Toronto Overdose Information System

Toronto Public Health is collaborating with the Toronto Overdose Early Warning and Alert Partnership to provide timely information on overdose activity, with a current focus on opioids. Additional data and indicators may be added to this site as they become available. 

Emergency department visits and hospital admissions for complications of substance use in Toronto hospitals fluctuated from October 2016 through early March 2017 but no upward or downward trend is indicated. Note that this data source includes visits related to intoxication, addiction, overdose or withdrawal, and it is not limited to opioids. Some Toronto hospitals are also excluded from these data, including CAMH and Sunnybrook. Please see the Data Notes tab for more information on this indicator.

Number of substance-related emergency department visits and hospital admissions by week, Toronto hospitals, October 3, 2016 to March 12, 2017

Source: Acute Care Enhanced Surveillance System. ED and AD Line Listings. October 3, 2016 to March 12, 2017. Extracted March 2017.  

 

There is an overall upward trend in emergency department visits for opioid poisoning from January 2015 to September 2016. Hospital admissions for opioid poisoning remained relatively stable over the period. This data source currently has a lag-time of approximately three to five months, and does not provide the most recent picture of opioid poisoning in Toronto. Please see the Data Notes tab for more information on this indicator.

Number of emergency department visits and hospital admissions due to opioid poisoning by month, Toronto hospitals, January 2015 to September 2016

Source: National Ambulatory Care Reporting System, January 2015 to September 2016. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.  Extracted March 2017. 

The number of deaths due to opioid toxicity increased from 2013 to 2015. The number of deaths from opioid plus alcohol toxicity was higher in 2014 and 2015 compared to 2013. The numbers presented here include deaths from all manners, including unintentional, suicide, and undetermined. Please see the Data Notes tab for more information on this indicator.

Annual number of opioid toxicity and opioid-alcohol toxicity deaths, Toronto, 2013 to 2015*

* Data from 2015 have been preliminarily released by the Office of the Chief Coroner for Ontario. Numbers are subject to change. Preliminary numbers show that in 2015, there were 135 unintentional opioid deaths (excluding suicide and undetermined manners), with or without alcohol

Source: Office of the Chief Coroner for Ontario. Number of Toxicity Deaths in Toronto – All Manners of Death. 2013 to 2015. Received Jan. 5th, 2017.

The number of Naloxone kits (both initial and refill) distributed by The Works clinic at Toronto Public Health was variable through 2016 into February 2017. The peaks in number of kits distributed per week, as seen on the graph below, are higher in the second half of 2016 and the early months of 2017, compared to the first half of 2016. New naloxone kits refer to those distributed to a client after completing the necessary naloxone training. The number of new kits given out may be increasing due to higher awareness of naloxone and not necessarily more overdoses. Refill naloxone kits may be distributed for many reasons in addition to use of the initial kit for an overdose, including loss, damage, and expiration of the original ampule. Please see the Data Notes tab for more information on this indicator.

Weekly number of naloxone kits (in ampules), initial and refill kits, distributed by Toronto Public Health, January 2016 to February 2017

Source: The Works – Toronto Public Health. Number of naloxone kits distributed. Extracted Feb. 24th, 2017.

Bulletins related to overdose activity will be posted here if/when they become available. Please check back again. 

Number of substance-related emergency department visits and hospital admissions by week, Toronto hospitals: 

Source: Acute Care Enhanced Surveillance System. ED and AD Line Listings. October 3, 2016 to March 12, 2017. Extracted March 2017.

