Hospital stays for substance use harms increased during the first months of the COVID-19 pandemic

During the first months of the pandemic in Canada, about 1 out of every 3 people age 16 and older reported increased alcohol consumption — with alcohol consumption rates higher among respondents with mental health and substance use concerns — according to a survey conducted by the Canadian Centre on Substance Use and Addiction (CCSA). A separate survey found that boredom and stress were the most cited reasons for increased drinking.

• Mental Health and Substance Use During COVID-19: Summary Report External link, opens in new window
• Boredom and Stress Drives Increased Alcohol Consumption During COVID-19: NANOS Poll Summary Report External link, opens in new window

However, CIHI data showed that visits to emergency departments (EDs) for less-serious alcohol-related conditions such as alcohol intoxication decreased. The decrease was greatest among younger age groups (those age 10 to 29). According to experts, this was likely due to bars being closed and restrictions being placed on large gatherings.

“We know from previous studies that 75% of youth who drink to such a level that they end up in the ED consumed high-alcohol-content beverages such as spirits,” said Catherine Paradis, senior research and policy analyst at CCSA. “These types of beverages are sometimes part of low-priced promotions in bars. The limited access to spirits, bottle service and other promotions that encourage the consumption of alcohol seems to have had a direct impact on the number of younger Canadians going to the hospital for intoxication.”

Paradis said that as restrictions on bars and large gatherings begin to lift, “we will need to remind folks of basic preventive measures to avoid excessive drinking. It will be interesting to see if hospital visits will jump shortly after everything starts to really open up again.”

Compared with other substances, alcohol is a social product, and what we’ve been seeing since the onset of the pandemic is that with bars closed and parties shut down, there has been a decrease in ED visits by younger people. — Catherine Paradis, Senior Research and Policy Analyst, Canadian Centre on Substance Use and Addiction

The latest data from CIHI’s Shared Health Priorities indicators shows that alcohol contributed to more than half of hospital stays for harm caused by substance use in 2019–2020.

ED visits and hospitalizations for opioid-related harms increased between March and September 2020, compared with the same period in 2019.

“It is not uncommon for people who use substances to use more than one at a time, which increases the risk of overdose. For instance, we see that among accidental opioid toxicity deaths, the majority also involved a stimulant such as methamphetamine or cocaine,” said Vera Grywacheski, senior epidemiologist in the Substance-Related Harms division of the Public Health Agency of Canada.

The proportion of hospital stays for stimulants has been increasing since 2017 — this trend began in Western Canada and has since moved to the eastern parts of the country.

Stimulants accounted for 14% of hospital stays in 2019–2020, compared with 11% in 2017–2018.

Temporary closures of harm reduction programs, substance-related therapies and other services meant that fewer mental health and addictions resources were available. This likely led to increased opioid-related harms during the pandemic.

Throughout 2020, the overdose crisis worsened across Canada. Our most recent quarterly data showed the highest recorded number of people who died from opioid-related overdoses since surveillance began in 2016. This could be due to the drug supply becoming more toxic during the COVID-19 pandemic, people using drugs alone, changes in services for people who use substances and people feeling more isolated. — Vera Grywacheski, Senior Epidemiologist, Substance-Related Harms Division, Public Health Agency of Canada

More than a third of adults who are hospitalized for harm caused by substance use also have a mental health condition such as anxiety, depression or schizophrenia.

Lisha Di Gioacchino, who required hospital care for opioid, cocaine and alcohol toxicity in the early months of the pandemic, said she would have benefitted from better access to care in the community.

“There were a lot of changes in my home caused by working-from-home orders and recurrence in mental disorder symptoms,” said Di Gioacchino. “This — in combination with losing access to in-person counselling, group programs and peer support — was difficult for me and contributed to my substance use disorder symptoms, which were managed well before the COVID-19 outbreak.”