Opioid-Related Emergency Department Visits at a Glance

Release date: April 2018

Highlights

This report demonstrates the burden of opioid use on the health system by examining the rates of opioid-related emergency department (ED) visits in Durham Region residents.
In 2016, there were 488 opioid-related ED visits in Durham Region residents. ED visit rates were higher in males than females. Rates generally increased since 2007 with the exception of a slight decline in 2012-2013 which coincided with the delisting of OxyContin in 2012.
The ED visit rates are highest in adults aged 20-34 years. In 2016, this young adult group accounted for 37 per cent (181 of 488) of the ED visits.
In 2016, heroin poisoning accounted for 14 per cent of the ED visits (main problem diagnosis only). Heroin poisoning, as a percentage of the total ED visits, has steadily increased since 2012 while the percentage of ED visits due to mental and behavioural disorders has declined from 60 per cent of the main problem diagnoses in 2012 to 42 per cent by 2016. The percentage of ED visits due to poisoning from prescription opioids, whether obtained from illegitimate sources or from a risky pattern of use, has remained constant.

Figure 1. Age-standardized opioid-related ED visit rate per 100,000 in Durham Region and Ontario, by sex, between 2007 and 2016.

Opioid-related ED visit rate per 100,000 in Durham Region and Ontario, by sex.

Data table for figure 1.

Table 1. Counts and age-standardized opioid-related ED visit rates per 100,000 in Durham Region and Ontario, by sex, between 2007 and 2016.

Statistic	Calendar year
Statistic	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016
Durham Region Females rate	39.7	39.8	54.8	53.0	59.1	59.7	51.0	49.7	63.7	63.0
Durham Region Females count	118	120	167	164	187	190	166	164	212	212
Durham Region Males rate	37.6	48.2	73.7	51.2	83.8	64.1	61.3	71.7	61.0	85.9
Durham Region Males count	113	143	214	152	250	196	190	222	197	276
Ontario Females rate	41.1	47.1	57.9	63.4	64.8	62.2	57.9	55.0	61.0	70.2
Ontario Females count	2,678	3,096	3,819	4,228	4,355	4,229	3,976	3,816	4,257	4,958
Ontario Males rate	51.4	63.5	79.5	83.1	85.3	83.2	73.8	76.3	84.5	103.6
Ontario Males count	3,311	4,089	5,109	5,389	5,579	5,496	4,916	5,129	5,704	7,075

Source: Ambulatory Visits, Ontario Ministry of Health and Long-Term Care, intelliHEALTH Ontario

Figure 2. Age-specific opioid-related ED visit rates per 100,000 in Durham Region and Ontario, ages 15 to 19 and 20 to 34, between 2007 and 2016.

Opioid-related ED visit rates per 100,000 in Durham Region and Ontario, ages 15 to 19 and 20 to 34.

Data table for figure 2.

Table 2. Counts and age-specific opioid-related ED visit rates per 100,000 for Durham Region and Ontario, ages 15 to 19, and 20 to 34, between 2007 and 2016

Statistic	Calendar year
Statistic	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016
Durham Region 15-19 Rate	47.1	45.9	30.9	24.6	53.3	45.6	25.4	41.2	73.1	38.6
Durham Region 15-19 Count	22	22	15	12	26	22	12	19	33	17
Durham Region 20-34 Rate	66.6	73.0	117.3	107.2	146.2	104.9	116.6	107.0	112.3	133.9
Durham Region 20-34 Count	75	83	135	126	175	129	147	138	148	181
Ontario 15-19 Rate	41.4	49.7	57.1	71.6	81.8	69.4	52.9	51.4	53.4	56.8
Ontario 15-19 Count	364	441	509	641	734	617	464	443	451	474
Ontario 20-34 Rate	82.1	98.1	126.6	148.7	163.4	153.1	139.4	136.5	146.9	183.5
Ontario 20-34 Count	2,116	2,540	3,303	3,933	4,380	4,188	3,878	3,854	4,191	5,353

Source: Ambulatory Visits, Ontario Ministry of Health and Long-Term Care, intelliHEALTH Ontario

Figure 3. Age-specific opioid-related ED visit rates per 100,000 in Durham Region and Ontario, ages 35 to 64 and 65 years and older, between 2007 and 2016.

Opioid-related ED visit rates per 100,000, ages 35 to 64 and 65 years and older.

Data table for figure 3.

Table 3. Counts and age-specific opioid-related ED visit rates per 100,000 for Durham Region and Ontario, ages 35 to 64, and 65 and older, between 2007 and 2016

Statistic	Calendar year
Statistic	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016
Durham Region 35-64 Rate	46.1	51.5	73.2	57.1	72.5	69.6	59.9	65.8	66.7	84.2
Durham Region 35-64 Count	118	134	193	153	196	190	165	183	187	238
Durham Region 65+ Rate	11.1	24.4	38.2	22.5	32.3	45.8	26.5	42.6	36.4	40.1
Durham Region 65+ Count	7	16	26	16	24	36	22	37	33	38
Ontario 35-64 Rate	57.1	67.5	81.2	78.7	75.0	74.4	68.7	68.5	78.9	92.7
Ontario 35-64 Count	3,074	3,679	4,467	4,371	4,200	4,186	3,878	3,886	4,491	5,309
Ontario 65+ Rate	17.6	20.1	24.2	26.1	23.9	28.4	24.2	27.0	28.2	29.5
Ontario 65+ Count	297	349	432	479	452	561	499	578	625	676

Source: Ambulatory Visits, Ontario Ministry of Health and Long-Term Care, intelliHEALTH Ontario

Figure 4. Age-specific opioid-related ED visit rates per 100,000 in Durham Region and Ontario, females of reproductive age (15 to 49 years), between 2007 and 2016.

