Real-time Intelligence on Opioidrelated Health Impacts in Ontario

Transcription

1 Real-time Intelligence on Opioidrelated Health Impacts in Ontario Brian Schwartz, Chief, Emergency Preparedness, Public Health Ontario Melissa Helferty, Epidemiologist, Ministry of Health and Long-Term Care Kieran Moore, Associate Medical Officer of Health, KFLA Public Health 2013 Harm Reduction Conference

2 Acknowledgements Emily Karas, Manager, Communicable Diseases, PHO Dr. Kieran Moore, Adam Van Dijk, Kingston Frontenac Lennox Addington Public Health Unit Andrew Stephen, Office of the Chief Coroner of Ontario Kirc Cobb, ConnexOntario Health Services Information (CAMH) Daniel Elliot, Manager of Operations, Drug and Alcohol Treatment Information System (CAMH) Ontario Poison Centre Public Health Units and Local Integrated Health Networks (LHINs) 2

3 Background Oxycontin was discontinued on February 27, Request from the Chief Medical Officer of Health to Public Health Ontario (PHO) to work with the The Ministry of Health and Long Term Care (the Ministry) in collecting and interpreting real-time intelligence/surveillance on health impacts from this discontinuation. PHO and the Ministry collaborated to assess available data sources in Ontario. Consultations with Public Health Units, LHINs, Office of the Chief Coroner, Kingston Frontenac Lennox Addington (KFLA) Public Health, CAMH and Ontario Poison Control to ascertain data sources that could be of assistance.

4 Since March 3, 2012, the Ministry in collaboration with PHO, developed a weekly report reviewing available data. Shared with Ministers office, CMOH and the expert working group on Narcotics Addictions. The data was used to inform the Narcotics strategy : a plan to provide recommendations related to the unintended health, social and economic impacts of narcotic addiction and withdrawal, supported by an Expert Working Group on Narcotic Addictions; and to conduct and review data available related to overdose, withdrawal and mortality associated to the discontinuation of Oxycontin and introduction of OxyNeo.

5 Data Sources Ontario s public health unit harm reduction programs (anecdotal information); Local Integrated Health Networks (anecdotal information); The Office of the Chief Coroner of Ontario (deaths attributed to opioid toxicity/withdrawal); Acute Care Enhanced Surveillance (ACES) developed by Kingston Frontenac Lennox & Addington Public Health (Emergency Department visits and hospital admissions related to opioids in half of Ontario s hospitals); ConnexOntario (provincial hotline for information on drug, gambling and mental health); Drug and Alcohol Treatment Information System (DATIS); Ontario Poison Centre 5

6 PHU harm reduction programs LHINs OCC ACES/EDSS ConnexOntario DATIS Ontario Poison Centre (OPC) MOHLTC MOHLTC MOHLTC PHO PHO PHO PHO 6

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8 PHU Harm Reduction Surveys There have been noted increases in Fentanyl patches, heroin, crystal meth, Dilaudid, cocaine and Wellbutrin. Health units are reporting that Oxycontin is unavailable. Anecdotal reports include two overdose deaths related to heroin use and one related to a Fentanyl patch. PHUs developing informative materials for clients, particularly for younger clients as its been noted that youth drug use rates are climbing. Several health units also report the utilization of Naloxone training modules available through OHRDP.

9 Local Integrated Health Network Staff and community education about overdose, withdrawal and Methadone treatment is ongoing. LHIN agencies developing informative materials for clients. Some community clinics have observed an increase in request for information or an increase in phone calls to the community clinic/service. Noting increased wait times for treatment and some at full capacity. Several agencies noting concern that greater resources are required in order to fulfill service requests. An observed decrease in the availability of oxycontin was noted.

10 Office of the Chief Coroner of Ontario On average 140 deaths per year From March to December, a preliminary total of 65 deaths of acute drug toxicity involving oxycodone were reported 77% occurred from March to July 2012 Average age: 44 years (20 to 85 years)

11 Opioid Hotlines: ConnexOntario 11

12 Opioid Toxicity: Ontario Poison Centre 12

13 Visits for Opioid Toxicity/Withdrawal: DATIS 13

14 ED Visits: Acute Care Enhanced Surveillance 14

15 ED Visits: Acute Care Enhanced Surveillance 15

16 Hospital Admissions: ACES 16

17 Hospital Admissions: ACES 17

18 Data Limitations Public health unit and LHINs data are anecdotal. Hospitals and LHINs are not representative of the province (few hospitals in the southwest, Ottawa and Greater Toronto Area). ConnexOntario, DATIS and OPC serve a self-selected population. Data from Methadone Maintenance Treatment Program and visits to primary care physicians are not included. Data from the Coroner s Office does not reflect deaths involving other substances ie. Fentanyl or heroin.

19 Acute Care Enhanced Surveillance (ACES) Initiative Kieran Moore MD CCFP EM FCFP FRCPC MPH Associate Medical Officer of Health Project Lead-Surveillance KFLA Public Health 19

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23 Acute Care Enhanced Surveillance (ACES) Partnership between MOHLTC, PHO and KFLA since 2005 Learn from SARS, Walkerton, H1N1 Local Public Health and Acute Care Partners linked electronically Track, map, monitor visits for infectious disease and allow rapid intervention New approach to apply to non communicable disease visits to hospitals...asked in Can it help with situational awareness for opiate use? 23

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26 What DATA do we collect? Real time Age Sex 5 descriptors of Postal code Date, time, hospital, health unit CTAS code Chief complaint-triage Nurse Admission diagnosis-physician 26

27 Drugs of Abuse Syndrome-Inclusion Drug addiction, ingestion, overdose, seeking, use Drug toxicity Drug withdrawal Illicit drug Multidrug Narcotic, opiate, opioid, oxy etc., heroine 27

28 Drugs of Abuse Syndrome-Exclusion Tylenol ASA Alcohol Anti s-cholinergic, inflammatory, psychotic, seizure, depressant 28

29 Evaluation of Drugs of Abuse Syndrome 29

30 Evaluation of Admission Drugs of Abuse Syndrome data 30

31 New Approach-Sensitive and not Specific Gold standard-toxicology NACRS-Physician diagnosis, coded ICD 10-9 months delayed DAD-Physician diagnosis, coded ICD 10-9 months delayed ACES NEEDS ONGOING EVALUATION AND REFINEMENT ACES can provide SITUATIONAL AWARENESS Anomaly detection and ALERTING 31

32 Comparison of monthly epidemic curves for EDSS visits, admissions, NACRS, and coroners data for the KFL&A area 32

33 Anomaly detection based on 17-week moving average for drugs-of-abuse ED Visits 33

34 Future Considerations Improve syndrome classification Further correlation analysis Increase the number of hospitals and regions covered Set regional alerts and enhance communication, collaboration, coordination and response Age, spatial analysis 34

35 Thank You!