Alcohol main cause of substance-related deaths in hospital

Heavy drinking landed Dawn Nickel in the emergency department four times twice for alcohol poisoning and two more times when she took pills with alcohol to try and kill herself.

"I had no recollection of either wanting to end my life or taking the pills to end my life," the Victoria resident said nearly 32 years after she downed her last drink.

Binge drinking finally gave way to treatment as Nickel realized the impact of her addiction on her daughters, who were two and six at the time.

She later founded the support group She Recovers to help other women struggling with substance use, though one thing remains the same years later there is a lack of treatment, even as alcohol-related hospitalizations are increasing.

Data from the Canadian Institute for Health Information (CIHI) show 10 Canadians die in hospital every day from harm caused by substance use, and 75 per cent of those deaths are related to alcohol. The agency did not have information on the number of deaths that occur outside of hospital, which is mostly the case for a greater number of opioid deaths among people who die alone.

Released earlier this month, the CIHI data also show alcohol contributes to more than half of all substance-use hospitalizations, which are 13 times more common than for opioid poisonings.

Nickel said the plight of a 65-year-old retired public servant who recently hired a sobriety coach through She Recovers to support her into recovery illustrates the struggles of people trying to stop their problematic drinking.

She said the woman, who did not want her name published, stopped drinking for three months after hiring the coach but then started downing a 26-ounce bottle of vodka and a case of beer every day while the coach was away for a week, during which time she had a serious fall, followed by a racing heartbeat that prompted her to go to a hospital in Victoria.

"Everybody in the emergency room was so compassionate and loving and kind," said Nickel, who has a PhD in health policy.

"She wants to stop drinking more than anything because she believes with every fibre of her being that her body will not survive it," Nickel said, adding the woman was advised by an emergency-room doctor to head to a liquor store after her release from the ER so she could drink moderately to avoid harrowing withdrawal symptoms while awaiting treatment, which wouldn't be available for six to eight weeks.

The CIHI data say that between 2017 and 2018, British Columbia had 361 alcohol-related hospitalizations every day per 100,000 people, the highest of all the provinces, while the Northwest Territories saw the highest overall alcohol-related hospitalizations in the country, at 1,751 per 100,000 residents.

Nickel said some private British Columbia facilities charge up to $30,000 a month for treatment because a publicly funded system has failed to address the "silent epidemic" of alcohol dependence across Canada.

Adam Sherk, a researcher at the Canadian Institute for Substance Use Research, said a study by the centre last year showed that compared with opioids, the economic costs of alcohol use are up to 10 times higher and related to criminal justice issues, lost productivity and health care.

"Ethanol, which is pure alcohol, is classified by the World Health Organization as a group one carcinogen," he said of the cancer-causing risks associated with alcohol.

Ontario's 'recipe for disaster'

"We would recommend policies that tend to drive down the amount of alcohol used by the population, basically the opposite of what Ontario is doing," Sherk said. "No one's arguing for prohibition. We just want to make it so that it's less culturally available and to drive down the consumption."

Ontario Premier Doug Ford has recently taken steps to try and loosen the province's strict control on alcohol sales and make it more readily available in places such as corner stores and tailgate parties, and allowed for producers to make ale as cheap as a dollar.

Robert Gibson, a spokesman for Ontario Finance Minister Victor Fedeli, said the government will continue working with public health and safety groups to carefully consider the safe and responsible sale and consumption of alcohol.

"We want to ensure any proposed improvements would uphold the health and safety of our communities and our roads," he said in a statement.

Imagine presenting with a heart attack or chest pain and you're given a piece of paper and told to navigate the health-care system by yourself.- Dr. Keith Ahamad

A special adviser to the province will work with retailers, beverage alcohol manufacturers and public health experts "to ensure increasing convenience does not lead to increased social costs related to alcohol," Gibson said.

Dr. Keith Ahamad, an addictions specialist at St. Paul's Hospital in Vancouver, said international scientific research has shown a clear relationship between alcohol pricing and accessibility and the harms associated with increased consumption as well as the effects on others connected to the drinker.

Ahamad called Ontario's policies increasing accessibility to alcohol a "perfect storm" when combined with cuts to health-care and social programs.

"It's a recipe for disaster," he said, adding B.C. has seen the harms related to privatization of alcohol sales starting in the early 2000s, eventually leading to higher alcohol-related hospitalization rates.

CIHI data show that in 2017-2018, there were 249 alcohol-related hospitalizations in Canada every day per 100,000 people, up from 241 hospitalizations in 2015-2016.

Most people seeking treatment often have nowhere to go but to an emergency room, where they're sometimes prescribed medications such as Valium to prevent seizures and delirium tremens, a severe form of alcohol withdrawal that causes confusion and can be associated with death for a small number of patients, but the underlying addiction is often not addressed, Ahamad said.

Detox dilemma

Instead, patients are usually told to make a call so they can refer themselves to a treatment program but many don't follow through and aren't prepared to wait days or weeks to get into a facility, he said.

"The responsibility has not been on the health-care system. Imagine presenting with a heart attack or chest pain and you're given a piece of paper and told to navigate the health-care system by yourself."

The BC Centre on Substance Use, where Ahamad is a researcher, has submitted treatment guidelines to the provincial Mental Health and Addictions Ministry aimed at restructuring the health-care system. They recommend family doctors screen patients who are dependent on alcohol and refer those who are at low risk to be stabilized in an outpatient setting instead of a treatment facility before their condition worsens.

"It's been historically difficult to know who is going to be at high risk and who is not so we've kind of lumped everyone together and asked them to go to detox facilities and use medications like benzodiazepines, which are not only addictive but also risky when consumed with alcohol," he said of the drugs prescribed to reduce withdrawal symptoms including seizures and anxiety.

About 30 to 40 per cent of people who are fatally overdosing in B.C. are testing positive for alcohol use, which has increased since the province declared a public health emergency in 2016 prompted by overdose deaths, Ahamad said, adding a review of charts by Vancouver Coastal Health has shown a significant proportion of people using opioids are not addicted to them.

"It's alcohol that is their drug of choice and they're drinking alcohol daily and using opioids intermittently and we're doing nothing for their alcohol-use disorder."