Services helping prevent overdose deaths

A Toronto Public Health official says the city is best-equipped to prevent deaths from opioid overdoses downtown — even though the majority of suspected overdose calls including those that are fatal are concentrated there — due to the prevalence of treatment services such as overdose prevention sites.

In the first year-long study of its kind, the city examined data from Toronto Paramedic Services on suspected opioid overdose calls from August 2017 to August 2018. During that span, paramedics responded to 3,203 suspected opioid overdoses, of which 161 were fatal, said Liz Corson, acting supervisor epidemiology and health status at Toronto Public Health.

“We’re definitely still seeing the vast majority of calls in the downtown,” said Corson, who co-authored the report. “That would correspond to the majority of deaths as well.”

However, according to the study, which mapped both the number of calls and the fatality rates in neighbourhoods across Toronto, many areas with a high fatality rate are outside the core.

Corson said the conclusion can be drawn that someone who overdoses

downtown has a greater chance of survival due to the concentration of resources to counter overdoses.

“People who are using drugs in the overdose prevention sites and supervised injections services are far less likely to overdose,” Corson said. “It’s even less likely for paramedics to have to come because they’re in the hands of health-care professionals already.

The overdose prevention sites and supervised injection services — totalling eight locations — are all situated downtown.

“The fact that there has been no deaths in any supervised injection services or overdose prevention services speaks to that better than the data in this report,” she said.

The city records monthly numbers of suspected opioid overdose calls on its website, dating back to August 2017. Last month, paramedics responded to 281 non-fatal and 19 fatal incidents.

During the duration of the study, the top five neighbourhoods and top10 main intersections with the highest number of calls were all in the downtown area, bounded roughly by Bathurst St. to the west, Bloor St. to the north, the Don Valley Pkwy. to the east, and Lake On- tario to the south.

“That’s where the vast majority of drug use is happening,” Corson said. “Downtown is the priority area for the services.”

The Church-Yonge corridor accounted for the most suspected overdose calls during the course of the study at 358, followed by Moss Park with 337.

Over the one-year period covered in the report, paramedics attended to 31 fatal suspected opioid overdoses in the eight neighbourhoods located in the downtown area. This represents 19 per cent of the total fatal cases across the city, Corson said.

“Those eight neighbourhoods only represent 5 per cent of the total number of neighbourhoods, but 19 per cent of the total fatalities,” Corson said. “That’s the highest volume area.”

Thirty-six per cent of total cases (non-fatal and fatal) responded to by paramedics were in this area.

“The count of fatalities is still disproportionately higher downtown, but the percentage of cases that are fatal is slightly lower in the downtown compared to the city as a whole.”

The stats in the study only represent people who die before medics arrive or while paramedics are administering care and does not include people who die at hospital. Overdoses paramedics did not respond to would not be captured in the study. Corson said those numbers would be tracked by the coroner.

The study also does not factor in deaths resulting from cases originally defined as accidental, but was later discovered to be from an opioid overdose by the coroner.

Coroner data shows there were 308 opioid overdose deaths in Toronto last year. This represents a 66 per cent increase in the deaths compared to 2016.

Corson cautioned the paramedics data collected is nuanced, but it does provide a good snap shot of the opioid crisis across the city. The data also shows high fatality rates scattered in areas such as Etobicoke, North York and Scarborough.

“That doesn’t necessarily show that the number of fatalities are higher (than downtown),” she said. “It might just be that there is a very small number of calls overall, and it just happen to be that a higher percentage of those are fatal.”

However, Corson said expanding overdose prevention and supervised consumption services beyond downtown is facing roadblocks.

“The provincial government has actually asked all of the current overdose prevention sites and supervised consumption services to reapply for a new model of harm reductions services,” Corson said.

They have limited the number of harm reduction services in the province to 21 locations.

“Under that model, expanding outside the downtown core of Toronto is going to be challenging,” she said. “They might not approve the applications of all the existing services in Toronto. We’re currently in the application process.”

Dr. Rita Shahin, Toronto’s associate medical officer of health, said the safety net is stronger downtown as services correspond to where drug use is happening most often.

“Not everyone who overdoses calls 911, so sometimes it’s hard to look at data and draw those conclusions,” she said about using just the paramedics data to delineate where it’s less likely for overdoses to be fatal.

“If you’re overdosing in a private residence and nobody is with you, it doesn’t matter where.”