Overdoses in Homelessness Services Settings

This page shares data that show the number of fatal and non-fatal suspected opioid overdose incidents in emergency shelters, shelter-hotels, and 24-hour respite sites in each quarter, starting in the first quarter of 2018. Fatal incidents are identified by the Ontario Office of the Chief Coroner, and non-fatal incidents are identified by Toronto Paramedic Services.

Toronto is seeing a substantial rise in non-fatal and fatal opioid overdoses and related shelter deaths, which increased during the COVID-19 pandemic. This is due to a number of reasons:

  • the increasing toxicity of the unregulated drug supply;
  • more people are consuming drugs alone as a result of physical distancing requirements and the shift from congregate settings to single occupancy rooms in hotel settings;
  • people who are staying in shelters in new locations may be purchasing from drug sellers that they do not know; and
  • reduced capacity in addiction treatment and withdrawal management, and access to harm reduction support for people who use drugs may be more limited.

Key Points

  • Since 2018, there have been over 3941 non-fatal overdoses and 212 fatal overdoses in homelessness service settings.
  • Non-fatal overdoses have been increasing steadily within shelter settings, going from an average of 26 per month in 2018, to an average of 67 per month in 2020 and an average of 125 per month in 2021. So far in 2022, the data indicates a decrease compared to the past year, with an average of 80 per month.
  • The true number of overdose incidents in Toronto shelters is likely higher given that paramedics may not always be called in every case, in particular if first responders on site are able to reverse the overdose and support and monitor the individual.
  • Non-fatal overdoses are often the result of the quick action and response of shelter staff or other residents intervening to save lives by administering naloxone and calling for emergency services.
  • Based on preliminary data, there were a total of 13 overdose deaths in Q3 of 2022 in Toronto shelters. The highest number of overdose deaths in homelessness services settings took place between October and December, 2021, with 27 fatal overdoses occurring in that quarter.
  • Fatal overdoses have increased from an average of less than one per month in 2018 to more than 4 per month in 2020 and per month in 2021. So far in the first 6 months of 2022, there has been an average of slightly more than 5 per month.

This data will be updated quarterly.

The full dataset can be found on our Open Data site.

For information on city-wide overdose activity, which includes this data specific to homelessness services setting, consult the Toronto Overdose Information System.

In November 2020, to respond to this emerging issue, the Toronto Board of Health requested the Medical Officer of Health and City to continue to work with community partners to urgently expand overdose prevention response and other harm reduction measures in shelters.

The City has taken substantial action to address this urgent issue and protect those in the shelter system from the risk of overdose.

The Integrated Prevention and Harm Reduction Initiative, or iPHARE, was established to address this request and help to advance the Toronto Overdose Action Plan. iPHARE is a multi-pronged effort by the City and community agencies to address opioid-related deaths in Toronto’s shelter system.

The City’s Shelter Support and Housing Administration (SSHA) division, in collaboration with Toronto Public Health (TPH), has also issued an updated directive for City operated and funded shelters and 24-hour respite sites, including the COVID-19 hotel programs. The directive provides updated requirements for overdose prevention and response strategies along with resources to support service providers.

These actions align with and support City’s Harm Reduction Framework for homelessness services funded by the City, established in 2017.

 

* Based on location of primary incident (includes deaths that occurred in hospital).

**Data from 2022 is preliminary and is reported up to September 30, 2022. Includes probable opioid-related deaths (toxicology positive for opioids) and suspected drug-related deaths. The Office of the Chief Coroner provides data on suspected cases while cases are still being processed. Once the case has been confirmed the status is changed to “confirmed.”

 

  • Due to improved methods for data linkage, along with additional data cleaning and the inclusion of two shelter addresses that may have been missing from previous reports provided by the Coroner’s Office, the number of overdose deaths reported in each year has changed from previous updates to this data. As a result, previous reports published here prior to August 2022 under-reported the number of overdose deaths that have occurred in the Toronto shelter system.
  • Non-fatal incidents are suspected based on the expertise of Toronto Paramedic Services to identify an opioid overdose based on physical and circumstantial information.
  • Only incidents where Toronto Paramedic Services are called are captured in the non-fatal suspected opioid overdose incident data set.
  • Some incidents may be duplicated in the fatal and non-fatal data sets because after Toronto Paramedic Services brings a patient to hospital, further outcomes are not recorded. A patient identified by Toronto Paramedic Services as experiencing a non-fatal suspected opioid overdose who later dies in hospital will be captured in both fatal and non-fatal data sets.
  • The Office of the Chief Coroner and Toronto Paramedic Services have identified cases for this data set based on addresses of locations in the shelter system. The data set excludes individuals living in encampments or outside of the formal homelessness services system.
  • The City’s Shelter, Support and Housing Administration division uses the Shelter Management Information System (SMIS) to record client information and track a wide range of incidents that occur at emergency shelter locations. Some information about overdose incidents is recorded in SMIS, but this information is less reliable than that provided by Toronto Paramedic Services and the Office of the Chief Coroner. Data collected in SMIS is not included in this data set.
  • Full data set available on Open Data.