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. 

Last Updated: August 15, 2017

Substance-related emergency department visits at Toronto hospitals increased from April through mid-August 2017. The number of suspected overdose cases also increased from May to mid-August 2017. The week of July 31 to August 6 had the highest number of both substance-related visits and suspected overdose cases over the observed time period. Note that neither of these indicators are specific to opioids. Substance-related emergency department visits may be due to intoxication, addiction, overdose, or withdrawal. Suspected overdose cases are a subset of substance-related visits that specifically mention overdose in the chief complaint and meet a set of inclusion criteria. Some Toronto hospitals are not included in this data source, including CAMH and Sunnybrook. Please see the Data Notes tab for more information on these indicators.

Number of substance-related emergency department visits and suspected overdose cases by week, Toronto hospitals, April 3 to August 13, 2017*

 

*The date noted indicates the start of the week. Counts are reported from Mondays to Sundays.

Source: Acute Care Enhanced Surveillance System. ED Line Listings. April 3 to August 13, 2017. Extracted August 14, 2017.


 

There was an overall upward trend in emergency department visits for opioid poisoning from April 2015 to March 2017 (most recent data available). 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, April 2015 to March 2017

 

Source for ED visit data: National Ambulatory Care Reporting System, April 2015 to March 2017. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO.  Extracted August 2017.

Source for hospitalization data: Discharge Abstracts Database, April 2015 to March 2017. Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. Extracted August 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 from January to June 2016 was nearly on par with the total annual deaths in both 2014 and 2015. 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 June 2016

* Data from 2015 are preliminary.
** Data from January to June 2016 are preliminary. These numbers only include 6 months of data.

Source: Office of the Chief Coroner for Ontario. Number of Toxicity Deaths in Toronto - Accidental Manners of Death. 2013 to June 2016. Received June 2017.


 

In 2015, heroin/morphine was the most commonly present opioid in both deaths due to opioid toxicity and opioid with alcohol toxicity. In the first six months of 2016, fentanyl replaced heroin/morphine as the most commonly present opioid in accidental deaths. Fentanyl was present in 43% of accidental opioid toxicity deaths and 48% of accidental opioid with alcohol toxicity deaths. Heroin/morphine, methadone and oxycodone remained commonly detected opioids from January to June 2016.

Type of opioids present in opioid and opioid with alcohol toxicity deaths, Toronto, 2015* and 2016**


* Data from 2015 are preliminary. Numbers are subject to change.

** Data from 2016 are preliminary. This data represents only six months of data.

Note: 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. 2015 to June 2016. Received July 2017.


There is a slight upward trend in the number of recipients of opioid substitution treatment (OST) from January 2016 to March 2017. More recipients are receiving methadone maintenance treatment (MMT), compared to those receiving suboxone and its generics. Recipients are unique individuals receiving at least one dispense of OST. Please see the Data Notes tab for more information on this indicator.

Number of recipients of opioid substitution treatment by treatment type, Toronto pharmacies, January 2016 to March 2017

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. January 2016 to March 2017. Date Received May 16, 2017.


 

Overall, there is a slight upwards trend in the number of dispenses (in days) for OST in 2016 and the beginning of 2017. 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, January 2016 to March 2017

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. January 2016 to March 2017. Date Received May 16, 2017.


 

There is a slight upwards trend in the number of prescribers for suboxone in 2016 and the beginning of 2017. The number of prescribers for methadone maintenance treatment (MMT) remained relatively stable over this time period. Prescribers refer to the number of unique health care professionals who wrote prescriptions for treatment dispensed at Toronto-based pharmacies. An increase in number of prescribers could mean that more individuals are accessing treatment or that the capacity of the health care system to provide treatment has increased. Please see the Data Notes tab for more information on this indicator.

Number of prescibers of opioid substitution treatment by treatment type, Toronto pharmacies, January 2016 to March 2017

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


 

The weekly number of new admissions to Toronto-based treatment centres fluctuated from May 2016 to June 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, May 30, 2016 to June 4, 2017

Source: Centre for Addiction and Mental Health. Drug and Alcohol Treatment Information System. May 30, 2016 to June 4, 2017. Extracted July 5, 2017.

The number of naloxone kits (both initial and refill) distributed by The Works clinic per month by Toronto Public Health was variable through January 2016 into June 2017. 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.

