Circumstances surrounding alcohol toxicity deaths and prior pharmacotherapy for alcohol use disorder in Ontario, Canada.

INTRODUCTION

Despite a high prevalence of alcohol use disorder (AUD) in Canada, access to medication-based treatment remains poor. Therefore, our aim was to explore patterns of alcohol toxicity deaths in Ontario, Canada, circumstances surrounding death, prior healthcare interactions, and pharmacotherapy for AUD.

METHODS

We conducted a population-based repeated cross-sectional study of alcohol toxicity deaths occurring between 1 January 2018 and 30 June 2022 in Ontario, Canada. We reported trends in deaths over time and determined demographic characteristics of decedents, circumstances surrounding death, and prior healthcare interactions. Among a subset of the cohort with an AUD diagnosis eligible for public drug benefits, we reported receipt of medications used to treat AUD before death.

RESULTS

We identified 1346 alcohol toxicity deaths over the study period, at a median age of 42 years, with 73.8% occurring among men. The majority of alcohol toxicity deaths involved other substances, including opioids (75.2%), benzodiazepines (10.8%), and/or stimulants (45.2%). Half had an AUD (50.4%) and 62.7% had an opioid, benzodiazepine or stimulant use disorder. Among decedents who were public drug beneficiaries with an AUD (N = 361), only 3.6% were actively prescribed first-line AUD pharmacotherapies (naltrexone and/or acamprosate) at time of death.

CONCLUSIONS

We found that the majority of alcohol toxicity deaths in Ontario involved other non-alcohol substances. We also detected a high prevalence of prior healthcare encounters for substance use disorders (SUDs) and low prevalence of evidence-based AUD pharmacotherapy. This suggests a need for integrated treatment across concurrent SUDs and improved access to pharmacotherapies for AUD across Ontario.