Rates of emergency department visits attributable to alcohol use in Ontario from 2003 to 2016: a retrospective population-level study

Daniel T. Myran; Amy T. Hsu; Glenys Smith; Peter Tanuseputro

doi:10.1503/cmaj.181575

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RE: Emergency department visits attributable to alcohol use. (DT Myran et al. CMAJ2019191:E804-10
Joseph H. Finkler

Posted on: 15 October 2019
Alarming Ontario drinking statistics obligates reappraisal of the impact of alcohol on newborns
Shiva M Singh

Posted on: 29 July 2019

Posted on: (15 October 2019)
Page navigation anchor for RE: Emergency department visits attributable to alcohol use. (DT Myran et al. CMAJ2019191:E804-10
RE: Emergency department visits attributable to alcohol use. (DT Myran et al. CMAJ2019191:E804-10
Joseph H. Finkler, Emergency Physician, St. Paul's Hospital, Vancouver, BC
As an emergency physician who has been in practice in BC for over 25 years, my observations on emergency department (ED) traffic related to alcohol intoxication mirror those of Drs. Myran and his co-investigators. However, my conclusions are a bit different. ED use is increasing all across the country for all causes, including alcohol. The public's exaggerated perceived risk to life from acute alcohol intoxication, decreased tolerance by night club operators for severely intoxicated patrons and enhanced emergency medical services systems in urban areas all contribute to the increased numbers of encounters on concert and weekend nights related by young people with acute alcohol intoxication, especially women. I do agree with the authors that part of the increased number of ED encounter is related to an increasing incidence of excessive alcohol ingestion (to the point that they are semi-comatose) in young people. I also think it is related to the increased use of the ED as a check point for discomforting symptom or situation. It would be interesting to do a similar analysis for other common drivers of ED encounters, such as upper respiratory tract infection, back pain, dysfunctional uterine bleeding, headache, etc. Still, I am also concerned about the increased incidence of excessive alcohol consumption amongst young people, which puts their physical safety at risk, especially young women who are alone or may have been abandoned by their friends.

Competing Interests: None declared.
Posted on: (29 July 2019)
Page navigation anchor for Alarming Ontario drinking statistics obligates reappraisal of the impact of alcohol on newborns
Alarming Ontario drinking statistics obligates reappraisal of the impact of alcohol on newborns
Shiva M Singh, Distinguished University Professor Emeritus, University of Western Ontario, London, Ontario
The report by Myran et al (2019)1 in CMAJ represents among the most comprehensive account of alcohol abuse in Ontario. It relies on emergency department visits caused by the alcohol use. The results show that from 2003 to 2016, emergency department visits due to alcohol consumption have increased 4.4 times more as compared to an overall increase in visits to emergency. It also identifies a number of demographic features. First, this increase is greater for women (86.5%) than for men (53.2%) with 25–29 year olds showing the largest (175%) increase. Second, the highest rate of emergency visits attributed to alcohol abuse were for 15-24 year old women and 45-54 year old men. Third, among the medical harms identified includes suspected fetal damage including fetal alcohol syndrome from 6 visits in 2003 to 134 in 2016. It represents an increase of 2133.3%, the largest percentage increase in any of the health outcomes assessed (range; 3.7% increase for alcohol dependence to 245.5% increase for alcohol-related mental and behavioural disorders). Further, given the nature of data used in this report these numbers must represent an under estimate and include only the extreme of cases. This trend documented for 2003 and 2016 for Ontario must be viewed as multifactorial. However, the conclusion that young reproductive age women represent a segment of the society that are increasingly attracted to alcohol use is unavoidable. In doing so, they expose themselves to the negative health ef...
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The report by Myran et al (2019)1 in CMAJ represents among the most comprehensive account of alcohol abuse in Ontario. It relies on emergency department visits caused by the alcohol use. The results show that from 2003 to 2016, emergency department visits due to alcohol consumption have increased 4.4 times more as compared to an overall increase in visits to emergency. It also identifies a number of demographic features. First, this increase is greater for women (86.5%) than for men (53.2%) with 25–29 year olds showing the largest (175%) increase. Second, the highest rate of emergency visits attributed to alcohol abuse were for 15-24 year old women and 45-54 year old men. Third, among the medical harms identified includes suspected fetal damage including fetal alcohol syndrome from 6 visits in 2003 to 134 in 2016. It represents an increase of 2133.3%, the largest percentage increase in any of the health outcomes assessed (range; 3.7% increase for alcohol dependence to 245.5% increase for alcohol-related mental and behavioural disorders). Further, given the nature of data used in this report these numbers must represent an under estimate and include only the extreme of cases. This trend documented for 2003 and 2016 for Ontario must be viewed as multifactorial. However, the conclusion that young reproductive age women represent a segment of the society that are increasingly attracted to alcohol use is unavoidable. In doing so, they expose themselves to the negative health effect of alcohol as well as alcohol’s effect on the fetus in cases of any recognized or unrecognized pregnancies. Often alcohol-exposed pregnancies can lead to fetal alcohol spectrum disorder (FASD).

