Opioid-related deaths in Ontario’s shelter system more than tripled during the pandemic, according to a new report.
Authored by researchers from the Ontario Drug Policy Network and Public Health Ontario, the report identified 210 opioid-related toxicity deaths in shelters between January 2018 and May 2022 — 48 occurred before mid-March 2020 and 162 after.
Of all the health units, Toronto Public Health recorded the highest number of deaths — 62 — after mid-March 2020. Ottawa Public Health saw 20 deaths and Hamilton Public Health 10 deaths during the same period.
Nearly half of those who died had an encounter with the health-care system in the week before death, and 90 per cent had sought help for a mental-health condition.
“This is a population with a high complexity of needs,” says Tara Gomes, a principal investigator of the ODPRN. “And we’re clearly not finding the best ways to support them.”
She attributes the spike in deaths to a litany of factors. These include the unregulated drug supply, the rise of hotel-based shelters during the pandemic, inadequate training and funding for harm-reduction approaches, and an over-reliance on part-time and temporary shelter staff.
A more fundamental problem, she says, is a punitive approach to drug use that pushes people who use drugs into isolation.
“There’s a real history within shelters of prohibiting or punishing people who use substances,” Gomes says. “So we know that a lot of people hide their substance use, whether it be in washrooms or stairwells, because they’re afraid they might get kicked out of the shelter.”
This is supported by another of the report’s findings: Only one in seven people who died in the shelter system had someone present in a position to intervene. For opioid deaths in Ontario overall, the number is roughly one in four.
“When you use drugs alone, and when that is happening with such a dangerous supply that we have right now, it really increases people’s likelihood of experiencing an overdose when there’s nobody there to respond,” Gomes says.
Unregulated supply a contributing factor
A major contributor to the spike in opioid-related overdoses in the shelter system had to do with changes to the unregulated drug supply as a result of pandemic measures, says Brett Wolfson-Stofko, manager of harm reduction and health services at Homes First in Toronto.
“Because of the border being shut down, the drug supply shifted and changed a lot,” he says. “We had fentanyl with benzodiazepines being added to it, and in some cases tranquilizers as well, all of different potencies. Without a doubt, that is the main driver of these deaths — that people don’t know what they’re using and how much.”
Agenda segment, September 15, 2022
According to the report, more than 90 per cent of overdoses in the shelter system could be traced back to non-pharmaceutical opioids.
“That’s why safe supply is so important, because when people know what it is that they’re using and how much, they are able to cater their use accordingly,” he says. “When we make something illegal like this, what ends up happening is we forfeit our ability to regulate the market and leave it up to the illicit market to dictate everything.”
Through his current role at Homes First, Wolfson-Stofko says he has seen a number of interventions that have proven useful in preventing overdoses.
“We train all our staff on how to use naloxone, as well as oxygen to support with their response, which is best practice. We have onsite pharmacies to make it as easy as possible for people to access their methadone and buprenorphine. We also provide 24/7 barrier-free access to harm-reduction supplies: clean needles, crack kits, meth kits, so that people have everything they need to consume as safely as possible.”
Ongoing distrust of harm reduction
In Timmins, a city in northeastern Ontario, not a single person died of an overdose in the shelter system during the first two years of the pandemic.
According to Jason Sereda, one of the report’s authors and president of DIY Community Health Timmins, this was because of additional pandemic-related funding that paid for extra shelter staff, outreach teams, health and safety measures, and harm-reduction training and initiatives.
All that changed in 2022 when the funding ended.
“Around that time, we really started to see an increase in stigma toward people who use drugs and a lot of misinformation circulating about harm reduction,” Sereda says. “A lot of organizations backed off from having robust harm-reduction programs because of the backlash they were getting from the community.”
This is when Timmins began to see the first overdose-related deaths in the shelter system in a decade.
“When we’re not open about our harm-reduction policies or we don’t create that safe space for people to be open about their use, it just leads to people hiding it more,” Sereda says.
Agenda segment, September 2, 2022
While the city did open its first safe-consumption site in 2022, Sereda says there was an assumption by service providers that this would serve all of the community’s needs.
But its limited hours and the loss of harm-reduction programs in other parts of the system, he says, meant that people were left to their own devices when it came to using drugs safely: “We need to implement harm-reduction policies throughout all the service providers in the community, not just in shelters and addictions agencies.”
Now that site, open for two years, is set to close at the end of the month.
“That’s only going to increase the gaps in our community,” Sereda says, “and drive up the deaths we’re already seeing.”
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