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

Source: The Works – Toronto Public Health. Number of naloxone kits distributed. Extracted July 18, 2017.


 

The number of naloxone kits distributed by Toronto pharmacies has increased quarterly since the start of the Ontario Naloxone Program for Pharmacies in July 2016.

Quarterly number of naloxone kits distributed by Toronto Public Health and Toronto pharmacies, July 2016 to March 2017

Source: The Works – Toronto Public Health. Number of naloxone kits distributed. Extracted July 18, 2017.
Source: Ontario Drug Benefit (ODB). Ministry of Health and Long-Term Care. Received on July 12, 2017.

29/05/2017: Interactive tool on opioid-related harms data

Public Health Ontario recently released an interactive tool that explores trends in opioid-related emergency department visits, hospitalizations and deaths from 2003 to 2015 in Ontario. Toronto Public Health has created a summary document(pdf) that reviews the key findings for Toronto. Please note that the interactive tool and summary document capture outcomes occurring among Toronto residents only and as such, will include fewer occurrences than those included on this website (which capture all overdose outcomes occurring in Toronto, regardless of where an individual resides).

 


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 by week, Toronto hospitals

Source: Acute Care Enhanced Surveillance System. ED Line Listings. Extracted August 14, 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 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.
  • 'Substance-related visits' include those caused by opioids or non-opioid related drugs (OPI and TOX syndromes, combined). It excludes those related to alcohol.
  • This indicator includes all visits to Toronto hospitals, regardless of whether or not the individual resides in Toronto.
  • 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 due to suspected overdoses by week, Toronto hospitals

Source: Acute Care Enhanced Surveillance System. ED Line Listings. Extracted August 14, 2017.

Data Notes:

  • This indicator is only available from May 2017 onwards, due to availability of data.
  • This data source only captures suspected overdoses 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.
  • 'Suspected overdoses' refer to a subset of substance-related visits that specifically reference 'overdose' in the chief complaint. It excludes overdoses that specify a substance of non-interest (e.g. alcohol, over-the-counter medication, prescription drugs of non-interest such as blood pressure medication, and toxic products such as cleaning products).
  • 'Suspected overdoses' include only visits with a Canadian Triage Acuity Score of 1 (Resuscitation), 2 (Emergency), or missing.
  • 'Suspected overdoses' excludes visits to children less than 10 years of age.
  • For the majority of visits, the substance causing overdoses is not specified. It is important to note that this indicator measures overdoses from all types of substances, not just opioids.
  • 'Suspected overdoses' also excludes intentional overdoses or those related to self-harm.
  • This data sources captures visits 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.
  • This indicator includes all visits to Toronto hospitals, regardless of whether or not the individual resides in Toronto.
  • 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 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 August 14, 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.
  • 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 August 14, 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.
  • 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 June 2016. Received June 2017.

Data Notes:

  • Data from 2015 and 2016 have been preliminarily released by the Office of the Chief Coroner for Ontario. Numbers are subject to change.
  • Data from 2016 include deaths occurring from January to June 2016. Use caution when comparing data from the first half of 2016 to full previous years.
  • This data includes all deaths that occur in Toronto and may include deaths to non-Toronto residents that occur in Toronto.
  • 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 / days dispensed / prescribers for opioid substitution treatment by treatment type, Toronto pharmacies

Source: Narcotics Monitoring System. Ontario Ministry of Health and Long-Term Care. Date Received June 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.
  • Prescribers refer to the number of unique health care professionals who wrote prescriptions for treatment dispensed at Toronto-based pharmacies. An increase in prescribers could indicate that more people are accessing treatment or that the capacity of the health care system to provide treatment has increased.
  • 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 July 5, 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.

 

Monthly 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 July 18, 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.
  • Prior to the August 2017 update, this indicator was calculated weekly. Monthly reporting was determined to be preferable, due to large fluctuations by week.

 

Quarterly number of naloxone kits distributed by Toronto pharmacies and Toronto Public Health

Source: The Works – Toronto Public Health. Number of naloxone kits distributed. Extracted July 18, 2017.

Source: Ontario Drug Benefit. Ministry of Health and Long-Term Care. Received on July 12, 2017.

Data Notes:

  • Toronto pharmacies are those with a postal code starting with an M.
  • The number of pharmacies has increased over time since the program began in July 2016.

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