Toronto, Canada — In Ontario, an alarming trend has emerged showing an increase in overdose fatalities linked to the simultaneous use of multiple drugs, according to a recent report. With the onset of the COVID-19 pandemic, cases of deaths involving multiple substances, particularly opioids mixed with stimulants, have risen sharply.
The collaborative study by the Ontario Drug Policy Research Network and Public Health Ontario reveals a significant escalation in polydrug fatalities. From 2018 to 2022, overdose deaths involving a single substance increased by 75%, those involving two substances climbed by 167%, and incidents with three or more substances spiked by 186%.
Tara Gomes, an epidemiologist at Unity Health and an investigator with the Ontario Drug Policy Research Network, emphasized the grave implications of this trend. “Increasingly, we’re seeing opioids and stimulants at the core of these tragic outcomes,” Gomes stated. “Moreover, the burgeoning presence of three or more drug mixtures complicates rescue efforts and therapeutic interventions significantly.”
Opioids, predominantly illicit fentanyl, were implicated in nearly 84% of drug toxicity deaths, surpassing 10,000 fatalities. Stimulants were involved in approximately 62% of these cases. Alarming also is the emergence of alcohol and benzodiazepines, detected in 13% and 9% of overdose deaths, respectively.
The research also examined the interaction of the deceased with healthcare facilities prior to their deaths. “Approximately one-third of those who died had been in contact with a healthcare service within a week before their death,” Gomes noted. The month preceding their passing saw 56% of deceased individuals engage with healthcare services, often involving visits to emergency departments or unconnected primary care appointments.
The report stresses that emergency rooms may not be adequately equipped to handle patients struggling with addiction, a significant shortfall amidst this crisis. To address this, Gomes advocates for widespread adoption of addiction medicine consult services across hospitals in Ontario. “These programs aim to integrate specialized care and support for substance users within our healthcare systems, helping individuals transition smoothly to community-based services post-discharge,” she explained.
Fentanyl has largely driven the local opioid epidemic since around 2015, with its influence and presence expanding alarmingly during the pandemic. Isolation during lockdowns and reduced accessibility to healthcare services exacerbated the issue.
Additionally, benzodiazepines have recently tainted the opioid supply, complicating the crisis further. “Benzodiazepines alongside opioids are an especially deadly combination, often leading to respiratory suppression and death,” highlighted Gomes. She pointed out that now, these depressants are found in nearly half of opioid-related deaths.
In response to the mounting crises, Ontario’s strategy towards opioid intervention is set to transform dramatically. In a controversial move, the province plans to shut down 10 supervised consumption sites by the end of March — citing their proximity to schools and daycares — and shift towards an abstinence-based treatment model. New recovery initiatives will soon replace these sites, including the creation of “homelessness and addiction recovery treatment hubs” scheduled to launch by April 1. These developments, backed by a $378 million investment, will also facilitate the establishment of 375 supportive housing units, aimed at aiding those battling addiction.
This multi-faceted approach reflects Ontario’s urgent reassessment of strategies to combat the opioid crisis, striving to adapt to the complex nature of drug use and its fatal outcomes. The province’s efforts underscore not only the dire necessity for integrated healthcare solutions but also a profound commitment to evolve policy in response to the shifting dynamics of drug abuse and addiction.