A growing number of overdose deaths in Ontario involve the use of more than one drug, with combinations of opioids and stimulants proving particularly dangerous, a new report says.
New research from the Ontario Drug Policy Research Network and Public Health Ontario shows that since the COVID-19 pandemic, it has become more common to blame deaths on two or more substances rather than a single drug.
From 2018 to 2022, the monthly rate of single-substance overdose deaths increased by 75 percent, deaths involving two substances increased by 167 percent, while the rate of deaths involving three or more substances increased by 186 percent, according to the report released Thursday. says
Researchers found that 12,115 accidental overdose deaths in the province were directly attributable to opioids, stimulants, alcohol and benzodiazepines in that time frame.
“Now, the most common scenario is that opioids and stimulants contribute to death together,” said Tara Gomes, an epidemiologist at Unity Health and an investigator with the Ontario Drug Policy Research Network and one of the report's authors.
“But we've also seen this increase in deaths where three or more substances are involved — an opioid, a stimulant and a benzodiazepine or alcohol — and that's really complicated a lot of things, including the fact that when people overdose. How do multiple substances support them? It can be very difficult to know.”
Opioids, in the form of largely illegal fentanyl, contribute to the vast majority of overdose deaths in the province. They were found in about 84 percent of drug poisoning deaths—more than 10,000 people.
Stimulants were found in about 62 percent of overdose deaths, with alcohol in 13 percent and benzodiazepines in nine percent, the report found.
Interaction with the health care system
The researchers also tracked each death to see if that person had any interaction with the health care system.
“We found that in the week before death, about a third of people had some type of health care encounter that week,” Gomes said.
Fifty-six percent of those who died in the previous 30 days had some form of involvement with the health care system.
Those “attachments” can be anything from a trip to the emergency department or a visit with a primary care doctor that isn't necessarily related to medicine, but a significant number of them involve attending hospitals.
“We need to make sure that those emergency departments are set up properly to actually provide support and care to the people who rely on them the most,” Gomes said.
“And, unfortunately, the concern we have with the findings in this report is that this is not always the case.”
Gomes said most hospitals don't have on-site addiction medicine specialists, but a promising program called the Addiction Medicine Consultation Service is available in some places and should be rolled out provincewide.
“The goal of those programs is to really make sure that there is specialized care for people who use addictive drugs and integrated substances in emergency departments and hospitals,” she said.
“Part of this is to help ensure that people receive the best quality care in the hospital setting, but also to help people plan when they are discharged to connect with primary care, their family doctor and other community-based services.”
The province's changing approach to the opioid crisis
Illegal opioids, largely fentanyl, spread to the province around 2015 and overdose deaths quickly followed. Deaths jumped significantly during the pandemic, which Gomes and other researchers point to lockdowns and social measures that left people alone, often using drugs. Health care supports were also closed for stretches at a time or access was limited, she said.
As fentanyl became more popular, it seeped into other drugs, tainting much of the drug supply — which also contributed to the sharp increase in deaths, Gomes said.
Benzodiazepines, which are depressants, have infiltrated the fentanyl supply in recent years and the two drugs work together to suppress breathing, which can easily lead to death.
“Right now we have a situation where over half of the opioid-related deaths we see are found to have some form of benzodiazepine,” Gomes said.
More than 2,600 Ontarians died from opioids in 2023, the latest annual statistics available from the Office of the Chief Coroner of Ontario.
Ontario will soon undergo a fundamental shift in its approach to the ongoing opioid crisis. The province will close 10 supervised consumption sites by the end of March because they are near schools and daycares.
It will move to an abstinence-based treatment model with plans to open new “homelessness and addiction recovery treatment centers” by April 1, as well as create 375 highly supportive housing units at a cost of $378 million.
