Opioids Substances Misuse Report 2016 Q4

Alberta Health
Opioids and Substances of Misuse

Alberta Report, 2016 Q4
February 7, 2017
Alberta Health, Health Standards, Quality, and Performance
Opioids and Substances of Misuse, Alberta Report, 2016 Q4 February 7, 2017
Opioids and Substances of Misuse Alberta Report

2016 Q4
Key points
From January to December 2016, 343 individuals died from an apparent drug overdose related to
fentanyl in Alberta (including 22 cases where carfentanil was involved).
In 2016, of the 343 drug overdose deaths related to fentanyl, 70 deaths occurred in the first
quarter, 81 in the second, 81 in the third, and 111 in the fourth. By comparison, in 2015 there were
257 deaths related to fentanyl, with 73 occurring in the first quarter, 66 in the second, 66 in the
third, and 52 in the fourth.
The majority of deaths (89%) in 2016 occurred in larger urban centers. 83 per cent of the deaths
in 2015 occurred in larger urban centers.
From Jan-Dec 2016, the rate of drug overdose deaths related to fentanyl in the Calgary Zone was
9.3 per 100,000 (n=150), and 8.1 in the Edmonton Zone (n=109).
The majority of drug overdose deaths related to fentanyl that occurred in the cities of Edmonton
and Calgary occurred outside of the central urban core (85%).
Approximately 25 per cent of deaths that occurred in the cities of Edmonton and Calgary were
among individuals with no fixed address or an unknown home address.
From Jan. 1, 2014 to September 30, 2016 there were (approximately) 19,930 emergency and
urgent care visits related to opioids and other substances of misuse, averaging 1,812 visits per
quarter.
These emergency and urgent care visits occurred among (approximately) 13,970 unique
individuals, of whom, 22 per cent had more than one visit. There has been an increase in the
number of visits over time, with 53 per cent more in the third quarter of 2016 compared to the
third quarter of 2014.
From Jan. 1, 2014 to Dec. 31, 2016, the quarterly opioid dispensations from community
pharmacies increased by 23 per cent to approximately 1,034,000 in the Q4 of 2016.
From Jan. 1, 2014 to Dec. 31, 2016, a quarterly average of approximately 12 per cent of people
with an opioid dispensation from a community pharmacy were dispensed an oral morphine
equivalence (OME) greater than 200 mg per day.
2017 Government of Alberta Page 1

Disclaimer
This surveillance report presents emergency department, prescriptions from community pharmacies,
emergency medical services, and mortality data associated with opioids and other substances of
misuse in Alberta. Results are subject to change based on differences in reporting schedules and
updates from the various data systems.
The majority of data is presented on a quarterly basis from Jan. 1, 2014 (unless specified
otherwise) and includes the most recent quarterly data available at the time the report is
created. Data sources are updated at differing time periods. Data may change in later reporting as it
is submitted by the medical examiner, health facilities, and pharmacies. Recent data may be less
complete due to delays in data submission. Emergency department data can have up to a three
month lag and therefore, the most recent quarter is not included for this data.
Mortality data is subject to change as certification of deaths can take up to six months. Deaths in this
report includes Albertans who died from an apparent drug overdose related to fentanyl and apparent
drug overdose deaths related to an opioid other than fentanyl.
Due to the complexity of non-fentanyl opioid related drug overdose deaths, and the ongoing
investigations necessary to reliably attribute cause of death in these cases, there is no Q4 data
available for non-fentanyl opioid drug overdose deaths in this issue of the report.
The number of apparent drug overdose deaths related to fentanyl/opioids may change
(including increases/decreases in previous numbers) as certification of cause of death may
lead to a change in classification in some instances.
Throughout this report:
Q1 =January to March
Q2 = April to June
Q3 = July to September
Q4 = October to December
Edmonton census metropolitan area (CMA) includes: City of Edmonton, Fort Saskatchewan,
Lancaster Park, Leduc, Sherwood Park, Spruce Grove, St. Albert, and Stony Plain
Calgary census metropolitan area (CMA) include: City of Calgary, Airdrie, Black Diamond,
Cochrane, High River, and Okotoks
Oral Morphine Equivalence (OME) is a relative measure of the strength of an opioid in comparison
to the strength of morphine. Cut offs of 90 and 200 OME were used for the purpose of this report as
these are often used as benchmarks to indicated higher doses than would typically be clinically
indicated.
For more details on data sources and methods, please see the Data notes section at the end of this
report.

