Drug checking, harm reduction sites needed to combat spike in opioid overdoses in Toronto

As the overdose crisis continues to worsen, there are calls for governments to invest in more harm reduction initiatives. Faiza Amin speaks with Toronto's drug checking service about what they see in the city's drug supply.

By Faiza Amin and Meredith Bond

As Toronto Public Health (TPH) warns of yet another increase in suspected opioid overdose deaths, several agencies working in harm reduction across the city say they don’t have enough resources to combat the crisis.

Last week, TPH said paramedics attended 10 suspected opioid deaths over five days from July 17-21.

Calling the cluster of deaths “very tragic,” Toronto police tells CityNews they saw similarly high clusters of death in November 2020, January 2021, and May 2021.

The City of Toronto says the COVID-19 pandemic exacerbated the already devastating opioid crisis and contributed to the “unprecedented increase” in opioid-related deaths.

There have been 143 suspected opioid overdose deaths recorded so far in 2022. The average number of deaths a month before March 2020 was 13; it is now 27.

Drug alerts, like the one issued last week, are done when an abnormality is detected that is usually informed by various sources, including harm reduction partners and their overdose monitoring system.

One of the harm reduction partners in the city is Toronto’s Drug Checking Service, funded as an overdose prevention measure by Health Canada and St. Michael’s Hospital Foundation.

The service provides people who use drugs with detailed information about the contents of their narcotics.

“We’re just allowing them or facilitating them to make the most informed decision by knowing what’s in their drugs because when you’re accessing drugs from an unregulated market, there’s no way of knowing exactly what’s going to be in them or even if you do know what’s in them the potency of what’s in it,” said Project Manager Hayley Thompson.

The drug checking service also then takes that data from the samples they have checked and shares that information publicly on their website. “[It’s to] help inform the care that people who use drugs receive as well as to inform clinicians, policymakers who are creating drug-related policies and researchers,” said Thompson.

They have checked over 7,000 samples of drugs since they opened in Oct. 2019, the majority (50 per cent) of which is fentanyl. The other 50 per cent is made up of various stimulants like cocaine, methamphetamine, psychedelics, and other opioids.

“The opioid supply and, in particular, the presence of fentanyl is what we know to be harming people because these drugs are so potent.”

Thompson said they have found that only 5 per cent of the fentanyl substances we check only contain fentanyl, meaning that 95 per cent of the time, the contents of expected fentanyl samples contain other substances.

“It really gives you an idea of just like how contaminated the fentanyl supply is, in particular, and what is contaminated with is a lot of other drugs that increase the fentanyl potency or increase the potential for adverse effects,” explained Thompson.


As Toronto Public Health (TPH) warns of yet another increase in suspected opioid overdose deaths, several agencies working in harm reduction across the city say they don’t have enough resources to combat the crisis. Photo: Raimond Klavins.

Currently, this drug checking service is only available in downtown Toronto, and they are only funded until the end of December, as it was originally funded as a pilot project.

Dayn Kent, a coordinator with the Consumption and Treatment Service at the Regent Park Community Health Centre, said he has been in this work for over 10 years and is constantly seeing people fall through the cracks.

“We’re seeing overdoses every week. We’re seeing people in desperation, we’re seeing a lack of access to services that are created for the people that are serving without a lot of consultation with those individuals, ultimately resulting in services that miss the mark in terms of effectiveness and comprehensiveness.”

He tells CityNews what they have been seeing over the last few weeks, months, and years is a result of policy failures.

Kent said one solution to this is continued access to more drug checking services.

“There isn’t necessarily the infrastructure or the testing capacity for us to find out in real-time that these things are happening,” he said.

“There are some channels that we use in social media and linkages with activities that allow us to share locally with each other drug trends that we’re seeing. But ultimately, this is indicative of an issue with supply and the risks associated with an illicit drug supply, which could be solved very, very easily with a more robust and permanent safe supply program.”

Safe supply programs provide users with access to safe alternatives to the toxic supply on the streets with opioid replacements in hopes of decreasing their reliance on the drugs.

Governments need to do more to combat drug poisoning crisis 

Health Canada has launched 25 safe supply pilot projects across Canada, including some in Toronto. But according to Kent, people he has spoken to are afraid to utilize the program over fears it won’t continue at the end of the pilot.

“We need to create a permanent safe supply program that the community can access with the understanding that they need three or four or five years of being on this program to get themselves stabilized to a point where they have a firm foundation in order to take those steps forward that they need and the program will be there to support them.”

The Ministry of Health said they are currently funding 17 consumption and treatment services sites across Ontario, including six in Toronto, and have allocated $31.3 million in annual funding.

The ministry tells CityNews that applications for new sites are currently being accepted, and they are continuing to review applications that have already been submitted.

Kent said the province should be investing more in safe injection sites because not only do they save people’s lives, but these sites are “an amazing way to save downstream costs on the healthcare system, the judicial system and the law enforcement system.”

An example he used was they currently operate on a budget of $1.2 million per year, which is about the same cost to the health care system as 18 to 20 cases of Hepatitis C.

“We have 700 people a month. So we’re looking at 10,000 visits a year and almost 10,000 visits a year for about 18 cases of Hep C transmission. We are now cost neutral, and that doesn’t include all of the reduction in capacity needs or capacity demands for police and fire when those overdoses are happening in the community.”

Thompson agrees a lot more work still needs to be done to combat the drug poisoning crisis.

“We need to see things like decriminalization come into play to help begin to tackle the stigma associated with substance use and also make substance use not a criminal act because it’s not,” said Thompson.

“Substance use is a public health issue, it’s not a criminal issue.”

“Individuals that come to us are interested in promoting their own health care, right?” shared Kent.

“They’re making active choices, to engage in whatever behaviours they choose in the most helpful way possible. And our site allows them to do that in a way that provides that self-determination, support and a stigma-free environment for them to manage themselves.”

Currently, the province of B.C. has received the only exemption from Health Canada to legalize the possession of illegal drugs for personal. Toronto and Vancouver have also applied for an exemption.

She added the provincial and federal governments need to provide the resources to scale up harm reduction services like drug checking and supervised consumption sites.

“The fact that drug checking is only available at five sites in downtown Toronto makes it very inaccessible to the rest of Ontario, despite the fact that we get a lot of outreach, wanting to access our service,” said Thompson.

“About a quarter of people have never used harm reduction services [use drug checking, so] drug checking is a gateway to accessing harm reduction services.”

Thompson said they are currently waiting to hear from the province on whether they will be funded past December 2022 or that they can find another funder that is willing to keep the service going.

Health Canada tells CityNews they are investing $100 million over the next three years to support harm reduction, treatment, and prevention.

“The overdose crisis is complex and affects each community differently. The Government of Canada continues to work with all jurisdictions and communities to support initiatives that meet their needs, to make a difference in the lives of Canadians,” read a statement from Health Canada.

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