Responding to Ontario’s Overdose Crisis in the Context of the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has exacerbated the overdose crisis in Canada. Using data from ICES and the Office of the Chief Coroner of Ontario, the authors characterized changing patterns of medication use and health services utilization during the pandemic. This analysis suggests that responses to the overdose crisis must confront the rapidly changing unregulated drug supply with a tailored response that addresses varied population needs, expands accessible treatment and harm reduction services and responds to the missed opportunities for engagement and support within various healthcare settings.

Real-world Evidence for Impact of Opioid Agonist Therapy on Nonfatal Overdose in Patients with Opioid Use Disorder during the COVID-19 Pandemic

“…23 In addition to treatment cohort and fentanyl use, the clinical variables most associated with risk of NF-OD in this sample were history of NF-OD, shorter duration of opioid use, history of injection drug use, and comorbid mental health disorder. This is consistent with Canadian administrative data, 24,25 which shows a high number of overdose deaths occur in young males with mental health comorbidities, a history of NF-OD, and frequent contact with the health care system. As most people who die of opioid-related toxicity in Canada are not on OAT at the time of death, 24,26 further research is needed to determine the acceptability of BUP-XR in these more complex or difficult-to-treat populations, and to validate the protective effects seen in this study.…”

‘I don't chase drugs as much anymore, and I'm not dead’: Client reported outcomes associated with safer opioid supply programs in Ontario, Canada

“…In our study, participants described how being prescribed a pharmaceutical alternative of known potency and dose to the toxic, unregulated opioid supply reduced their risk of overdose death. Some participants also had improved memory, which may be associated with experiencing fewer overdoses and no longer being exposed to unregulated benzodiazepines that are increasingly present alongside fentanyl in the unregulated opioid supply in Canada [1,38].…”

“…Several participants also reported improved memory since starting the program, and some described experiencing fewer seizures. It is possible that these improvements were associated with both experiencing fewer overdoses and no longer experiencing withdrawal symptoms related to benzodiazepines reported to be present in the unregulated supply (1,38).…”

“…North America's overdose death crisis is fuelled by a toxic and volatile unregulated drug supply. Fentanyl and its analogues, like carfentanil, and recently synthetic benzodiazepines have significantly increased the potency of unregulated drugs and subsequently increased fatal overdoses [1]. Additionally, the shift to illicitly manufactured fentanyl has changed the way people use drugs, further increasing the risk of overdose [2,3].…”

Opioid‐related overdose deaths among people experiencing homelessness, 2017 to 2021: A population‐based analysis using coroner and health administrative data from Ontario, Canada

“…Recent point-in-time (PiT) counts between 2020 and 2022 observed a 12% increase in enumeration to comparable PiT counts conducted in 2018, and estimated that 0.7%, or one in 150 Canadians, encounter homelessness in a year [7]. Recent research also indicates that acute drug-toxicity contributes to upwards of one in four deaths among individuals experiencing homelessness [8], reinforcing the well-established concern that PEH are over-represented among substance-related deaths in North America [8][9][10][11]. Homelessness commonly exists at the intersection of, or result from, trauma, mental health problems and a range of other socio-economic instability in an individual's life, with strong links between homelessness and substance use [12], including opioid use in PEH populations.…”