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People who died from a substance-related overdose faced significant gaps in treatment, report finds


Toronto, ON, March 5, 2024 – In the months and years before their death, many people had received substance use diagnoses and used healthcare services, but few engaged with evidence-based substance use treatment—signaling the need for a multi-factorial approach, researchers urge.

The report, led by the Ontario Drug Policy Research Network (ODPRN) at St. Michael’s Hospital and Public Health Ontario, used data from the Office of the Chief Coroner of Ontario and ICES to describe prior prescribing patterns, substance use disorder diagnoses, and toxicity events among people who died from accidental opioid, benzodiazepine, stimulant and/or alcohol-related toxicities in Ontario.

Similar to a 2023 report, the unregulated drug supply and polysubstance use continues to drive these deaths. This report aimed to delve further into people’s prior experience with the healthcare system to better understand the types of responses needed and opportunities for intervention.

“The crisis of escalating substance toxicities is complex, and impacts people in different ways,” says 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. “This means we need a multifaceted response that will most benefit those at risk of serious harms.”

Interaction with the healthcare system

There were 10,024 accidental substance toxicity deaths in Ontario over the four- and half-year study period—an increase of 72% comparing deaths in the first 12 months compared to the final 12 months.

Almost two-thirds (61%) of people who died from substance-related toxicity had prior healthcare encounters for substance use disorder—yet engagement with evidence-based substance use treatment was relatively low. For example, among people with opioid use disorder who died from an opioid-related toxicity, less than one-third received recommended medications in the month before their death. Similarly, among those with a diagnosis of an alcohol use disorder, less than 5% had received first-line medications to treat their diagnosis in the month before death.

“People experiencing harms from substance use have varied needs, and treatment, while an integral component to our response to this crisis, cannot be our only response,” says Gomes. “With many people disengaged from medical care for substance use, responses that integrate both harm reduction and treatment services are imperative. Finally, in the current context of an increasingly unpredictable unregulated drug supply and rising use of multiple substances, we need to ensure that these services are adequately resourced to meet the complex needs of people who use drugs in our communities.”

The researchers also found that 1 in 5 people who died from substance-related toxicities had been treated in hospital for a non-fatal overdose in the year prior to death, the majority of which were related to opioid-related toxicity events. Although prior alcohol-related toxicities were much less common (1%), nearly half of people who died from an alcohol-related toxicity had a hospital visit related to alcohol use disorder in the five years prior to their death.

Gomes says that these findings reflect the high burden of ongoing harms experienced by people who use substances in Ontario, especially among those accessing the unregulated drug supply, which is increasing in potency and unpredictability.

This work also reinforces the need for hospitals to ensure that they have accessible expertise in substance use care, and adequate training for clinicians and staff to ensure the provision of high quality, trauma-informed care for people who use substances who engage with the healthcare system.

“Our communities are currently struggling enormously with an increasingly unpredictable and toxic drug supply that is leading to unprecedented harm,” says Gomes. “The urgency of the tragedy that is unfolding across the province needs to be reflected through widespread support for innovative, multidisciplinary responses that are accessible both through community-based organizations and our hospital system.”

About St. Michael’s

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, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education.

About Public Heath 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. For the latest ICES news, visit www.ices.on.ca.


Misty Pratt
Senior Communications Officer, ICES
[email protected]