Mortality data
Figure 1: Number of individuals who died from an apparent drug overdose related to fentanyl, by
zone (based on place of death) and quarter. Jan. 1, 2014 to Dec. 31, 2016.
120 800
North
700
100
Femtanyl related deaths
Edmonton
Central 600
80
Cumlative total deaths

Calgary 500
South
60 Cumulative total
400
300
40
200
20
100
0 0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2014 2014 2014 2014 2015 2015 2015 2015 2016 2016 2016 2016
Since Jan. 1, 2014, a total of 717 Albertans died from an apparent drug overdose related to
fentanyl, with an average of 60 per quarter.
Total
Calgary Zone 6 5 6 13 28 18 22 14 30 38 37 44 261
Central Zone 1 1 4 7 7 11 12 4 11 5 5 16 84
Edmonton Zone 6 8 8 13 17 16 20 19 17 25 31 36 216
North Zone 5 4 10 9 17 19 7 9 8 11 3 8 110
South Zone 1 5 2 3 4 2 5 6 4 2 5 5 44
Unknown 0 0 0 0 0 0 0 0 0 0 0 2 2
Total 19 23 30 45 73 66 66 52 70 81 81 111 717
Q1 2014
Q2 2014
Q3 2014
Q4 2014
Q1 2015
Q2 2015
Q3 2015
Q4 2015
Q1 2016
Q2 2016
Q3 2016
Q4 2016
Note: There are some instances where the individual did not have a place of death address identified. Therefore, some
deaths were not assigned to an Alberta location and labeled unknown.

Figure 2: Rate of deaths per 100,000 due to an apparent drug overdose related to fentanyl, by place
of death, by Zone & number of deaths in major urban centers* 20142016
2014 2015 2016
Total AB deaths: 117|AB rate: Total AB deaths: 257 |AB rate: Total AB deaths: 343 |AB rate:
2.9 6.1 8.1
Deaths in urban centers: 88 Total deaths
Deaths in urban
to date centers:
since 213 717 Deaths in urban centers: 305
Jan 1, 2014:
The rate of deaths per 100,000 due to an apparent drug overdose related to fentanyl increased by
110 per cent from 2014 to 2015, and by 33 per cent from 2015 to 2016.
Compared to Edmonton CMA, Calgary CMA had 38 per cent more apparent drug overdose
deaths related to fentanyl in 2016.
From 2014 to 2016, 85 per cent (606) of these deaths occurred in larger urban centers. Fort
McMurray (35), Grand Prairie (36), Red Deer (39), Medicine Hat (10), Lethbridge (22), Edmonton
CMA (215), Calgary CMA (249).
Note: Coloured (orange-red) Zones represent fatality rate per 100,000 and blue circles represent number of deaths in major
urban centers.
* Fort McMurray, rand Prairie, Red Deer, Medicine Hat, Lethbridge, Edmonton, Calgary, and municipalities within the census
metropolitan area of Edmonton and Calgary.

Figure 3: Proportion of apparent drug overdose deaths related to fentanyl, by central urban core/non-
central core addresses, in the Cities of Edmonton and Calgary, based on the individuals home
address, Jan. 1, 2016 to Dec. 31, 2016.
City of Edmonton
Total deaths 5.4%
included: 92
Central urban core
30.4%
Non central urban core
64.1% No fixed address or

address unknown
City of Calgary
6.5%
20.3%
Central urban core
Total deaths
included: 138
No fixed address or
address unknown
73.2%
Edmonton central urban core: Boyle Street, Central McDougall, McCauley, Oliver, Queen Mary Park, Riverdale, Rossdale
Cloverdale, Garneau, Strathcona , University of Alberta.
Calgary central urban core: Downtown (including the Downtown West End and Downtown East Village), Eau Claire,
Chinatown, Beltline, Connaught/Cliff Bungalow, and Victoria Park.
If an individual had a unknown address, but died in Edmonton or Calgary, they were included as NFA/address unknown.

