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: December 5, 2017
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 67 non-fatal and 5 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 13 non-fatal cases per week had naloxone administered by a community member before paramedic arrival. Paramedics administered naloxone in an average of 11 non-fatal cases per week.
Weekly* number of suspected opioid overdose calls received by Toronto Paramedic Services, Toronto, August 7 to December 3, 2017
Graph showing weekly number of suspected opioid overdose calls received by Toronto Paramedic Services, August 7 to December 3, 2017
Table showing weekly number of suspected opioid overdose calls received by Toronto Paramedic Services, August 7 to December 3, 2017
*Weeks are calculated Monday to Sunday and are labeled with the Monday of each week period.Prepared by Surveillance & Epidemiology Unit, Toronto Public Health. Source: Toronto Paramedic Services. Electronic Patient Care Record. August 7 to December 3, 2017. Extracted December 5, 2017.
The map shows the distribution of opioid overdose calls received by Toronto Paramedic Services from November 1 to 30, 2017. 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.
Map of suspected opioid overdose calls received by Toronto Paramedic Services, Toronto, November 1 to 30, 2017overdose heat map, november 2017
Prepared by Surveillance & Epidemiology Unit, Toronto Public Health.
Source: Toronto Paramedic Services. Electronic Patient Care Record. November 1 to 30, 2017. Extracted December 5, 2017.

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: December 5, 2017
Substance-related emergency department visits at Toronto hospitals fluctuated from July to early November. The number of suspected overdose cases also fluctuated. The week of July 31 to August 6 had the highest number of both substance-related visits and suspected overdose cases over the observed time period. 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, July 3 to December 3, 2017*

Graph showing number of substance-related emergency department visits and suspected overdose cases by week, Toronto hospitals, July 3 to December 3, 2017Table showing number of substance-related emergency department visits and suspected overdose cases by week, Toronto hospitals, July 3 to December 3, 2017
*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. July 3 to December 3, 2017. Extracted December 4, 2017.
There was a significant upward trend in emergency department visits for opioid poisoning from July 2015 to June 2017 (most recent data available). Hospitalizations for opioid poisoning remained relatively stable over the period. This data source currently has a lag-time of approximately three to five months, and does not provide the most recent picture of opioid poisoning in Toronto. 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, July 2015 to June 2017

Graph showing number of emergency department visits and hospitalizations due to opioid poisoning by month, in Toronto hospitals, from July 2015 to June 2017
Source for ED visit data: National Ambulatory Care Reporting System, July 2015 to June 2017. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.  Extracted November 2017.
Source for hospitalizations: Discharge Abstracts Database, July 2015 to June 2017. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. Extracted November 2017.

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

The number of accidental deaths in Toronto due to opioid toxicity increased each year from 2013 to 2016. This includes deaths where opioids were a direct contributor to death, either alone or in combination with other substances. From 2015 to 2016, the number of opioid toxicity deaths increased by 33%. This is the largest annual increase over the observed time period. Alcohol, in combination with opioids, was a direct contributor in 20% to 30% of accidental opioid toxicity deaths each year. Please see the Data Notes tab for more information on this indicator.
Graph showing annual number of accidental opioid toxicity deaths in Toronto from 2013 to 2016Annual number of accidental opioid toxicity deaths, Toronto, 2013 to 2016* * Data are preliminary.
Source: Office of the Chief Coroner for Ontario. Number of Toxicity Deaths in Toronto – Accidental Manners of Death. 2013 to 2016. Received September 2017.In 2015, heroin/morphine was the most commonly present opioid in accidental deaths due to opioid toxicity. In 2016, fentanyl replaced heroin/morphine as the most commonly present opioid. Fentanyl was present in 48% of accidental opioid toxicity deaths in 2016, compared to 31% in 2015. Heroin/morphine, methadone, and oxycodone remained commonly detected opioids in 2016.Type of opioids present in opioid toxicity deaths, Toronto, 2015* and 2016*Graph showing type of opioids present in opioid toxicity deaths in Toronto from 2015 and 2016 * Data are preliminary. Numbers are subject to change.Note: Percentages do not equal 100%, as multiple opioids may be present in a single death.
Source: Office of the Chief Coroner for Ontario. Number of Toxicity Deaths in Toronto – Accidental Manners of Death. 2015 to 2016. Received September 2017.


