Item - 2020.HL23.2

The Board of Health:

1.  Reiterated its call urging the Federal Minister of Health to use the authority under the Controlled Drugs and Substances Act to permit the simple possession of all drugs for personal use, the need for which has become critical as the opioid poisoning crisis continues to worsen during the COVID-19 pandemic and, further, to support the immediate scale up of prevention, harm reduction, and treatment services.

2.  Urged the Federal Minister of Health to provide additional funding for longer-term safer supply programs, injectable medications, and other safer supply options, including for stimulants.

3.  Reiterated its request urging the Provincial Minister of Health to:

a.  convene a multi-sectoral opioid overdose task force comprised of public health officials, community-based service providers, people with lived and living experience of drug use, and family members;

b.  support and fund the implementation of a spectrum of safer supply options, including listing high-dose injectable formulations of hydromorphone on the Ontario Drug Benefit Formulary; and

c.  dedicate funding for overdose-related grief and trauma supports for frontline workers, people who use drugs, and family members.

4.  Urged the Provincial Minister of Health to:

a.  create and fund an Urgent Public Health Need Site (UPHNS) program for Ontario to facilitate the implementation of these lifesaving services in a variety of settings;

b.  provide funding to pilot and evaluate virtual and/or telephone-based supervised consumption services as well as in-person peer supervision in congregate or residential settings to complement the current service options;

c.  allocate some of the new treatment funding recently announced to evidence-based, on-demand treatment services in Toronto; and

d.  designate harm reduction and treatment services as essential services and provide funding to ensure that these services can effectively operate and meet the needs of people who use drugs during the COVID-19 pandemic.

5.  Requested the Provincial Minister of Health to reinstate funding for the Overdose Prevention Sites operated by Street Health and St. Stephen's Community House given the urgent and ongoing need for these lifesaving health services.

6.  Requested the Provincial Minister of Health to expand the criteria for naloxone distribution to allow service providers to administer naloxone to clients in their programs.

7.  Requested the Provincial Minister of Health to collect and provide socio-demographic data, such as sexual orientation, Indigenous identity, race or ethnicity, and income status, on fatal and non-fatal overdoses in Toronto to better understand who is being impacted to inform overdose responses.

8.  Urged the Health Professions Regulatory Advisory Council to review the regulatory changes in British Columbia, consult with current safer supply prescribers about the regulatory issues they are facing, and advise the Provincial Ministry of Health and the relevant regulatory colleges on how to address regulatory uncertainties to support the expansion of safer supply initiatives in Ontario.

9.  Requested the Medical Officer of Health to report on the status of conversations with the City of Toronto, enforcement agencies, and the Federal and Provincial Governments on decriminalizing the simple possession of drugs for personal use.

10.  Requested the Medical Officer of Health to work with the Executive Director, Social Development, Finance and Administration, to include the decriminalization of the simple possession of all drugs for personal use as a key plank in the City of Toronto's Community Safety and Wellbeing Plan in recognition of the differential and negative impacts that this criminal law has on equity-seeking groups in Toronto such as Black and Indigenous peoples.

11.  Requested the Medical Officer of Health, in consultation with the General Manager, Shelter, Support and Housing Administration, to continue to work with community partners toward urgently expanding the overdose prevention response and other harm reduction measures in shelters.

12.  Requested the Medical Officer of Health to work with community partners and City divisions on options to expand grief and trauma supports for people who use drugs, family members, and service providers who are impacted by the opioid poisoning crisis.

13.  Directed that the report (November 5, 2020) from the Medical Officer of Health be forwarded for information and consideration to all Boards of Health in Ontario, the Council of Medical Officers of Health, the Urban Public Health Network, the Canadian Public Health Association, the Ontario Public Health Association, the Ontario Medical Association, the Registered Nurses' Association of Ontario, the Canadian Association of Chiefs of Police, the Ontario Association of Chiefs of Police, the Federation of Canadian Municipalities, and the Association of Municipalities of Ontario.

The Policy Development Officer, Toronto Drug Strategy Secretariat, Toronto Public Health, gave a presentation on Opioid Poisoning Crisis in Toronto.

The COVID-19 pandemic is worsening the opioid poisoning crisis in Toronto and across Canada. Multiple jurisdictions, including Toronto, have reported spikes in fatal and non-fatal overdoses during the pandemic, which may reflect changes in the unregulated drug supply, as well as service reductions and physical distancing requirements.

While there has been a decrease in calls to Toronto Paramedic Services during the pandemic, there has been an overall increase in calls resulting in fatalities. Paramedic data reveals that 132 people died of suspected opioid overdoses between April 1 and September 30, 2020, a near doubling of deaths compared to a two-year average of 67 fatal suspected opioid overdoses for the same period in 2018/2019. July and September 2020 also both saw the highest monthly number of fatal calls (27) attended by paramedics since September 2017.

This staff report provides an update on the opioid poisoning crisis and identifies key actions needed urgently to help address the crisis. Crucial to the response is an expansion of the safer supply of regulated drugs in order to provide an alternative to the increasingly toxic unregulated drug supply and the decriminalization of the simple possession of drugs for personal use. Increased access to lifesaving harm reduction, treatment and other services that protect and promote the health and well-being of people who use drugs is also needed, as are grief and trauma supports for people impacted by the opioid poisoning crisis.