Ontarians’ life expectancy is flattening, mainly due to a steep increase in opioid-related deaths.
Life expectancy in Ontario is levelling off after years of steady improvement, a change that is largely attributed to a sharp increase in deaths from opioid poisoning. As well, population health risks such as smoking, obesity, and heavy drinking have the potential to shorten Ontarians’ lifespans in the future.
Opioid-related deaths in Ontario have nearly doubled in three years and tripled over the last 12 years, rising to 10.2 per 100,000 population in 2018, from 5.3 in 2015 and 3.4 in 2006. That’s a total of 1,473 * preliminary number, September 2019 opioid poisoning deaths in 2018, up from 728 in 2015, and 436 in 2006.
When opioids are prescribed, it’s usually for managing pain. However, their use carries risks that include addiction, overdose and death. While opioid-related deaths are often a consequence of using drugs obtained from illicit sources, 1 Government of Canada, Government of Canada Actions on Opioids: 2016 and 2017. Available from: https://www.canada.ca/en/health-canada/services/publications/healthy-living/actions-opioids-2016-2017.html health care professionals can help reduce people's exposure to the risks of opioids by starting patients on them less often, at lower doses and for shorter periods of time, if appropriate.
This is not just an Ontario issue – other provinces and some other countries are also seeing decreases in life expectancy and striking increases in opioid deaths. An Organisation for Economic Co-operation and Development (OECD) report on the opioid crisis found that the U.S. and Canada had the highest rates of opioid-related deaths among 25 OECD countries for which data are available. 2 Addressing Problematic Opioid Use in OECD Countries. Available from: https://www.oecd-ilibrary.org/social-issues-migration-health/addressing-problematic-opioid-use-in-oecd-countries_a18286f0-enOECD (2019). A 2019 report found that increases in life expectancy have recently stalled, citing an increase in accidental opioid poisoning as one of the contributors. 3 https://www.bma.org.uk/-/media/files/pdfs/about%20the%20bma/how%20we%20work/divisions/pre%20arm%20briefings/2%20pre%20arm%20briefing%20-%20life%20expectancy.pdf?la=en 4 BMJ, August 2018. Recent trends in life expectancy across high income countries: retrospective observational study. Available from https://www.bmj.com/content/362/bmj.k2562
Suicide rates are rising among children and youths. In 2016, there were 6.6 deaths by suicide per 100,000 population aged 10 to 24, compared to 4.8 in 2013.
Ontarians’ health is at risk from smoking, obesity, and heavy drinking. More than 1 in 7 Ontarians aged 12 and older (15.3%) reported smoking cigarettes in 2017, while just over 1 in 4 (25.5%) of those aged 18 or older were obese 5 Obesity rates are based on adjusted self-reported weight and height , and about 1 in 6 (18.0%) aged 12 and older reported being heavy drinkers.
Learn more about what health care professionals are doing to improve care for patients with pain: https://hqontario.ca/Quality-Improvement/Practice-Reports/Partnered-Supports-for-Helping-Patients-Manage-Pain
Minimizing opioids after surgery
Read Dierdre and Dr. Lisi’s Story
Before she underwent colon surgery at Collingwood General and Marine Hospital, Deirdre decided she wanted to manage her post-surgery pain without any opioids. The 68-year-old former teacher had been given opioids after two other surgeries in the past, didn’t like the way they made her feel, and worried about becoming dependent on them.
Deirdre knew from her own research that some people who are prescribed opioids after surgery end up staying on them for many months or even years. She discussed the issue with her surgeon, Dr. Michael Lisi, who is also the hospital’s chief of staff, and they came up with a plan to manage her post-surgical pain without a prescription for opioids.
Deirdre’s colon surgery took a little longer than expected, but everything went well. She left the hospital the next day to return to her home in Creemore, with two non-opioid medications for pain. “That was all I had, and it was all I needed,” Deirdre says.
Dr. Lisi says Deirdre’s experience is an example of early success in the hospital’s new program to reduce unnecessary opioid prescribing after common surgeries, which is part of a province-wide surgical quality improvement campaign among 47 hospitals in Ontario. Many post-operative patients leave Collingwood General and Marine Hospital with a prescription for a small amount of opioids, consistent with Health Quality Ontario’s quality standard on opioid prescribing for acute pain, and some patients like Deirdre choose to avoid opioids altogether.
In some areas of the Simcoe Muskoka region, including Collingwood, emergency department visits for opioid poisoning are much higher than the Ontario average because people have become addicted to them. “Although not just a surgical issue, surgery does play a role in the opioids problem because it’s how many patients are first exposed to them,” Dr. Lisi says.
Collingwood General and Marine Hospital’s opioids reduction strategy educates patients about their expectations for pain, reviews the risks of opioids, and develops strategies for taking fewer opioid pills post-surgery or managing pain without opioids, by using other types of non-opioid medications and therapies. The program also provides health care providers with education on opioid prescribing practices.
Early results of the initiative showed a substantial reduction in the percentage of patients who were prescribed opioids after surgery. Dr. Lisi reports that the rates of opioid prescribing after day surgery dropped to 28% from 59% before the program started, and to 47% from 90% for patients admitted to the hospital.
Two months after her surgery, Deirdre says she’ll soon be cleared to get back to the gym to work out. “I can’t wait,” she says.
Patients, families and the public are central to improving health quality.
Are you passionate about quality health care for all Ontarians? Stay in-the-know about our newest programs, reports and news.