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 April 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 not included in this data source, 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 April 30, 2017

Source: Acute Care Enhanced Surveillance System. ED and AD Line Listings. October 3, 2016 to April 30, 2017. Extracted May 2017.  


 

There is an overall upward trend in emergency department visits for opioid poisoning from January 2015 to September 2016. Hospitalizations 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 hospitalizations due to opioid poisoning by month, Toronto hospitals, January 2015 to September 2016

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

Source for hospitalization data: Discharge Abstracts Database, January 2015 to September 2016. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. Extracted May 2017. 

The number of accidental deaths due to opioid toxicity increased each year from 2013 to 2015. The number of accidental deaths occurring in Toronto from opioid with alcohol toxicity was higher in 2014 and 2015, compared to 2013. Please see the Data Notes tab for more information on this indicator.

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

* Data from 2015 are preliminary.

Source: Office of the Chief Coroner for Ontario. Number of Toxicity Deaths in Toronto - Accidental Manners of Death. 2013 to 2015. Received April 2017.


 

Of the 102 accidental deaths in Toronto in 2015 where only opioids were present, fentanyl was present in 34% of deaths. Heroin was present in 23% of deaths and methadone in 22%.

Of the 33 accidental deaths in Toronto in 2015 where opioids and alcohol were both present, heroin was present in 36% of deaths. Fentanyl was present in 21%.

In 2015, there were also 30 cocaine with opioid toxicity accidental deaths and 14 cocaine with alcohol toxicity accidental deaths in Toronto (not pictured here).

Annual number of accidental opioid toxicity and opioid with alcohol toxicity deaths by drug type, Toronto, 2015*

* Data from 2015 are preliminary. Numbers are subject to change. Percentages do not equal 100%, as multiple opioids may be present in a single death.

Source: Office of the Chief Coroner for Ontario. Number of Toxicity Deaths in Toronto - Accidental Manners of Death. 2013 to 2015. Received April 2017.

There is a slight upward trend in the number of recipients of opioid substitution treatment (OST) in 2016. Recipients are unique individuals receiving at least one dispense of OST. More recipients are receiving methadone maintenance treatment (MMT), compared to those receiving suboxone and its generics. Please see the Data Notes tab for more information on this indicator.

Number of recipients of opioid substitution treatment by treatment type, Toronto pharmacies, 2016

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. January 2016 to December 2016. Date Received March 22, 2017.


 

Overall, there is a slight upwards trend in the number of dispenses (in days) for OST in 2016. However, the number of days dispensed varies per month and did not increase consistently on a month-to-month basis. Days dispensed refer to the number of days' worth of treatment that was distributed from a pharmacy. An increase in number of days dispensed could mean that more individuals are accessing treatment, individuals are accessing treatment more frequently, or a combination of both scenarios. Please see the Data Notes tab for more information on this indicator.

Number of days dispensed for opioid substitution treatment by treatment type, Toronto pharmacies, 2016

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. January 2016 to December 2016. Date Received April 6, 2017.


 

The weekly number of new admissions to Toronto-based treatment centres fluctuated over 2016 and the first three months of 2017. Since the beginning of 2017, more admissions have reported prescription opioids as a problem substance, compared to heroin/other non-prescription opioids. Please see the Data Notes tab for more information on this indicator.

Number of weekly new admissions to provincially-funded drug treatment centres by presenting problem substance, Toronto, Jan. 4, 2016 to April 2, 2017

Source: Centre for Addiction and Mental Health. Drug and Alcohol Treatment Information System. Jan. 4, 2016 to April 2, 2017. Extracted May 1, 2017.

The number of Naloxone kits (both initial and refill) distributed by The Works clinic at Toronto Public Health was variable through 2016 into April 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 April 2017

Source: The Works – Toronto Public Health. Number of naloxone kits distributed. Extracted April 28, 2017.

28/03/2017: Toronto Overdose Action Plan

Toronto Public Health worked with community partners to develop the Toronto Overdose Action Plan: Prevention & Response (pdf), which was endorsed by the Board of Health on March 20, 2017. The Plan includes a comprehensive set of actions for all orders of government to prevent and respond to drug overdoses.

 


28/03/2017: Naloxone information

The Province of Ontario has launched a new website with information on where to get free naloxone kits in your area.


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. Extracted May 1, 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.

