Toronto Public Health is collaborating with the Toronto Overdose Early Warning and Alert Partnership to provide timely information on overdose activity, with a current focus on opioids. Additional data and indicators may be added to this site as they become available.

Last Updated: August 15, 2018

Toronto Paramedic Services is collaborating with Toronto Public Health to share information on calls for suspected opioid overdoses received by paramedics in Toronto. This includes the number and location of cases where the responding paramedic suspects an opioid overdose. This may differ from the patient’s final diagnosis in hospital or cause of death determined by the coroner. These findings are preliminary and subject to change. Please see the Data Notes tab for more information on these indicators.

Since August 7, 2017, Toronto Paramedic Service attended 58 non-fatal and 3 fatal suspected opioid overdoses per week on average. Fatal cases include those where the patient died on scene and the coroner was notified.

Over this period, an average of 11 non-fatal cases per week had naloxone administered by a community member before paramedic arrival. Paramedics administered naloxone in an average of 8 non-fatal cases per week.

Weekly* number of suspected opioid overdose calls received by Toronto Paramedic Services, Toronto, August 7, 2017 to August 12, 2018** Line graph of calls to paramedics for suspected overdose cases

 

Table of calls to paramedics for suspected overdose cases*   Weeks are calculated Monday to Sunday and are labelled with the Monday of each week period. 

** Due to ongoing review of case definition, some weekly numbers of suspected opioid overdose calls have changed slightly from what was posted prior to August 13th, 2018. 

Source: Toronto Paramedic Services. Electronic Patient Care Record. August 7, 2017 to August 12, 2018. Extracted August 15, 2018.

 

The map shows the distribution of opioid overdose calls received by Toronto Paramedic Services for June 2018. It includes fatal and non-fatal suspected opioid overdoses combined. The map shows the locations where paramedics made contact with patients. Please see the Data Notes tab for more information on these indicators. For more information on the number of calls by neighbourhood and nearest main intersection, please see Calls to Paramedic for Suspected Opioid Overdoses – Geographic Information.

Map of suspected opioid overdose calls received by Toronto Paramedic Services, Toronto, July 2018

Source: Toronto Paramedic Services. Electronic Patient Care Record. July 1 to 31, 2018. Extracted August 7, 2018.


Contact Us

For information about data sources and indicators Surveillance and Epidemiology Unit

seu@toronto.ca

416-392-7450

For information about naloxone and supervised injection services The Works

theworks@toronto.ca

416-392-0520

For information about the Toronto Overdose Early Warning & Alert Partnership Toronto Drug Strategy

drugstrategy@toronto.ca

416-338-3585

Last Updated: August 15, 2018

Substance-related emergency department visits at Toronto hospitals fluctuated from October to early August. The number of suspected overdose cases also fluctuated. Note that neither of these indicators are specific to opioids. Substance-related emergency department visits may be due to intoxication, addiction, overdose, or withdrawal. Suspected overdose cases are a subset of substance-related visits that specifically mention overdose in the chief complaint and meet a set of inclusion criteria. Please see the Data Notes tab for more information on these indicators.

Number of substance-related emergency department visits and suspected overdose cases by week, Toronto hospitals, October 2, 2017 to August 12, 2018*

 Graph of hospital visits for suspected overdose cases

Table of hospital visits for suspected overdose cases*The date noted indicates the start of the week. Counts are reported from Mondays to Sundays.
Source: Acute Care Enhanced Surveillance System. ED Line Listings. October 2, 2017 to August 12, 2018. Extracted August 15 , 2018.

There was a significant upward trend in emergency department visits for opioid poisoning from January 2016 to December 2017 (most recent data available). Hospitalizations for opioid poisoning remained relatively stable over the period. Note that changes to hospital reporting for opioid overdoses at the start of May 2017 may account for some of the increase in this indicator. Please see the Data Notes tab for more information on this indicator.

Number of emergency department visits and hospitalizations due to opioid poisoning by month, Toronto hospitals, January 2016 to December 2017

Line graph of opioid poisonings at Toronto hospitals.

Source for ED visit data: National Ambulatory Care Reporting System, January 2016 to December 2017. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.  Extracted May 2018.Source for hospitalizations: Discharge Abstracts Database, January 2016 to December 2017. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. Extracted May 2018.


