December 15, 2020

Increase in opioid deaths in 2020

  • Toronto is seeing a substantial year-over-year rise in fatal opioid overdoses and shelter deaths with further increases during the COVID-19 pandemic. Early estimates indicate there could be 450 opioid-related deaths in Toronto in 2020, an increase from 300 deaths in recent years.[1] The City’s Shelter, Support and Housing Administration (SSHA) Division is reporting a 48 per cent increase in shelter deaths since March 2020.
  • As of the end of November, there have been 29 suspected overdose deaths in Toronto shelters compared to 13 in 2019 and 5 in 2018. Since the start of the pandemic there have also been more than 200 calls to EMS for non-fatal overdoses in shelters, where the quick action of shelter staff and use of available resources such as the administration of naloxone, have saved lives.
  • This increase in overdose deaths is largely due to the increasing toxicity of the unregulated drug supply as carfentanil and other substances are added to the supply.
  • Public health measures required to reduce the spread of COVID-19 may also be inadvertently adding to the risk of overdose deaths due to:
    • more people consuming drugs alone as a result of physical distancing
    • the disruption of drug supply chains by moving people who use drugs to new locations (e.g. shelters) with dealers they do not know
    • the reduction in the congregated settings as a result of physical distancing and the introduction of more than 2,000 hotel spaces
    • a reduction in service hours and capacity in health-funded harm reduction and other health services due to COVID-19
  • At its meeting on November 16, 2020, the Board of Health requested the Medical Officer of Health, in consultation with the General Manager, Shelter, Support and Housing Administration, to continue to work with community partners toward urgently expanding the overdose prevention response and other harm reduction measures in shelters.
  • The iPHARE initiative is a cooperative effort with the Shelter, Support and Housing Administration working closely with Toronto Public Health (TPH) and other City departments and community agencies to address the opioid poisoning crisis through the Council supported Toronto Overdose Action Plan.

Protecting public health and public safety

  • The iPHARE initiative will save lives, reduce public drug use and reduce drug paraphernalia in parks and public spaces.
  • iPHARE 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.

The following comprehensive measures are planned by SSHA working with TPH and other agencies as part of this iPHARE initiative:

  • $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 (UPHNS) into selected shelters across the City, allowing shelter residents to consume drugs under trained supervision to reduce the risk of overdose fatalities. These UPHNS are for residents of the shelter where the service is located only and not open to the public.

It is anticipated that services will be rolled-out starting in December 2020.

The operation of Urgent Public Health Needs Sites requires an exemption under Section 56(1) of the federal Controlled Drugs and Substances Act. Health Canada has created a streamlined approval process to expedite implementation of UPHNS during the pandemic in areas of demonstrated need.

The greatest risk factor for death from overdose is using drugs alone, which is occurring in some of the physical distancing shelters. The shelter-based UPHNS will allow residents to consume drugs on-site under the supervision of trained staff. These services would not be open to the public.

SSHA is currently looking at introducing supervised consumption services at a number of shelter sites across the city, starting with the site at 65 Dundas Street East. Additional sites will be confirmed as resources, such as staff and training, are put in place.

There have been hundreds of overdoses at shelter sites since the start of COVID-19, which have been reversed by shelter staff and paramedics, and 29 fatal overdoses at City shelters.

Community engagement

  • Although there is no requirement to engage the public to introduce the iPHARE initiative, we will be rolling-out a communications and community engagement process to provide information on these local services.
  • Online public meetings will be held on January 12, 18 and 19 at 7 p.m. so that Torontonians can learn more about these vital services.
  • To find out more about these sessions go to

Details of harm reduction supports to be implemented at all shelter locations

As part of iPHARE, TPH and other community harm reduction programs are working with SSHA and shelter operators 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

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[1] Toronto Paramedic Services data reveal that 188 people died of suspected opioid overdoses between April 1 and November 30, 2020, a near doubling of deaths for the same period in 2018/2019. It is important to note that paramedic data does not capture all deaths. Data from the Officer of the Chief Coroner for Ontario shows, on average, double the number of deaths seen in Toronto paramedic data.

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