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 is increasing 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.
- Since 2018, there have been over 2,336 non-fatal overdoses and 91 fatal overdoses in homelessness service settings.
- The highest number of overdose deaths in homelessness services settings took place between October and December, 2020, with 19 fatal overdoses.
- 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 102 per month in 2021 (up to the end of June)
- Non-fatal overdoses are often the result of the quick action and response of shelter staff intervening to save lives by administering naloxone and calling for emergency services.
- Fatal overdoses have similarly increased, from an average of about one per month in 2018 to four per month in 2020.
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.
About the City's Response
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.
Non-fatal Suspected Opioid Overdoses in Homelessness Service Settings
Suspected and Confirmed Opioid Overdose Deaths in Homelessness Service Settings
* Based on location of primary incident (includes deaths that occurred in hospital).
** Only data up to the end of Q2 is available for 2021.
*** 2021 data is preliminary and includes 5 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.”
Data Notes & Limitations
- 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.