Contact Us

For information about data sources and indicators Surveillance and Epidemiology Unit

seu@toronto.ca

416-392-7450

For information about naloxone and supervised injection services The Works

theworks@toronto.ca

416-392-0520

For information about the Toronto Overdose Early Warning & Alert Partnership Toronto Drug Strategy

drugstrategy@toronto.ca

416-338-3585

Last Updated: May 30, 2018

In 2017, there were 303 opioid overdose deaths in Toronto. This includes both accidental deaths and suicides combined. This represents a 63% increase in the deaths compared to 2016 and a 121% increase in deaths compared to 2015. In 2017, 1 in 4 opioid overdose deaths in Ontario occurred in Toronto. Please see the Data Notes tab for more information on this indicator.

Annual number of deaths from opioid-related causes, Toronto, 2013 to 2017* 

Bar graph of opioid overdose deaths.

* Data are preliminary and includes probable cases for which the investigation to determine cause of death is ongoing. Numbers are subject to change.
Source: Public Health Ontario. Interactive Opioid Tool. 2013 to 2017. Accessed on May 25, 2018.

Contact Us

For information about data sources and indicators Surveillance and Epidemiology Unit

seu@toronto.ca

416-392-7450

For information about naloxone and supervised injection services The Works

theworks@toronto.ca

416-392-0520

For information about the Toronto Overdose Early Warning & Alert Partnership Toronto Drug Strategy

drugstrategy@toronto.ca

416-338-3585

Last Updated: August 9, 2018

On August 21, 2017, Toronto Public Health opened the interim site for supervised injection services at The Works. Services moved to the permanent site on October 30, 2017.

Supervised injection services are health services that provide a hygienic environment for people to inject pre-obtained drugs under the supervision of a trained health care professional. In addition to supervised injection, individuals are provided with sterile injection supplies, education on safer injection, overdose prevention and intervention, medical and counselling services, and referrals to drug treatment, housing, income support and other services. Please see the Data Notes tab for more information on these indicators.

As of July 14, 2018, there were 15,362 visits to the supervised injection service. There were 213 visits where an overdose occurred, including 67 visits where the client required naloxone.

Weekly** visits to the supervised injection service, The Works, August 21, 2017 to July 14, 2018

 * Week includes reduced hours due to holiday schedule.
**Weeks are calculated Monday to Saturday, with the date of the Monday labeled on the graph. Data is preliminary and subject to change.

Source: The Works – Toronto Public Health. Supervised Injection Services. Updated August 8, 2018.


Contact Us

For information about data sources and indicators Surveillance and Epidemiology Unit

seu@toronto.ca

416-392-7450

For information about naloxone and supervised injection services The Works

theworks@toronto.ca

416-392-0520

For information about the Toronto Overdose Early Warning & Alert Partnership Toronto Drug Strategy

drugstrategy@toronto.ca

416-338-3585

Last Updated: August 9, 2018

There was an upward trend in the number of recipients of opioid substitution treatment (OST) in the past two years. More recipients were receiving methadone maintenance treatment (MMT), compared to those receiving suboxone and its generics. Recipients are unique individuals receiving at least one dispense of OST. Please see the Data Notes tab for more information on this indicator.

Number of recipients of opioid substitution treatment by treatment type, Toronto pharmacies, April 2016 to March 2018

Line graph of opioid substitution treatment recipients.
Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. April 2016 to March 2018. Received May 2018.

 

Overall, there was an upward trend in the number of dispenses (in days) for suboxone and its generics in the past two years. However, the number of days dispensed for methadone maintenance treatment (MMT) remained relatively consistent over time. Days dispensed refer to the number of days’ worth of treatment that was distributed from a pharmacy. An increase in number of days dispensed could mean that more individuals are accessing treatment, individuals are accessing treatment more frequently, or a combination of both scenarios. Please see the Data Notes tab for more information on this indicator.

Number of days dispensed for opioid substitution treatment by treatment type, Toronto pharmacies, April 2016 to March 2018

Line graph of opioid substitution treatment days dispensed.

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. April 2016 to March 2018. Received May 2018.

There was an upward trend in the number of prescribers for suboxone and its generics in the past two years. The number of prescribers for methadone maintenance treatment (MMT) remained relatively stable over this time period. Prescribers refer to the number of unique health care professionals who wrote prescriptions for treatment dispensed at Toronto-based pharmacies. An increase in number of prescribers could mean that more individuals are accessing treatment or that the capacity of the health care system to provide treatment has increased. Please see the Data Notes tab for more information on this indicator.