Figure 4: Proportion of apparent drug overdose deaths related to fentanyl, by central urban core/non-
central core addresses in the Cities of Edmonton and Calgary, based on the place of death, Jan. 1,
2016 to Dec. 31, 2016.
City of Edmonton
Total deaths
included: 95 20.0%
Central urban core

80.0%
City of Calgary
11.4%
Total deaths
included: 140 Central urban core
88.6%
Edmonton central urban core: Boyle Street, Central McDougall, McCauley, Oliver, Queen Mary Park, Riverdale, Rossdale
Cloverdale, Garneau, Strathcona , University of Alberta.
Calgary central urban core: Downtown (including the Downtown West End and Downtown East Village), Eau Claire,
Chinatown, Beltline, Connaught/Cliff Bungalow, and Victoria Park.
There are instances where an individual died in Edmonton or Calgary, but resided outside the cities

Figure 5: Deaths due to an apparent drug overdose related to fentanyl, by sex and age. Jan. 1, 2016
to Dec. 31, 2016.
100
90
80
70
Propostion of fentanyl deaths
60
Female Male
50
40
30
20
10
0
15to19 20to24 25to29 30to34 35to39 40to44 45to49 50to54 55to59 60to64 65to69 70+
80 per cent of deaths due to an apparent drug overdose related to fentanyl were among males.
The majority (48%) of these deaths occurred among males spanning the ages of 2539.

Figure 6: Proportion of deaths due to an apparent drug overdose related to fentanyl, by additional
substances contributing to cause of death. Jan. 1, 2016 to Dec. 31, 2016.
W 18 2%
Prescribable opioid 5%
Benzodiazepines 6%
Heroin 9%
Methamphetamine 15%
Alcohol 18%
Cocaine 25%
Multi-substance (inlcudes at least one other

57%
substances in addition to fentanyl)
0% 10% 20% 30% 40% 50% 60%
Among deaths due to an apparent drug overdose related to fentanyl, multiple substances are
involved in the majority of deaths. The most frequent being cocaine, alcohol, and
methamphetamine.
Note: Out of all reported apparent drug overdose related to fentanyl, 124 had the substances contributing to the cause of
death confirmed.
Prescribable opioid includes: codeine, oxycodone, hydromorphone, tramadol, morphine, and methadone

Figure 7: Proportion of deaths due to an apparent drug overdose related to fentanyl, by medical
history within the 30 days before the date of death. Jan. 1, 2016 to Dec. 31, 2016.
Within 30 days before death
Suboxone dispensed from a community pharmacy 1%
Medical care for pain (physician, inpatient, or

2%
emergency visit)
Methadone dispensed from a community pharmacy 3%
Mental health related visit (physician, inpatient, or

10%
emergency visit)
ED visit related to opioid/substances of misuse 13%
Substance abuse related visit (physician, inpatient, or

16%
emergency visit)
Opioid dispensed from a community pharmacy 24%
Antidepressant/anxiolytic prescribed from a

36%
community pharmacy
0% 5% 10% 15% 20% 25% 30% 35% 40%
Among deaths due to an apparent drug overdose related to fentanyl, the most frequent health
care utilization within the 30 days before the individuals date of death was a dispensation for an
opioid, antidepressant, or anxiolytic, and/or a service related to a mental health or substance
abuse issue.
Note: 134 deaths due to an apparent drug overdose related to fentanyl, had their primary healthcare (PHN) number
available and are therefore included this analysis. The above includes the number of individuals who sought one of the
services at least once. Individuals can be counted in more than one category.

Figure 8: Proportion of deaths due to an apparent drug overdose related to fentanyl, by prescription
opioid related factors within the year before the date of death. Jan. 1, 2016 to Dec. 31, 2016.
OME 200 mg per day 3%
Type of opioid prescribed same as 7%
Opioid dispensed from multiple pharmacies (3 or more) 23%
Opioid prescribed from multiple providers (3 or more) 37%
Morphine prescription 4%
Fentanyl prescription 4%
Tramadol prescription 11%
Hydromorphone prescription 18%
Oxycodone prescription 23%
Codeine prescription 55%
Benzodiazepine prescription 1 week before or after an 56%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Among deaths due to an apparent drug overdose related to fentanyl, almost 60 per cent of the
individuals who had an opioid prescribed in the year before their death, also had a
benzodiazepine prescribed within a week before or after an opioid was prescribed.
Almost 40 per cent of individuals were prescribed an opioid from three or more different health
care providers. In addition, 23 per cent of individuals went to three or more pharmacies for an
opioid prescription.
The most frequent type of opioid prescribed in the year leading up to a drug overdose death that
matched one of the types of opioid that contributed to the cause of death were codeine and
hydromorphone.
Note: The above includes 72 individuals who had at least one opioid prescribed in the year leading up to their death.

