At least 18 people died from suspected opioid overdoses in the city in February, up from 11 in January, according to paramedic records published by Toronto Public Health.

This number is the highest monthly total recorded since last November, which saw 19 deaths.

Paramedics also reported 302 calls for suspected opioid overdoses in which people did not die last month, the highest number recorded since Sept. 2018, which saw 338.

The paramedic count of suspected opioid overdoses is preliminary and subject to change, and therefore may underestimate the true number of overdoses in the city, according to Toronto Public Health’s Overdose Information System.

That’s in part because not all opioid overdoses in the city result in a 911 call involving paramedics. Any patient who dies in hospital after first being transported alive by paramedics might also be recorded as a “non-fatal” overdose in the data.

A paramedic’s assessment of an opioid overdose may also may differ from a hospital’s ultimate diagnosis, or the coroner’s call on cause of death.

According to separate data maintained Public Health Ontario, Toronto saw 308 deaths from opioid-related causes in 2017. Public Health Ontario has not yet released its count of 2018 overdose deaths in the city.

The Overdose Information System’s preliminary findings reported 146 deaths from suspected opioid overdoses in 2018.

Toronto Public Health launched the Overdose Information System in Aug. 2017 at a time when opioid-related deaths in the city were spiking. Paramedics reported 24 deaths due to suspected opioid overdoses and 396 non-fatal calls that month, and 27 deaths and 373 non-fatal calls in September.

Those highs have not been exceeded since.

The greatest density of overdose calls is in the city’s downtown core.

Toronto Public Health released its first report on a full year’s worth of paramedic data in November. It found in part that the city is best-equipped to prevent deaths from opioid overdoses downtown due to the prevalence of treatment services such as overdose prevention sites.

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With files from Stefanie Marotta.