Number of prescribers of opioid substitution treatment by treatment type, Toronto pharmacies, April 2016 to March 2018

Line graph of opioid substitution treatment prescribers

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. April 2016 to March 2018. Received May 2018.

 

The weekly number of new admissions to Toronto-based treatment centres fluctuated over the past two years. More admissions reported prescription opioids as a problem substance, compared to heroin/other non-prescription opioids. Please see the Data Notes tab for more information on this indicator.

Number of weekly new admissions to provincially-funded drug treatment centres by presenting problem substance, Toronto, July 3, 2017 to July 1, 2018

Source: Centre for Addiction and Mental Health. Drug and Alcohol Treatment Information System. July 3, 2017 to July 1, 2018. Extracted August 8, 2018.


Contact Us

For information about data sources and indicators Surveillance and Epidemiology Unit

seu@toronto.ca

416-392-7450

For information about naloxone and supervised injection services The Works

theworks@toronto.ca

416-392-0520

For information about the Toronto Overdose Early Warning & Alert Partnership Toronto Drug Strategy

drugstrategy@toronto.ca

416-338-3585

15/01/2018: Survey on Opioid Awareness (2017) Results
Statistics Canada has released results from the Survey on Opioid Awareness. The survey found that 29% of Canadians aged 18 years and older reported using some form of opioids in the past five years. It also found that 78% of Ontarians were ‘very aware’ or ‘somewhat aware’ of the opioid issue. For more information see the full results and infographicPlease note that Toronto-specific statistics are not available

29/05/2017: Interactive tool on opioid-related harms data
Public Health Ontario recently released an interactive tool that explores trends in opioid-related emergency department visits, hospitalizations and deaths from 2003 to 2015 in Ontario. Toronto Public Health has created a summary document that reviews the key findings for Toronto.

Please note that the interactive tool and summary document capture outcomes occurring among Toronto residents only and as such, will include fewer occurrences than those included on this website (which capture all overdose outcomes occurring in Toronto, regardless of where an individual resides).

28/03/2017: Toronto Overdose Action Plan

Toronto Public Health worked with community partners to develop the Toronto Overdose Action Plan: Prevention & Response, which was endorsed by the Board of Health on March 20, 2017. The Plan includes a comprehensive set of actions for all orders of government to prevent and respond to drug overdoses.

28/03/2017: Naloxone information

The Province of Ontario has launched a new website with information on where to get free naloxone kits in your area.


Contact Us

For information about data sources and indicators Surveillance and Epidemiology Unit

seu@toronto.ca

416-392-7450

For information about naloxone and supervised injection services The Works

theworks@toronto.ca

416-392-0520

For information about the Toronto Overdose Early Warning & Alert Partnership Toronto Drug Strategy

drugstrategy@toronto.ca

416-338-3585

Paramedic Response

Weekly number of suspected opioid overdose calls received by Toronto Paramedic Services, Toronto

Source: Toronto Paramedic Services. Paramedic Electronic Patient Care Record.

Data Notes:

  • This indicator is preliminary and subject to change pending further review of the data source.
  • This indicator includes cases where the responding paramedic suspects an opioid overdose. This may differ from the final diagnosis in hospital or cause of death determined by the coroner.
  • Fatal cases includes those where the patient died on scene and the coroner was notified. Patients who die after being transported to hospital may be miscategorized here as ‘non-fatal’ cases.
  • This indicator includes only instances where 911 is called and underestimates the true number of overdoses in the community.

Map of suspected opioid overdose calls received by Toronto Paramedic Services, Toronto

Source: Toronto Paramedic Services. Paramedic Electronic Patient Care Record.

Data Notes:

  • This indicator is preliminary and subject to change pending further review of the data source.
  • The map shows the locations where paramedics made contact with patients, which may or may not be the same location from which 911 was called.
  • The colours of the heat map indicate the relative density, defined as the number of cases per unit area. As a stretch legend is used to visualize the density, this map should not be interpreted in absolute terms when compared to heat maps from other time periods.
  • Suspected opioid overdoses occurring slightly outside the City of Toronto boundaries were excluded from the map.
  • This indicator includes cases where the responding paramedic suspects an opioid overdose. This may differ from the final diagnosis in hospital or cause of death determined by the coroner.
  • This indicator includes only instances where 911 is called and underestimates the true number of overdoses in the community.

Hospital Visits

Number of substance-related emergency department visits by week, Toronto hospitals

Source: Acute Care Enhanced Surveillance System. ED Line Listings.

