A new report shows overdose deaths are often linked to more than one drug

TORONTO — A growing number of overdose deaths in Ontario involve the use of more than one drug, a new report shows, with the combination of opioids and stimulants proving particularly dangerous.

New research from the Ontario Drug Policy Research Network and Public Health Ontario shows that attributing deaths to two or more substances, rather than just one drug, has become increasingly common since the COVID-19 pandemic.

The report released Thursday found that between 2018 and 2022, the monthly rate of overdose deaths involving a single substance increased by 75%, deaths involving two substances increased by 167% and the number of deaths involving three or more substances increased by 186 %. says.

Researchers found that 12,115 accidental overdose deaths across the province during this period were directly attributable to opioids, stimulants, alcohol and benzodiazepines.

“The most common situation right now is that opioids and stimulants combine to cause death,” said Tara Gomes, an epidemiologist at Unity Health and a researcher at the Ontario Drug Policy Research Network, and one of the report’s authors.

“But we’ve also seen an increase in deaths involving at least three substances – an opioid, a stimulant and a benzodiazepine or alcohol – which has really complicated a lot of things, including the fact that when people overdose on multiple substances, it’s very difficult to know how best to support them “

Opioids, primarily in the form of illicit fentanyl, account for the vast majority of overdose deaths in the province. They were detected in almost 84 percent of drug poisoning deaths – more than 10,000 people.

The report found that stimulants were found in nearly 62 percent of overdose deaths, alcohol in 13 percent and benzodiazepines in 9 percent.

The researchers also tracked each death to see if the person had any interaction with the health care system.

“We found that in the week before they died, about one-third of people had some kind of health care encounter that week,” Gomes said.

Fifty-six percent of people who died had some contact with the health care system in the last 30 days.

These ‘engages’ can include anything from an emergency room visit or a GP visit, which are not necessarily drug-related, but a significant number of them involved a hospital visit.

“We need to make sure that these emergency departments are truly well-prepared to support and provide care to the people who rely so heavily on them,” Gomes said.

“And unfortunately, the findings in this report raise our concerns that this is not always the case.”

Gomes said most hospitals don’t have addiction medicine specialists on-site, but a promising program called Addiction Medicine Consultation Services is available in a few places and should be rolled out across the province.

“The goal of these programs is really to provide specialized addiction and substance use medicine care integrated within emergency departments and hospitals,” she said.

“Part of this is to help ensure that people receive the highest quality of care in a hospital setting, but also to help them plan for discharge to ensure they have access to primary care, GPs and other community-based services.”

Illegal opioids, primarily fentanyl, entered the province around 2015, and overdose deaths increased shortly thereafter. Deaths have increased significantly during the pandemic, which Gomes and other researchers have pointed to lockdowns and social measures that often left people alone using drugs. She said health care facilities were also temporarily closed or access was restricted.

As fentanyl gained prominence, it seeped into other drugs, contaminating much of the drug supply, which also contributed to the spike in deaths, Gomes said.

In recent years, benzodiazepines, which have a sedative effect, have also made their way into drugs containing fentanyl, and the two drugs work together to suppress breathing, which can easily lead to death.

“We currently have a situation where over half of the opioid-related deaths we have recorded have some form of benzodiazepine detected,” Gomes said.

According to the most recent annual data available from the Office of the Chief Coroner of Ontario, more than 2,600 Ontarians died from opioids in 2023.

Ontario is about to undergo a fundamental change in its approach to the ongoing opioid crisis. By the end of March, the province will close 10 supervised consumption sites because they are located too close to schools and kindergartens.

It will shift to an abstinence-based treatment model and plans to launch new “homelessness and addiction treatment centers” by April 1, as well as create 375 supportive housing units at a cost of $378 million.

This report by The Canadian Press was first published Jan. 9, 2025.

Liam Casey, Canadian Press