Unintended consequences of COVID-19: Impact on harms caused by substance use, self-harm and accidental falls

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December 9, 2021 — Canadians are experiencing prolonged public health measures during the COVID-19 pandemic. While these measures are intended to restrict the spread of COVID-19, they may also be leading to unintended consequences. Surveys have found declining mental health among Canadians during the pandemic due to high levels of anxiety and loneliness, and changes to the care they were able to access.Reference1, 2 Many of those surveyed reported that their substance use increased, with 30% reporting increased alcohol consumption and 40% reporting increased cannabis use. As well, at least 5% reported seriously considering suicide.Reference3 This analysis tells the story of 3 selected unintended consequences of the pandemic: harms caused by substance use, self-harm behaviours and accidental falls that require care at a hospital (emergency department or inpatient care). 

Hospitalizations increased for harms caused by substance use

While hospitalizations for most other conditions declined during the first 16 months of the pandemic period (March 2020 to June 2021), hospitalizations for harms caused by substance use rose by 9%. The increase, totalling more than 16,000 additional hospitalizations, was largest in the later stages of the pandemic period (October 2020 to June 2021). Overall, there were about 190,000 hospitalizations for harms caused by substance use during the entire pandemic period.

Change in hospitalizations for harms caused by substance use, March 2020 to June 2021

Month All hospitalizations Hospitalizations for substance use
March 2020 -11% 1%
April 2020 -33% -15%
May 2020 -25% 3%
June 2020 -12% 17%
July 2020 -3% 14%
August 2020 -6% 9%
September 2020 -3% 14%
October 2020 -6% 12%
November 2020 -8% 13%
December 2020 -8% 14%
January 2021 -12% 11%
February 2021 -9% 18%
March 2021 -3% 23%
April 2021 -5% 16%
May 2021 -15% 4%
June 2021 -16% -2%

Notes
Substances included in this analysis are alcohol, opioids, cannabis, cocaine, other central nervous system stimulants (e.g., amphetamines), other central nervous system depressants (e.g., benzodiazepines), other substances, and unknown and multiple substances.
Quebec data is not available for hospitalizations.
Discharge Abstract Database and National Ambulatory Care Reporting System: Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data.
Ontario Mental Health Reporting System (OMHRS): Provisional data submitted as of September 1, 2021.
Emergency department data was used to validate harms caused by substance use in the OMHRS data set. See notes to readers in the data tables for more information.

Sources
Discharge Abstract Database, National Ambulatory Care Reporting System and Ontario Mental Health Reporting System, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for Health Information.

There are known social inequities related to harms from substance use. In a typical year, people from the lowest-income neighbourhoods experience more harms from substance use than people from the highest-income neighbourhoods. This inequity has been more pronounced during the COVID-19 pandemic, with hospitalizations for harms caused by substance use increasing the most in the lowest-income communities (13%) compared with the highest-income communities (5%). These findings may reflect the uneven burden of the pandemic on those who use substances.Reference4 

In contrast, emergency department visits due to harms caused by substances remained similar to pre-pandemic (2019) levels, while overall emergency department visits declined. One of the notable exceptions is for alcohol harms, where a marked decrease in emergency department visits was observed.

Patterns of care for alcohol harms changed for youth and middle-aged adults

Emergency department visits for alcohol harms dropped by 9% during the pandemic period. The decreases were most pronounced among younger age groups, dropping 36% among those age 10 to 19 and 18% among those age 20 to 29. These decreases may be due to closures of bars and restaurants, reductions in social interactions and parties, and youth being at home under parental supervision.Reference5 

In contrast, hospitalizations due to alcohol harms rose by 10% during the pandemic. The increase was more pronounced among middle-aged adults (22% increase for those age 30 to 39). Furthermore, hospitalizations increased more for conditions that can be attributed to chronic alcohol use. For example, there were almost 4,300 additional hospital stays for chronic medical conditions related to alcohol, such as liver diseases, and almost 8,000 additional hospitalizations for mental and behavioural disorders due to alcohol use.

Increases in opioid- and cannabis-related harms differed by gender

From October 2020 to June 2021, opioid-related harms showed a notable increase — up 36% for emergency department visits and 30% for hospitalizations. During the pandemic period, men experienced a larger increase in harms from opioids — 33% more hospitalizations compared with a 5% increase for women. It should be noted that our data includes only those who sought or survived to receive care in hospital. The Public Health Agency of Canada reported an 88% increase in opioid toxicity deaths from April 2020 to March 2021 relative to the same period prior to the pandemic.Reference6 This has been attributed to an increasingly toxic drug supply; increased feelings of isolation, stress and anxiety; and limited availability of or access to services.

From October 2020 to June 2021, there was a notable increase in cannabis-related emergency department visits and hospitalizations (14% each). In total, there were about 25,000 hospitalizations for cannabis-related harms from March 2020 to June 2021. Increases in emergency department visits for cannabis harms were higher for women (21%) compared with men (6%).

