Overview

Toronto Overdose Action Plan: Prevention and Response

Introduction

People dying from drug overdose is an urgent public health crisis across Canada. The situation in British Columbia has become critical with high numbers of overdose deaths, and we are seeing a significant rise in overdose deaths in Toronto. Between 2004 and 2015, there was a 73% increase in the reported number of overall drug toxicity (overdose) deaths in Toronto (from 146 in 2004 to 253 in 2015).[i] Accidental deaths (i.e., not suicide/undetermined) represent the majority of these deaths, and increased 149%, from 82 deaths in 2004 to 204 deaths in 2015.[ii] Opioids, alone or in combination with other drugs, accounted for 135 or 66% of all accidental deaths in 2015.[iii] Between 2014 and 2015 deaths from heroin/morphine dropped by 24% (from 76 to 58) while deaths from fentanyl almost doubled (from 22 to 42).[iv]

 

While federal, provincial and municipal governments have taken some steps to address this crisis, more action is needed, and urgently. Toronto Public Health is developing an overdose plan for Toronto that includes actions that can be taken by all orders of government to prevent and respond to drug overdoses. We are consulting with a broad range of stakeholders to ensure the action plan meets the needs of our community. The final Action Plan will be submitted to the Board of Health for consideration at its March 20, 2017 meeting.

 

[i] These data were provided by the Officer of the Chief Coroner for Ontario and compiled and analyzed by Toronto Public Health. It is important to note that data from 2015 are preliminary only and subject to change.

[ii] Officer of the Chief Coroner for Ontario

[iii] Officer of the Chief Coroner for Ontario

[iv] Officer of the Chief Coroner for Ontario

Proposed Actions for Discussion

1. All governments should develop and implement a comprehensive, evidence-based overdose prevention and response plan. The plan should address overdoses resulting from all drugs with a primary focus on opioids (non-pharmaceutical and pharmaceutical).    

Actions for the City of Toronto:  

  • Once the final Toronto Overdose Action Plan is approved, work with multi-sector partners, people who use drugs and their family/friends, to implement it.   
  • Work with an Indigenous facilitator on a dedicated process to engage the Indigenous community in identifying overdose prevention and response strategies, in accordance with the operating principles of the Toronto Indigenous Health Strategy created by the Toronto Indigenous Health Advisory Circle.

Actions for the Province of Ontario and the Government of Canada:

  • Develop an overdose strategy within six months, in consultation with municipalities, health and community services, people who use drugs and their family/friends. 
  • Dedicate resources to support and coordinate implementation of the plan.
  • Work with an Indigenous facilitator on a dedicated process to engage the Indigenous community in identifying overdose prevention and response strategies.

2. Organizations serving people at risk of overdose should have an overdose prevention and response plan as part of their emergency first aid protocols, including a naloxone component. 

Actions for the City of Toronto:

  • Develop overdose policies/protocols at City programs that serve people at risk of overdose.
  • Expand overdose prevention and response training for City and community services and people who use drugs.  
  • Expand distribution of naloxone to people who use drugs and their family/friends.
  • Develop public education resources about overdose prevention, and stigma and discrimination related to substance use.
  • Develop an overdose prevention and response resource for businesses that serve people at risk of overdose (e.g., bars and clubs). 

Actions for the Province of Ontario: 

  • Ensure health and social services have overdose policies/protocols in place, in particular treatment programs. 
  • Fast-track provision of free naloxone to community services that serve people at risk of overdose, including agencies already distributing harm reduction supplies. 
  • Fast-track availability of the nasal formulation of naloxone.
  • Ensure naloxone kits are given to people with a history of opioid use when leaving hospitals, treatment services, and prison.
  • Ensure naloxone is available on all prison ranges for staff use.
  • Ensure overdose education and naloxone is provided to opioid substitution treatment clients.

 

3. Substance use treatment should be available when people need it with options to suit individual needs. In particular, opioid substitution treatment (OST), including low-threshold programs, should be available.

