Item - 2018.HL27.1

City Council considered Items EX35.46 and HL27.1 together.

The Board of Health recommends that:

1.  City Council reaffirm its support for a comprehensive, evidence-based response to the opioid overdose crisis that includes prevention, harm reduction, and treatment and, in particular, the critical role that harm reduction measures, such as naloxone distribution, peer support, supervised consumption services, and overdose prevention sites, play in saving lives and improving health.

2.  City Council call on the Province of Ontario to continue its response to the opioid overdose crisis by supporting and expanding existing provincially-funded prevention, harm reduction, and treatment measures in the City of Toronto. 

3.  City Council request the Medical Officer of Health to work with the Toronto Community Housing Corporation to train their staff on the safe disposal of drug use equipment and actively participate in the safe disposal of this equipment.

4.  City Council request the Toronto Community Housing Corporation to require their staff to receive overdose training from Toronto Public Health staff.

5.  City Council request the Toronto Community Housing Corporation to urgently review their current policies that discriminate against people who use drugs, and implement a moratorium on evicting tenants based on drug use during the opioid poisoning crisis.

The Board of Health:

1.  Reinforced with provincial and federal governments the urgency of the opioid poisoning emergency, and the critical need to scale up actions in response. 

2.  Urged the Ministry of Health and Long-Term Care to extend approval of the maximum term for overdose prevention sites from the current 6 months to a 12-month period.

3.  Urged the Ministry of Health and Long-Term Care to support urgent implementation of managed opioid programs (i.e., pharmaceutical heroin/diacetylmorphine and/or hydromorphone), including low-barrier options, across Ontario.

4.  Reaffirmed its support for a comprehensive, evidence-based response to the opioid overdose crisis that includes prevention, harm reduction, and treatment and, in particular, the critical role that harm reduction measures such as naloxone distribution, peer support, supervised consumption services, and overdose prevention sites, play in saving lives and improving health.

5.  Directed that the Board of Health's decision and the report (June 4, 2018) from the Medical Officer of Health be forwarded to all Boards of Health in Ontario for information.

6.  Requested that the Medical Officer of Health review the communications and public presentations received at the Board of Health meeting on June 18, 2018 for consideration as to the next steps in developing the Toronto Drug Strategy.

Toronto continues to be in the midst of an opioid poisoning emergency. Rates of fatal opioid poisoning and emergency room visits related to opioid poisoning are increasing. Fentanyl is prevalent in illicit opioid markets, and has replaced heroin/morphine as the most commonly present opioid in accidental overdose deaths in Toronto.

In March 2017, the Board of Health endorsed the Toronto Overdose Action Plan, which provides a comprehensive set of actions to prevent and respond to overdoses, targeted to all levels of government. Over the last year, the Medical Officer of Health and Toronto Public Health staff have worked with other City divisions and community and institutional partners to implement the Action Plan recommendations. This staff report provides a summary of actions taken over the last year. The report also highlights ongoing efforts, including community dialogues on a public health approach to drug policy in Canada.

While considerable work has been done, the situation remains urgent, and more must be done. Toronto Public Health remains committed to working with our partners to scale up our response to this public health crisis in our community and enable service providers to implement actions, as recommended in the Action Plan.