Meth use in Canada: Emergency room visits up

Amphetamine-related visits to emergency departments in Ontario have skyrocketed over the past two decadesaccording to a recent study published in the Canadian Journal of Psychiatry.

“It’s amazing,” said lead author James Crispo, a postdoctoral researcher in pharmaceutical sciences at the University of British Columbia, based in Sudbury, Ont.

Researchers used health administrative data to review emergency department visits for adults in Ontario between January 2003 and December 2020.

They found that the number of ER patients suffering from amphetamine-related illnesses increased nearly 15-fold during that period.

Because they excluded prescription amphetamines, which are sometimes used to treat ADHD, the researchers believe most emergency department visits were due to methamphetamine, or meth, a stimulant street drug that is becoming increasingly popular in Canada. :

The study showed a particularly sharp increase between 2015 and 2020.

Emergency departments in western Canada and the Prairies have also seen a sharp increase in patients arriving with paw-related illness, said Sarah Konefall, senior research and policy analyst at the Canadian Center on Substance Use and Addiction.

He said there has also been an “uptick” in Quebec.

The Atlantic states have not seen the same increase in meth use, Konefall said, because cocaine is “much more popular” in that region.

Dr. Arun Abbey, an emergency physician at Foothills Medical Center and the Peter Luffid Center in Calgary, said they started seeing an influx of patients taking meth long before Ontario hospitals.

Patients are “agitated” and often brought to the emergency room by police “because they’re hallucinating and paranoid, sometimes screaming,” Abbey said.

Meth-induced psychosis is a huge problem, he said.

“When you look at our psychiatric unit, often 50 percent of short-stay admissions are meth 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 are no inpatient facilities.”

Many people who use methamphetamine are marginalized, Konefall said.

People who are homeless, for example, may use meth “to keep (their stuff) awake,” he said.

Abby said this is consistent with what she sees in practice. He estimates that the vast majority of patients who come to the hospital for meth are homeless.

Another major problem across the country is that people often use more than one drug, mixing stimulants like meth or cocaine with opioids like fentanyl, Konefall said.

It can be intentional or unintentional, he said, and can lead to overdoses. People may not realize that the meth or cocaine they are taking contains fentanyl. Or, they may mistakenly believe that taking a stimulant medication will reverse an opioid overdose.

In fact, “the combination of opioids and stimulants can make it more likely overall that someone will experience an overdose because one is masking the other,” he said, leading someone to overdose on an opioid because they don’t feel the effects.

A study by an Ontario emergency department found that about a third of amphetamine users were also using opioids, Crispo said.

“This is a multi-material issue,” he said.

“Whether it’s opioids or amphetamines, I think we have a problem. And this issue needs significant investment.”

Some of that investment should go toward research into how to treat methamphetamine use disorders, Crispo said.

While medications, including methadone and Suboxone, are available to ease opioid withdrawal symptoms, there is no such long-term treatment to help patients manage meth cravings, Abbey said.

Emergency physicians can only provide short-term care by sedating patients with metapsychosis and then discharging them when they are stable, he said, noting that more residential treatment services are needed in the community, along with access to housing.

One of the limitations of the Ontario Emergency Department study, Crispo said, is that if someone did not have a health card, their data was not included in the study.

That means some vulnerable or transient patients may not be counted, and the increase in amphetamine-related emergency visits may be even greater than the study suggests.

“That’s probably an understatement of what’s actually going on,” Crispo said.

This report by The Canadian Press was first published on March 15, 2023.

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