Item - 2021.HL29.2

The Board of Health:

1.  Recognized the drug poisoning crisis as a public health crisis in the City of Toronto and committed to supporting the actions that are urgently needed to respond to the crisis and stem the tide of overdose deaths.

2.  Urged the Federal and Provincial Governments to provide a long-term financial commitment to assist the City of Toronto in creating and operating more affordable and supportive homes for people in need, including people who use drugs.

3.  Reiterated its call urging the Federal Minister of Health to:

a.  use the authority under the Controlled Drugs and Substances Act to permit the simple possession of all drugs for personal use, and further, to support the immediate scale up of prevention, harm reduction and treatment services; and

b.  support evidence-based knowledge exchange and the development of innovative responses to reducing the harms of stimulant use.

4.  Urged the Federal Minister of Health to:

a.  declare the drug poisoning crisis to be a national public health emergency and develop a coordinated Canada-wide plan; and

b.  support the domestic production of diacetylmorphine to increase the accessibility of this medication and build on previous support provided that promotes the scale up of safer supply programs to meet the needs of people at high risk of overdose in Toronto.

5.  Reiterated its requests urging the Provincial Minister of Health to:

a.  recognize the urgency of the drug poisoning crisis and the critical need to scale up actions in response by convening a multi-sectoral 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.  remove the current cap of 21 Consumption and Treatment Services permitted in Ontario;

c.  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;

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

e.  increase the availability of services for people using methamphetamine and other stimulants and fund enhanced training for service providers on supporting people who use stimulants alone or with other drugs;

f.  support and fund the implementation of a spectrum of safer supply options, including listing injectable opioid agonist treatment (iOAT) medication on the Ontario Drug Benefit Formulary; and

g.  provide consistent and ongoing funding for grief and trauma supports for frontline workers responding to the drug poisoning crisis, people who use drugs and family members.

6.  Urged the Provincial Minister of Health to:

a.  expand funding for supervised consumption and other harm reduction services to better address the needs of specific groups (such as Black, Indigenous and People of Colour, Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, Two-Spirit, etc. communities), expand services across Toronto, support the provision of supervised inhalation and smoking services and allow for consumption services to remain open for longer hours;

b.  improve employment standards for frontline harm reduction workers, including adequate pay and benefits coverage, by increasing funding for supervised consumption and other harm reduction services;

c.  expand funding for harm reduction services urgently needed to stem the tide of increasing overdose deaths in the shelter system;

d.  fund longer-term implementation of vital drug checking services and provide additional funding to create more locations in diverse settings to meet local needs;

e.  fund proposals that include a system-level approach to addressing the drug poisoning crisis across the continuum of health care in Toronto to increase the capacity of several organizations that are part of the Toronto Academic Health Science Network/Toronto Public Health Opioid Task Force to offer expanded harm reduction and treatment services that respond to the intensifying crisis;

f.  expand funding for evidence-based harm reduction, including supervised consumption services, treatment and social support services that meet the needs of women, gender-diverse people and parents who use substances; and

g.  fund a comprehensive Substance Use Crisis Centre in Toronto.

7.  Requested the Medical Officer of Health to convene a meeting with construction sector stakeholders, including the Ontario Construction Consortium and the Carpenters' District Council of Ontario, and the Chair, Toronto Board of Health, to discuss opioid use and overdoses among construction workers and how Toronto Public Health's comprehensive Toronto Overdose Action Plan can assist in addressing these issues and to report to the Board of Health in the fall of 2021 on the outcomes and further recommendations.

8.  Requested the Medical Officer of Health, in consultation with the Executive Director, Social Development, Finance and Administration and other relevant City divisions, to convene a working group to develop a health- and social equity-based alternative approach to criminal sanctions for the possession of all drugs for personal use within the city environs, as a step towards requesting an exemption under the Controlled Drugs and Substances Act, with such working group to be comprised of the following:

a.  people with lived and living experience of drug use and family members;

b.  community-based service providers, including Black- and Indigenous-led agencies;

c.  relevant City divisions and agencies, including law enforcement; and

d.  policy and research experts in relevant areas, including substance use, human rights and mental health.

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

The Medical Officer of Health and the Acting Manager, Toronto Drug Strategy Secretariat, Toronto Public Health gave a presentation on Toronto Overdose Action Plan: Status Report 2021.

The opioid crisis in Toronto continues to intensify during the COVID-19 pandemic – a record number of overdose deaths have occurred. This may be due to the unintended consequences of the measures required to mitigate the spread of COVID-19 resulting in service reductions, and changes to the increasingly toxic unregulated drug supply.

In Toronto, deaths involving all substances, including opioids, have increased to record highs. There was a 71 percent increase in suspected drug-related overdoses and a 78 percent increase in the number of confirmed opioid toxicity deaths in Toronto in 2020 compared to 2019. These alarming increases are unprecedented.

Fatal suspected opioid overdose calls attended by paramedics have also increased to record highs. In the first three months of 2021, paramedics responded to 1,173 suspected opioid overdose calls, including 93 calls involving death; this is a 102 percent increase in calls involving death compared to the first three months of 2020. In January 2021, paramedics responded to the highest number of fatal suspected opioid overdose calls (38 deaths) ever recorded in Toronto. On May 5th, paramedics responded to the highest number of fatal suspected opioid overdose calls (5 deaths) in one day ever recorded in Toronto. Across Ontario, the number of opioid-related deaths among people experiencing homelessness more than doubled during the COVID-19 pandemic in 2020 compared to before the COVID-19 pandemic.

The increased involvement of stimulants alongside opioids directly contributing to the cause of death in overdoses in Toronto means that what we are facing goes beyond an opioid poisoning crisis and is now most accurately described as a drug poisoning crisis. The drug poisoning crisis is also reflected in results from Toronto's drug checking services, which continue to identify larger quantities of unexpected substances of concern in the unregulated drug supply.

This staff report highlights actions taken to implement the Toronto Overdose Action Plan (TOAP) since the last status report, and makes recommendations for actions that are urgently needed to mitigate the harms from drugs that are worsening during the COVID-19 pandemic.

While some actions have been taken to respond to the drug poisoning crisis, they have not stemmed the tide of the crisis; the situation remains urgent and continues to worsen. There is much more to do in order to respond effectively to this crisis, including the decriminalization of the possession of all drugs for personal use, scaling up overdose prevention and harm reduction, and supporting the expansion of treatment services.