Item - 2022.HL38.3

The Board of Health:

1.  Continued to recognize the drug poisoning crisis as a public health crisis in the City of Toronto and continue to commit to supporting actions that are urgently needed. 

2.  Reiterated its call requesting the Federal government to:

a.  develop a national framework to permit the simple possession of all drugs for personal use;

b.  support the immediate scale up of prevention, harm reduction and treatment services; and 

c.  support and fund additional safer supply options in Toronto.

3. Reiterated requests for the following actions from the Province of Ontario:

a.  expand funding for harm reduction and treatment services for disproportionately impacted communities, including African, Caribbean, Black, and Indigenous people to allow additional hours of operation, expand supervised consumption services to include supervised inhalation and smoking, and hire additional peer workers;

b.  expand funding for a comprehensive continuum of harm reduction and treatment services that respect the diverse needs of people who use drugs; 

c.  remove the cap of 21 Consumption and Treatment Services Sites in Ontario; 

d.  fund the proposal submitted to Ontario Health for the Substance Use Crisis Centre – Toronto; 

e.  integrate long-term and sustainable program funding for injectable Opioid Agonist Treatment and other safer supply tablet programs to ensure a seamless transition for clients on this medication once Health Canada's Substance Use and Addictions Program funding expires in March 2023;

f.  support safer supply options, including listing high dose hydromorphone on the Ontario Drug Benefit Formulary and exploring other evidence-informed options;

g.  identify and remove barriers to safe inhalation and smoking at Consumption and Treatment Service sites;

h.  formally integrate drug checking into harm reduction services in Ontario by extending funding for the only drug checking service currently operating in Ontario, and expanding drug checking services to all supervised consumption services in Ontario; and

i.  provide sustainable funding for the Integrated Prevention and Harm Reduction initiative, and expand funding for harm reduction services in the shelter system.

4.  Requested the Medical Officer of Health to continue working with Health Canada on the conditions that would allow for an exemption approval under Section 56(1) of the Controlled Drugs and Substances Act within the City of Toronto.  

5.  Requested the Medical Officer of Health to conduct community consultations throughout 2022 to inform a refreshed Toronto Drug Strategy for consideration by the Board of Health in 2023.

The Medical Officer of Health gave a presentation on Toronto Overdose Action Plan: Status Report 2022.

The drug poisoning crisis has continued to intensify since 2015 and has been exacerbated by the COVID-19 pandemic. Toronto Public Health (TPH) continues to implement the Toronto Overdose Action Plan (TOAP), initially launched in 2017 and updated in 2019.

The Office of the Chief Coroner for Ontario estimates 511 confirmed and 54 probable opioid toxicity deaths occurred in Toronto, in 2021. This level of opioid poisoning deaths is in line with trends observed in 2020, but represents a 71 percent increase from 2019 and a 273 percent increase from 2015. Alarming trends are also being observed at the provincial level. Across Ontario, 2,819 people died due to confirmed or probable opioid overdoses in 2021. 

This significant loss of life is reverberating throughout Toronto communities, impacting the families, chosen families, friends, and co-workers of people who use drugs. First-responders and frontline shelter, health, and social support workers are also grieving these losses.

Overdose deaths are preventable and are due in large part to the unregulated drug supply, where the use of highly-potent opioids combined with more unexpected and concerning substances are significantly increasing the risk of overdose.

This staff report highlights actions taken by TPH and City Divisions towards the continued implementation of the TOAP and provides an update on Board of Health direction for the Medical Officer of Health to submit a request to Health Canada for an exemption under Section 56(1) of the Controlled Drugs and Substances Act. This report also recommends further actions that are urgently needed by the Provincial and Federal governments to prevent additional drug poisoning deaths.

Shelter Support and Housing Division (SSHA), Social Development, Finance and Administration (SDFA), Toronto Community Housing Corporation (TCHC), and community partners were consulted in the development of this report.