Zoe Dodd never imagined she’d lose her friend, Ang, the way she did. The young woman, who worked with Dodd to prevent people from overdosing, died from an opioid overdose herself last September. She was alone at her home.

“I felt really devastated by it because I’ll never see her again and she was so proud of the work she was doing,” said Dodd, with the Toronto Overdose Prevention Society. “This has been the case for so many people.”

Ang’s death was one of 1,475 opioid-related deaths in Ontario in 2018 — far greater than the province’s 650 related to motor vehicles or 200 homicides. It was also remarkably typical of what happens in many cases, according to a report released this summer that offers a portrait of who dies of opioid overdoses in the province and how.

The province’s Office of the Chief Coroner, together with Public Health Ontario, analyzed 1,337 opioid-related deaths in the province between July 2017 and June 2018. Their report found that, like Ang, nearly half the people who died did so alone, many in their own homes. Fentanyl or fentanyl analogues were involved in almost three-quarters (71 per cent) of the deaths.

Young people between the ages of 25 and 44 made up half the deaths, while men made up 72 per cent. Toronto had the highest number of opioid-related deaths, though Thunder Bay had the highest rate, adjusted for population size.

“This is one of the most significant public health problems that we have,” said chief coroner of Ontario Dr. Dirk Huyer. “What’s even worse is … these are very young people dying from a very preventable cause of death.

“It’s a complex problem that’s not easily solved, but they’re preventable deaths.”

One of the most important potential solutions that should be considered is a safer drug supply, said Barbara Panter, manager of housing and drop-in services at St. Stephen’s Community House, which offers a wide range of services, including an overdose prevention site in Kensington Market and other support for people with addictions.

“We can only do so much,” Panter said. “But if we have a poisoned drug supply then there’s always going to be a risk that any shot somebody engages in is going to be their last.”

She said governments need to look at legalization as a way to regulate the drug market and ensure people aren’t unwittingly using toxic drugs, such as those laced with potentially fatal amounts of fentanyl.

Dodd agreed and said doctors should be prescribing a safe supply of opioids.

“It’s actually a lot of people in my life who have passed away … who knew how to use safely,” Dodd said. “It’s just been a complete obliteration of people. I sometimes dream about what three years ago looked like before all of this, because this has been like a living hell.”

Data from Huyer’s office’s shows that in 2015, fentanyl was involved in just 30 per cent of opioid-related deaths in the province. That number rose sharply in 2016 with 41 per cent, and even more in 2017 with 64 per cent.

“We’ve never seen anything like that,” Dodd said. “It really speaks to the toxic drug supply.”

She said safe consumption sites are valuable because rather than using drugs alone at home, people can be around trained individuals who can reverse an overdose with naloxone. Those prepared individuals can also offer immediate support to someone who is in crisis, but they’re just one solution.

“This is a public health emergency that hasn’t had the same response as other emergencies,” Dodd said.

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Toronto Public Health said the findings of the report match its own statistics which show that people using drugs alone is the greatest risk for death. Under the Toronto Overdose Action Plan, the health authority has been operating a supervised injection service, distributing naloxone to frontline agencies, and alerting communities to reports of toxic drugs.

“Overall, we need to continue expanding prevention, harm reduction and treatment interventions in Toronto in order to increase our capacity to respond to the crisis,” said Dr. Rita Shahin, associate medical officer of health. “We also need to improve access for people who use drugs to a broad range of health and social services, including primary care, mental health services, housing, and employment opportunities, and we continue to advocate for these measures.”