Amphetamine-related visits to Ontario emergency departments have skyrocketed over the last two decades, a recent study published in the Canadian Journal of Psychiatry says.
鈥淚t鈥檚 astonishing,鈥 said lead author James Crispo, a postdoctoral research fellow in pharmaceutical sciences at the University of British Columbia who is based in Sudbury, Ont.
The researchers used health administrative data to review adult emergency department visits throughout Ontario between January 2003 and December 2020.
They found that the number of ER patients suffering from an amphetamine-related condition increased almost 15 times over that time period.
Because they eliminated prescription amphetamines, which are sometimes used to treat ADHD, researchers believe the majority of the emergency department visits were specifically due to methamphetamine, or meth 鈥 a stimulant street drug which has become increasingly prevalent in Canada.
The study showed an especially sharp increase between 2015 and 2020.
Emergency departments in Western Canada and the Prairies have also seen dramatic increases in patients arriving with meth-related illness, said Sarah Konefal, senior research and policy analyst with the Canadian Centre on Substance Use and Addiction.
There has also been an 鈥渦ptick鈥 in Quebec, she said.
The Atlantic provinces have not seen the same rise in meth use, Konefal said, as cocaine is 鈥渂y far much more prominent鈥 in that region.
Dr. Arun Abbi, an emergency physician at Foothills Medical Centre and the Peter Lougheed Centre in Calgary, said they started seeing an influx of patients who had taken meth well before Ontario hospitals did.
Patients are 鈥渁gitated鈥 and are often brought to the emergency department by police 鈥渂ecause they鈥檙e hallucinating and paranoid, sometimes yelling,鈥 Abbi said.
Meth-induced psychosis is a huge problem, he said.
鈥淲hen you look at our psychiatric ward, often 50 per cent of the people admitted to short stay are meth-induced psychosis,鈥 he said.
鈥淚t often affects our flow for mental health patients because we鈥檙e often holding a lot of mental health patients in Emerg because there鈥檚 no inpatient capacity.鈥
Many people who use methamphetamine are marginalized, Konefal said.
People who are homeless, for example, may use meth 鈥渢o stay awake (to) guard their belongings,鈥 she said.
Abbi said that鈥檚 consistent with what he sees in practice. He estimates the vast majority of patients who come to the hospital due to meth are homeless.
Another significant issue across the country is that people often use more than one drug, mixing a stimulant 鈥 like meth or cocaine 鈥 with an opioid, such as fentanyl, said Konefal.
That can either be intentional or unintentional, she said, and can lead to overdoses. People may not realize the meth or cocaine they鈥檙e taking are laced with fentanyl. Or, they may mistakenly believe that taking a stimulant drug will counteract an opioid overdose.
In fact, 鈥渃ombining opioids and stimulants can generally make it more likely that someone might experience an overdose because one masks the other,鈥 she said, leading someone to take too much opioid as they鈥檙e not feeling the effects.
The Ontario emergency department study found that about one-third of the people on amphetamines also use opioids, Crispo said.
鈥淭his is very much an issue of polysubstance use,鈥 he said.
鈥淲hether it鈥檚 opioids or whether it鈥檚 amphetamines, I think we have a problem. And this problem needs critical investment.鈥
Part of that investment needs to be directed toward research on how to treat methamphetamine use disorders, Crispo said.
While medications, including methadone and suboxone, are available to ease the withdrawal symptoms of opioid addiction, there鈥檚 no such long-term treatment to help patients manage meth cravings, Abbi said.
Emergency physicians can only give short-term relief by sedating patients suffering from meth psychosis, then discharging them when they鈥檙e stable, he said, noting that more residential treatment services 鈥 along with access to housing 鈥 are needed in the community.
One of the limitations of the Ontario emergency department study, Crispo said, was that if someone didn鈥檛 have a health card, their data wasn鈥檛 included in the study.
That means that some vulnerable or transient patients may not have been counted 鈥 and the increase in amphetamine-related emergency visits could be even bigger than the study suggests.
鈥淚t鈥檚 probably an underestimate of what鈥檚 actually going on,鈥 Crispo said.
This report by The Canadian Press was first published March 15, 2023.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
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