The rising opioid death toll comes as front-line staff struggle with burnout while navigating the unpredictability of COVID-19

By Nadine Yousif, Toronto, Ontario, Canada, February 16, 2022 /Toronto Star/ –

Toronto’s supervised drug consumption sites are seeing a record number of overdoses, while the city’s paramedics responded to more fatal overdoses in 2021 than any other recorded year — all signs that experts say point to a worsening opioid crisis both in Ontario and elsewhere.

The toll comes as front-line staff struggle with burnout and grief while navigating the unpredictability of COVID-19 and the latest Omicron wave. And a lack of swift action on the part of policy-makers to reduce opioid-related harms, some critics say, has exacerbated an already dire situation.

“The drug poisoning crisis is not getting better,” said Shaun Hopkins, manager of The Works, a supervised consumption site run by the city of Toronto. “We’re continuing to see records being set in terms of paramedic calls, deaths, overdose numbers.”

The Works saw a record 165 overdoses in December, accounting for 8.8 per cent of all visits to the site that month. It is a marked increase from December 2019, where the rate of overdoses hovered around 1.4 per cent. In January 2022, the rate of overdoses remained high at 5.6 per cent.

Paramedics in Toronto also saw a record number of opioid deaths in 2021, responding to a total of 357 fatal suspected overdose calls. In 2020, paramedics responded to 268 fatal calls. Because paramedics aren’t involved in every opioid fatality, the numbers for opioid-related deaths in 2021 may be higher, said Gillian Kolla, a post-doctoral fellow at St. Michael’s Hospital with expertise in drug policy.

Due to a data lag in Ontario, preliminary numbers of opioid-related fatalities for 2021 are only available up until June, but they hover at 1,415 deaths. In all of 2020, the province saw 2,431 deaths. British Columbia, which released its 2021 data on Monday, saw its deadliest year yet for opioid-related deaths, with 2,224 fatalities.

In Ontario, experts say the issue is multi-pronged. One aspect is the volatility and unpredictability of the street drug supply, which is seeing benzodiazepines increasingly present alongside fentanyl, making the drugs more potent and increasing the likelihood of an overdose.

“The benzos are not affected by Naloxone, so people are out for longer and it’s harder for us to monitor those people,” Hopkins said. (Naloxone is a drug used to reverse the effects of an opioid overdose.)

Other factors are more systemic, Kolla said, like the ongoing housing affordability crisis in the city, alongside the public health crisis of COVID-19 that has posed capacity challenges for existing services. For example, The Works usually operates with six booths, but had to limit capacity to two at the height of COVID. Now, Hopkins said that as of January, only five out of six booths are open due to distancing requirements.

Another issue is access to treatment. Lorraine Lam, an outreach worker at Sanctuary Toronto, said people are still often waiting months for space to open up. Access to detox beds in Toronto, she said, is nearly impossible because there are so few compared to demand.

“It’s not surprising to me that we’re seeing an increased amount of overdoses happening because we’re not doing much at the moment to address any of these crises,” Kolla said.

Lam added it’s important to recognize not everyone who uses drugs is seeking treatment, and that harm reduction approaches such as a safer drug supply and access to supervised consumption sites remain the key to keeping people alive.

During the pandemic, Toronto introduced three supervised consumption sites in temporary COVID-19 hotel shelters, but experts say barriers to accessing services remain, as all of Toronto’s sites are concentrated south of College Street. Also, none of them are open 24 hours a day.

“People use drugs all day and through the night, so there’s definitely a need for something that is open,” Hopkins said.

To address the growing crisis, the province announced last week funding of $90 million over the next three years for an Addictions Recovery Fund, which will expand treatment beds across the province, including in rural and remote communities. But in a statement to the Star, the province reiterated its funding cap for up to 21 Consumption and Treatment Services. Currently, the Ministry of Health is funding 16.

A spokesperson for the ministry added the province is allocating $32.7 million of new and annualized funding for substance use services in 2021-22, including harm reduction and community-based addictions treatment.

The province did not respond to questions about whether it will fund four additional sites pending approval in Ontario, one of which is being proposed in Markham, but said applications continue to be accepted by the ministry.

For those working on the ground in harm reduction, the worsening crisis has not only had a profound impact on people who use drugs, but also on the workers and their colleagues. Lam said that a few years ago, frontline workers had time to debrief with one another after responding to an overdose. Now, overdoses happen so frequently that there isn’t time to reflect.

“As we started responding to more and more overdoses, it just kind of became the norm,” Lam said. “We don’t do these intense debriefs anymore, because it’s become such a part of our regular day.”

Hopkins said staff have witnessed many people lose their lives to overdose over the last few years. “It’s a lot of grief, loss and trauma for them,” she said. “For people who use drugs throughout the city, they’ve lost friends and family members.”

Nadine Yousif is a Toronto-based reporter for the Star covering mental health. Follow her on Twitter: @nadineyousif_

This article was first published on Toronto Star