Researchers from the Ontario Drug Policy Research Network (ODPRN) at St. Michael's Hospital and Public Health Ontario analyzed health data from the Office of the Chief Coroner of Ontario and ICES, and found that there were 210 accidental opioid-related toxicity deaths within shelters between January 2018 to May 2022, with the number of deaths more than tripling during the study period (48 before the pandemic versus 162 during the pandemic).
Statistics Canada data shows that the annual number of emergency beds in Ontario grew by only 15% (6,764 to 7,767) between 2018 and 2022.
People who use Ontario's shelter system are not only facing housing instability, but also have complex healthcare needs and unique barriers to accessing treatment and harm reduction programs. This report underscores the disproportionate impact of the opioid crisis on this population."
Bisola Hamzat, lead author, epidemiologist with the ODPRN
Trends in shelters differed from rest of Ontario
When exploring the circumstances surrounding the overdose and death, the data showed that someone was present and able to intervene for only 1 in 10 opioid-related toxicity deaths within shelters, which is lower than in Ontario overall (approximately 1 in 4). However, naloxone was administered most of the time when someone could intervene within shelters.
In the week before death, nearly half of people who died within a shelter had contact with the healthcare system, and in the five years prior to death, almost 80% had a hospital visit related for a mental health diagnosis, which is much higher than 56% of people in Ontario overall.
Several factors remained consistent with the rest of Ontario, including the rise of multiple substances contributing to death (such as benzodiazepines and stimulants), a greater tendency toward smoking and inhalation of drugs, and fentanyl from the unregulated drug supply being the most common driver of deaths.
In a secondary analysis of hotels and motels, the researchers found that opioid-related overdose deaths followed similar patterns to those in shelters but began to decline toward the end of the study period in 2022. The researchers say that the rise in deaths was likely influenced by the rapid expansion of temporary hotel-based shelters early in the COVID-19 pandemic.
Urgent need for improved response to crisis
"Our report highlights the need for improved and expanded harm reduction approaches, overdose response, as well as staff training and supports within shelters," says co-lead author Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and ICES, and a principal investigator of the ODPRN.
"Additionally, improved connection to community-based healthcare, treatment programs, and mental health supports are needed for people experiencing homelessness and housing instability, in combination with efforts to address upstream factors such as more accessible housing, income and employment supports, and community-based social supports across the province."
"The report highlights what we have witnessed the last few years in Timmins. It demonstrates the need for comprehensive support across the spectrum of care for unhoused community members, and of the importance of shelter design and management to ensure services are accessible and safe for people who use drugs. An increase in deaths in the Timmins shelter system over the past two years serves as a stark reminder of this importance," says Jason Sereda, President, Board of Directors: DIY Community Health Timmins.
The report, "Opioid-related toxicity deaths within Ontario shelters: circumstances of death and prior medication & healthcare use" was published on the ODPRN website.
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