Social Policy in Ontario

Last weekend was a particularly dangerous one for opioid users in Toronto. It was so perilous, in fact, that Toronto police put out a safety alert after the city saw four drug-related deaths and 20 overdoses in just two days.

Authorities believe the deaths and overdoses were from heroin laced with fentanyl, an opioid that is 50 times stronger than heroin.

Sadly, things did not get better from there. On Tuesday the bodies of two teenaged girls were found in an Etobicoke condominium. Police suspect they, too, died of overdoses.

In fact, from July 26 to July 31 alone, there were 79 visits to Toronto emergency departments for suspected overdoses.

The only good news from this frightening toll is that it spurred Mayor John Tory to meet with senior police, fire and paramedic officers and Toronto’s chief medical officer of health to identify ways to stem the tide of overdoses.

The bad news is that they did not come up with a bold enough plan to fight the crisis, despite the fact that Councillor Joe Cressy, head of the city’s drug prevention strategy, pointed out that “every day lost is a potential life lost.”

This is a fast-moving crisis and it’s clear from trends in British Columbia, where opioid use is even more pronounced, that it is almost certain to get worse. The city must move much more quickly and nimbly to prevent the rising tide of overdoses in Toronto and do better than the tepid plan it came up with on Thursday.

For example, in a tragic twist, two of the four weekend overdose victims died within steps of the Queen West Central Toronto Community Health Centre at Queen West and Bathurst Sts.

That’s one of three city locations that received federal approval to offer supervised injection services aimed at preventing overdose deaths. But according to Toronto Public Health, none of the three are slated to open before late this fall.

One of the obvious recommendations, then, from Thursday’s meeting was to speed up the opening of the three supervised injection sites at Queen West, South Riverdale Community Health Centre and the needle exchange at Yonge and Dundas Sts.

A better idea comes from harm reduction workers at the sites who argue that while the centres are being renovated for supervised injection services, temporary or mobile sites should be opened now.

Pop-up clinics like that would be in line with how the city responds to a flu outbreak. So why, workers sensibly ask, not respond the same way to an overdose crisis?

The idea is not new. More than 20 temporary supervised injection sites were opened in Vancouver, Victoria and across British Columbia in the last year. Meanwhile, a mobile medical unit was deployed in Vancouver’s Downtown East Side with life-saving naloxone and trained staff to contain the crisis there.

Another recommendation from Thursday’s meeting was a simple request for police to consider carrying naloxone, an antidote to opioid overdoses, as police in Vancouver do.

And why not? Toronto paramedics already carry naloxone, and firefighters will do that by the fall. Even front-line TTC workers have access to it. But the Toronto Police Service is refusing to equip its officers with the life-saving drug, saying only that “paramedics are the best way to protect people in overdose situations.”

Dr. David Juurlink, head of clinical pharmacology and toxicology at the University of Toronto, strongly disagrees. “All first-responders should have it on them,” he argues.

In light of all this, Toronto police should reconsider their decision.

Another weak idea proposed on Thursday was to try to get better overdose information by tracking when paramedics used naloxone.

A better proposal would be to monitor overdoses in real time, as B.C. does, city by city. Then Toronto would have a more accurate idea of what is headed this way.

And if what has happened in British Columbia is any indication, it is a tsunami of deaths. In 2016 the overdose crisis was responsible for 922 deaths, with some addicts actually overdosing multiple times a day.

Unbelievably, the most recent data available for Toronto dates from 2015. That year there were 730 opioid-related deaths in Ontario, or roughly two a day, 137 of which were in Toronto. That number has risen steadily since 2012, when there were 585 deaths in Ontario, 85 of them in Toronto. But what are this city’s year-to-date figures, never mind last year’s? No one knows.

The country, never mind this city, needs up-to-date data of the kind collected in British Columbia if it is going to fight this crisis with the urgency and effectiveness it requires. Toronto should be compiling it, not relying on paramedics to simply share naloxone information.

There are further lessons that Toronto can learn from other cities to save lives.

One is to take supervised injection sites to drug users. Montreal already has Canada’s first mobile supervised injection service up and running.

Another is to target resources to specific drug users. Vancouver has opened up a safe injection site that serves only women who won’t use sites frequented by men.

Vancouver is also providing in-home addiction treatment for opioid users and has increased the number of emergency beds at the city’s detox facility.

Toronto would do well to follow suit.

Last weekend was an eye-opener on how Toronto needs to deal quickly and effectively with its drug overdose crisis. It’s not enough to wait until supervised sites are opened this fall. Real action is needed now.

https://www.thestar.com/opinion/editorials/2017/08/03/torontos-plan-for-tackling-opioid-crisis-falls-short-editorial.html