As Toronto records its highest number of monthly overdose deaths since March 2019, addictions experts say reduced access to services due to COVID-19 and an ongoing surge in contaminated illicit drugs is further straining an already underserved sector.

Recent data from Toronto Paramedic Services shows the highest number of overdose-related fatalities in a month since March 2019. There were 345 suspected opioid overdose calls to paramedics — including 19 fatalities — last month, according to Toronto Public Health. In March 2019, there were 22 deaths.

This uptick in deaths is causing concern for service providers, including Toronto’s associate medical officer of health, Rita Shahin, who said “these increases in overdoses show the impact of an increasingly toxic drug supply while we are also trying to address the COVID-19 pandemic.”

It also comes at a time when overdose consumption sites are limiting hours and services, and public health closed its supervised injection site, The Works, on March 18. The Works averages just over 3,000 visits per month. The other eight Toronto sites, run by different agencies, have also seen their services drastically impacted by COVID-19 safety measures.

Kelly White, co-ordinator of the overdose prevention site at Street Health at 338 Dundas St. E., said the site, which mainly serves people who are experiencing homelessness, is facing similar pressures, such as limited personal protective equipment for staff and increased wait times.

Then there is the contaminated supply of opioids.

“This (contaminated drugs) has resulted in overdoses where the person remains unconscious for extended periods of time, which is difficult to handle when we are trying to limit the amount of time clients spend in the space due to COVID,” she said.

A regular client died of an overdose on March 24, she said.

Last week, four people in the Downtown East community experienced severe opioid overdoses from smoking crack, she said. Many addicts are advised to use drugs with someone present, so the observer can apply naloxone in the case of an overdose.

“A further issue is that bystanders seem reluctant to provide assistance in OD situations due to fear of getting close to people,” she said.

Shahin said The Works was closed to protect clients and staff while it implements safety measures, including addressing lineups and large groups gathered outside the building.

“Once these health and safety measures are fully in place, the site will reopen,” she said, adding that no date has been set.

“Prior to COVID-19, many of the responses we had to address the opioid crisis were already operating at maximum capacity and not able to meet some people’s needs in ways that reduced their risk of overdose,” Shahin said. “There are concerns that the necessary precautions to prevent the spread of COVID-19 will further limit these vital responses to the opioid-poisoning crisis.”

Chetan Mehta, a Toronto doctor who specializes in addictions medicine, said the decreased in-person visits are leaving many of his clients panicked.

“If they don’t have access to addictions mediation services, they’re at risk at going into withdrawals, committing suicide or running out to score with dealers who are engaging in risky activity,” he said. “There are great risks, of harm, to themselves and to the public, when people are in that situation.”

One of his patients bought illicit pills that were laced with the deadly opioid fentanyl, Mehta said.

“Because the supply chain has been interrupted, the illicit drug supply has become increasingly unpredictable and more dangerous,” he said.

“These conditions create a tremendous amount of risks for relapse,” he said.

Camille Quenneville, CEO of the Canadian Mental Health Association Ontario, says her colleagues in Toronto say “substance abuse issues are spiking.”

“We know, across the province, that substance misuse is on the rise,” she said of the picture over the last month.

Loading... Loading... Loading... Loading... Loading... Loading...

“The opioid supply is harder to come by, so people are turning to different drugs, such as crack cocaine,” she said. “That’s scary on many fronts. Coupled with the closure of sites (like The Works) it’s a bleak picture.”

Services like Kids Help Phone “are having way more conversations with young people, who are talking about anxiety, isolation, as well as substance abuse,” said Alisa Simon, senior vice-president, innovation and chief youth officer.

White said though there is no overnight solution, we could move the needle in the right direction by relaxing access by addiction medicine providers to medications like methadone and suboxone, so that people can limit physician and pharmacy visits. Many doctors are doing this, but a directive to make it mandatory for all prescribers would be helpful, she said.

She also hopes that more prescribers in Ontario will follow the lead of those in British Columbia, to prescribe safer supply medications like hydromorphone and pharmaceutical stimulants to reduce people’s dependence on the street supply.

Mehta agrees.

“The health of the general populations also depends on the health of this population,” Mehta said. “If we have an outbreak in our substance-using population and our shelters, it will be extremely difficult to control.”

Jason Miller is a breaking news reporter based in Toronto. Reach him on email: jasonmiller@thestar.ca or follow him on Twitter: @millermotionpic