Figure 9: Deaths due to an apparent drug overdose related to an opioid other than fentanyl, by
prescription opioid related factors within the year before the date of death. Jan. 1, 2016 to Dec. 31,
2016

Type of opioid prescribed same as 26%
Opioid dispensed from multiple pharmacies (3 or more) 34%
Opioid prescribed from multiple providers (3 or more) 39%
Fentanyl prescription 8%
Tramadol prescription 5%
Morphine prescription 8%
Hydromorphone prescription 11%
Oxycodone prescription 45%
Codeine prescription 63%
Benzodiazepine prescription 1 week before or after an 76%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Among deaths due to an apparent drug overdose related to an opioid other than fentanyl, over 70
per cent of the individuals who had an opioid prescribed in the year before their death, also had a
benzodiazepine prescribed within a week before or after an opioid was prescribed.
Almost 40 per cent of individuals were prescribed an opioid from three or more different health
care provider. In addition, over 34 per cent of individuals went to more than one pharmacy for an
opioid prescription.
The most frequently type of opioid prescribed in the year leading up to a drug overdose death that
matched one of the types of opioid that contributed to the cause of death was oxycodone.
Note: The above includes 38 individuals who had at least one opioid prescribed in the year leading up to their death.

Emergency department visits
Figure 10: Rate of emergency department (ED) visits related to opioid use and other substances of
misuse, by quarter and zone, per 100,000 population. Jan. 1, 2014 to Sept. 30, 2016.
90 Calgary
80 Central
Edmonton
70
North
ED visit rate per 100,000
60
South
50
40
30
20
10
The rate of emergency department visits related to opioid use and substance misuse increased by
an average of six per cent on a quarterly basis from 20142106, and increased by 23 per cent
from the first quarter in 2016 to the third quarter in 2016.
The rate of emergency department visits related to opioid use and substance misuse in the South
Zone was the highest on average; approximately 23 per cent higher the provincial average.
The Edmonton and Calgary zones had the highest number of emergency department visits related
to opioid use and substance misuse, and on average per quarter made up 27 and 29 per cent of
all provincial ED visits related to opioid use and other substances of misuse, respectively.

Figure 11: Proportion of emergency department visits related to accidental poisoning by opioids and
other substances of misuse, by substance and quarter. Jan. 1, 2014 to Sept. 30, 2016.
100%
4% 3% 4%
90% 5% 8% 10%
15% 16%
80% 15% 15% 16%
70%
60%
Per cent of ED visits
50%
40%
30%
20% 43% 43% 43% 41% 41% 40% 36% 36% 35% 36% 36%
10%
0%
Q1 2014 Q2 2014 Q3 2014 Q4 2014 Q1 2015 Q2 2015 Q3 2015 Q4 2015 Q1 2016 Q2 2016 Q3 2016
Opioids Other illicit Cocaine Other narcotics Synthetic narcotics Opium/heroin
(inc. codeine, oxycodone) (i.e. cannabis derivatives) (inc. fentanyl)
Opioids are consistently involved in a significant number of ED visits for accidental poisoning by
opioids and other substances of misuse, averaging 39 per cent per quarter.
The number of ED visits for accidental poisoning by opioids and other substances of misuse
where fentanyl was involved has increased from four per cent in 2014, to 12 per cent in 2015, and
15 per cent in 2016.
Note: Multiple drugs may be involved in the same ED visit; therefore, visits may be counted more than once.

Figure 12: Emergency department visits related to poisoning by opioids and narcotics by cause and
age. Jan. 1, 2014 to Sept. 30, 2016.
100%
Proportion of ED visits for opioid poisoning
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
0 to 4 5 to 14 15 to 24 25 to 39 40 to 64 65 to 84 85 +
Age group
Accidental Intented self harm Adverse reaction during theraputic use Unknown
Among those under the age of five, nearly all opioid poisonings are accidental (97%).
Opioid poisoning as a result of intended self harm was most frequent among youth aged 514
(57%), and decreased as age increased.
Among older individuals, opioid poisoning as a result of an adverse reaction during therapeutic
use occurred most frequently, especially among those 85 and older (54%).

