Toronto paramedics saw nearly twice as many people die of suspected opioid overdoses in the first four months of 2019 than in the same period last year, according to preliminary data published by Toronto Public Health.

According to the data, at least 17 people were added to the mounting tally in April, down from 22 in March. That month was the worst single month since the late summer of 2017, when the health agency first began reporting paramedics’ data amid the city’s worst period on record for opioid overdoses.

In total, paramedics reported 68 deaths from suspected opioid overdoses from Jan. 1 to May 1 this year, up from 35 over the same period in 2018.

The recent surge comes as activists and city officials continue to warn more people may die following the province’s decision to pull funding from two supervised drug-consumption sites earlier this spring and to Toronto Public Health itself.

“It’s been a challenging first few months,” Dr. Eileen de Villa, the city’s medical officer of health, said of the deaths, though she cautioned the final tally may change as the coroner’s office investigates each death.

If the province follows through with its planned cuts, she said “every program at Toronto Public Health is at risk.”

Calling the opioid crisis the “defining public health emergency of our time,” Councillor Joe Cressy on Wednesday said the province’s cuts to overdose prevention sites in Toronto and across the province are “unconscionable.”

“Make no mistake, these deaths are preventable,” he said.

Sarah Ovens, a co-ordinator with the Toronto Overdose Prevention Society, said the rise in deaths compared to the previous time last year is not an anomaly but part of a worsening upward trend, linked to a shift away from more limited and predictable sources of drugs like heroin and towards an ever-widening range and strengths of fentanyl.

A major contributor to the crisis, Ovens said, has been a continued crackdown on prescription drugs which has forced people to turn to an increasingly toxic street supply.

Ovens said they saw a rise in overdoses in December and “every month since then” it has been getting worse. “There is no reason to think that trend is going to stop unless we do something drastic.”

Her group advocates for decriminalization in part, Ovens said, because people creating drugs illegally will always try to create a stronger product that will be easier to transport and can be cut with less expensive and bulkier fillers — which can include everything from over-the-counter medications to other street drugs.

Among a key risk to users, front-line workers have told the Star, is that the potency of illicit fentanyl and its analogues is almost impossible to gauge prior to taking it. It is also far cheaper to produce.

“Heroin requires you to have a field of poppies, a whole lot of people to harvest . . . then make it into big bricks,” which have to be shipped, said Nick Boyce, director of the Ontario Harm Reduction Network.

“Fentanyl requires a few people and chemicals in a lab and you can create,” a very concentrated powder, said Boyce, “that you can ship through the mail.”

The paramedic count of suspected opioid overdoses is preliminary and subject to change, and therefore may underestimate the true number of fatal 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 differ from a hospital’s ultimate diagnosis, or the coroner’s call on cause of death.

Even so, the rate of calls for non-fatal overdoses is also up this year. Since August 2017, paramedics attended an average of 65 non-fatal suspected opioid overdoses per week. Toronto has exceeded that rate every week since late February; the most recent week in the data, from April 29 to May 5, saw the highest number of non-fatal overdoses of any in the record, at 126.

Overall, paramedics reported 406 calls for non-fatal opioid overdoses in April — the second most in data that goes back to August 2017, after March.

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Toronto Public Health launched the Overdose Information System in August 2017 at a time when opioid-related deaths in the city were spiking to the highest levels the city has seen. Paramedics reported 24 deaths due to suspected opioid overdoses and 396 non-fatal calls that month.

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 — where the greatest density of overdoses occur — due to the prevalence of treatment services such as overdose prevention sites.

Overdose prevention sites, like the two facilities threatened with closure in Toronto, are meant as an emergency solution to a mounting crisis. Workers at the sites monitor for signs of infection or overdose and are trained to reverse an overdose in progress and also strive to provide a sense of community and support.

Both threatened sites have managed to stay open despite the province’s instructions that they should close their doors and direct clients elsewhere.

Kapri Rabin, executive director of Street Health, which runs one site near Dundas and Sherbourne Sts., said they have been able to raise enough in private donations to stay operational for several months.

“We are up and running. We are not closed,” she said.

The other affected site, St. Stephen’s Community House in Kensington Market, has also received enough donations to stay open for the foreseeable future, said Lorie Steer, director of urban health and homelessness services.

Both Rabin and Steer say they have applied to the province to operate under its new model. For now the private money, with an exemption from the federal government, allows them to continue to serve their clients.

A third Toronto facility, the city-run safe-injection site called the Works, is also in limbo after the province announced it is reviewing its legal status.

The site will continue to provide services during this review, de Villa said.

Safe injection sites offer similar services as overdose prevention sites but are meant to be permanent. A lengthy application process must take place before the sites can open.

The Works, on Victoria St. near Yonge-Dundas Square, is the busiest such site in the province, recording more than 45,000 visits since August 2017. The facility saw 3,603 visits in April, its second busiest month after March, according to Toronto Public Health.

With files from David Rider