iPHARE, which stands for Integrated Prevention and Harm Reduction initiative, 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 components:

  • $2.76 million for Parkdale Queen West Community Health Centre to provide a range of harm reduction supports to hotels set up to create physical distancing in the shelter system and other shelter programs across Toronto
  • $1.47 million to fund LOFT Community Services and Toronto North Support Services for enhanced intensive mental health case management supports
  • $3.38 million to expand the range of harm reduction services and embed Urgent Public Health Needs Sites into selected shelters across the city, allowing residents at the location to consume drugs under trained supervision to reduce the risk of overdose fatalities. These sites will not be open to the public.

Services started to roll-out in December 2020.

iPHARE will save lives, reduce public drug use and reduce drug paraphernalia in parks and public spaces. It will also assist first responders, harm reduction workers and shelter workers who are faced every day with the difficult job of reversing overdoses or coping with overdose fatalities.

Toronto is seeing a substantial rise in 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 as carfentanil and other substances are added to the supply
  • more people are consuming drugs alone as a result of physical distancing
  • some shelter residents have been moved to ensure physical distancing, which means those who use may be purchasing from dealers they do not know
  • to ensure physical distancing, the City has reduced the number of shared congregate settings, and opened more hotel spaces, which can be isolating
  • health-funded harm reduction services (i.e. detox, withdrawal and mental health facilities) have had to reduce their service hours and capacity

In 2020, there were more than 500 opioid-related deaths in Toronto, an increase from 300 deaths in recent years. Shelter, Support and Housing Administration is also reporting a 48 per cent increase in shelter deaths since March 2020.

This increase in overdose deaths is largely due to the increasing toxicity of the unregulated drug supply as carfentanil and other substances are added.

In November 2020, the 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.

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

As part of iPHARE, the City is working with TPH and other community harm reduction programs to introduce a range of harm reduction measures in all shelter locations. This includes:

  • 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. Option may 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 not 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 will be establishing Urgent Public Health Needs Sites, 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 looking at introducing supervised consumption services at a number of shelter sites across the city. The first site opened at the shelter at 65 Dundas Street East in December 2020 and another is scheduled to open at 185 Yorkland Boulevard in March 2021.

These sites are for residents of the shelter only and not open to the public.

Additional sites will be confirmed as resources, such as staff and training, are put in place.

Information Sessions

The City hosted online information sessions about iPHARE on January 12, 18 and 19 to allow Torontonians to learn more about iPHARE and ask questions. The following presentation was given at the meetings.

View a recording of the January 12, January 18 and January 19 meetings.

E-updates

The City has created a listserv to share important updates on harm reduction, mental health and consumption treatment services in the shelter system.

See the next accordion to subscribe.

Online Comment Form

You can also share your comments and questions through this form.  This information will help us to develop content for future e-updates.

Type (don’t copy and paste) your email into the box below, check the box next to the e-update description and then click “Subscribe”. You will receive an email with instructions to confirm your request.


Subscribe to get information on initiatives undertaken by the City and community agencies to provide harm reduction, mental health case management and consumption treatment services to shelter users in an effort to reduce the risk of opioid-related overdoses. You can unsubscribe at any time.
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