Accidental drug and alcohol-related deaths rising in Ontario, especially those involving multiple substances: report

Latest data shows over 25% of people admitted to hospital, and 1 in 7 who visited an ER, left before medically advised in week before death

A new report from researchers at the Ontario Drug Policy Research Network and Public Health Ontario shows the number of accidental drug and alcohol toxicity-related deaths continued to rise dramatically from January 2018 and December 2022.

Ontario saw a significant rise in the number of accidental substance-related toxicity deaths across the province – increasing from an average of 4.5 substance-related deaths per day in 2018 to a total of eight deaths per day in 2022.

There were 12,115 accidental deaths from substance-related toxicities over the 5-year period, with the annual number of deaths increasing by 68 per cent from 2018 (N=1,660) to 2022 (N=2,796).

Death rates involving one substance increased by 75 per cent, those involving two substances increased by 167 per cent, while those involving three or more substances increased by an alarmingly high 186 per cent from 2018 to 2022.

The rate of substance-related toxicity deaths involving three or more substances in 2022 also accounted for a total of 11 per cent of all deaths, further highlighting the evolving dynamics of toxicity deaths involving multiple unregulated drugs over time.

The most common combination of substances involved in toxicity deaths was opioids with stimulants – rising from 30 per cent in 2018 to 42 per cent of all substance-related toxicity deaths in 2022.

“The volatility of the illicit drug supply and increased exposure to multiple substances has led to unprecedented harm across the province” says senior author Dr. 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.

“With rising deaths involving stimulants, benzodiazepines and alcohol, there is a clear need for a comprehensive response to the drug toxicity crisis that extends beyond opioids alone and considers the dynamic nature of substance use and harms across the country.”

Missed opportunities for health care interventions

The report also found a high prevalence of concurrent mental health-related diagnoses and recent Hepatitis C diagnoses among people experiencing fatal substance-related toxicities, reinforcing the potential benefits of integrated-care models that support people with both substance use disorders and other health care needs.

Finally, almost one-third of people who died of a substance-related toxicity had a health care encounter in the week before death, and those with recent hospital visits had a high prevalence of leaving before medically advised.

This reveals the challenges and missed opportunities for the health-care system to engage with this vulnerable population with timely interventions and supports at critical junctures.

“People who use drugs are often highly reliant on our hospitals and emergency departments for their healthcare needs, but that system is not sufficiently prepared or resourced to meet those needs,” says Dr. Gomes. “With inconsistent and inadequate access to specialized addictions medicine services throughout our hospital system, people who use drugs often face stigma and sub-optimal care, leading them to leave hospital before receiving the support they are seeking.”

In 2022, over one-quarter of people admitted to hospital and one in seven people visiting an emergency department left before medically advised in the week before death.

This is the final report in a series dedicated to expanding the understanding of circumstances around substance-related toxicity deaths in Ontario. Overall, it finds that substance toxicity death rates continue to grow, particularly those involving multiple substances, and that these deaths continue despite high engagement with the healthcare system in the week before death.

By Adam Miller, Unity Health Toronto

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About the Ontario Drug Policy Research Network

Established in 2008, the Ontario Drug Policy Research Network (ODPRN) is a research program based out of St. Michael’s Hospital that brings together researchers, people with lived experience, clinicians, and policy-makers to generate evidence to inform effective drug policy development in Ontario.

About Unity Health Toronto

Unity Health Toronto is one of the largest academic health sciences networks in Ontario with a wingspan across Toronto’s core. The breadth of services we provide, strengthened by community partnerships and our global profile in health research, education and innovation, positions us as a model for collaborative, integrated, high quality care as we work to build a stronger, resilient and equitable health system for all.

Our mission and values, instilled over 130 years ago by the Sisters of St. Joseph of Toronto, drive our commitment to equity and social justice, as we seek to understand the challenges of disadvantaged populations and find new ways to eliminate the barriers they face. This mission is part of our legacy and ingrained in our culture. We know if we can get it right for those who need our help the most, we can have life changing impacts for all in society.

Our motto – Caring hearts. Leading minds – captures our dual commitment to compassionate patient care and excellence in teaching, research and innovation. As a leading Canadian health research institution and learning destination of choice for top health professionals, we are advancing healthcare for all united by one vision: The best care experiences, created together.

About Public Health Ontario

Public Health Ontario is a Crown corporation dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health. Public Health Ontario links public health practitioners, front-line health workers and researchers to the best scientific intelligence and knowledge from around the world. For the latest PHO news, follow us on Twitter: @publichealthON.

About ICES

ICES is an independent, non-profit research institute that uses population-based health information to produce knowledge on a broad range of health care issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting health care needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, visit www.ices.on.ca.