Figure 13: Number of emergency department visits related to opioid and narcotic use, by individuals
opioid prescription status (from a community pharmacy) in the last 12 months, by sex and age. Jan. 1,
2014 to Sept. 30, 2016.
85+
Females-Opioid Rx
80-84
Males-Opioid Rx 75-79
Females-No Opioid Rx 70-74
65-69
Males-No Opioid Rx
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
0-4
900 700 500 300 100 100 300 500 700
ED visits
In general, males had significantly more visits than females across most age groups, most notably
in the age groups spanning 2044 years of age. For both sexes, persons between 2529 years of
age had the most emergency department visits.
On average, 20 per cent of individuals visiting the emergency department for opioid and narcotic
use were taking prescription opioids equivalent to 90 mg of morphine per day in the year leading
up to their ED visit.
Among individuals aged 65 and higher, males were 1.8 times more likely than females to have an
OME of 90 mg or more per day in the year before their ED visit related to opioid and narcotic use.
Oral Morphine Equivalence (OME) is the strength of an opioid equivalent to the strength of morphine. OME is calculated;
OME = strength (in mg) X quantity X OME conversion factor (unique to opioid type).

Emergency Medical Services data
Figure 14: Distribution of Emergency Medical Services (EMS) responses to opioid related events,
Alberta, Jan. 1, 2016 to Dec. 31, 2016.
In 2016, there were 2,267 EMS responses in Alberta to opioid related events. 84 per cent of these
events occurred in the following larger urban centers: City of Calgary (988), City of Edmonton
(812), City of Grande Prairie (53), City of Medicine Hat (61).
Note: This data is from AHS EMS Direct delivery ground ambulance. Air ambulance and Contractors are not included.
There are close to 70 communities serviced by contractors, including Ft. McMurray, Lethbridge, and Red Deer. Therefore not
all EMS activity is captured here. EMS opioid related events refers to any EMS response where the Medical Control Protocol
of Opiate Overdose was documented and/or naloxone was administered.

Figure 15: Distribution of Emergency Medical Services (EMS) responses to opioid related events,
Edmonton and Calgary, Jan. 1, 2016 to Dec. 31, 2016.
Edmonton Calgary
Within the City of Edmonton, the areas with the highest concentration of EMS responses to opioid
related events were the downtown areas, including Central McDougall, McCauley, and Boyle
Street.
Within the City of Calgary, the areas with the highest concentration of EMS responses to opioid
related events were the downtown areas, including the Downtown East Village, Beltline, and
Downtown West End. In addition, the Eastern Central areas had high concentrations, including the
Forest Lawn areas.
Note: This data is from AHS EMS Direct delivery ground ambulance. Air ambulance and Contractors are not included.
Therefore not all EMS activity is captured here. EMS opioid related events refers to any EMS response where the Medical
Control Protocol of Opiate Overdose was documented and/or naloxone was administered.

Opioid dispensing from community pharmacies
Figure 16: Total opioid dispensations from community pharmacies, by sex. Jan. 1, 2014 to Dec. 31,
2016.
1,200,000
Female
Total opioid dispensations
Male
1,000,000
800,000
600,000
400,000
200,000
0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2014 2014 2014 2014 2015 2015 2015 2015 2016 2016 2016 2016
From Jan. 1, 2014 to Dec. 31, 2016, there was a quarterly average of approximately 929,000
opioid dispensations.
The average annual opioid dispensations was approximately 3.7 million representing 637,000
people between 2014-2016
Females were dispensed opioids 1.1 times more than males.

Figure 17: Rate of opioid dispensations from community pharmacies, by sex and age. Jan. 1, 2016
to Dec. 31, 2016.
35000
Female
30000
Dispensations per 10,000 population
Male
25000
20000
15000
10000
5000
0
0to9 10to19 20to29 30to39 40to49 50to59 60to69 70to79 80to89 90+
From Jan. 1, 2016 to Dec. 31, 2016, the dispensation rate for opioids was slightly higher in
females than males less than 50 years old, and significantly higher among females than males 69
years and older.
The dispensation rate for opioids was two times higher in females than males among those aged
90 years and older.

Figure 18: Opioid dispensation rate from community pharmacies, by type and sex. Jan. 1, 2016 to
Dec. 31, 2016.
Females 629 464 BUPRENORPHINE
1,599 1,155 METHADONE

Males
96 166 FENTANYL
423 488 MORPHINE
Opioid Type
769 926 HYDROMORPHONE
1,435 1,570 OXYCODONE
624 998 TRAMADOL
3,500 4,175 CODEINE
68 154 Other
4,500 3,500 2,500 1,500 500 500 1,500 2,500 3,500 4,500
Rate per 10,000 population
Overall, the rate of opioid dispensations for products containing Codeine (e.g., Tylenol 3 and 4)
was the highest across both sexes.

