Opioids - What is the situation?

London has multiple overlapping drug-related crises.

Opioid-related Deaths

Opioid-related death rates have been fluctuating in Middlesex-London since 2005. Since 2014, opioid-related deaths have been increasing, with Middlesex-London showing significantly higher rates than Ontario and the Peer Group, especially among males and those aged 25-44 and 45-64, in 2021. In 2022, Middlesex-London reported 124 opioid-related deaths.

Opioid-related Emergency Department Visits

In 2022, Middlesex-London reported 764 opioid-related emergency department visits. Emergency department visits for opioid poisonings were particularly high among males, individuals aged 25-44, and those living in urban areas.

Data Source: Public Health Ontario Interactive Opioid Tool

Opioid-related Hospitalizations

Hospitalizations for opioid toxicity have been increasing generally over time in both Middlesex-London and Ontario. In 2022, Middlesex-London reported 96 opioid-related hospitalizations.

Data Source: Public Health Ontario Interactive Opioid Tool

Naloxone

According to reports from community partners to MLHU, 10,035 naloxone kits were distributed in 2022, with an additional 89,405 kits provided by local pharmacies. Over 500 overdose reversals were reported.

Data Sources: Regional HIV/AIDS Connection and Collective Action to Address Substance Use and Harms in Middlesex-London -  Board of Health Report 36-24.

Invasive Group A Streptococcal (iGAS) Infection

Invasive Group A Streptococcal (iGAS) infections are caused by the bacterium Streptococcus pyogenes. These bacteria are naturally found in the throat and on the skin of many people. However, when the bacteria get into parts of the body that are usually bacteria-free, like the bloodstream, it is called an invasive infection. Invasive infections can cause serious conditions like pneumonia, meningitis, necrotizing fasciitis, and streptococcal toxic shock syndrome.

Prior to 2016, iGAS rates in Middlesex-London were generally similar to the Ontario rate, except in 2008 and 2012 when local clusters of cases emerged. Since 2016, local rates have exceeded the provincial rate. Although the Middlesex-London rate decreased in 2018, the local rate was still nearly two times greater than the rate across the rest of Ontario.

Data source: Public Health Ontario Infectious Disease Query. Data current as of January 23, 2019 at 7:00 a.m.

HIV

Human Immunodeficiency Virus (HIV) is a virus that weakens a person’s immune system, leaving the body unable to fight other infections and illnesses. Some people have mild symptoms 2-6 weeks after becoming infected with HIV, but these symptoms go away after a few weeks. Most people do not develop symptoms until years after they have been infected with HIV.

Prior to 2014, HIV rates in Middlesex-London were lower than or similar to the Ontario rate. Between 2014 and 2016, local rates increased whereas the provincial rate was stable. In 2017 HIV rates in Middlesex-London began to decline, and in 2018, the local rate was more than 50% lower than at the peak of the outbreak in 2016.

In 2016, 74% of newly diagnosed HIV cases in Middlesex-London reported injection drug use as a risk factor. By 2018, the proportion had decreased to 52%. However, people who use injection drugs are still over-represented among local HIV cases. The Public Health Agency of Canada (2018) found that approximately 14% of HIV cases newly diagnosed across Canada in 2016 reported injection drug use as a risk factor.

Data source: Public Health Ontario Infectious Disease Query. Data current as of January 23, 2019 at 7:00 a.m.

Reference: Public Health Agency of Canada. Summary: Estimates of HIV Incidence, Prevalence and Canada’s Progress on Meeting the 90-90-90 HIV targets, 2016. Public Health Agency of Canada, 2018. Available from: https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/diseases-conditions/summary-estimates-hiv-incidence-prevalence-canadas-progress-90-90-90/pub-eng.pdf. Accessed January 16, 2019.

Hepatitis C

Hepatitis C is an infection of the liver caused by the Hepatitis C virus. Many people infected with the Hepatitis C virus do not get sick, or they feel ill for only a short time. However, three out of four people infected with the Hepatitis C virus will carry it for years.

Since 2007, Hepatitis C rates have been consistently higher in Middlesex-London when compared to provincial rates. Injection drug use is a risk factor reported by many cases, and may contribute to the local rate being higher than the Ontario rate. For example, in 2018, 54% of Middlesex-London Hepatitis C cases reported current or previous injection drug use.

Data source: Public Health Ontario Infectious Disease Query. Data current as of January 23, 2019 at 7:00 a.m.

Endocarditis

Endocarditis which is also called infective endocarditis, is an infection and inflammation of the heart valves and the inner lining of the heart chambers. It can occur when infectious organisms, such as bacteria or fungi, enter the bloodstream and settle in the heart People who inject drugs are at high risk of acute endocarditis, because numerous needle punctures give bacteria many opportunities to enter the blood through broken skin. Re-using drug paraphernalia increases the risk. Endocarditis is treated through intravenous antibiotics and surgery may be required in some cases. If untreated, this form of endocarditis can be fatal in less than six weeks.

Needle Recovery

Middlesex-London currently has up to 28 access points, including a mobile unit, satellite locations, pharmacies, a large fixed site at Regional HIV/AIDS Connection, and a site at MLHU’s CitiPlaza location. Additionally, there are 23 public needle disposal bins, and the City of London offers 24/7 needle pick-up through its Dispatch service. In 2022, 1.7 million syringes were distributed across these access points.

• Free and confidential needle exchange services are available at Regional HIV/AIDS Connection (RHAC), the Middlesex-London Health Unit and My Sister’s Place.
• Well-marked stationary needle disposal bins in several public areas collect discarded needles and syringes; they also assist with overall recovery of used injection drug equipment. See the list of stationary needle disposal bin locations and learn more about the safe handling and disposal of needles.

If needles are found on public property:
If needles are found on public property, please call 519-661-2489 ext. 4965. This phone line is answered 24 hours per day, 7 days per week.

Public drug use

People tend to use drugs in public areas, because they don’t otherwise have a safe location to do so. This public drug use can lead to unsafe consumption practices, which increase the risk of overdose and the spread of diseases, such as hepatitis C and HIV. In addition, discarded equipment, such as used needles, pose a potential risk of injury for those who use public spaces where people inject drugs.