People who died from a substance-related overdose faced significant gaps in treatment, report finds

In the months and years before their death, many people had received substance use diagnoses and used healthcare services, but few engaged with evidence-based substance use treatment—signaling the need for a multi-factorial approach, researchers urge.

The report, led by the Ontario Drug Policy Research Network (ODPRN) at St. Michael’s Hospital and Public Health Ontario, used data from the Office of the Chief Coroner of Ontario and ICES to describe prior prescribing patterns, substance use disorder diagnoses, and toxicity events among people who died from accidental opioid, benzodiazepine, stimulant and/or alcohol-related toxicities in Ontario.

Similar to a 2023 report, the unregulated drug supply and polysubstance use continues to drive these deaths. This report aimed to delve further into people’s prior experience with the healthcare system to better understand the types of responses needed and opportunities for intervention.

“The crisis of escalating substance toxicities is complex, and impacts people in different ways,” says author Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and ICES, and a principal investigator of the ODPRN. “This means we need a multifaceted response that will most benefit those at risk of serious harms.”

Interaction with the healthcare system

There were 10,024 accidental substance toxicity deaths in Ontario over the four- and half-year study period—an increase of 72% comparing deaths in the first 12 months compared to the final 12 months.

Almost two-thirds (61%) of people who died from substance-related toxicity had prior healthcare encounters for substance use disorder—yet engagement with evidence-based substance use treatment was relatively low. For example, among people with opioid use disorder who died from an opioid-related toxicity, less than one-third received recommended medications in the month before their death. Similarly, among those with a diagnosis of an alcohol use disorder, less than 5% had received first-line medications to treat their diagnosis in the month before death.

“People experiencing harms from substance use have varied needs, and treatment, while an integral component to our response to this crisis, cannot be our only response,” says Gomes. “With many people disengaged from medical care for substance use, responses that integrate both harm reduction and treatment services are imperative. Finally, in the current context of an increasingly unpredictable unregulated drug supply and rising use of multiple substances, we need to ensure that these services are adequately resourced to meet the complex needs of people who use drugs in our communities.”

The researchers also found that 1 in 5 people who died from substance-related toxicities had been treated in hospital for a non-fatal overdose in the year prior to death, the majority of which were related to opioid-related toxicity events. Although prior alcohol-related toxicities were much less common (1%), nearly half of people who died from an alcohol-related toxicity had a hospital visit related to alcohol use disorder in the five years prior to their death.

Gomes says that these findings reflect the high burden of ongoing harms experienced by people who use substances in Ontario, especially among those accessing the unregulated drug supply, which is increasing in potency and unpredictability.

This work also reinforces the need for hospitals to ensure that they have accessible expertise in substance use care, and adequate training for clinicians and staff to ensure the provision of high quality, trauma-informed care for people who use substances who engage with the healthcare system.

“Our communities are currently struggling enormously with an increasingly unpredictable and toxic drug supply that is leading to unprecedented harm,” says Gomes. “The urgency of the tragedy that is unfolding across the province needs to be reflected through widespread support for innovative, multidisciplinary responses that are accessible both through community-based organizations and our hospital system.”