Figure 19: Opioid dispensation rate from community pharmacies, by zone and type. Jan. 1, 2016 to
Dec. 31, 2016.
5,000
4,500
Dispensations per 10,000 population
4,000
3,500
3,000
2,500
2,000
1,500
1,000
500
0
South Calgary Central Edmonton North
CODEINE FENTANYL HYDROMORPHONE MORPHINE
OXYCODONE TRAMADOL METHADONE Other
.
The dispensing rate for codeine containing products was by far the highest throughout the
province.
The South Zone had the overall highest dispensing rates for opioids and on average rates were
50 per cent higher than the provincial average.

Figure 20: The proportion (quarterly average) of people with opioid dispensations from community
pharmacies of >90 OME and >200 OME per day, of those with at least one opioid dispensation.
50%
Proportion of people with Opioid Dispensations
>90 OME per day

45%
>200 OME per day
40%
35%
30%
25%
20%
15%
10%
5%
0%
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
2014 2014 2014 2014 2015 2015 2015 2015 2016 2016 2016 2016
There is a quarterly average of approximately 12 per cent of people with opioid dispensations
>200 OME per day, and 23 per cent of people with opioid dispensations >90 OME per day.
Oral Morphine Equivalence (OME) is the strength of an opioid equivalent to the strength of morphine. OME is calculated;
OME = strength (in mg) X quantity X OME conversion factor (unique to opioid type).

Naloxone kit dispensing
Figure 21: Naloxone kits dispensed through community pharmacies and harm reduction
agencies, by zone. Jan. 1, 2016 to Dec. 31, 2016.
1,200
Community Pharmacies
1,000
Harm Reduction Agencies
Naloxone kits dispensed
800
600
400
200
0
North Zone Edmonton Zone Central Zone Calgary Zone South Zone
As of Dec 31, 2016, 9,572 naloxone kits have been dispensed to Albertans. This includes
distribution from: community pharmacies, Harm Reduction Agencies, provincial correctional
facilities, post-secondary institutions, Opioid Dependency Treatment Clinics, community health
centres, inner city agencies, AHS pharmacies, First Nations reserve communities and urgent care
centres in urban and rural communities.
Throughout the province, with the exception of the Edmonton Zone, Harm Reduction agencies are
dispensing approximately 60 per cent more naloxone kits compared to community pharmacies.
Number of sites registered to distribute naloxone kits

Community Pharmacies Other sites Total
North Zone 79 52 131
Edmonton Zone 247 34 281
Central Zone 89 36 125
Calgary Zone 271 51 322
South Zone 73 21 94
Total 759 194 953

Figure 22: Naloxone kits dispensed through community pharmacies, by zone and month. Jan. 1,
2016 to Dec. 31, 2016.
400 2,500
North
350
Edmonton
2,000
Cumulative total kits dispensed

300 Central
Naloxone kits dispensed
Calgary
250
South 1,500
200 Cumulative total

1,000
150
100
500
50
0 0
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
The Edmonton zone has had the largest volume of Naloxone kits dispensed, with an average of
70 kits per month. The Calgary zone dispensed the next highest volume with an average of 47 kits
per month. Across Alberta, 164 kits were dispensed by community pharmacies a month on
average.
The median age of an individual receiving a Naloxone kit was 35 years, and 57 per cent were
male.
Since Jan 1, 2016, 1,964 naloxone kits have been dispensed from community pharmacies in
Alberta. There were 1,593 unique individuals (of the individuals that submitted a primary
healthcare number) who had a naloxone kit dispensed. Of those, 208 had more than one claim.
Note: Only naloxone kits dispensed from community pharmacies (as submitted into the Pharmaceutical Information
Network) are included in this graph. Naloxone kit distribution occurring from non-pharmacy sites is not captured here.

