The Integrated Prevention and Harm Reduction initiative (iPHARE), is a multi-pronged effort by the City and community agencies to address opioid-related deaths in Toronto’s shelter system. The initiative comes in response to the escalating opioid poisoning crisis in Toronto.

iPHARE has three key funding components for:

  • Parkdale Queen West Community Health Centre to provide a range of harm reduction supports for hotels that have been set up to create physical distancing in the shelter system and other shelter programs across Toronto
  • LOFT Community Services and Toronto North Support Services for enhanced intensive mental health case management supports
  • Urgent Public Health Needs Sites embedded into selected shelters across the city, allowing residents at the location to consume drugs under trained supervision, reducing the risk of overdose fatalities. These sites will not be open to the public.

iPHARE began in December 2020 and is saving lives and reducing public drug use and drug paraphernalia in parks and public spaces. It is assisting shelter workers, first responders and harm reduction workers who have the challenging job of reversing overdoses or coping with overdose fatalities every day.

Toronto has seen a substantial rise in fatal opioid overdoses and related shelter deaths during the COVID-19 pandemic. 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. Non-fatal overdoses are often the result of the quick action of shelter staff intervening to save lives by administering naloxone and calling for emergency services. Even so, fatal overdoses have increased, from an average of about one per month in 2018 to four per month in 2020.

There are several factors that have contributed to these increases, including:

  • increasing toxicity of the unregulated drug supply as carfentanil and other substances are added to the supply
  • higher numbers of people consuming drugs alone as a result of physical distancing requirements
  • some shelter residents having been moved to ensure physical distancing, meaning that they may be purchasing from unfamiliar dealers
  • reduced numbers of shared congregate settings and more open hotel spaces, resulting from the City’s COVID-19 infection prevention and control measures, which can be isolating for residents
  • reduced health-funded harm reduction services and service hours (i.e. detox, withdrawal and mental health facilities)

To address this crisis, in November 2020, the Board of Health requested that the Medical Officer of Health and the City continue to work with community partners to urgently expand overdose prevention response and other harm reduction measures in shelters.

iPHARE will address this request and help to advance the Toronto Overdose Action Plan.

For more data about overdose incidents in the shelter system, see Overdoses in Homelessness Services Settings.

As part of iPHARE, the City is working with Toronto Public Health and other community harm reduction programs to introduce a range of harm reduction measures in all shelter locations. These include:

  • ensuring locations have access to on-site harm reduction supplies, including naloxone
  • mandatory staff training on drug use, overdose prevention and response
  • grief and loss support services for shelter staff and residents
  • creating an overdose response program for shelter residents that use drugs. Options include:
    • establishing a peer witnessing program where residents can consume drugs in the company of a hired or appointed staff person
    • conducting wellness checks and establishing monitoring options that are non-stigmatizing and non-fear-based
    • establishing a safe inhalation or smoking space that allows harm reduction/peer workers to witness drug use from an appropriate distance
    • establishing virtual services, such as a dedicated on-call consumption support person available by telephone
  • establishing Resident Peer Harm Reduction Advisory Committees at all hotel locations
  • investigating options to support a safer supply of drugs
  • whenever possible, working with people with lived experience to develop and potentially deliver harm reduction and overdose-related services on-site

The greatest risk factor for death from overdose is using drugs alone, which is occurring in some of the shelters set up in hotels to create physical distancing in the shelter system.

The City of Toronto has established Urgent Public Health Needs Sites (UPHNS), also known as overdose prevention sites or supervised consumption services, to allow shelter residents to consume drugs under trained supervision to reduce the risk of overdose.

Shelter, Support and Housing Administration is introducing UPHNS at a number of shelter sites across the city. The first sites opened at the City’s COVID-19 recovery and isolation site for people experiencing homelessness, a shelter at 65 Dundas Street East in December 2020 and at 185 Yorkland Boulevard in March 2021. A fourth site opened at 45 the Esplanade in June, 2021. These sites are for residents of the shelter only and not open to the public.

Additional sites will be confirmed as needs and resources are established.


Upcoming Information Sessions

The City of Toronto is hosting a virtual public meeting to assist the public to better understand the opioid crisis, its impact on shelters and work being led by the City, Toronto Public Health and community agencies to prevent opioid overdoses in the shelter system.

Tuesday, September 28 at 7 p.m. to 8:30 p.m.

  • Join the online meeting
  • Event password: HarmReduction! (if prompted)
  • Telephone connection: 416-915-6530; Access code: 177 977 5037

Past Information Sessions

The City hosted previous information sessions about iPHARE. This presentation was given at the January meetings. This is the August 9 meeting presentation.

Recordings of each session are available below:


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