By Adam Miller
Canada is facing a devastating overdose crisis that has been severely exacerbated by the COVID-19 pandemic, the rising cost of living and lack of affordable housing and the toxic unregulated drug supply.
In the past year alone, there were at least 7,328 suspected opioid overdose deaths across Canada, according to the latest federal government data. That’s an average of 20 deaths per day, up from 10 in 2019, signalling a worsening crisis with no signs of slowing down.
August 31st marked International Overdose Awareness Day – the world’s largest annual campaign to help end overdose, remember loved ones lost and acknowledge the grief families and friends face in the wake of the crisis.
“It’s an important day to remind ourselves that overdose is one of the leading causes of death in Canada right now – particularly among people under 65,” said Dr. Irfan Dhalla, VP of Care Experience and Equity and a general internal medicine physician at Unity Health Toronto.
“The resources we need still pale in comparison to the need for care.”
Dr. Dan Werb, the Director of the Centre on Drug Policy Evaluation at St. Michael’s Hospital, says he’s more worried about the future of the overdose crisis now than he’s ever been.
“In Ontario, the number of people who have died of an overdose is higher than the number of people who have died of COVID. The number of people who are dying of COVID is going down, the number of people who are dying of an overdose is going up,” he said.
“The average age of people who die of an overdose is half that of people who have died COVID-19. And so what that means is in accounting for the number of years of life lost, this is an epidemic that is twice that in terms of its magnitude.”
Programs
Unity Health’s outreach programs have made a difference in the lives of those experiencing harms from substance use, and are focused on providing evidence-based health care within a harm reduction philosophy.
“At Unity Health, we’ve been real leaders in trying to improve treatment for our patients who use substances,” said Anita Srivastava, Unity Health’s Medical Director of Addictions and a family physician at St. Joseph’s Health Centre.
“Obviously, we have more work to be done, but I’m proud of what Unity Health has accomplished to date. We have really worked hard.”
Srivastava says programs that provide naloxone kits to those at risk of overdose in withdrawal management centres, outpatient clinics and the emergency department, and upcoming e-modules for staff on harm reduction, are making a significant impact.
The My Baby and Me Clinic at St. Michael’s Hospital provides low-barrier support to mothers grappling with substance use and offering a judgment-free space with obstetrics, addictions support and counselling.
And the Toronto Centre for Substance Use in Pregnancy (T-CUP) program, part of the Family Medicine Centre, at St. Joseph’s Health Centre, also offers multidisciplinary addiction, obstetric and neonatal care to pregnant women in a non-judgmental environment.
“They might need additional services, they might need specific medications, they might need some counseling, and they might need some reassurance that although their baby might need to spend some more time in the hospital after they’re born they will likely do very well,” said Dhalla.
“And those are all things that we are able to do, often with the support of philanthropy, because the system isn’t set up to provide funding for these kinds of vital services.”
Research
Dr. Tara Gomes, an epidemiologist at St. Michael’s Hospital and Principal Investigator of the Ontario Drug Policy Research Network, is on the cutting edge of research to help reveal the true scale of the crisis in Ontario and help find solutions.
“For more than a decade, we have been working closely with provincial and federal partners to generate evidence and improve the accessibility of data that can be used to monitor and report on drug toxicities across
Ontario,” she said.
“Through this work, and strong partnerships with Public Health Ontario, the Ministry of Health, and the Office of the Chief Coroner, we have been fortunate to have incredibly rich,
high quality data that helps shed light on the changing patterns of drug related harms in our province, and the shifting circumstances that underlie these harms.”
While Gomes and her team are “constantly working to improve the data and reporting” they can provide, the public reports and online dashboard of opioid-related indicators they have developed are important resources for policy-makers and local communities.
“Understanding the types of drugs that are contributing to serious opioid-related harms, changing patterns of drug use, and the opportunities and gaps in services provide to people who use drugs can have important implications on public policy,” she said.
“Similarly, this work can also help shape public opinion as it can help show the widespread impacts of opioid-related harms in all parts of the province while also sharing key information about how each of us can play a part in keeping each other safe.”
Dr. Ahmed Bayoumi, a Scientist at the MAP Centre for Urban Health Solutions at the Li Ka Shing Knowledge Institute of St. Michael’s and a general internal medicine physician, says Unity Health researchers have a strong community focus that sets them apart from other health networks in Canada.
“It is a critical time, because the crisis continues and people continue to die,” he said.
“But even people who survive overdose we know are at greater risk for repeat overdose, and so part of the research that we’re doing is trying to identify patterns of care to help to prevent people from having repeat
overdoses.”
More support needed
Bayoumi said there is an urgent need to provide integrated care between both the hospital and the community to help those at higher risk of overdose navigate the healthcare system and get the support they need.
“The collaboration between hospital and community is so important,” said Kelly Sequeira, Manager of the Toronto Opioid Overdose Action Network, adding that if substance users feel safer with harm reduction workers in the community and not the hospital, “it doesn’t make sense to not work together.”
One way that is happening is a new partnership between the City of Toronto, Unity Health and University Health Network to expand frontline health care services in responding to the escalating toxic drug crisis in Toronto.
The partnership is the first time that acute care hospitals in Ontario and Public Health have worked together to offer supervised consumption services, adding a new way of providing essential harm reduction programming and care in the city.
Zoë Dodd, MAP’s inaugural Community Scholar, says the work she and other Unity Health researchers like Bayoumi are doing evaluating supervised consumption sites during the pandemic, as well as harm reduction in shelters and encampments is critical.
“All of that work is really important, because it’s helped us generate a lot of knowledge that we should be using to make policy changes and to make investments,” she said. “We are living in a time of anti-science and anti-evidence and that’s one of our biggest challenges.”
But despite the work being done at Unity Health to help those at risk of overdose, the worsening crisis highlights the need for more financial support in order to continue to help address the needs of those in the community.
“The fact is that these programs and these organizations are the one thing in a lot of ways that is holding the whole continuum of care for people who use drugs together,” says Werb.
“Harm reduction does not exacerbate substance use, it doesn’t make people use longer. What it does is keep people alive and act as an entry point, the best entry point, the best door that we’ve got to get people connected to the kind of care that they need.”
Dhalla says that despite the hard work of many frontline healthcare workers and staff at Unity Health, the resources to provide care to people who use substances are “dramatically lower” than other areas of the healthcare system despite the significant loss of life.
“The crisis was bad, and it’s getting worse, and people are working really, really hard,” said Kelly Sequeira, Manager of the Toronto Opioid Overdose Action Network.
“Despite all the work that’s happening, it’s going to take a lot of effort on the part of a lot of people for a long time to really address those in a way that makes them go away.”
Adam Miller works in communications at Unity Health.
