Opioid deaths in Ontario shelters more than tripled during pandemic

A study examining data from the Ontario coroner's office and other sources indicates opioid-related deaths in the province's shelters more than tripled during the COVID-19 pandemic when compared with a few years prior. 

The study conducted by researchers from the Ontario Drug Policy Research Network at Toronto's St. Michael’s Hospital and Public Health Ontario found there were 210 accidental opioid deaths in shelters between January 2018 and May 2022. 

It found 48 of those deaths took place before the COVID-19 pandemic took hold in mid-March 2020, and 162 were recorded after. 

Dr. Tara Gomes, a lead author of the study and principal investigator with the Ontario Drug Policy Research Network, said Ontario in general saw an increase in opioid-related deaths during the pandemic. Still, that increase was more rapid in shelters. 

Many of those deaths were driven by the illicit drug supply, including fentanyl and benzodiazepines, which are sedatives, she said. Researchers found that many overdose deaths at shelters were also related to the use of methamphetamine, which is a stimulant that some people use to counter the sedation effects of illicit opioids. 

"It's actually quite a dangerous situation where the illicit supply has become really unpredictable, really sedating with the different substances that are in it," Gomes said in a phone interview. 

"So people are having to adapt their use and use other drugs, like stimulants such as methamphetamines, to counteract those effects. And that can increase the risk of harm for this population."

The majority of opioid-related deaths within shelters are occurring when there is nobody present to intervene, either by using naloxone or calling for first responders, Gomes said. 

The study found that somebody was present and able to intervene in only one in seven opioid-related deaths within shelters in Ontario. 

Gomes said policies that remain in force in some shelters today punish people if they are found to be using illicit substances. That means people are more likely to hide their drug use and use drugs in stairwells or in bathrooms, she said.

"If they're using in those spaces, there often isn't somebody there to recognize if they're in need of help and in need of resuscitation or naloxone," Gomes said. 

"There's a real concern that some of the policies that have existed within shelters, and the fear that people have of being kicked out of a shelter if their substance use is noted, is leading to people using drugs alone. And that's increasing the risk of death."

Gomes said inadequate resources within shelters to handle the rising numbers of overdoses, as well as the rising harms from the illicit drug supply, have contributed to the spike in opioid-related deaths within shelters. 

"When you see a really potent and unpredictable supply in a setting where there is a lot of use of drugs alone, the harms can increase even more quickly," she said.

People who use drugs typically have friends or others who check in on them, Gomes said, but those networks of support dissolved during the pandemic and individuals weren't able to access the same services they had before. 

The study found that half of those who died in shelters from opioid overdoses during the pandemic were between 24 and 44 years old, and three out of four were men. 

The Toronto Public Health unit had the highest number of opioid-related deaths within shelters during the pandemic period studied, with 65 deaths, followed by Ottawa Public Health with 20 fatalities and Hamilton Public Health with 10 deaths. 

Gomes said shelter staff need to be trained and have resources to be able to identify and support people who use drugs.

"It can't all be just on (shelter) staff to identify and respond," she said. "But we need to also think about how to integrate harm reduction and treatment services within these settings, where we know a lot of people are at risk of these harms, to help keep them safe."