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Substance Use and Addiction Medicine

Measuring the Burden of Opioid-Related Mortality in Ontario, Canada, During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article

1 Credit CME

JAMA Network Open

Published Online: May 26, 2021

Research Letter

Article Information and Disclosures

Tara Gomes, PhD^1,2;

Sophie A. Kitchen, MSc¹;

Regan Murray, MPH³

Author Affiliations

¹Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto, Ontario, Canada
²Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
³Office of the Chief Coroner for Ontario, Toronto, Ontario, Canada

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The COVID-19 pandemic struck in the midst of an epidemic of opioid overdoses that has resulted in nearly 20 000 deaths in Canada since 2016.¹ Pandemic-mandated measures, including changes to health care delivery to accommodate physical distancing and increased social isolation, can increase the risk of harm for people who use drugs.² For example, reduced operation hours of health care services (eg, pharmacies and outpatient clinics) and harm reduction services (eg, drug checking programs and supervised consumption sites) have introduced additional barriers to care for people with opioid use disorder.² Data from across North America suggest that the rate of opioid-related deaths has increased during the pandemic.¹^,3^,4 We sought to quantify the added burden of fatal opioid overdoses occurring in Ontario during the first 6 months of the COVID-19 pandemic.

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Article Information

Accepted for Publication: April 9, 2021.

Published: May 26, 2021. doi:10.1001/jamanetworkopen.2021.12865

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Gomes T et al. JAMA Network Open.

Corresponding Author: Tara Gomes, PhD, Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, 30 Bond St, Toronto, ON M5B 1W8 Canada (tara.gomes@unityhealth.to).

Author Contributions: Mss Murray and Kitchen had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Gomes, Kitchen.

Critical revision of the manuscript for important intellectual content: Kitchen, Murray.

Statistical analysis: Kitchen.

Administrative, technical, or material support: All authors.

Supervision: Gomes.

Conflict of Interest Disclosures: Dr Gomes reported receiving grants from the Ontario Ministry of Health outside the submitted work. No other disclosures were reported.

Funding/Support: This study was funded by a grant from the Ontario Ministry of Health and the Canadian Institutes of Health Research.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources.

Additional Information: The authors thank the Ontario Office of the Chief Coroner for their support in accessing this data.

References

Government of Canada. Opioid and stimulant-related harms in Canada. Published March 2021. Accessed April 14, 2021. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/graphs?index=477

Canadian Centre on Substance Use and Addiction. Impacts of the COVID-19 pandemic on substance use treatment capacity in Canada. Accessed February 11, 2021. https://www.ccsa.ca/sites/default/files/2020-12/CCSA-COVID-19-Impacts-Pandemic-Substance-Use-Treatment-Capacity-Canada-2020-en.pdf

Ontario Drug Policy Research Network; Office of the Chief Coroner for Ontario/Ontario Forensic Pathology Service; Public Health Ontario; Centre on Drug Policy Evaluation. Preliminary patterns in circumstances surrounding opioid-related deaths in Ontario during the COVID-19 pandemic. Published November 2020. Accessed April 14, 2021. https://www.drugsandalcohol.ie/33326/1/Opioid-Death-Report_FINAL-2020NOV09.pdf

US Centers for Disease Control and Prevention. Overdose deaths accelerating during COVID-19. Published December 17, 2020. Accessed January 18, 2021. https://www.cdc.gov/media/releases/2020/p1218-overdose-deaths-covid-19.html

Department of Information Evidence and Research. WHO methods and data sources for global burden of disease estimates 2000-2015. Published January 2017. Accessed April 14, 2021. https://www.who.int/healthinfo/global_burden_disease/GlobalDALYmethods_2000_2015.pdf

Government of Canada. Background document: public consultation on strengthening Canada’s approach to substance use issues. Published September 2018. Accessed April 14, 2021. https://www.canada.ca/content/dam/hc-sc/documents/services/substance-use/canadian-drugs-substances-strategy/strengthening-canada-approach-substance-use-issue/strengthening-canada-approach-substance-use-issue.pdf

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.