The past four years have seen a drastic uptick in suspected opioid overdoses in Greater Sudbury.
According to a report from Sudbury’s emergency services, paramedics responded to 173 emergency overdose calls in 2018, compared with 92 the year before — a jump of 88 per cent. November and December were the municipality’s worst two months on record; during a two-day span in late December, there were eight suspected overdoses. As well, non-paramedic use of the lifesaving medication naloxone has increased — it was administered 70 times in 2018, compared with only nine reported instances in 2017.
In November, members of Sudbury’s Community Drug Strategy — a group of 25 community agencies working to implement harm-reduction strategies in the area — decided to take action. Public Health Sudbury and Districts (PHSD) had been using year-old information from coroners’ reports to track suspected overdoses in the area. The CDS determined that fresher data was needed.
Enter the Early Aberration Response System — EARS, for short. Still in its pilot stage, it uses emergency-services data, combined with on-the-ground intelligence from the city’s police services and front-line care organizations, to create an accurate picture of how many overdoses are occurring at any given time. Other jurisdictions have used the system to track illnesses, such as the flu.
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Emergency services records data in real time “because when paramedics complete an emergency call, they must also complete a patient-care record at the end of their shift,” says Melissa Roney, acting deputy chief of Sudbury’s emergency services. “Our data is very raw, but what we’re seeing is that it’s reliable.”
Shana Calixte, co-chair of CDS and manager of mental health and addictions at PHSD, says it’s important to get intelligence from emergency services, police services, and front-line care workers because the CDS has to do some detective work: “We have to ask ourselves what the cause of the surge might be: it might be that there’s a bad batch of substances out there or a lack of knowledge around naloxone use. We would contact all of our partners — the police, the hospital, outreach services — and ask them about any intel they might have.”
Calixte says that, ideally, EARS will let community members know how many suspected overdose calls have been made and the possible reason for any increase. Users can then adjust their habits to avoid a potential overdose.
“Maybe they will use with someone they know instead of alone; maybe they can avoid mixing drugs or make sure they have a naloxone kit available,” she says. “We want them to take whatever steps they are able to in order to reduce harm.”
The system is based on syndromic surveillance — that means data is systematically collected and reviewed on a continuous basis for the sake of public health. Calixte says it’s no different in principle from tracking the flu or school absenteeism: “The idea here is that we are constantly monitoring the situation and informing the public on any changes that could affect their well-being.”
One such change: the recent introduction to the Sudbury area of fentanyl-laced heroin, colloquially known as “purple heroin” or “purp.”
“What we’ve been seeing lately is a lot more overdoses, and we’re also seeing an increase in stronger substances,” says Julie Gorman, interim executive director of the Sudbury Action Centre for Youth (SACY), an agency that provides harm-reduction programs for young drug users. “Being able to tell the community that there’s been a change is important — the more information we can get to people, the better.”
EARS is just one step toward the larger public-health goal of keeping users safe. Recently, for example, SACY launched a pilot program that makes it possible for users to check their drug supply for the presence of fentanyl. The organization also regularly sends outreach teams to different parts of the city, providing users with safe-injection kits.
Gorman says drug users have expressed appreciation for the alert system, but have noted that it sometimes feels to them like a Band-Aid solution to a growing problem. Many users, she notes, want a safe-injection site in the area.
“We’ve been getting a lot of questions about what we’re doing in the meantime before we can get a safe-consumption service in the area,” says Gorman. “But they do appreciate [the alert system] and the work that we do.”
The CDS is in the process of conducting a feasibility study about a possible supervised-consumption site. While the Ontario government has capped the number of injection sites in the province at 21, the CDS plans to lobby the province for an exception if the study finds that a site is needed.
“We are in [the very early stages] of the process,” she says. “What we’re hoping to do with [EARS] is keep our community informed about what exactly the situation is so they can take steps to protect themselves. That’s the bottom line — we want to protect lives and reduce harm as much as we can.”
Correction: An earlier version of this story indicated that paramedics had responded to 70 emergency overdose calls in 2018, up 88 per cent from 2014. In fact, they responded to 173 such calls in 2018, up 88 per cent from 2017. TVO.org regrets the error.
Sarah Niedoba is a freelance journalist based in Toronto.
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