June.

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, Q4 2020, and Q1 2021).

Deaths

By the end of June, Lethbridge had seen 31 substance-related deaths in 2021. This is the highest number the city has seen since 2016 during the first half of the year. The next highest was last year, when we saw 25.

July saw only 1 reported death, the lowest of any July in the last 5 years, and June saw 6, the second highest of any June since 2016. That brings the year-to-date number of drug-related deaths to 32 for the year, the highest number during the same period since at least 2016.

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 32 deaths related to substance use.

Calgary and Edmonton had, by far, more total deaths during the second quarter of 2021, putting Lethbridge at the 3rd highest number of total deaths related to substance use between April and June (16). Red Deer was fourth at 14.

However, when we account for population, Lethbridge had the 2nd highest death rate per 100,000 person years of the 7 communities included in the data.

Lethbridge’s Q2 2021 death rate was 63.9 per 100,000 person years. Grande Prairie had the highest death rate, at 73.4/

Here’s how the Lethbridge 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	April 2021	May 2021	June 2021	Q2 2021
Non-pharmaceutical opioids	3	5	6	14
Pharmaceutical opioids	0	0	0	0
Methamphetamine	3	2	0	5
Cocaine	1	0	0	1
Alcohol	0	2	0	2
Benzodiazepines	0	1	0	1

The first 6 months of 2021 reported so far saw an average of 4.57 deaths per month and a median of 5 deaths per month. Here’s what 2021 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	4.33	4	1
2021	4.57	5	0

2021, so far, has been the only year in the reporting period that has reported substance-related deaths every month.

The highest month this year so far was May, which saw 7 deaths, the highest May on record and the second highest number of any month on record.

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 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 11 months since the SCS closed, here’s how the number of deaths compares to the same 11-month period of previous years.

	Total	Median	Average
2016–17	22	2.0	2.00
2017–18	34	3.0	3.09
2018–19	24	2.0	2.18
2019–20	35	2.0	3.18
2020–21	46	4.0	4.18

Before 2020–21, the average of this 11-month period among the previous 4 years was 28.75. The 2020–21 death count is roughly 1.5 times that average. As well, this most recent 9-month death count is so high, that it increased the average among all years to 32.2.

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 second quarter of 2021, at 1,902 per 100,000. The North Zone had the highest, at 2,270 per 100,000.

As far as general hospitalization goes, the South Zone had the second highest hospitalization rate in the province, at 679 per 100,000. The next highest was the Central Zone, at 695.

EMS responses

I just did an article last week on EMS responses to opioid-related events in Lethbridge (which you can read here), but please note that EMS responded to another 13 such events in the 7 days of new data. That’s 3 more than the previous week and the second highest number in the last 2 months.

Supervised consumption

Supervised consumption in Lethbridge was up significantly in the second quarter of this year.

The Lethbridge Overdose Prevention Site saw 13,020 visits in the second quarter from 237 unique visitors: a rate of 48.4 visits per visitor in the quarter, or an average of 16.1 visits per visitor per month.

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	6,949	356	19.5	6.5
Q4 2020	10,061	215	46.8	15.6
Q1 2021	10,327	244	42.3	14.1
Q2 2021	13,020	269	48.4	16.1

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 come to trust the service.

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

In the 3 quarters since the SCS closed, usage of the local mobile unit operated by AHS has continued to be at levels similar to that seen at the beginning of the pandemic, and nowhere even close to the usage of the SCS run by ARCHES.