The overdose crisis continues to be an urgent public health issue in Toronto and across Ontario

BY SIMONE J. SMITH

“We have seen a tragic increase in overdoses throughout the pandemic and the data released today confirms this crisis has been made worse by the COVID-19 emergency.  Any life lost to a drug overdose is preventable and thus unacceptable.

 The experts are clear that harm reduction programs will save lives and that’s why the City and Toronto Public Health has worked to implement those programs in our city with the help of the Government of Canada. I am determined to keep working with the other governments to help people with substance use issues, to expand treatment programs, and to save lives.

 Much of this should properly be done by our healthcare system and I look to the province for increased initiative.” Mayor John Tory

Toronto is home to more than 2.9 million people whose diversity and experiences make this great city Canada’s leading economic engine and one of the world’s most diverse and liveable cities. As the fourth largest city in North America, Toronto is a global leader in technology, finance, film, music, culture, and innovation, and consistently places at the top of international rankings due to investments championed by its government, residents and businesses.

What is unfortunate is that in this great city, there is a growing epidemic that must be revisited until our members of parliament do something about it. On the news, our daily intake is about the growing cases, and deaths due to COVID-19. What we don’t hear enough about is how the measures that have been implemented in Ontario have severely affected the lives of its citizens.

Toronto Public Health (TPH) has released preliminary data from the Office of the Chief Coroner for Ontario highlighting a record high number of confirmed opioid overdose deaths in Toronto in 2020 – a total of 521 fatalities. This represents a 78% increase from 2019 and a 280% increase from 2015.

There has been a notable increases in overdose deaths since the COVID-19 emergency was declared in 2020. Did you know that prior to COVID-19, the average number of fatal calls attended by paramedics in Toronto for suspected opioid overdoses, was thirteen per month? The sad news is that during COVID-19, it has increased to twenty-six per month.  I want readers to think about that for a minute. The total has doubled in a little over a year.

The issue; in 2021, the overdose crisis has continued to worsen. TPH recently issued a drug alert (https://www.toronto.ca/wp-content/uploads/2021/05/964a-Drug-AlertMay-72021.pdf) about the worst cluster of fatal, suspected opioid-overdose-related calls attended by Toronto Paramedic Services. Between May 2^nd and May 6^th, 2021, thirteen fatal suspected opioid-related overdose calls occurred, including five fatal calls on the day of May 6^th, which is the highest daily number on record since TPH began tracking this data. The latest numbers that were provided were as of April 30^th, 2021. In the week of April 26^th, 2021, there were sixty overdoses, and one fatal overdose. I am curious; why are these numbers not being reported as readily as the COVID-19 numbers?

Toronto’s Drug Checking Service has detected increasingly toxic and unpredictable contaminants in the unregulated drug supply in Toronto, and has issued a number of alerts (https://drugchecking.cdpe.org/alerts).  There are three ultra potent opioids that have been identified:

Carfentanil
This is a drug typically used by veterinarians on very large animals that is approximately 100 times stronger than fentanyl, 4,000 times stronger than heroin, and 10,000 times stronger than morphine.

Between March 1^st and May 17^th, 2021, carfentanil was found in 4% of the expected fentanyl samples checked by Toronto’s drug checking service (11 of 274 samples). This is the most carfentanil they have identified in a period of less than three months since launching their drug checking service in October 2019.

Etonitazene
This opioid was synthesized in the 1950s and was never clinically approved for market, and is about 10 times stronger than fentanyl.

Isotonitazene
This opioid was synthesized in the 1950s and was also never clinically approved for market, and is about five times stronger than fentanyl.

The use of carfentanil, isotonitazene, or etonitazene may result in extreme sedation and dangerous suppression of the respiratory system. It is because these drugs are so strong, that the risk of overdose has increased.

The team at TPH are incredibly concerned about the impacts that both the overdose crisis and the COVID-19 emergency are having on people who use drugs. The overdose crisis continues to be an urgent public health issue in Toronto and across Ontario.

There have been additional efforts to address the noted increases in overdoses among people who are experiencing homelessness. TPH has also expanded supervised consumption services by opening Urgent Public Health Need Sites (UPHNS) as part of the Integrated Prevention and Harm Reduction Initiative (iPHARE). The sites provide lifesaving services for residents in physically distant hotels, and ensure that someone is available to provide medical support if someone overdoses.

Action is needed more than ever to address this public health emergency; there is more to life than Covid-19.