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Drug supply changes, physical distancing measures and the curtailing of social services during the COVID-19 epidemic have led to a dramatic spike in overdose deaths in Ontario, with more than 2,200 people anticipated to be dead in 2020.

The grim figure, contained in a new report released Tuesday, is a 50-per-cent increase from the death toll of 2019, the province’s deadliest year on record.

Tara Gomes, a scientist in the Li Ka Shing Knowledge Institute at St. Michael’s Hospital and principal investigator at the Ontario Drug Policy Research Network, one of the groups that produced the report, called the overdose surge an “enormous issue” requiring urgent attention.

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“Prior to COVID, I’ve always said that this is the biggest public-health crisis of our time,” Dr. Gomes said in an interview. “While obviously a lot of focus is, and needs to be, with the COVID-19 pandemic, we can’t shift our focus away from the harmful effect of drug policy right now on overdoses across the province.”

Ontario declared a state of emergency in response to COVID-19 on March 17. In the 15 weeks following, the province recorded 695 opioid-related deaths, or an average of 46 deaths weekly – a 38.2-per-cent increase from the 15 weeks immediately prior to the declaration (503 deaths, or 34 deaths weekly).

The Ministry of Health did not return a request for comment on Tuesday.

The unintended consequences of COVID-19 restrictions on people who use drugs are playing out across the country. Lockdowns, border closings and other measures implemented to stop the spread of the coronavirus have disrupted global drug supply chains, making an already volatile trade even more so. Meanwhile, COVID messaging to self-isolate and avoid social interactions is directly counter to that for people who use drugs: Never use alone.

In Canada, such disruptions have meant a decrease or change in the availability of illicit drugs and increased drug adulteration. In Ontario, postmortem toxicology testing has shown that fentanyl was detected in 87.2 per cent of overdose deaths during the pandemic, compared to 79.2 per cent prior. In British Columbia, about 15 per cent of overdose deaths during the pandemic involved “extreme” fentanyl concentrations, compared to 8 per cent prior.

Meanwhile, etizolam was detected in 13.8 per cent of deaths in Ontario during the pandemic, compared to 7.9 per cent prior, according to the report. This drug, which is chemically similar to benzodiazepines, which are a class of drug typically used to treat anxiety and sleep disorders, began showing up in Canada’s illicit drug supply about two years ago.

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Benzodiazepines and opioids combined are particularly dangerous because of the increased risk for potentially lethal respiratory depression.

Postmortem toxicology tests also showed a drop in methadone use during the pandemic (13.3 per cent compared to 9.2 per cent), which may reflect barriers to accessing prescription treatments during COVID-19.

The report noted changes in the location of opioid-related deaths, with a significantly lower percentage (0.7 per cent) occurring in public indoor places during the pandemic than prior (3.1 per cent) and a higher percentage (7.8 per cent) occurring outdoors than prior (3.9 per cent.).

Dr. Gomes at St. Michael’s in Toronto said this may have been because many community-based programs and services either had to close or reduce hours, particularly during the first wave of COVID-19, because they did not have adequate access to personal protective equipment.

“There was also a huge push for people to remain physically distant and to isolate themselves, which obviously is important from a COVID-19 perspective," she said. “But when you consider that this could lead to more people using drugs alone, and not having somebody there to intervene if there’s an overdose, that obviously can have very devastating impacts.”

In B.C.'s Vancouver Coastal Health region, supervised consumption services average roughly 6,000 visits in any given week. In the early weeks of the pandemic, that figure dropped to around 2,000, coinciding with a surge in overdose deaths.

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Dr. Gomes said the most urgent measures Ontario must implement are broader access to supervised consumption services, including outside of urban centres, and the expansion of safer, pharmaceutical alternatives to illicit drugs, coupled with treatment options.

“Given how toxic and contaminated it is right now, we really need to consider a safer supply of opioids, and low-barrier, rapid access to treatment,” she said.

On the ground, Zoë Dodd, a co-organizer with the Toronto Overdose Prevention Society, said front-line workers are struggling with trauma and hopelessness.

“We’re seeing more people burn out, and people who have been shouldering the crisis are really suffering,” said Ms. Dodd, who has helped reverse hundreds of overdoses in recent years. “Many people have now found someone who’s dead on the street. One man was pulled out of a [portable toilet]. We’re all witnessing death in plain sight."

Ms. Dodd said there is a desperate need for co-ordinated working groups and data-sharing across multiple levels of government to direct interventions, but none exist. “It feels like a horror movie and there’s nobody coming to help us.”

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