Nearly two-thirds of Ontario residents who died from accidental drug and alcohol overdoses in recent years had interactions with the health care system for substance-use disorders before their deaths, according to a new report published Monday. Yet, despite the high rate of exposure to the health care system, only a small number of people were able to access addiction-treatment services, researchers found.
The report, published by the Ontario Drug Policy Research Network and Public Health Ontario, highlights an urgent need to make treatment services more accessible, said Tara Gomes, one of the authors. For instance, methadone treatment programs, which stave off debilitating opioid withdrawal symptoms, often require individuals to show up in person every day at a pharmacy to get their dose. This can be onerous to maintain and can lead people to miss work and face other challenges as a result, she said.
“It can be a very challenging thing for people,” said Dr. Gomes, who is a scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital and the Institute for Clinical Evaluative Sciences (ICES) in Toronto. “Some of our traditional approaches aren’t working well.”
Opioid overdoses have claimed the lives of nearly 41,000 people in Canada from January, 2016, to June, 2023, the most recent date for which data are available. During the first six months of 2023, 22 people died each day from opioid overdoses across the country, according to the Public Health Agency of Canada.
Of the overdoses that occurred last year, 84 per cent involved fentanyl, which is an extremely potent opioid that is often added to drugs without a user’s knowledge. Even small amounts can be fatal, which is why many who work in the field of addiction and substance-use disorders are calling for action to address the toxic drug supply.
There were more than 10,000 accidental substance-related overdoses in Ontario during the study period, which looked at data from Jan. 1, 2018, to June 20, 2022. There was a 72-per-cent increase in overdose deaths during the last year of the study compared with the first year, underscoring the severity of the continuing toxic drug crisis. Many of the individuals who died had taken more than one substance. About 84 per cent of overdose deaths involved opioids; 61 per cent involved stimulants; 13.4 per cent involved alcohol; and nearly 8 per cent involved benzodiazepines.
Of the individuals who died, one in five had been treated for a non-fatal overdose in the year before their death, the report found. More than one-third who died from overdoses had an outpatient visit related to a substance-use disorder in the year before their deaths. And 61 per cent had a previous interaction with the health care system for a substance-use disorder.
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According to the findings, based on provincial health data, nearly 83 per cent of those who died from accidental overdoses had received methadone or another opioid agonist therapy in the five years before their death. But only 30 per cent had received treatment in the month before their death and just 10.8 per cent had received treatment the day of their death.
Dr. Gomes said the fact that many of those who died had recent visits to health care facilities for non-fatal overdoses suggests that more could be done in hospitals and outpatient settings to help connect those individuals with support.
She said that stigma around opioid use and other substance-use disorders, including from within health care institutions, can keep individuals from accessing care and treatment, which also needs to be addressed.
Addictions and Mental Health Ontario chief executive Alisha Tharani said there needs to be a significant investment by the province in treatment and support for individuals living with a substance-use disorder. This includes an investment in affordable housing and supportive housing, where at-risk individuals can access the services they need.
“We need a full continuum of services.”
Carly Weeks