Data notes
Data source(s) for report
1. Alberta Ambulatory Care database (ACCS)

2. Alberta Health Care Insurance Plan (AHCIP) Quarterly Population Registry Files
3. Alberta Health and Wellness Postal Code Translation File (PCTF)
4. Pharmaceutical Information Network (PIN)
5. Alberta Consolidated Laboratory Database
6. Scheduled monthly release of OMCE fentanyl & opioid fatality data
Mortality data
Mortality statistics are subject to change as certification of deaths can take up to six months due to the
inherent complexity of testing and interpretation of results, which requires specialized knowledge and
must be done by medical examiners and the Chief Toxicologist and Deputy Chief Toxicologist. The
deaths in this report includes Albertans who died from an apparent drug overdose related to fentanyl.
Emergency Medical Services data

Emergency Medical Services (EMS) data comes from AHS EMS Direct delivery ground ambulance
services. Air ambulance and Contractors are not included. AHS direct delivery does 97.7 per cent of
the operational responses in the City of Edmonton, 99.9 per cent in the City of Calgary, and
approximately 82 per cent in the entire province of Alberta. There are close to 70 Alberta communities
serviced by contractors, including Ft. McMurray, Lethbridge, and Red Deer. This data does not reflect
the contract services in those communities.
Note: AHS dispatch manages EMS resources within a borderless system and will move units (direct
delivery/ contractor) to provide coverage and response in any area of the province according to the
respective dispatch centres system status management plan. Therefore, if an AHS Direct delivery
ground unit responded in a community that normally has contracted units stationed in it, this data
would be represented here.
EMS opioid related events refers to any EMS response where the Medical Control Protocol of Opiate
Overdose was documented and/or naloxone was administered.
Emergency visits
Emergency Department (ED) visits are defined by the Alberta MIS chart of accounts. Specifically, the
3 Functional Centre Accounts used to define any ACCS visits into an emergency visit could be:
1. 71310 Ambulatory care services described as emergency
2. 71513 Community Urgent Care Centre (UCC). As of 2014, the UCCs in Alberta are listed below:
Airdrie Regional Health Centre, Cochrane Community Health Centre, North East Edmonton
Health Centre, Health First Strathcona, Okotoks Health and Wellness Centre, Sheldon M
Chumir Centre, South Calgary Health Centre
3. 71514 Community Advanced Ambulatory Care Centre (AACC). As of 2014, the only AACC in
Alberta is La Crete Health Centre
Figure 10: Includes ED visits for all behavioural and mood disorders due to opioid use, and poisoning
by all substances-all causes. (All F11 and T40 ICD-10 codes, any diagnosis field)

Figure 11: Includes ED visits for poisoning by all substances-all causes. (All T40 ICD-10 codes, any
diagnosis field)
Figure 12: Includes ED visits for poisoning by opioids (including methadone), synthetic narcotics
(including fentanyl), and other narcotics-all causes. (T40.2-T40.4, T40.6 ICD-10 codes, any diagnosis
field)
Figure 13: Includes ED visits for all behavioural and mood disorders due to opioid use, poisoning by
opioids (including methadone), synthetic narcotics (including fentanyl), and other narcotics-all causes.
(All F11, T40.2-T40.4, T40.6 ICD-10 codes, any diagnosis field)
All behavioural and mood disorders due to opioid use includes: acute intoxication, harmful
use, dependence syndrome, withdrawal state, psychotic disorder, amnesic state, other and
unspecified disorders.
Poisoning refers to an overdose, or toxic effect.
All substances include: opium, heroine, methadone, other opioids, synthetic narcotics (including
fentanyl), cocaine, other narcotics, cannabis derivatives, LSD, hallucinogens.
Opioid dispensing and oral morphine equivalents
1. The Pharmaceutical Information Network (PIN) Database is used to estimate dispensation rates
for the province between 2014 and 2016 only from community pharmacies. The dispensation
rates presented are not unique and it is possible that one person could have more than one
dispensation of the same drug within a week, month, and/or year. Much of this variability is
dependent on the way the drug is prescribed.
2. The PIN database is up-to-date; To date, the PIN database has records up to Dec. 31, 2016. PIN
records can change due to data reconciliations, which may affect results. Results are more stable
with older data, that is, data in 2015 will experience less changes than data in 2016.
3. Dispensation rates are calculated using the adjusted mid-year population size in 2015 and PIN
data for the current calendar year. To date, the current calendar year is from Dec. 31, 2015 to
Dec. 31, 2016.
4. Oral Morphine Equivalence (OME) is the strength of an opioid equivalent to the strength of
morphine. OME is calculated; OME = strength (in mg) X quantity X OME conversion factor (unique
to opioid type). OME is used to standardize the strength and quantities of various opioids for
purposes of comparison.
5. OME calculations were restricted to drugs administered orally and those with an OME factor.
Other units such as bottles, box, syrups were not included.