  • In the April 2017 update of this indicator, the weekly count has been updated to reflect all visits and admissions to Toronto-based hospitals, including those who may not have a health card or who may reside in another health unit, but are accessing care in Toronto. This change was made to better capture the true burden of substance-related visits at Toronto hospitals.

 

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

Source: National Ambulatory Care Reporting System. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.  Extracted May 1, 2017.

Data Notes:

  • This data source also only captures overdoses where patients visited the emergency department. 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 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 where opioid poisoning was listed as a main or a contributing cause.
  • Emergency department visits includes only unscheduled visits.

Number of hospitalizations due to opioid poisoning by month, Toronto hospitals:

Source: Discharge Abstracts Database. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.  Extracted March 2017.

Data Notes:

  • This data source also only captures overdoses where patients were hospitalized. 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 hospitalizations 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 includes hospitalizations where opioid poisoning was listed as a main or a contributing cause.
  • In the May 2017 update of this indicator, the data source was changed from the National Ambulatory Care Reporting System to the Discharge Abstracts Database to be consistent with how Public Health Ontario is measuring this indicator. The Discharge Abstracts Database also contains more detailed information about hospitalizations, as records include all information available at the time of discharge which is often more specific than information available at admission.

 

Annual number of accidental opioid toxicity and opioid with alcohol toxicity deaths, Toronto

Source: Office of the Chief Coroner for Ontario. Number of Toxicity Deaths in Toronto – Accidental Manners of Death. 2013 to 2015. Received Jan. 5, 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 all deaths that occur in Toronto and may include deaths to non-Toronto residents that occur in Toronto.
  • in the May 2017 update of this indicator, death data includes only accidental manners of death. A previous iteration of this indicator measured deaths caused by 'all manners' including unintentional, suicide and undetermined cause of death. While intentional deaths are an important public health issue, they represent a different subcategory within overdose deaths.
  • The data presented here include the deaths where opioid or opioid with 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 with alcohol toxicity'.

  • For the type of drug contributing to death, percentages may not equal 100%, as multiple opioids may be present in a single death. For instance, in an opioid toxicity death where fentanyl and heroin were both present, this death would be captured under both drug types.

 

Number of recipients for opioid substitution treatment by treatment type, Toronto pharmacies

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. Date Received April 2017.

Data Notes:

  • This data source does not directly measure overdose. It provides a measure of those seeking care for opioid addictions.
  • Recipients refer to unique individuals receiving treatment. An increase in recipients means that more people are accessing opioid substitution treatment. However, it does not tell us if individuals are regularly accessing treatment.
  • For recipients, only those with a valid Ontario health card number were included.
  • Days dispensed refers to the days' worth of treatment distributed from a pharmacy. An increase in days dispensed could mean that more individuals are accessing treatment, individual are accessing treatment more frequently, or a combination of both scenarios.
  • It is necessary to report the days dispensed, rather than number of dispenses, as one dispense of opioid substitution treatment can contain treatment for multiple days.
  • Toronto pharmacies include those with a postal code beginning with the letter 'M'. Individuals who access care at Toronto pharmacies are not necessarily residents of Toronto, and residents of Toronto may access pharmacies outside of the city boundaries.  

 

Weekly new admissions to provincially-funded drug treatment centres by presenting problem substance, Toronto

Source: Drug and Alcohol Treatment Information System. Centre for Addiction and Mental Health. Extracted May 1, 2017.

Data Notes:

  • This indicator captures new admissions to treatment centres in Toronto only.
  • Individuals who access addiction treatment services through primary care, hospitals, private clinics and federally-funded First Nations health service providers are not included in this indicator.
  • Presenting problem substances are self-reported by clients. Individuals can list up to 5 substances upon admission.
  • Individuals who specify multiple presenting problem substances are counted as a new admission for each type of substance. For instance, if an individuals specifies heroin and prescription opioids as presenting problem substances, they will be counted as a new admission for both heroin and prescription opioids.
  • Completeness of this indicator is limited by timeliness of what is submitted by health service providers. This can vary from provider to provider. Counts for recent weeks may be subject to change, as more service providers complete their reporting.

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 April 28, 2017.

Data Notes:

  • The number of kits distributed in recent weeks may lag behind actual numbers, due to delays in reporting. Numbers are subject to change.
  • '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.

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