Change in emergency department visits and hospitalizations for opioid and cannabis harms, by gender, March 2020 to June 2021

 
Type of care Male Female
Emergency department visits for opioids 29% 13%
Hospitalizations for opioids 33% 5%
Emergency department visits for cannabis 6% 21%
Hospitalizations for cannabis 10% 12%

Notes
For emergency department data, full regional coverage is available for Quebec, Ontario, Alberta and Yukon. Partial regional coverage is available for Prince Edward Island, Nova Scotia, Saskatchewan and British Columbia.
Quebec data is not available for hospitalizations.
Discharge Abstract Database and National Ambulatory Care Reporting System: Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data.
Ontario Mental Health Reporting System (OMHRS): Provisional data submitted as of September 1, 2021.
Emergency department data was used to validate harms caused by substance use in the OMHRS data set. See notes to readers in the data tables for more information.

Sources
Discharge Abstract Database, National Ambulatory Care Reporting System and Ontario Mental Health Reporting System, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for Health Information.

Increases in care for self-harm for young females

The pandemic has also impacted patterns of hospital care for self-harm. There were decreases in emergency department visits (7%) and in hospitalizations (6%) for self-harm from March 2020 to June 2021, compared with before the pandemic, with larger decreases in the first few months. 

The impact of the pandemic on those requiring care for self-harm varied by age and gender. Females age 10 to 24 saw overall increases in care for self-harm, mostly in the later months of the pandemic period, with a 10% increase in emergency department visits and a 12% increase in hospitalizations from October 2020 to June 2021. These young females also represented the largest group seeking care for self-harm during the pandemic, accounting for almost 40% of all emergency department visits and more than 30% of all hospitalizations overall.

Change in emergency department visits and hospitalizations for self-harm, females age 10 to 24, March 2020 to June 2021

Month Emergency department visits Hospitalizations
March 2020 -3% -8%
April 2020 -20% -33%
May 2020 -20% -23%
June 2020 -11% -16%
July 2020 12% 9%
August 2020 -10% 12%
September 2020 21% 6%
October 2020 4% 9%
November 2020 -3% -12%
December 2020 7% 1%
January 2021 7% -1%
February 2021 -3% 2%
March 2021 33% 24%
April 2021 39% 10%
May 2021 14% 38%
June 2021 10% 22%

Notes
For emergency department data, full regional coverage is available for Ontario, Alberta and Yukon. Partial regional coverage is available for Prince Edward Island, Nova Scotia and Saskatchewan.
Quebec data is not available for hospitalizations.
Discharge Abstract Database and National Ambulatory Care Reporting System: Data for March 2020 to March 2021 is closed. Data for April to June 2021 is provisional and is subject to change; this data should be interpreted with caution. Learn about how to use CIHI’s provisional health data.
Ontario Mental Health Reporting System (OMHRS): Provisional data submitted as of September 1, 2021.
Emergency department data was used to validate self-harm in the OMHRS data set. See notes to readers in the data tables for more information.

Sources
Discharge Abstract Database, National Ambulatory Care Reporting System and Ontario Mental Health Reporting System, January to December 2019 (pre-pandemic baseline data) and March 2020 to June 2021 (pandemic data), Canadian Institute for Health Information.

It is important to remember that, for self-harm, our data does not capture deaths that occur outside of hospital or care provided in the community. This analysis provides a high-level indication of whether Canadians are getting access to the mental health care they need during the pandemic. Changes in self-harm hospitalizations and emergency department visits, particularly among young adults, will need to continue to be monitored.

The third story of unintended consequences of the pandemic is about accidental falls. Overall, there was a decrease in emergency department visits (22%) and hospitalizations (4%) for accidental falls during the pandemic period compared with pre-pandemic levels in 2019. The largest decreases were seen for those age 5 to 19. For more information about accidental falls, please see the data tables.

What we don’t know from this information

  • Were supervised consumption sites Reference7 and other harm reduction programs able to continue operating during the pandemic?
  • Are the changes in care for self-harm linked to changes in suicide rates during the pandemic?

Featured resources

Impact of COVID-19 on Harms Caused by Substance Use

​These data tables contain information on emergency department (ED) visits and hospitalizations from 2 periods: pre-pandemic and pandemic, to help understand the impact of COVID-19 on harm caused by substance use in Canada.

Download data tables (XLSX)

Impact of COVID-19 on Self-Harm Behaviour

​​These data tables contain information on emergency department (ED) visits and hospitalizations from 2 periods: pre-pandemic and pandemic, to help understand the impact of COVID-19 on intentional self-harm in Canada. 

Download data tables (XLSX)

Impact of COVID-19 on Accidental Falls in Canada

​These data tables contain information on emergency department (ED) visits and hospitalizations from 2 periods: pre-pandemic and pandemic, to help understand the impact of COVID-19 on accidental falls in Canada.

Download data tables (XLSX)

 

How to cite:

Canadian Institute for Health Information. Unintended consequences of COVID-19: Impact on harms caused by substance use, self-harm and accidental falls. Accessed March 28, 2024.

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