Opioids: Study finds poorest Canadians most at risk

A new study looking at opioid-related deaths in Canada over 17 years has found that low-income Canadians are almost four times more likely to die from opioids than high-income Canadians.

Researchers at the University of Waterloo examined opioid-related deaths and hospitalizations in Canada from 2000 to 2017 from a socioeconomic perspective.

They found that not only were lower-income Canadians more likely to die from opioids, but the poorest Canadians also had five times more emergency room visits due to opioids than the wealthiest Canadians.

The findings, published in June in the journal Health Promotion and Chronic Disease Prevention in Canada, underscore the wide discrepancy between the risks faced by the rich and the poor when opioids are involved, the researchers say, and indicate where policy changes can be made to help those who are most vulnerable.

“Opioid-related harms are at a critical level in Canada,” Wasem Alsabbagh, professor of pharmacy at Waterloo and lead author of the study, said in a news release. “Opioid-related hospitalizations in Canada increased by more than 50% between 2007 and 2017. In Ontario, emergency department visits more than doubled. We explored patterns between socioeconomic status and opioid harm to better understand the opioid crisis.

The researchers looked at death rates, hospitalizations and emergency room visits related to opioid use, and cross-referenced them with census data to get a picture of the median household income associated with patients’ neighborhoods.

Income and population estimates are from the 2006 and 2016 censuses.

In total, the researchers looked at more than 19,500 deaths, 82,000 hospitalizations and 71,000 emergency room visits, and compared them across five income brackets.

Among all opioid-related risks, people in the lowest income bracket had the highest rate per million people in Canada, or per million in Ontario in the case of emergency room visits.

This means that the lower income a neighborhood was, the more opioid-related deaths, hospitalizations and emergency room visits there were.

Experts say we can help mitigate these risks by targeting policies and support systems to low-income areas, such as safe injection sites.

In Timmins, Ont., a safe injection site called Safe Health Site Timmins is set to open on Monday, and doctors said they weren’t surprised by the study results.

“People with less income have fewer opportunities for health and wellness,” Dr. Liane Catton, a physician at the Porcupine Health Unit in Timmins, told CTV News Northern Ontario. “They tend to face greater inequities in terms of health and health care, and that includes social services, supports [for] mental health and addiction.

Social services and public programs need to step up their efforts to fill the void for those unable to access certain mental health or addiction services, experts say.

“The goal of this site is to reach the hardest to reach, most marginalized and most vulnerable people,” said Dr. Louisa Marion-Bellemare, addictions manager at Timmins and District Hospital, at CTV News Northern Ontario. “And those who don’t really know how to seek help or treatment for their addiction.”

The study reported progress. When looking at the risk of death from an opioid overdose, the dramatic gap between rich and poor narrows somewhat – researchers found that the difference in death rates between the lowest and highest income decreased between 2000 and 2017.

However, the disparity in emergency department visits and hospitalizations over this period has not diminished.

And in 2017, Canadians in low-income areas were still nearly 2.5 times more likely to die from opioid-related causes than those in high-income areas.

“For many, socioeconomic status is the result of past experiences – families, neighborhoods, education and other prior life events, in addition to current access to material and social resources that help individuals cope with challenges,” said Alsabbagh. “Often we see low socio-economic status in concentrated geographic areas where access to resources is more limited. In addition, psychosocial factors, such as feelings of marginalization or persistent discrimination and social isolation, can have an effect. By making the connection between low socioeconomic status and the harms of opioids, we can design policies that better meet the needs of our communities.”

With files by Lydia Chubak