Opioid-Related Toxicity Deaths Within Ontario Shelters: Circumstances of Death and Prior Medication & Healthcare Use

Ontario is facing an ongoing opioid-related toxicity crisis. Shelters, which provide short-term housing for people experiencing homelessness, have seen a significant rise in opioid-related deaths, especially during the COVID-19 pandemic.

This study describes the demographic characteristics, circumstances surrounding death, and types of healthcare encounters prior to opioid-related toxicity deaths within Ontario shelters.

We conducted a cross-sectional descriptive study of trends, characteristics, and patterns of healthcare use among people who died of an opioid-related toxicity within shelters in Ontario, Canada between January 1, 2018 and June 30, 2022 — a time frame that encompasses periods before and during the COVID-19 pandemic.

Between 2018 and 2022, the quarterly number of opioid-related toxicity deaths within shelters nearly quadrupled, rising from 8 deaths (Q2 2018) to 31 deaths (Q2 2022). Across pre-pandemic and pandemic periods, most deaths occurred in people aged 25-44 (50.0% vs 54.9%), followed by those aged 45-64 (37.5% vs 33.3%). A small proportion of deaths were among those under 25 (≤10.4% vs 8.6%) and over 65 (≤10.4% vs ≤3.1%). Over three-quarters of the deaths were among males (81.3% vs 76.5%). There was no significant change in the age and sex distribution of opioid-related toxicity deaths in shelters during the pandemic. The majority of opioid-related toxicity deaths in shelters involved non-pharmaceutical opioids such as fentanyl and increased during the pandemic, rising from 85.4% (N=41) to 94.4% (N=153). Notably, only 1 in 7 of these deaths occurred in the presence of someone who could intervene (13.6%, N=22 of 162), indicating that most individuals used drugs alone.

Opioid-related toxicity deaths within Ontario shelters have grown considerably during the COVID-19 pandemic. People experiencing homelessness or unstable housing are disproportionately affected by the opioid toxicity crisis. The rise in deaths in shelters underscores the urgent need to invest in expanded access to harm reduction services, healthcare, social care, treatment programs, and to ensure sufficient staff availability, training, and support in these settings.

Hamzat B, Leece P, McCormack D, Holton A, Dodd Z, Firestone M, Wolfson-Stofko B, Smuts H, Sereda J, Smoke A, Watford J, Watts T, Shearer D, Schneider E, Singh S, Cheng C, Gomes T, on behalf of the Ontario Drug Policy Research Network and Ontario Agency for Health Protection and Promotion (Public Health Ontario). Opioid-related toxicity deaths within Ontario shelters: circumstances of death and prior medication and healthcare use. Toronto, ON: Ontario Drug Policy Research Network; 2024.

Date Released: June 18, 2024

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