Opioid poisoning is behind an “unprecedented” increase in fatal overdoses across this city and unless services are immediately expanded — including the creation of safe drug supply — more deaths will come, Toronto’s chief medical officer of health told the city Monday.

“We continue to be in the midst of an opioid poisoning crisis. It continues here in Toronto. It continues elsewhere in Canada and the crisis is indeed claiming thousands of lives,” said Dr. Eileen de Villa, speaking to the board of health about proposed updates to the Toronto Overdose Action Plan at city hall.

De Villa said the update to the action plan, which is more than two years old, is in response to “very grave concerns around the situation in which we find ourselves” and includes recommendations for all levels of government that will be discussed by city council next week. They include:

Toronto should provide better supports for underserved groups, including Indigenous peoples and racialized communities, and continue to press the federal government to decriminalize drugs for personal use and explore the creation of a safe supply — a regulated source of opioids that would limit the need to buy drugs off the street.

The province should reinstate support for the overdose prevention site model it pulled back on in March that served as an “agile, low-barrier service option,” and increase harm-reduction funding for community-based organizations as well as work with community partners to find ways to have women who use drugs keep custody of their children through family-centred supports.

The federal government should increase funding for local programs and explore a “range of safer drug supply options” and what frontline workers would need to get those safe supply programs off the ground.

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In Toronto, in 2017, at least 308 people died from opioid overdoses, according to Toronto Public Health, and preliminary data for 2018 counts at least 294 deaths.

The biggest risk comes from illicit versions of the synthetic opioid fentanyl that have flooded the street market providing users with a cheap and powerful high — while exposing them to unpredictably lethal potency.

Canada-wide the number of “accidental drug poisoning deaths” in 2017, when compared to 2016 deaths, has halted life expectancy for the first time in 40 years, with the bulk of losses reported among young men, Statistics Canada reported in May.

“I want you to think about that for a moment,” de Villa said. “Life expectancy in our country has stopped increasing for the first time in four decades.”

Meanwhile the province has pulled back, cutting funding to two Toronto overdose prevention sites that did not meet the requirements of the new provincial model and leaving a third site, run by Toronto Public Health, in limbo as the province considers its application. Six approved sites in Toronto have yet to receive funding, with press secretary Hayley Chazan saying the Ministry of Health was working with the sites to transition and funding agreements would come in “short order.”

Toronto Public Health opened the first sanctioned safe injection site in the city in August 2017 — a process fast-tracked after advocates opened a renegade site in Moss Park — and since then the public health agency has served almost 50,000 clients and responded to 845 overdoses, de Villa said.

Michelle Sault with Minokaw Consulting spoke after de Villa about the need for a Toronto Indigenous Overdose Strategy designed to recognize and address the ties between systemic oppression, intergenerational trauma and addiction, which will also be discussed at council.

“Every one of those numbers is a human being. With a family attached. With a community attached. So the impact of this is rippling,” said Sault, a facilitator for the city’s Indigenous Health Strategy, released in May 2016.

The strategy states that addiction and mental health services should be “aligned and supported by a seamless network of culturally secure care and trauma-based care,” through both Indigenous and non-Indigenous providers, as part of overall strategic direction.

“You can’t address someone’s grief. But you can provide services and supports,” she said.

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Board chair Joe Cressy said despite hard-fought-for gains there remains a sense of deep frustration and fatigue, most notably at the community level, where memorials are a regular occurrence.

That included, he noted, one held the night before for Leon (Pops) Alward in Moss Park. Alward had shared his own story to educate people about overdose prevention. He died on May 25 of what those close to him told the Star was a fentanyl overdose during the very early morning when all sites were closed for the night.

“He saved lives every single day. Even with all his knowledge and all his experience he was not immune of passing away from a preventable death,” Cressy said.

On Sunday evening, about 120 members of Alward’s family, loved ones and allies gathered in a large circle to remember an immediate father to many and dedicated father to two sons, who loved purple and violets and somehow managed to see the light in most situations.

There was a potluck, prayers offered through word and song, sage was burned, strawberries and tobacco were given out, stories were told and then, a gesture Alward would have approved of, a small stockpile of fireworks were set off without a permit in the park.