1 in 5 opioid-related deaths in Ontario involve alcohol, study suggests

A new study out today shows that alcohol may be a factor in one in five opioid-related deaths in Ontario.

The paper, which was written in collaboration with the Institute for Clinical Evaluative Sciences, St. Michael’s Hospital and the Ontario Drug Policy Research Network, looks at a 20-year period between 1993 and 2013. During that time, the number of opioid-related deaths that involved alcohol in Ontario increased from 48 in 1993 to 137 in 2013.

“That is really a combination that patients should be warned to avoid,” said Tara Gomes, a scientist at the Institute for Clinical Evaluative Sciences in St. Michael’s Hospital and one of the study’s researchers. “Both opioids and alcohol can act as sedatives, so they can decrease your respiration and it can lead to somebody perhaps falling asleep and not waking up.”

Huge recent spike in deaths

Gomes said the news of this increase may be overshadowed because the province has seen such a large spike in opioid-related deaths in recent years.

On Monday, Ontario health-care workers wrote an open letter about the “disturbing” increase in opioid-related overdose deaths in the province in recent months. The next day the provincial government vowed to invest $222 million over three years to improve access to harm-reduction services and addiction treatment.

Dr. Jameet Bawa, the medical director for Horizons Opioid Treatment Services in Ontario, said drug dealers cutting fentanyl into street drugs is to blame for most of the deaths. Fentanyl is a highly potent drug — between 50 and 80 times stronger than morphine — that many recreational drug users take unknowingly, putting them at high risk of an overdose. ​Because of this overall increase in fatalities, the percentage of opioid-related deaths involving alcohol dropped from 38 per cent in 1993 to 22 per cent in 2003.

Gomes said the message not to mix alcohol and opioids needs to be reinforced.

People underestimate alcohol’s role

Dr. Tim Stockwell, director of the Centre for Addictions Research of BC at the University of Victoria, is currently using the researchers’ methods in a national study looking at alcohol, tobacco and other drug-related deaths and hospital admissions.  “People need to know that just one or two drinks of alcohol can wipe out your tolerance to opioid drugs. You think you’ve got a dose that you can cope with but you add a couple of drinks and the consequences, sadly, can sometimes be fatal,” Stockwell told CBC News.

Information about the connection between opioid-related deaths and alcohol in the last four years is not yet available. Public Health Ontario confirmed that data on opioid-related deaths in 2016 will be coming out in the next few weeks. But Gomes says since testing for alcohol involvement in these deaths is an extra step in the process, these numbers will cover opioids only.

Stockwell said in the course of his studies he has noticed a tendency for doctors to underestimate alcohol’s contribution to an overdose. When interviewing street-drug users about alcohol involvement in their own overdoses, the rates were much higher than those recorded in hospital records.  “There is a bias towards blaming illicit drugs when it’s the thing we’re so familiar with — alcohol — which is contributing,” said Stockwell.

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