Amphetamine-related visits to Ontario emergency departments have skyrocketed over the past two decades, says a recent study published in the Canadian Journal of Psychiatry.
“It’s surprising,” said lead author James Crispo, a postdoctoral researcher in pharmaceutical sciences at the University of British Columbia who lives in Sudbury, Ontario.
The researchers used administrative health data to review emergency department visits for adults in Ontario between January 2003 and December 2020.
They found that the number of emergency room patients suffering from an amphetamine-related condition increased nearly 15-fold during this period.
As they phased out prescription amphetamines, which are sometimes used to treat ADHD, researchers believe that most emergency department visits were specifically due to methamphetamine, or methamphetamine – a street stimulant drug that 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 the number of patients arriving with methamphetamine-related illnesses, said Sarah Konefal, senior research fellow and policy analyst at the Canadian Center on Substance Use and Addiction.
There was also an “uptick” in Quebec, she said.
Atlantic provinces have not seen the same increase in methamphetamine use, Konefal said, as cocaine is “much more prominent” in that region.
doctor Arun Abbi, an emergency physician at Foothills Medical Center and the Peter Lougheed Center in Calgary, said they began to see an influx of patients who took methamphetamine well before Ontario hospitals.
Patients are “agitated” and are often taken to the emergency room by the police “because they are hallucinating and paranoid, sometimes screaming,” Abbi said.
Methamphetamine-induced psychosis is a big problem, he said.
“When you look at our psychiatric ward, often 50 percent of the people admitted for short stays are methamphetamine-induced psychosis,” he said.
“It often affects our flow of mental health patients because we often keep a lot of mental health patients in Emerg because there is no inpatient capacity.”
Many people who use methamphetamine are marginalized, Konefal said.
Homeless people, for example, may use methamphetamine “to stay awake (to) put their belongings away,” she said.
Abbi said this matches what he sees in practice. He estimates that the vast majority of patients who come to the hospital for methamphetamine are homeless.
Another key issue across the country is that people often use more than one drug, mixing a stimulant — such as methamphetamine or cocaine — with an opioid such as fentanyl, Konefal said.
This can be intentional or unintentional, she said, and can lead to overdoses. People may not realize that the methamphetamine or cocaine they are consuming is laced with fentanyl. Or, they may mistakenly believe that taking a stimulant drug will counteract an opioid overdose.
In fact, “combining opioids and stimulants can often make someone more likely to overdose because one masks the other,” she said, leading someone to take too much opioid because they aren’t feeling the effects.
The Ontario emergency department study found that about a third of people who take amphetamines also use opioids, Crispo said.
“This is a polysubstance use issue,” he said.
“Whether it’s opioids or amphetamines, I think we have a problem. And that problem needs critical investment.”
Some of that investment needs to go into 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 is no long-term treatment to help patients manage meth cravings, Abbi said.
Emergency physicians can only provide short-term relief by sedating patients suffering from methamphetamine psychosis and discharging them when they are stable, he said, noting that more residential care services — along with access to housing — are needed in the community.
One of the limitations of the Ontario emergency department study, Crispo said, was that if someone didn’t have a health card, their data wasn’t included in the study.
That means some vulnerable or transient patients may not have been counted — and the increase in amphetamine-related emergency room visits could be even greater than the study suggests.
“It’s probably an understatement of what’s really going on,” Crispo said.
This report by The Canadian Press was first published on March 15, 2023.
Canadian Press health coverage is supported through a partnership with the Canadian Medical Association. CP is solely responsible for this content.