Opioid-related ED visit rates per 100,000, females of reproductive age (15 to 49 years).

Data table for figure 4.

Table 4. Counts and age-specific opioid-related ED visit rates per 100,000 for Durham Region and Ontario, females of reproductive age (15 to 49 years) between 2007 and 2016

Statistic	Calendar year
Statistic	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016
Durham Region Females 15-49 Rate	52.0	52.2	74.2	75.0	81.4	71.9	70.0	67.7	90.4	83.1
Durham Region Females 15-49 Count	81	82	117	119	129	114	111	107	143	132
Ontario Females 15-49 Rate	63.6	71.2	85.1	98.2	102.2	96.3	88.2	82.6	91.6	110.6
Ontario Females 15-49 Count	2,058	2,312	2,769	3,202	3,335	3,147	2,882	2,693	2,979	3,622

Source: Ambulatory Visits, Ontario Ministry of Health and Long-Term Care, intelliHEALTH Ontario

Figure 5. Per cent of main problem diagnosis codes, by diagnosis category, in Durham Region and Ontario between 2007 and 2016.

Per cent of main problem diagnosis codes, by diagnosis category, in Durham Region and Ontario.

Data table for figure 5.

Table 5. Count and per cent of main problem diagnosis codes, by diagnosis category, in Durham Region and Ontario between 2007 and 2016

Location	Diagnosis Category	Calendar year
Location	Diagnosis Category	2007	2008	2009	2010	2011	2012	2013	2014	2015	2016
Durham Region	Illegal	1.3	1.1	0	0.8	0.6	1.1	1.5	6.5	9.1	13.7
	MBD	56.7	60.6	60.1	62.2	66.0	59.9	56.4	49.2	43.2	42.2
	Prescription	42.0	38.3	39.9	37.0	33.3	39.0	42.1	44.2	47.7	44.1
Ontario	Illegal	1.4	1.4	1.3	1.6	1.4	2.3	2.5	5.2	5.8	7.9
	MBD	61.4	65.6	66.5	71.3	71.5	67.9	64.5	61.6	61.9	58.8
	Prescription	37.2	33.0	32.2	27.1	27.1	29.8	33.0	33.2	32.3	33.3

Source: Ambulatory Visits, Ontario Ministry of Health and Long-Term Care, intelliHEALTH Ontario

Data sources

ED visit data are collected by the Canadian Institute for Health Information (CIHI) on a fiscal year basis. For ED visits, the main diagnostic code is the “main problem” (MP) that is deemed to be the clinically significant reason for the visit. ED visit data provide only a crude measure of the burden of opioid use. Data are influenced by factors that are unrelated to health status such as availability and accessibility of care, administrative policies and hospital procedures. This may influence comparisons between areas and over time.

For all indicators, data were analyzed by the residence of the patient, not where the ED visit occurred. Ontario residents treated outside of the province were excluded. Data were reported by calendar year, based on year of the ED visit. This report includes ED visit indicators with relevance to public health programming.

Opioid-related ED visits were selected using ICD-10-CA codes T40 (.0 -.4, .6) (i.e., poisoning) and F11 (.0-.9) (i.e., mental and behavioural disorders due to acute intoxication, harmful use, dependence, etc. due to the use of opioids) whether it was the MP or a comorbidity. As such, the counts and rates included in this report are higher than the information presented by Public Health Ontario – Interactive Opioid Tool. Visits where the health care provider documented uncertainty in the diagnosis (diagnosis prefix Q) and visits which resulted in a transfer to another ambulatory care facility were included in the counts. ED visits for mental and behavioural disorders due to multiple drug use (F19) were excluded. Multiple codes can exist for each ED visit. As such, a unique visit number, NACRS key, was used to count the number of visits where at least one of the above codes was captured as the main problem or comorbidity.

In Figure 3, only MP codes were included in the denominator. Diagnosis categories were defined using the following codes: illegal T40 (.0 and .1); prescription T40 (.2-.4, .6); and mental and behavioural disorders (MBD) F11 (.0-.9). Opioid-related ED visits within the prescription category can occur when prescription drugs are obtained from illegitimate sources or from a risky pattern of use (excluding under use) such as deviating from acceptable practice or using for purposes that are not therapeutic.

Definitions

Figures and tables are provided for the following indicators:

Age-standardized opioid-related ED visit rates by sex
Age-specific opioid-related ED visits rates in individuals aged 15 to 19 years , 20 to 34 years, 35 to 64 years, 65 years and older

Age-standardized ED visit rate

An age-standardized ED visit rate is the number of ED visits per 100,000 that would occur if the population had the same age distribution as the 2011 Canadian population. This rate provides a single summary number that allows populations with different age compositions to be compared.

Age-specific ED visit rate

This rate is the total number of ED visits in a specified age group per 100,000 population in that age group. The numerator and denominator refer to the same age group.

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