This Note is part of a series of Notes on key City issues to update City Council at the start of its 2018 – 2022 term.

Issue description


Toronto continues to be in the midst of an opioid overdose emergency. Toronto Public Health and other City divisions are actively implementing the Toronto Overdose Action Plan, endorsed by the Board of Health in March 2017. The Action Plan provides a comprehensive set of actions to prevent and respond to overdoses resulting from all drugs across the City with an initial focus on opioids, and targets actions from all levels of government.

Status


Toronto Public Health is leading City efforts and working with divisions and community partners to implement the Toronto Overdose Action Plan to prevent and respond to drug overdoses in Toronto’s communities. Toronto Public Health’s supervised consumption service is funded entirely by the Province of Ontario. Toronto Public Health is monitoring the Provincial Government’s response to the overdose crisis as the current government has indicated they will be adopting a different approach than the previous government. Toronto Public Health will report back to the Board of Health mid-2019 on the opioid overdose emergency as well as a status update on the Toronto Overdose Action Plan.

Background


In Toronto, like other major cities across Canada, rates of fatal opioid overdoses calls to paramedics for opioid overdoses and emergency room visits related to substance poisoning are increasing.

In 2017, there were 303 opioid overdose deaths in Toronto (accidental deaths and suicides combined), which is a 63 percent increase in deaths compared to 2016, and a 121 percent increase in deaths compared to 2015. Illicit market forms of fentanyl (as opposed to prescription opioids) caused 80 percent of opioid deaths in Ontario in 2017 and were the most commonly present opioids in accidental overdose deaths in Toronto. Despite having one-fifth of Ontario’s population, Toronto had one-quarter of Ontario’s overdose deaths in 2017.

In six months (February 5 to August 5, 2018), Toronto Paramedic Services attended 1,421 suspected opioid overdoses including 66 fatal cases. During the same period, City emergency divisions saw 9,311 visits for substance-related issues, including 1,708 visits for suspected overdoses for all substances.

 

Chart showing an increasing rate in opioid toxicity deaths in Toronto between 2013 and 2017

*2017 data are preliminary until confirmed by the Office of the Chief Coroner for Ontario. Numbers are subject to change.

Actions or Plans


Since 2016, all orders of government have taken action, including regulatory changes, targeted funding, and overdose prevention and response measures.

The Federal Government implemented a new Canadian Drugs and Substances Strategy, which included policy measures and funding for opioid overdose-related responses across the country. A “good Samaritan” law was passed to protect those that report overdoses. The Big City Mayors Caucus of the Federation of Canadian Municipalities struck a task force calling for coordinated action from all governments.

In Toronto, the Board of Health endorsed the Toronto Overdose Action Plan in 2017, which provides a comprehensive set of actions to prevent and respond to overdoses, targeted to all levels of government. Over the last year, the Medical Officer of Health and Toronto Public Health staff worked with other City divisions, and community and institutional partners to implement the Action Plan recommendations. Actions taken to date are summarized in the Toronto Overdose Action Plan: Status Report 2018. While considerable work has been done, the situation remains urgent, and there is much more to do.

In October 2018, the Government of Ontario presented the findings of a review of supervised consumption services and overdose prevention sites and announced a new consumption and treatment services model that would replace the supervised consumption services and overdose prevention site models. Sites are expected to begin moving to the new model starting in January 2019, with all approved sites expected to be in place by April 2019.

The Province of Ontario released the guidelines for this new program on November 1, 2018. Requirements include identification of proximity to daycare, parks, schools and other Consumption and Treatment Services (CTS), community consultation and mitigation plans, and identification of onsite services and pathways to withdrawal management, treatment, mental health and primary care services.

Date Actions
October 2018 The Province announced it would replace supervised injection services and overdose prevention sites with a new “consumption and treatment services” program.
July 2018 The Board of Health endorsed recommendations calling on the federal government to decriminalize the possession of all drugs for personal use, and to strike a task force to explore legal regulation of all drugs.
June 2018 The Medical Officer of Health provided a status report on the implementation of the Toronto Overdose Action Plan to the Board of Health and City Council adopted the Board of Health recommendations calling on the Province to continue/enhance its response to the overdose crisis.
November 2017 The Government of Canada announced $100 million over five years and $22.7 million in ongoing funding nationally to support responses to the opioid crisis.
October 2017 The Board of Health and City Council approved additional urgent measures to respond to the overdose crisis, including designating the Medical Officer of Health as lead with the authority to direct and coordinate the City’s response across all divisions and agencies.
August 2017 The Government of Ontario announced $222 million in funding over three years for opioid overdose initiatives.
May 2017 The Big City Mayors’ Caucus of the Federation of Canadian Municipalities released recommendations to address the opioid overdose crisis, which were adopted as a formal policy position.
March 2017 The Board of Health adopted the Toronto Overdose Action Plan, which was developed by TPH in consultation with the community.
October 2016 The Government of Ontario announced the Strategy to Prevent Opioid Addiction and Overdose.
July 2016 The Board of Health and City Council approved implementation of three small-scale integrated supervised injection services in Toronto.
September 2015 In September 2015, the Medical Officer of Health submitted a report to the Board of Health highlighting increases in overdoses occurring in Toronto.

 

 

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