Data Notes:

  • This data source only captures substance-related visits that result in an individual seeking care in a hospital setting. This is likely an underestimation of the true burden of overdose in the population.
  • ACES is a syndromic surveillance system that classifies visits and admissions into ‘syndromes’ using algorithms to assess and classify open text from the chief compliant recorded at triage or registration. This process allows ACES to provide daily counts of visits and admissions.
  • This data sources captures visits to acute care facilities in Toronto. However, it does not currently capture visits to Sunnybrook hospital. Moreover specialty hospitals, such as the Women’s College Hospital are not captured. Visits to the Centre for Addiction and Mental Health are included in ACES as of November 23, 2017.
  • ‘Substance-related visits’ include instances of intoxication, addiction, overdose, or withdrawal.
  • ‘Substance-related visits’ include those caused by opioids or non-opioid related drugs (OPI and TOX syndromes, combined). It excludes those related to alcohol.
  • This indicator includes all visits to Toronto hospitals, regardless of whether or not the individual resides in Toronto.
  • Monday to Sunday week units are used here as the unit of analysis, with the starting date of each week labeled on the x-axis of the graph.

Number of emergency department visits due to suspected overdoses by week, Toronto hospitals

Source: Acute Care Enhanced Surveillance System. ED Line Listings.

Data Notes:

  • This indicator is only available from May 2017 onwards, due to availability of data.
  • This data source only captures suspected overdoses that result in an individual seeking care in a hospital setting. This is likely an underestimation of the true burden of overdose in the population.
  • ACES is a syndromic surveillance system that classifies visits and admissions into ‘syndromes’ using algorithms to assess and classify open text from the chief compliant recorded at triage or registration. This process allows ACES to provide daily counts of visits.
  • ‘Suspected overdoses’ refer to a subset of substance-related visits that specifically reference ‘overdose’ in the chief complaint. It excludes overdoses that specify a substance of non-interest (e.g. alcohol, over-the-counter medication, prescription drugs of non-interest such as blood pressure medication, and toxic products such as cleaning products).
  • ‘Suspected overdoses’ include only visits with a Canadian Triage Acuity Score of 1 (Resuscitation), 2 (Emergency), or missing.
  • ‘Suspected overdoses’ excludes visits to children less than 10 years of age.
  • For the majority of visits, the substance causing overdoses is not specified. It is important to note that this indicator measures overdoses from all types of substances, not just opioids.
  • ‘Suspected overdoses’ also excludes intentional overdoses or those related to self-harm.
  • This data sources captures visits to acute care facilities in Toronto. However, it does not currently capture visits to Sunnybrook hospital. Moreover specialty hospitals, such as Women’s College Hospital are not captured. Visits to the Centre for Addiction and Mental Health are included in ACES as of November 23, 2017.
  • This indicator includes all visits to Toronto hospitals, regardless of whether or not the individual resides in Toronto.
  • Monday to Sunday week units are used here as the unit of analysis, with the starting date of each week labeled on the x-axis of the graph.

Number of emergency department visits due to opioid poisoning by month, Toronto hospitals

Source: National Ambulatory Care Reporting System. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.

Data Notes:

  • This data source also only captures overdoses where patients visited the emergency department. It is likely these data underrepresents the true burden of overdose in the population.
  • This data source includes all visits to Toronto hospitals, including those who are residents of other municipalities accessing care in Toronto.
  • Opioid poisonings were measured using ICD-10 codes: T40.0 – Opium, T40.1 – Heroin, T40.2 – Other opioids (e.g. Codeine, Morphine), T40.3 – Methadone, T40.4 – Other synthetic narcotics (Pethidine) and T40.6 – Poisoning by other and unspecified narcotics.
  • This indicator include visits where opioid poisoning was listed as a main or a contributing cause.
  • Emergency department visits includes only unscheduled visits.

Number of hospitalizations due to opioid poisoning by month, Toronto hospitals

Source: Discharge Abstracts Database. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.

Data Notes:

  • This data source also only captures overdoses where patients were hospitalized. It is likely these data underrepresents the true burden of overdose in the population.
  • This data source includes all hospitalizations to Toronto hospitals, including those who are residents of other municipalities accessing care in Toronto.
  • Opioid poisonings were measured using ICD-10 codes: T40.0 – Opium, T40.1 – Heroin, T40.2 – Other opioids (e.g. Codeine, Morphine), T40.3 – Methadone, T40.4 – Other synthetic narcotics (Pethidine) and T40.6 – Poisoning by other and unspecified narcotics.
  • This indicator includes hospitalizations where opioid poisoning was listed as a main or a contributing cause.
  • In the May 2017 update of this indicator, the data source was changed from the National Ambulatory Care Reporting System to the Discharge Abstracts Database to be consistent with how Public Health Ontario is measuring this indicator. The Discharge Abstracts Database also contains more detailed information about hospitalizations, as records include all information available at the time of discharge which is often more specific than information available at admission.

