Harm reduction workers battling Ontario's opioid crisis say COVID-19 is making the situation worse, as police and public health officials in Toronto report a spike in overdoses and related deaths since the start of the pandemic.

Nick Boyce, of the Ontario Harm Reduction Network, said the dramatic measures that have been implemented to slow the spread of the new coronavirus are limiting drug users' access to support services that help prevent overdose deaths.

"We have these two crises where you have the drug crisis intersecting now with another serious public health crisis and the most marginalized folks are the ones bearing the brunt," he said.

"Their access to any sort of supports has been significantly reduced, if not eliminated."

Boyce said the restrictive measures have also increased the risk of overdose for people consuming illegal drugs in isolation.

Toronto Public Health said data from the city's paramedic service for March and preliminary figures for April show a spike in suspected overdoses and deaths.

In March, there were 345 suspected opioid overdose calls and 19 deaths. The preliminary figures between April 1 and 26 show there were 300 suspected overdose calls and 20 deaths. On March 31 alone, the paramedic service said it responded to 25 overdose calls.

Toronto police said that between April 23 and 27 they had received numerous calls to respond to drug overdoses in the city's downtown core. Officers used the overdose reversing drug naloxone in a number of cases, but still two people died.

Highest overdose deaths since March 2019

Public health said the overdose deaths are the highest they've been since March 2019 when 22 people died. Overdose deaths in the city had declined throughout 2019, according to public health's statistics, with six overdose deaths reported in September.

But the figures began to bump back up at the start of 2020, with 15 deaths reported in January.

Toronto's associate medical officer of health acknowledged that there were concerns the anti-pandemic measures would further limit responses to the opioid crisis.

"This is very concerning and underscores the critical need for life-saving supervised consumption services in our community," Dr. Rita Shahin said in a statement.

After the new coronavirus was declared a pandemic on March 11 supervised consumption sites were forced to curtail their hours, with one site in downtown Toronto closing for weeks.

The sites changed their layouts, installed barriers, and now serve fewer clients at a time or by appointment to observe physical distancing. Staff are using personal protective gear while meeting with clients, even during street outreach.

Peter Leslie, a harm reduction worker in Regent Park, said the sites' new setups and the look of workers clad in PPE is upsetting for many clients.

"People take that personally, like, 'Oh my God, they must think I have something'," said Leslie, who is a substance user himself and spent seven years living on the streets. "That's the mentality you have when you're on the street because you feel like you're dirty."

'It feels terrible'

Jennifer Ko, a front-line worker at the South Riverdale Community Health Centre, said in the current environment it is difficult to establish and maintain trust with clients with so many physical barriers.

Normally, harm reduction workers would ease clients into change, but there has been no time, she said.

"It feels terrible for workers to not be offering the robust services that we usually do," she said. "We can't engage in the

kind of relationship building and support that we often do and to also then wonder about the folks that we're not seeing that we normally see."

Jason Altenberg, the CEO of the South Riverdale Community Health Centre, said the pandemic safety messaging directly contradicts strategies harm reduction workers have used to help drug users.

Where people are being told to stay home and physically distance themselves from others to fight the virus, substance users have been told for years never to use alone.

"My harm reduction team is trying to educate people who use drugs how to stay safe from COVID-19 and somehow balance that message with the overdose prevention messages that we provide," he said.

Visitors to some harm reduction sites down significantly

Altenberg said the volume of visitors to the city's Moss Park site is down by approximately half in a six hour shift — from 100 visits to about 50. Volumes at the South Riverdale site are down by 25 per cent, he estimates.

He said advocates have been asking governments to expand access to safe supply of drugs to help stem the tide of overdoses during the pandemic.

"It would allow people to potentially get off of the street fentanyl that is so toxic," he said, adding it could also help some people move towards treatment. "Our immediate concern really is (stopping) the preventable deaths that seem to be increasing in this moment."

Gillian Kolla of the Toronto Overdose Prevention Society and a researcher at the University of Toronto pointed out that British Columbia moved to further open access to safe supply early in the pandemic.

"People who were using the illicit drug supply would then have access to a pharmaceutical known drug supply that could maybe help reduce the risk both of overdose and of COVID," she said.