Hospital visits attributed to alcohol and drug abuse increased by 63 per cent in the Greater Vancouver area over just four years ending in 2013, and visits to St. Paul’s Hospital in downtown Vancouver for substance abuse increased by a whopping 89 per cent over the same period, according to provincial government figures.

And despite dire headlines about opioid addiction and IV drug use, alcohol is driving most of the increase.

According to a national report released this weekend by the Canadian Centre on Substance Abuse, alcohol accounts for about 10 times more hospital costs than all other substances combined, and the number of hospital stays due to alcohol abuse is growing three times faster than for all other drugs combined.

Dramatic increases in hospital visits associated with alcohol abuse appear to be in lockstep with increasing access to alcohol in the retail market, said Evan Wood, Medical Director for Addiction Services at Vancouver Coastal Health and Physician Program Director for Addiction at Providence Health Care, which operates St. Paul’s Hospital.

“The biggest issue in British Columbia is availability,” said Wood. “There is an excellent study that looks at how deregulation and privatization of alcohol sales have led to an increase in alcohol-related mortality in B.C.”

The study, published in the scientific journal Addiction, found that for every 20-per-cent increase in the density of private liquor stores, alcohol-related deaths increased 3.25 per cent.

As part of a sweeping regulatory liberalization, B.C. is set to expand liquor sales to grocery stores and will allow government liquor stores to open Sundays, both starting April 1, 2015. New regulations also allow beer and wine sales at farmers markets.

“Alcohol is one of the leading causes of disease and disability in our province, and experts have predicted that damage and costs will increase if the status quo persists,” said Attorney General Suzanne Anton in an email interview. “That’s why we made balancing health and safety concerns a priority in the changes to our liquor laws. In fact, over one-quarter of the recommendations in the Liquor Policy Review are focused on health, safety, social responsibility, enforcement and education.

“For instance, ensuring continued restricted access to alcohol for minors was a key consideration during the development of recommendations coming out of the B.C. Liquor Policy Review. The store-within-a-store model for liquor in grocery stores will restrict minor’s entry, just as the existing model does, and grocery stores that are licensed to sell B.C. wine in-store will have designated shelves and checkouts, helping to prevent access to alcohol by minors.”

“We know from a public health perspective that alcohol is something that really needs to be controlled,” said Wood. “We know from our own and international data, that as you increase the availability of alcohol you see increases in alcohol-related harms.”

The national addiction data released Sunday also show that Canadians increasingly find themselves in hospital as a result of abusing opioids, cocaine and cannabinoids, such as hashish and marijuana.

Opioids — heroin, methadone and prescription pain medications — recently passed cocaine as the family of drugs responsible for the second greatest use of hospital resources, after alcohol.

The number of days in hospital due to opioids increased 48 per cent over the five years between 2006 and 2011. Hospital days related to cannabinoids rose 39 per cent, while the number of days attributed to cocaine abuse dropped by 48 per cent.

Overall, Canadian hospital costs associated with a primary diagnosis of a substance abuse disorder went up 22 per cent over five years, from $219 million in 2006 to $261 million in 2011.

Health Minister Terry Lake said last week that the impacts of addiction extend far beyond the confines of Vancouver’s Downtown Eastside into every community, noting that one new funding initiative for addictions focuses on mild and moderate substance abuse problems to be delivered by St. Paul’s.

Which drug inflicts the most harm varies by age, according to the national data, with hospitalizations for cannabinoids rising fastest for 15- to 24-year-olds and alcohol for people 45 to 64. People between 25 and 44 stayed the longest in hospital due to opioid abuse, while the largest increase in length of stay for opioids was among people 65 and older.

Wood worries that steady increases in harm attributed to drug abuse is related to flawed public policy.

“We know that the ‘Just Say No’ approach doesn’t really work,” he said. “Rather than investing in prisons and things that make societies worse off from a substance abuse perspective, we need to invest in addictions treatment and other things that we know are effective.”

A recent study from Columbia University found that more than 70 per cent of people who have a chronic condition such as hypertension are getting appropriate treatment, while only ten per cent of people with chronic substance abuse problems receive treatment.

“To quote the report, most people get addiction care from unskilled lay persons,” said Wood. “And most physicians, who should be diagnosing and treating addictions, don’t know how to do so. That is certainly true in Canada and British Columbia, where we haven’t invested in training physicians in addiction medicine.”

Addictions research is “exploding” with new treatments and prevention, according to Wood.

“It’s changing everything we thought we knew about addictions treatment and what works,” he said. “There are very effective drugs for treating alcohol addiction, but they just don’t get prescribed because physicians are not comfortable using them.”

Physician training at St. Paul’s — which includes Western Canada’s first American Board of Addiction Medicine accredited training program and the largest in North America — is focused on training practising doctors and medical students to use new, effective drugs to treat addiction as well providing experience on the front lines, treating patients in addiction programs and detox centres around Metro Vancouver.

rshore@vancouversun.com

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