Deaths

Annual number of deaths from opioid-related causes, Toronto

Source: Public Health Ontario. Interactive Opioid Tool. 2013 to 2017. Accessed on May 25, 2018.

Data Notes:

  • Data from 2017 have been preliminarily released by the Office of the Chief Coroner for Ontario. Numbers are subject to change. These data include probable cases for which the investigation to determine cause of death is ongoing.
  • These data from 2017 are part of a new initiative by the Office of the Chief Coroner for Ontario to increase the timeliness of data on opioid overdoses. Caution should be exercised when comparing these data to data from previous years.
  • These data include all manners of death (i.e. accidental and intentional) combined.
  • A previous iteration of this indicator included data specific to accidental opioid overdose deaths only. This information is not currently available to Toronto Public Health. Content will be updated when this becomes available.

Supervised Injection Services

Weekly indicators for the interim supervised injection services, The Works

Source: The Works – Toronto Public Health. Supervised Injection Services.

Data Notes:

  • Number of visits refers to the number of clients visiting the supervised injection services (SIS). This includes all visits to the SIS, regardless of whether the client injected. Visits may be from repeat clients.
  • Number of overdoses refers to the number of visits resulting in an overdose event that occurs within the site or that occurs to a client who has injected at the site, as reported by the manager at The Works. This does not refer to unique clients.
  • Number of naloxone administrations refers to the number of visits resulting in a naloxone administration. Note that multiple doses of naloxone may be administered during one overdose event.

Treatment

Number of recipients / days dispensed / prescribers for opioid substitution treatment by treatment type, Toronto pharmacies

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care.

Data Notes:

  • This data source does not directly measure overdose. It provides a measure of those seeking care for opioid addictions.
  • Recipients refer to unique individuals receiving treatment. An increase in recipients means that more people are accessing opioid substitution treatment. However, it does not tell us if individuals are regularly accessing treatment.
  • For recipients, only those with a valid Ontario health card number were included.
  • Days dispensed refers to the days’ worth of treatment distributed from a pharmacy. An increase in days dispensed could mean that more individuals are accessing treatment, individual are accessing treatment more frequently, or a combination of both scenarios.
  • It is necessary to report the days dispensed, rather than number of dispenses, as one dispense of opioid substitution treatment can contain treatment for multiple days.
  • Prescribers refer to the number of unique health care professionals who wrote prescriptions for treatment dispensed at Toronto-based pharmacies. An increase in prescribers could indicate that more people are accessing treatment or that the capacity of the health care system to provide treatment has increased.
  • Toronto pharmacies include those with a postal code beginning with the letter ‘M’. Individuals who access care at Toronto pharmacies are not necessarily residents of Toronto, and residents of Toronto may access pharmacies outside of the city boundaries.

Weekly new admissions to provincially-funded drug treatment centres by presenting problem substance, Toronto

Source: Drug and Alcohol Treatment Information System. Centre for Addiction and Mental Health.

Data Notes:

  • This indicator captures new admissions to treatment centres in Toronto only.
  • Individuals who access addiction treatment services through primary care, hospitals, private clinics and federally-funded First Nations health service providers are not included in this indicator.
  • Presenting problem substances are self-reported by clients. Individuals can list up to 5 substances upon admission.
  • Individuals who specify multiple presenting problem substances are counted as a new admission for each type of substance. For instance, if an individuals specifies heroin and prescription opioids as presenting problem substances, they will be counted as a new admission for both heroin and prescription opioids.
  • Completeness of this indicator is limited by timeliness of what is submitted by health service providers. This can vary from provider to provider. Counts for recent weeks may be subject to change, as more service providers complete their reporting.

Contact Us

For information about data sources and indicators Surveillance and Epidemiology Unit

seu@toronto.ca

416-392-7450

For information about naloxone and supervised injection services The Works

theworks@toronto.ca

416-392-0520

For information about the Toronto Overdose Early Warning & Alert Partnership Toronto Drug Strategy

drugstrategy@toronto.ca

416-338-3585