Overdose Crisis

COVID-19 and the Overdose Crisis

People Who Use Drugs and those who are under-housed, immunocompromised, and incarcerated, are at increased risk of contracting and suffering complications from COVID-19. People Who Use Drugs are at a heightened risk of fatal overdose due to:

  • decreased access to a consistent drug supply due to border closures,

  • increased isolation and solitary drug use due to physical distancing protocols, and

  • respiratory impairment caused by COVID-19 which compounds the respiratory depression caused by opiate overdoses.

Opioid overdose rates have significantly increased in Toronto since the start of the COVID-19 pandemic.

The Overdose Crisis in Canada

Canada is in the midst of a growing overdose crisis which is devastating families and communities across the country. In 2016, there were 3,017 opioid-related deaths in Canada, in 2017 there were 4,100, and in 2018 there were 4,460 opioid related deaths in Canada (Public Health Agency of Canada, 2019). Ontario ranks second in the number of deaths per province, with over 1,470 Ontarians having died from opioid-related causes in 2018 (Public Health Agency of Canada, 2019).

More than twice the number of Canadians died of accidental opioid overdoses in 2018, than died during the height of the HIV/AIDS epidemic.

The Overdose Crisis in Toronto:

The rate of opioid related deaths has been steadily rising in Toronto since 2012.  Between 2010 and 2017 there were 1,139 opioid related deaths, with deaths reaching their highest point in 2017 with 308 deaths, jumping from 186 deaths in 2016 (Public Health Ontario, 2019).  According to the most recent available data, there were 203 deaths in the first 9 months of 2018 (Public Health Ontario, 2019).  

 Up-to-date information on the overdose crisis in Toronto and Ontario is available from Public Health Ontario at this link.

Factors That Contribute to the Overdose Crisis

The biggest contributing factor in illicit drug overdoses, is the prohibition of certain drugs and the people who use them. Substance use is a universal human trait and is a common coping mechanism for people dealing with adverse experiences. Thus, when people cannot obtain drugs legally, they will look elsewhere to meet their needs. Under prohibition, the production and distribution of drugs is forced underground and into criminal markets, where drugs are concentrated, cut, and sold with unknown potency and adulterants. The criminalization of drugs and the people who use them leads to increasingly potent and dangerous drugs, violence, over-incarceration, and human rights abuses Criminalization also forces users into solitary and hidden drug-use practices and alienates them from needed healthcare, legal, and law enforcement services.

What else is Contributing to the crisis?

  • Fentanyl, a dangerously strong opioid that is being mixed into illicit drugs

  • Lack of access to a safe drug supply and adequate and affordable pain treatment options

  • Pharmaceutical industry practices including falsified research and marketing, and the overprescription of opioids

  • Stigma and discrimination towards people who use drugs

  • Social inequality, racism and colonization

  • Unresolved collective, historical, and individual trauma

  • Mass incarceration and policing

  • The affordable housing crisis

  • Lack of shelter, education, meaningful employment, family supports, and mental health resources

  • Lack of access to harm reduction services, and barriers to receiving care due to abstinence-based models

  • Cuts to healthcare and EMS services

  • Concentration of services in the downtown core of cities

Opioids and Fentanyl

Opioids are being overprescribed in Canada, with Canadians being the 2nd highest per capita consumers of opioids in the world. Common opioids include fentanyl, heroin, morphine, methadone, and oxycodone. While these opioid drugs are usually used to treat pain, they are also used by people to treat symptoms of withdrawal, to cope with stress, trauma, and isolation, or to get high. Part of the reason why so many people have turned to the street in need of opioids, is due to a decision made by Purdue Pharmaceuticals in 2012, which made the prescription opioid OxyContin harder to crush or melt down.

In 2017 there was a 2,000% rise in all street drugs testing positive for fentanyl. The drug is relatively cheap and extremely potent, so dealers are mixing it into their supplies. Fentanyl is fifty to one hundred times more potent than morphine, is highly toxic, and can be hidden in heroin, oxycodone, crystal meth, methamphetamines, and cocaine. Heroin shows the most dramatic rise in fentanyl adulteration, with fentanyl contained in less than one percent of heroin tested in 2013, and more than 60% of heroin tested in 2017. More recently, carfentanil, an even more deadly opioid, has been found mixed in street drugs.

Opioid overdose deaths result both from prescription opioids and illicit drugs with synthetic opioids, such as fentanyl. The majority of accidental opioid-related deaths involve fentanyl. When fentanyl analogues are injected, snorted, or smoked, they can bring on an immediate overdose, causing a person’s breathing to slow down or stop completely, leading to death. Non-fatal overdoses are also a concern because they can lead to seizures, organ damage, and physical injury.

A way forward?

In order to meaningfully address the Overdose Crisis in Canada, there must be a multi-pronged approach that considers all of the contributing factors. To address prohibition, models of drug decriminalization and legalization have been proposed to either repeal harmful laws, and/or put in place laws that regulate and control currently illegal drugs. Harm Reduction approaches to substance use prioritize public health and evidence-informed practices to reduce the harms associated with drug use. Harm reduction aims to reduce stigma and discrimination and has been proven to produce a number of positive health outcomes for communities. Examples of harm reduction include Safe Consumption Services (SCS), the Good Samaritan Drug Overdose Act, and other services like needle exchanges and drug checking services. Addressing other contributing factors such as over-policing, mass incarceration, affordable housing, and access to adequate health care are necessary for wholistic and long-term change, and will require large-scale social and institutional changes.