Actions for the City of Toronto:  

  • Explore the feasibility of providing injectable diacetylmorphine (pharmaceutical heroin) and/or hydromorphone as OST. 

Actions for the Province of Ontario:

  • Expand the capacity and models of substance use treatment programs so the right help is there when people need it.
  • Expand opioid substitution treatment (OST) options, including:
    • Access to Suboxone in emergency departments, community health centres, physician offices, etc.
    • Provide comprehensive and integrated supports such as counselling, and access to medical care and mental health services.
    • Support provision of injectable diacetylmorphine (pharmaceutical heroin) and/or hydromorphone in health clinics.
    • Ensure OST is provided in a barrier-free, non-stigmatizing way.
  • Ensure that no one is refused entry into a substance use treatment program because they have an OST prescription.

Actions for the Government of Canada: 

  • Fast-track access to injectable diacetylmorphine (pharmaceutical heroin) and/or hydromorphone as OST. 

4. Supervised injection services (SIS) should be available with medical intervention in case of overdose, and links to treatment and other supports and services.

Actions for the City of Toronto:

  • Open the planned supervised injection service as soon as possible. 

 Actions for the Province of Ontario:

  • Confirm adequate funding for the three planned supervised injection services in Toronto, as soon as possible. 

Actions for the Government of Canada:

  • Fast-track approval of the three planned supervised injection services in Toronto.
  • Support urgent measures such as overdose prevention sites, similar to those in British Columbia.

 

5. Drug checking/testing programs should be available to allow people to test illicit drugs for the presence of toxic contaminants, adulterants or unexpected drugs (e.g., bootleg fentanyl).

Actions by the City of Toronto:  

  • Continue to work with the community to implement drug checking programs at harm reduction services and music event settings.

Actions by the Province of Ontario:  

  • Fund and support community drug checking programs.

Actions by the Government of Canada:  

  • Facilitate approval of Controlled Drugs and Substances Act Section 56 exemptions that are needed to operate drug checking programs.
  • Clarify legal requirements for reagent testing programs in community settings.

6. Barriers to calling 911 for medical assistance during an overdose must be eliminated.  

Actions by the City of Toronto:  

  • Revise policies so police do not attend overdose events without a clear need identified (e.g. safety issue). 

Actions by the Government of Canada: 

  • Fast-track passage of the Good Samaritan bill, which protects people from arrest for drug possession at the scene of an overdose. 

7. All governments should have “real-time” overdose surveillance and monitoring systems in place.

Actions for the City of Toronto: 

  • Develop an overdose surveillance/monitoring system for Toronto as soon as possible.
  • Provide clear messages/alerts about toxins or contaminants found in illicit drugs to people who use drugs and community services. 

Actions for the Province of Ontario and Government of Canada: 

  • Develop an overdose surveillance/monitoring system as soon as possible.
  • Require institutions with data about overdose to compile/share that information in a timely manner, as close to 'real time' as possible.
  • Require health service providers to report fatal and non-fatal overdoses to public health.   

8. Governments should identify and address potential adverse health consequences such as overdose before changing access to prescription drugs. 

Actions for the Province of Ontario and Government of Canada:   

  • Put prevention measures in place before making changes to the availability of prescription opioids to ensure people are not forced into the illicit drug market to use more dangerous opioids.
  • Consult with people who use drugs and other community stakeholders on these prevention measures.
  • Create protocols for health care providers for prescribing and tapering patients off of opioids.
  • Consider restricting pharmaceutical advertising of opioids to health care providers.

9. All governments should address social factors that can lead to overdose and other health harms related to substance use. 

Actions for all governments:

  • Expand affordable and supportive housing, including harm reduction housing.
  • Implement poverty reduction measures.
  • Address stigma and discrimination against people who use drugs.
  • Implement diversion options for people who come into conflict with the law because of substance use.

Back to: Overview