As Canada continues to grapple with a worsening overdose crisis, hospitalization rates for opioid poisonings are continuing to rise across Canada, with smaller communities being hit the hardest.

Though major cities have received most of the attention when it comes to the opioid crisis, it’s towns and cities in Canada with populations between 50,000 and 99,999 that had the highest rates of hospitalizations due to opioid poisoning in 2017 — more than double the rates of Canada’s largest cities, according to a new report by the Canadian Institute for Health Information.

The CIHI released new figures on Wednesday regarding “opioid-related harms in Canada” that also show a 27 percent increase in hospitalizations for opioid poisoning across the country over the last five years, for an average of 17 opioid poisoning hospitalizations per day, up from 16 the year before. And between 2016 and 2017, opioid-related emergency department visits spiked by 73 percent in Ontario, and 23 percent in Alberta.

The report defines opioid poisoning as an incident where someone incorrectly ingests an opioid — either in prescription or bootleg form — and harm is caused as a result.

Of the 15 smaller communities studied, Nanaimo, British Columbia had the highest opioid poisoning rate for 2017 with 49 hospitalizations, and Sault Ste. Marie, Ontario came in eighth with 30. Sault Ste. Marie was the subject of a VICE Canada/W5 documentary from earlier this year that explored the harsh stigma faced by many drug users in the city of around 70,000. Last month, the police force there said three people were believed to have died of opioid overdoses in the span of a week.

From 2013 to 2018, the report, entitled Opioid-Related Harm in Canada, found that adults from 25 to 44 years old and youth from 15 to 24 year olds had the highest increase in opioid poisoning rates. Adults from 25 to 44 saw a 62 percent increase in opioid poisonings, while youth from 15 to 24 years old saw a 53 percent jump.

In 2017, more than half of opioid poisoning hospitalizations were caused by accident, and one-third were reported as intentional.

Opioid poisoning data. Canadian Institute for Health Information, 2018.

Even though national opioid poisoning hospitalization rates continue to rise, some provinces saw slight decreases in 2017. The report states this decrease could be due to provincial and local harm reduction approaches, such as increasing the availability of naloxone and the implementation of legislation such as the Good Samaritan Drug Overdose Act.

The report provides the first-ever combined analysis of information pertaining to opioid poisonings, opioid use disorder, adverse drug reactions, and neonatal withdrawal, which is when an infant experiences symptoms of withdrawal stemming from the mother’s drug use. This includes neonatal abstinence syndrome, the report states.

Across Canada, rates of hospitalizations for neonatal withdrawal symptoms increased by 21 percent between 2013 and 2017, according to the report.

The Public Health Agency of Canada only recently began compiling national statistics relating to opioid overdoses and deaths. Its latest report, also released on Wednesday, found there have been more than 9,000 opioid-related deaths in Canada from January 2016 to June 2018. There were 3,996 deaths in 2017, a spike from the 3,005 people who died in 2015. Most of these deaths were found to be accidental and involved fentanyl or a fentanyl analogue.

NDP MP Alistair MacGregor recently repeated the call for the federal government to declare the opioid overdose crisis a national public health emergency. MacGregor, represents a riding in British Columbia, which has been hit the hardest by opioid overdose deaths. Last month, NDP leader Jagmeet Singh urged the Trudeau government to investigate pharmaceutical companies for their role in the opioid crisis, even though the vast majority of overdose deaths in recent years are attributed to the illicit supply that has been tainted with potent opioids.