Ontario's opioid-related death toll surged to 2,050 during pandemic in 2020, new report finds

Opioid-related deaths surged in Ontario after the COVID-19 pandemic hit in 2020, with a total of 2,050 people dying between the months of March and December, according to a report released on Wednesday. 

The report, entitled "Changing Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic," found that one in six of the deaths occurred among people experiencing homelessness. The deaths were logged between March 16, 2020 and Dec. 31, 2020. There were 1,162 opioid-related deaths in the same time period in 2019.

The researchers say 139 people died of opioid-related overdoses in February 2020, before the province declared a state of emergency. They say the number of deaths ballooned in December 2020 to 248, the highest monthly opioid-related death toll ever recorded in Ontario.

The number of opioid-related overdose deaths in the unhoused population more than doubled during the pandemic months of 2020 compared to the same period in 2019, according to the report. 

Researchers found there were "small shifts" in the location of the deaths with fewer occurring in private residences and more occurring outdoors and in supportive and alternative housing. Thirty per cent, or 45 out of 150 deaths that occurred in hotels, motels, or inns, were in those designated to provide shelter or COVID-19 isolation services.

More than half of opioid-related deaths occurred among people who were unemployed, the report found.

Researchers say the surge in deaths is due to an unregulated drug supply that is increasingly toxic, limited access to supports, health-care services and community programs for people who use drugs, greater isolation as a result of public health measures to curb the spread of COVID-19, and shifting patterns of substance use that can be attributed to a rise in anxiety during the pandemic. 

They say the number of lives lost to opioid-related overdoses during the pandemic shows that the overdose crisis is getting worse, it is affecting marginalized people, including unhoused and unemployed people, and it requires an immediate and coordinated response from all levels of government. 

Ontario's response has 'lagged behind,' researcher says

Gillian Kolla, one of the authors of the report and a research fellow at the Canadian Institute for Substance Use Research at the University of Victoria, said an action plan is needed. She added that Health Minister Christine Elliott and Dr. David Williams, the province's chief medical officer of health, have yet to take any kind of action. 

"Unfortunately, Ontario has lagged behind in terms of an evidence-based public health response to the overdose crisis," Kolla said on Tuesday.

"Community-based harm reduction programs, front-line workers in overdose prevention sites and supervised consumption sites have been trying to call attention during the COVID pandemic to the high rates of overdose and overdose deaths that they were seeing. Unfortunately, we haven't seen concerted action from the province."

Kolla said the unregulated drug supply mentioned in the report refers to the street drug supply. Since 2016 in Ontario, there has been a "massive shift" towards fentanyl, an opioid used in medical settings, and increasingly, one trend is that fentanyl is being mixed with sedatives, such as benzodiazopines. The combination is potent, she said.

"You don't know the dose and the potency, or what is in the drugs themselves. This is really fuelling the crisis of overdose deaths that we are seeing," she said.

Non-prescription benzodiazepines, a drug considered dangerous when mixed with opioids, were present in nearly half of all opioid-related deaths during the pandemic. Before the pandemic, they were detected in only 30 per cent of deaths.

Zoe Dodd, a harm reduction worker for nearly 20 years and a community scholar for the MAP Centre for Urban Health Solutions, said people have been cut off from their supports during the pandemic.

"I think that the overdose deaths, what they really show us, is that not only are we failing people around drug policy, but also health and social policy. It is grave inequality that is driving the overdose crisis," Dodd said on Tuesday.

The report also found:

• Some of the largest increases in opioid-related death rates occurred among northern and rural parts of the province, including in North Bay, Sudbury, Thunder Bay and Timmins.
• Men accounted for 76 per cent of opioid-related deaths, an increase from 71 per cent the year before.
• People aged 25 to 44 accounted for 1,109 opioid-related deaths during the pandemic, an increase of 501 deaths from before the pandemic.
• Of those who were employed, about one-third of opioid-related deaths occurred among people in the construction industry.
• No one was present to intervene for 73 per cent of opioid-related deaths.

The Ontario Drug Policy Research Network, housed at St. Michael's Hospital of Unity Health Toronto, the Office of the Chief Coroner for Ontario and Public Health Ontario led the study.