At least 146 people died of suspected opioid overdoses in Toronto in 2018, according to data from city paramedics.

The tally, which includes all suspected overdose deaths that happen before paramedics arrive or while they are administering care, comes from the first calendar year’s worth of data reported by the city’s public health department.

The paramedics’ reports show a decrease in overdose deaths in the second half of the year compared to the same period in 2017, but it is too early to determine if that’s part of a larger trend, said Dr. Eileen de Villa, Toronto’s medical officer of health.

Toronto Public Health began monitoring paramedic reports of suspected opioid overdoses in August 2017 and publishes the data through its Overdose Information System.

“While considerable work has been done, the situation remains urgent,” de Villa said. “Too many people in our community are dying from preventable deaths attributed to drugs in the illegal market which are contaminated with fentanyl and other potent substances.”

The count of deaths is expected to climb once the provincial coroner’s office, which determines a person’s cause of death, releases its tally, de Villa said.

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Paramedics’ numbers do not include any deaths that happen after a patient is taken to hospital, nor any paramedics determine to be accidental that the coroner later rules an overdose.

Opioid deaths have increased sharply in Toronto in recent years. An average of 94 people died of opioid overdoses in the city each year between 2005 and 2013 — but that number has risen each year since, to a high of 308 in 2017, according to coroner’s data published by Public Health Ontario.

According to preliminary coroner’s data, Toronto saw 125 opioid overdose deaths in the first six months of 2018 — that’s three less than the same time frame in 2017, said Dr. Dirk Huyer, Chief Coroner for Ontario.

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“What we don’t know yet is what the second six months (of 2018) will be,” he said of the final count for 2018 to be released in April. “I hope we continue along that pathway of reduction. It’s such a significant issue for such young people.”

According to Health Canada, 2017 also saw a nationwide high in apparent opioid deaths, at nearly 4,000.

De Villa said the city’s public health department is throwing everything in its tool kit at the overdose crisis, pointing especially to harm-reduction services and supervised injection sites that opened this year.

The city late last year released a study of examining its first full year of paramedics’ data on suspected opioid overdoses, from August 2017 to August 2018. During that span, paramedics responded to 3,203 suspected opioid overdoses, of which 161 were fatal.

The study — the first of its kind — mapped both the number of calls and the fatality rates in Toronto neighbourhoods, showing overdoses are concentrated downtown, where officials say the city is also best-equipped to prevent deaths.

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De Villa called the opioid overdose crisis “the defining health issue of our time” and said it must be tackled with multiple mechanisms including supervised consumption.

“Criminalizing those who use drugs adds to stigma,” she said. “We need to recognize that the current approach to the opioid overdose crisis is not achieving optimal community health, and it is not reducing the health harms associated with drug use. Our residents deserve evidence-based public health interventions that help them to start life healthy and stay that way for as long as possible.”

Those sentiments were echoed by Dr. Philip Berger, who has been an advocate for those grappling with opioid addictions since the early 1990s.

“Safe drug using sites — they should be all over the place,” Berger said. “There is nowhere near enough.”

There should be a wider slate of treatment options being made more readily available, he said, adding: “Every user should have (an overdose-reversing) naloxone kit.”