Data Notes:

  • This data source only captures substance-related visits that result in an individual seeking care in a hospital setting. This is likely an underestimation of the true burden of overdose in the population.  
  • ACES is a syndromic surveillance system that classifies visits and admissions into 'syndromes' using algorithms to assess and classify open text from the chief compliant recorded at triage or registration. This process allows ACES to provide daily counts of visits and admissions.
  • This data sources captures visits and admissions to acute care facilities in Toronto. However, it does not currently capture visits to Sunnybrook hospital. Moreover specialty hospitals, such as the Centre for Addiction and Mental Health and Women's College Hospital are not captured.
  • 'Substance-related visits' include instances of intoxication, addiction, overdose or withdrawal. Current limitations of this data source do not allow for a separate daily measure of drug overdoses.
  • 'Substance-related visits' include those caused by opioids (i.e. methadone, fentanyl, codeine, morphine, hydromorphone, hydromorph, carfentanil, dilaudid, heroin, oxycodone, opium, percocet) or non-opioid related drugs (OPI and TOX syndromes, combined). It excludes substance-related visits that are specifically marked as accidental, alcohol‐related or insulin overdoses.
  • Monday to Sunday week units are used here as the unit of analysis, with the starting date of each week labeled on the x-axis of the graph.  

 

Number of emergency department visits and hospital admissions due to opioid poisoning by month, Toronto hospitals:

Source: National Ambulatory Care Reporting System, January 2015 to September 2016. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.  Extracted March 2017.

Data Notes:

  • This data source also only captures overdoses where patients visited the emergency department or were admitted to the hospital. It is likely these data underrepresents the true burden of overdose in the population
  • While estimates for October and November of 2016 were available at the time of posting, the data quality assessment indicated that the counts were preliminary and not all hospitals were captured.
  • This data source includes all visits and admissions to Toronto hospitals, including those who are residents of other municipalities accessing care in Toronto.
  • Opioid poisonings were measured using ICD-10 codes: T40.0 – Opium, T40.1 – Heroin, T40.2 – Other opioids (e.g. Codeine, Morphine), T40.3 – Methadone, T40.4 – Other synthetic narcotics (Pethidine) and T40.6 – Poisoning by other and unspecified narcotics.
  • This indicator include visits or admissions where opioid poisoning was listed as a main or a contributing cause.
  • Emergency department visits includes only unscheduled visits.
  • Hospital admissions captures a subset of emergency department visits where the patient was admitted to reporting facility to either ICU/operating room or another unit or transferred to another acute care facility. This indicator likely captures the most severe opioid poisonings.  

 

Annual number of opioid toxicity and opioid-alcohol toxicity deaths, Toronto

Source: Office of the Chief Coroner for Ontario. Number of Toxicity Deaths in Toronto – All Manners of Death. 2013 to 2015. Received Jan. 5th, 2017.

Data Notes:

  • Data from 2015 have been preliminarily released by the Office of the Chief Coroner for Ontario. Numbers are subject to change.
  • This data includes deaths caused by 'all manners' including unintentional suicide, and undetermined causes of deaths.
  • The data presented here include the deaths where opioid and/or alcohol toxicity was the cause of death.
  • 'Opioid toxicity' refers to deaths that occur from a single opioid or from more than one opioid in combination with other medications or drugs. Deaths that occur from an opioid used in combination with alcohol are captured in' opioid-alcohol toxicity'.  

 

Weekly number of naloxone kits (in ampules), initial and refill kits, distributed by Toronto Public Health

Source: The Works – Toronto Public Health. Number of naloxone kits distributed. Extracted Feb. 24th, 2017.

Data Notes

  • 'New' kits refer to those distributed to a client after completing the necessary naloxone training. 'Refill' kits refer to those distributed to clients who have already completed the training.
  • This data source may include repeat clients, particularly where 'refill' kits are considered.
  • Trends in initial kit distribution may be driven by heightened awareness of naloxone due to promotion within the clinic and in the community, and does not necessarily directly reflect a greater burden of overdose. 
  • There are many reasons why a client requests a refill kit, including using the kit to reverse the effects of an overdose from opioids, including a lost, damaged or expired kit. 
  • Naloxone is also being distributed by pharmacies and other community agencies. Those numbers are not captured here.

Contact Us

Toronto Public Health                                                Toronto Drug Strategy

Surveillance and Epidemiology Unit                              drugstrategy@toronto.ca

seu@toronto.ca                                                             416-338-3585

416-392-7450