Lethbridge’s 2020 drug-related death rate highest in Alberta

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

The online dashboard tracks various metrics related to substance use in the province, including deaths, EMS responses, supervised consumption site usage, and hospitalizations.

This is the first update that has data available to the end of 2020.

Since the updated data was available, I thought I’d breakdown stats for Lethbridge (see my previous coverage for Q1 2020, Q2 2020, and Q3 2020).

Deaths

Lethbridge saw 52 substance-related deaths in 2020, up from the 44 reported in November (the December update had this number at 46). 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 44 deaths related to substance use.

Calgary and Edmonton had, by far, more total deaths this year, putting Lethbridge at the 4th highest number of total deaths related to substance use. Red Deer was third at 52.

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

Lethbridge’s 2020 death rate was 52.5, its highest rate since at least 2016. and up from 48.5 reported in November. The next highest was in 2018, when it was 37.7 per 100,000.

Lethbridge saw 8 deaths in December 2020, giving it a death rate of 96.9 per 100,000 people. This was the highest death count and death rate of any December on record for Lethbridge. Plus, the death count is tied with two other months for the highest ever (June 2020 and June 2018 also saw 8 deaths).

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	46
Pharmaceutical opioids	2
Methamphetamine	21
Cocaine	11
Alcohol	13
Benzodiazepines	2

Lethbridge saw an average of 4.2 deaths per month in 2020 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	4.33	4	1

2020 was one of only 2 years in the reporting period that has reported substance-related deaths every month except one.

Two months tied for the highest month last year: June and December, which each saw 8 deaths. That also happens to be the highest number of deaths in a single month in Lethbridge since at least January 2016 (although July 2018 also saw 8 deaths).

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 SCS closure, Lethbridge saw 14 deaths. Since 2016, there has been only 2 years where at least one of those months saw 3 or more deaths: October 2018 saw 3 deaths and November 2016 saw 4.

So, even with the previous SCS closed, we’re seeing more deaths for this time of year than normal.

Finally, in the 4 months following the closure of the SCS (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
2020	3	3	0	8	14	3.5
2019	1	2	0	1	4	1.0
2018	0	3	2	2	7	1.8
2017	0	2	2	2	6	1.5
2016	2	1	4	2	9	2.3
	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.

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 fourth quarter, at 1,629 per 100,000. The North Zone had the highest, at 2,137 per 100,000.

July through September last year, the South Zone saw its third highest rate of substance-related ER visits of any quarter in the last 5 years. The fourth quarter of 2020 had the lowest ER visit rate in the South Zone than in any other previous fourth quarter.

As far as general hospitalization goes, the South Zone had the third highest hospitalization rate in the province, at 624 per 100,000. both the Calgary Zone and the North Zone were higher (683 and 639 respectively).

The fourth quarter hospitalization rate for 2020 was the second highest hospitalization rate of any fourth quarter in the entire reporting period. The highest fourth quarter was in 2019, when the South Zone saw 694 per 100,000 substance-related hospitalizations.

The South Zone hospitalization rate for the fourth quarter had decreased to 624 from 694 in the third quarter, which itself was higher than the rate of 709 reported in the second quarter of this year.

EMS responses

Lethbridge saw 3,672 EMS responses to opioid-related events in 2020. This is higher than the 2,361 we saw in 2019, 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 55.5% in EMS responses for 2020 compared to 2019.

Lethbridge had the highest EMS response rate in the province in the fourth quarter of 2020. Local EMS responded to 299 opioid-related events per 100,000 between October and December 2020. The next highest community was Grande Prairie, at 281.

This was also Lethbridge’s fifth highest quarter during the last 3 years, and it was the highest fourth quarter in the reporting period; although Q4 of 2018 ws 894.

This past December saw the third highest EMS response rate of 2020: 400. Only July (691) and June (557) were higher; although August was also at 400.

Lethbridge’s average EMS response rate this year was 306 per month. Its median rate was 267. 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 had seen lower EMS response rates: 267 in September, 206 in October, and 291 in November. However, the EMS response rates are higher than they were during the first 4 months of the year, which varied between 97 and 194. And, as I mentioned, at 400 responses, December saw the 3rd highest response rate.

Supervised consumption

Supervised consumption in Lethbridge was down significantly in the last half of 2020.

The Lethbridge SCS and the AHS mobile overdose prevention site saw a combined 6,949 visits in the third quarter 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 fourth 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.

	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

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 last 3 quarters of 2020.

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 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.

This is the first 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.