Opioids types are defined by ATC Code, as given in the table below.
ATC Code Drug Name ATC Name

N02AA59, N02AA79, R05DA04, Codeine Codeine
R05DA20 1, R05FA02 2, M03BA53,
M03BB53, N02BE51, and N02BA51
R05DA03, R05DA20 3, R05FA02 4 Hydrocodone Hydrocodone
N02AB03, N01AH01 Fentanyl Fentanyl
N02AA03 Hydromorphone Hydromorphone
N02AA01 Morphine Morphine
N02AA05, N02AA55, N02BE51, and Oxycodone Oxycodone
N02BA51
N02AX02, N02AX52 Tramadol Tramadol
N07BC02 Methadone Methadone
N02AA Natural Opium Other
Alkaloids
N02AA02 Opium Other
N02AB02 Pethidine Other
N02AC04,N02AC54 Dextropropoxyphene Other
N01AH03 Sufentanil Other
N01AH06 Remifentanil Other
N01AX03 Ketamine Other
R05DA20 Normethadone Other
N02AD01 Pentazocine Other
N02AE01,N04BC51 Buprenorphine Other
N02AF01 Butorphanol Other
N02AF02 Nalbufine Other
N02AX06 Tapentadol Other
1
The ATC name for R05DA20 is combinations which include drugs that contain codeine, hydrocodone, and normethadone
hydrochloride. Classifications of codeine and hydrocodone were based on both drug identification number and ATC code.
2
The ATC name for R05FA02 is opium derivatives and expectorants which include drugs that contain codeine and
hydrocodone. Classifications of these drugs were based on both drug identification number and ATC code.
3
See footnote #1
4
See footnote #2

Opioids Substances Misuse Report 2016 Q4

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Alberta Health

Opioids and Substances of Misuse

Opioids and Substances of Misuse Alberta Report

2017 Government of Alberta Page 1

2017 Government of Alberta Page 2

Cumlative total deaths

Edmonton Zone 6 8 8 13 17 16 20 19 17 25 31 36 216

North Zone 5 4 10 9 17 19 7 9 8 11 3 8 110

2017 Government of Alberta Page 3

2014 2015 2016

2017 Government of Alberta Page 4

64.1% No fixed address or

2017 Government of Alberta Page 5

Central urban core

2017 Government of Alberta Page 6

2017 Government of Alberta Page 7

Multi-substance (inlcudes at least one other

0% 10% 20% 30% 40% 50% 60%

2017 Government of Alberta Page 8

Within 30 days before death

Suboxone dispensed from a community pharmacy 1%

Medical care for pain (physician, inpatient, or

Methadone dispensed from a community pharmacy 3%

Mental health related visit (physician, inpatient, or

ED visit related to opioid/substances of misuse 13%

Substance abuse related visit (physician, inpatient, or

Opioid dispensed from a community pharmacy 24%

Antidepressant/anxiolytic prescribed from a

0% 5% 10% 15% 20% 25% 30% 35% 40%

2017 Government of Alberta Page 9

Within 365 days before death

OME 200 mg per day 3%

OME 90 mg per day 7%

Type of opioid prescribed same as 7%

Opioid dispensed from multiple pharmacies (3 or more) 23%

Opioid prescribed from multiple providers (3 or more) 37%

Tramadol prescription 11%

Hydromorphone prescription 18%

Oxycodone prescription 23%

Codeine prescription 55%

Benzodiazepine prescription 1 week before or after an 56%

2017 Government of Alberta Page 10

Within 365 days before death

OME 90 mg per day 26%

Type of opioid prescribed same as 26%

Opioid dispensed from multiple pharmacies (3 or more) 34%

Opioid prescribed from multiple providers (3 or more) 39%

Hydromorphone prescription 11%

Oxycodone prescription 45%

Codeine prescription 63%

Benzodiazepine prescription 1 week before or after an 76%

2017 Government of Alberta Page 11

Emergency department visits

2017 Government of Alberta Page 12

2017 Government of Alberta Page 13

2017 Government of Alberta Page 14

2017 Government of Alberta Page 15

Emergency Medical Services data

2017 Government of Alberta Page 16

2017 Government of Alberta Page 17

Opioid dispensing from community pharmacies

2017 Government of Alberta Page 18

2017 Government of Alberta Page 19

Females 629 464 BUPRENORPHINE