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: November 28, 2017
On August 21, 2017, Toronto Public Health opened the interim site for supervised injection services at The Works. 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. Services moved to the permanent site on October 30, 2017. Note that the current site is open Monday to Saturday from 4pm to 10pm.Please see the Data Notes tab for more information on these indicators.
As of November 25, 2017, there were 1,147 visits to the interim supervised injection service to date, including 708 visits where clients received additional services (e.g., harm reduction supplies, naloxone training/kit, harm reduction education, referrals, etc.). There were 19 visits where an overdose occurred, including 10 visits where the client required naloxone.
Weekly* visits to the interim supervised injection services, The Works, August 21 to November 25, 2017
Graph showing weekly visits to the interim supervised injection services, The Works, August 21 to November 25, 2017* 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 November 27, 2017.

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

There was a slight upward trend in the number of recipients of opioid substitution treatment (OST) from January 2016 to June 2017. 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, January 2016 to June 2017
Chart showing number of recipients of opioid substitution treatment by treatment type, Toronto pharmacies, January 2016 to June 2017
Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. January 2016 to June 2017. Date Received September 15, 2017.


 

Overall, there was a slight upward trend in the number of dispenses (in days) for OST in 2016 and the first half of 2017. However, the number of days dispensed varied per month and did not increase consistently on a month-to-month basis. 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, January 2016 to June 2017

Chart showing number of days dispensed for opioid substitution treatment by treatment type, Toronto pharmacies, January 2016 to June 2017

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. January 2016 to June 2017. Date Received September 15, 2017.

There was a slight upward trend in the number of prescribers for suboxone in 2016 and the first half of 2017. 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, January 2016 to June 2017

Chart showing number of prescibers of opioid substitution treatment by treatment type, Toronto pharmacies, January 2016 to June 2017

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. January 2016 to June 2017. Date Received September 15, 2017.

The weekly number of new admissions to Toronto-based treatment centres fluctuated from November 2016 to October 2017. Since the beginning of 2017, more admissions have 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, November 7, 2016 to October 29, 2017

Graph showing number of weekly new admissions to provincially-funded drug treatment centres by presenting problem substance, Toronto, November 7, 2016 to October 29, 2017

Source: Centre for Addiction and Mental Health. Drug and Alcohol Treatment Information System. November 7, 2016 to October 29, 2017. Extracted December 4, 2017.

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

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(pdf) 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 (pdf), 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 accidental opioid toxicity deaths, Toronto

Source: Office of the Chief Coroner for Ontario. Number of Toxicity Deaths in Toronto – Accidental Manners of Death. 2013 to 2016.

Data Notes:

  • Data from 2015 and 2016 have been preliminarily released by the Office of the Chief Coroner for Ontario. Numbers are subject to change.
  • This data includes accidental manner of deaths only. It does include intentional or undetermined manners of deaths.
  • This data includes all deaths that occur in Toronto and may include deaths to non-Toronto residents that occur in Toronto.
  • The data presented here include the deaths where opioid toxicity (alone or in combination with alcohol) was the cause of death. ‘Opioid toxicity’ refers to deaths that occur from a single opioid or from more than one opioid in combination with other medications or drugs.
  • For the type of drug contributing to death, percentages may not equal 100%, as multiple opioids may be present in a single death. For instance, in an opioid toxicity death where fentanyl and heroin were both present, this death would be captured under both drug types.
  • A previous iteration of this indicator included data stratified by deaths due to opioids alone and those due to opioids in combination with alcohol. This indicator was revised to combine these categories and to improve the readability of this indicator.

 

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 visits where a client received an additional service refers to visits when the client received at least one of: referral, health education, health counselling, naloxone training or refills, and/or harm reduction supplies.
  • 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