The pandemic is worsening the opioid crisis
Recently, Toronto Public Health confirmed what those of us on the front lines have feared for months: the opioid crisis is getting worse.
Escalating numbers of overdoses and deaths are being reported in many party of the country. In Toronto in both April and May, there were more suspected opioid deaths than any month since September 2017. So bad was the summer of 2017 that hundreds of health-care workers, myself included, wrote a letter urging Ontario to declare a public health emergency.
The thought that whatever progress was made since then is being undone by COVID-19 is tragic and heartbreaking. The people who are dying are parents, loved ones, children and friends, and their deaths are entirely avoidable. The Government of Ontario must urgently address the gaps in co-ordination and communication, and formulate a systematic approach to tackling this issue.
There are many hypotheses as to why this increase in deaths has occurred. Changes in drug supplies have seen an increase in opioids mixed with benzodiazepines, the results of which can be deadly. Social isolation, unemployment and worsening mental health issues can also make problematic substance use worse. At the same time, people are reporting having a harder time accessing resources that can help, as many have closed their doors due to COVID-19.
I would like to think that government and the public want to save lives, but even if you are inclined to look away, even if you’re inclined not to care as much, there’s one detail that’s inescapable: death is just one possible outcome of an overdose. For everyone who dies, there are many more who suffer significant medical complications, which puts an additional strain on hospital resources. In Toronto, the past three months have seen significant spikes in ambulance calls for overdoses.
The health system has been working creatively to increase the number of ventilators, intensive care beds and the overall capacity of our hospitals to deal with the current wave of COVID-19 and be prepared for any future waves. Yet I have seen far too many young people on ventilators, in the emergency department and admitted for weeks at a time due to an overdose. If we are serious about conserving our resources, we need to avoid the unnecessary and tragic outcomes faced by people who use drugs.
On the front lines, there have been some innovative grassroots strategies. People are finding ways to use technology to catch overdoses more frequently, or supervise injections virtually. Mobile phones have been distributed, in order to make it easier for service providers to connect with marginalized people. Substance use and harm reduction services are increasing their efforts help those in shelters who are at higher risk. There have also been calls to get better and quicker access to innovative medications and treatments that could save lives.
What has been lacking, however, is a systematic strategy to help co-ordinate, fund, implement and evaluate these ideas. By now, we are accustomed to the daily
THERE HAVE BEEN SOME INNOVATIVE GRASSROOTS STRATEGIES.
updates, case counts and targeted interventions for COVID-19, but we haven’t seen anything of that sort for the rapidly worsening opioid crisis.
The Government of Ontario should immediately appoint an overdose co- ordinator who reports directly to the minister of health. It should appoint regional co-ordinators to be deployed to hot spots across the province to address changes in overdose rates in real time. The government should also reopen the opioid emergency task force, which was closed in 2018, to allow front- line workers a means of communicating with government, in order to allow for a nimble and quick response that is based on science and evidence.
Co- ordination between treatment centres, harm- reduction services, health providers and government will allow for an organized response, which has been desperately lacking so far.