Overdose deaths in Ontario increasingly involve more than one drug, new report says

A client draws up fentanyl in the consumption room at Moss Park Consumption and Treatment Service in Toronto, Dec. 3, 2024. THE CANADIAN PRESS/Chris Young

An increasing number of overdose deaths in Ontario involves the use of more than one drug, with the combination of opioids and stimulants proving to be especially dangerous, a new report says.

Since the COVID-19 pandemic, attributing deaths to two or more substances rather than just one drug has become more common, new research from the Ontario Drug Policy Research Network and Public Health Ontario shows.

From 2018 to 2022, the monthly rate of overdose deaths involving one substance increased by 75 per cent, deaths involving two substances increased by 167 per cent, while the rate of deaths involving three or more substances increased by 186 per cent, the report released Thursday says.

The researchers found that 12,115 accidental overdose deaths across the province were directly attributed to opioids, stimulants, alcohol and benzodiazepines during that time frame.

"Now, the most common situation is that opioids and stimulants together are contributing to death," said Tara Gomes, an epidemiologist with Unity Health and investigator with the Ontario Drug Policy Research Network, and one of the report's authors.

"But we've also seen this increase in deaths where there are three or more substances involved – an opioid, a stimulant and a benzodiazepine or alcohol – and that has really complicated a number of things, including the fact that when people are overdosing from multiple substances it can be very hard to know how best to support them."

Opioids, largely in the form of illicit fentanyl, contribute to a vast majority of overdose deaths in the province. They were found in nearly 84 per cent of drug toxicity deaths – more than 10,000 people.

Stimulants were found in nearly 62 per cent of overdose deaths, while alcohol was found in 13 per cent and benzodiazepines in nine per cent, the report found.

The researchers also tracked each death to see if that person had any interaction with the health-care system.

"We found that in the week before death, about a third of the people had some kind of health-care encounter in that week," Gomes said.

Fifty-six per cent of people who died had some type of engagement with the health-care system in the previous 30 days.

Those "engagements" could be anything from a trip to an emergency department or a visit with a primary care doctor that is not necessarily drug related, but a significant number of them involved attending hospitals.

"We need to make sure that those emergency departments are actually well set up to support and provide care to people who are relying so heavily on them," Gomes said.

"And, unfortunately, the concern we have in the findings in this report is that that's not always the case."

Gomes said most hospitals don't have addiction medicine specialists on site, but a promising program called addiction medicine consult services is available in a few places and should be rolled out provincewide.

"The goal of those programs is really to make sure that there is specialized care for addictions medicine and for people who use substances integrated within emergency departments and hospitals," she said.

"Part of that is to help make sure people get the best quality of care within the hospital setting, but also to help plan for when people are discharged to connect them to primary care, their family doctor, and other community-based services."

Illicit opioids, largely fentanyl, swept into the province around 2015 and overdose deaths rose soon after. Deaths jumped significantly during the pandemic, which Gomes and other researchers pointed to lockdowns and social measures that often left people using drugs alone. Health-care supports were also shuttered for stretches at a time or access was limited, she said.

As fentanyl became more prominent it found its way into other drugs, tainting much of the drug supply – which also contributed to the stark rise in deaths, Gomes said.

Benzodiazepines, which are depressants, also infiltrated the fentanyl supply in recent years and the two drugs act together to suppress breathing, which can easily lead to death.

"We now have a situation where upwards of half of the opioid-related deaths that we see have some kind of benzodiazepine detected in them," Gomes said.

More than 2,600 Ontarians died from opioids in 2023, the latest annual data available from Ontario's Office of the Chief Coroner.

Ontario will soon undergo a fundamental shift in its approach to the ongoing opioid crisis. The province will close 10 supervised consumption sites by the end of March because they are too close to schools and daycares.

It will move to an abstinence-based treatment model with plans to launch new "homelessness and addiction recovery treatment hubs" by April 1, plus create 375 highly supportive housing units at a cost of $378 million.

This report by The Canadian Press was first published Jan. 9, 2025.