Fetal alcohol spectrum disorder (FASD) is a serious neurodevelopmental disorder. It is caused exclusively by prenatal alcohol exposure invariably resulting from maternal drinking. There is no known safe dose of alcohol or safe timing of alcohol exposure during pregnancy2. Most of the defects we see in FASD represent the tip of the iceberg. Diagnosis of FASD is subjective. There is no biological diagnostic test and there is no cure. Given the alarming increase in alcohol consumption (175%) by young women (15 to 24 years) of reproductive age and apparently high incidence of FASD in Ontario (~3%)3, the issue demands a concerted action. On a longer term, this action must focus on research on understanding the mechanism of action of alcohol on fetal development and how to reduce its impact4. On an immediate basis and at the minimum, there is an urgent need and obligation to take measures to reduce alcohol abuse, particularly in the high-risk group of people.

Ours is an alcohol friendly society. Alcohol is easily accessible, commonly used, even glorified in some circles and promoted. Although highly addictive, it is part of our social fabric. Also, as identified in the report, it represents a major impediment to societal health and wellbeing. The current regulations of its use and abuse are not effective. There is a need to bring in measures that will offer checks and balances to its harms. The current report by Myran et al. is an eye-opener. The issue is simple but there is no simple solution. There is a need for the government, industry and society to work together and reduce the societal harm caused by abuse of alcohol during pregnancy.

On the surface the issue of FASD appears straight forward. No maternal drinking during pregnancy means no FASD and related disorders. However, in practice it has been hard to implement. There is a continuous need for an educational program with a singular and unified message of “no alcohol during pregnancy to no FASD” by health professionals, alcohol industry and of course young people. It may include youth education programs at home and throughout school systems for societal change. We suggest that “not doing anything” is not an option and “the time is now!”

1. Myran, D. T., Hsu, A. T., Smith, G. & Tanuseputro, P. Rates of emergency department visits attributable to alcohol use in Ontario from 2003 to 2016: a retrospective population-level study. CMAJ191, E804–E810 (2019).
2. Singh, S. M., Laufer, B. I. & Kapalanga, J. Fetal alcohol and the right to be born healthy…. Front. Genet. 5, 356 (2014).
3. Popova, S. et al. World Health Organization International Study on the Prevalence of Fetal Alcohol Spectrum Disorder (FASD). Cent. Addit. Ment. Heal. (2018).
4. Chokroborty-Hoque, A., Alberry, B. & Singh, S. M. Exploring the complexity of intellectual disability in fetal alcohol spectrum disorders. Front. Pediatr. 2, (2014).

Bonnie Alberry, PhD Candidate
Shiva M Singh, Distinguished University Professor Emeritus
University of Western Ontario, London, Ontario
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Competing Interests: None declared.