Surge In Fatal Opioid Overdoses In Ontario Shelters, Report Finds

Opioid-related toxicity deaths within shelters more than tripled during the pandemic compared to the number of deaths occurring overall in the province, according to new research from the Ontario Drug Policy Research Network (ODPRN) at St. Michael’s Hospital and Public Health Ontario.

Using health data from the Office of the Chief Coroner of Ontario and ICES, researchers found that there were 210 accidental opioid-related toxicity deaths within shelters between January 2018 to May 2022, with the number of deaths more than tripling during the study period (48 before the pandemic versus 162 during the pandemic).

Statistics Canada data shows that the annual number of emergency beds in Ontario grew by only 15% (6,764 to 7,767) between 2018 and 2022.

“People who use Ontario’s shelter system are not only facing housing instability, but also have complex healthcare needs and unique barriers to accessing treatment and harm reduction programs,” says lead author Bisola Hamzat, an epidemiologist with the ODPRN. “This report underscores the disproportionate impact of the opioid crisis on this population.”

Trends in shelters differed from rest of Ontario

The researchers found that methamphetamines were a direct contributor to opioid overdose deaths in shelters more so than for overdose deaths in the rest of Ontario (48% versus 27%, respectively).

When exploring the circumstances surrounding the overdose and death, the data showed that someone was present and able to intervene for only 1 in 10 opioid-related toxicity deaths within shelters, which is lower than in Ontario overall (approximately 1 in 4). However, naloxone was administered most of the time when someone could intervene within shelters.

In the five years prior to death, almost 80% of people who died within a shelter had a hospital visit related to a mental health diagnosis, which is much higher than 56% of people in Ontario overall.

Several factors remained consistent with the rest of Ontario, including the rise of multiple substances being used (such as benzodiazepines and stimulants), a greater tendency toward smoking and inhalation of drugs, and fentanyl as the most common opioid coming from the unregulated drug supply.

In a secondary analysis of hotels and motels, the researchers found that opioid-related overdose deaths followed similar patterns to those in shelters but began to decline toward the end of the study period in 2022. The researchers say that the rise in deaths was likely influenced by the rapid expansion of temporary hotel-based shelters early in the COVID-19 pandemic.

Urgent need for improved response to crisis

“Our report highlights the need for improved and expanded harm reduction approaches, overdose response, as well as staff training and supports within shelters,” says co-lead 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.

“Additionally, improved transitions of care and connection to community-based healthcare, treatment programs, and mental health supports are warranted for people experiencing homelessness and housing instability.”

The report, “Opioid-related toxicity deaths within Ontario shelters: circumstances of death and prior medication & healthcare use” was published on the ODPRN website.

About St. Michael’s
St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About the Ontario Drug Policy Research Network
Established in 2008, the Ontario Drug Policy Research Network (ODPRN) is a research program based out of St. Michael’s Hospital that brings together researchers, people with lived experience, clinicians, and policy-makers to generate evidence to inform effective drug policy development in Ontario.

About Unity Health Toronto
Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.

About Public Heath Ontario
Public Health Ontario is a Crown corporation dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health. Public Health Ontario links public health practitioners, front-line health workers and researchers to the best scientific intelligence and knowledge from around the world. For the latest PHO news, follow us on Twitter: @publichealthON.

About ICES
ICES is an independent, not-for-profit research and analytics institute that uses population-based health information to produce knowledge on a broad range of healthcare issues. ICES leads cutting-edge studies and analyses evaluating healthcare policy, delivery, and population outcomes. ICES knowledge is highly regarded in Canada and abroad and is widely used by government, hospitals, planners, and practitioners to make decisions about healthcare delivery and to develop policy. For the latest ICES news, follow us on X, formerly Twitter: @ICESOntario