An epidemic of fatal drug overdoses across Canada is on the rise amid COVID-19 pandemic restrictions that harm-reduction workers and doctors say exacerbates the toxic supply.
Overdose prevention sites continue to run but physical distancing guidelines mean fewer people are able to use the services. For example, a site in Toronto that previously averaged more than 100 visits a day now sees fewer than half that.
From March 2019 to May 2020, Ontario’s coroner reported a 25 per cent increase in fatal overdoses, based on preliminary estimates for all substances.
Nick Boyce, director of the Ontario Harm Reduction Network, said the increase is significant.
“It matches anecdotally what I’ve been hearing from the front-line workers we work with around the province,” Boyce said. “They’re all saying deaths are going up. But to hear that number and to see that number, I was not expecting it to be that high.”
Last year, fentanyl directly contributed to about 75 per cent of opioid-related deaths in Ontario.
More than 14,000 Canadians have been killed by opioids in the last four years, according to federal data.
“Laws actually incentivize drug dealers and suppliers to come up with new and different drugs,” Boyce said. “We learned this lesson in the 1920s with alcohol prohibition when people switched from drinking beer to toxic moonshine. We’re seeing that with the opioid drug supply now.”
Stimulant-related deaths have also increased in Ontario.
British Columbia saw a 39 per cent jump in overdose deaths in April compared to the same month last year.
And in Alberta during the pandemic, the number of opioid-related calls to EMS increased from 257 in March to 550 this May.
Dr. Theresa Tam, Canada’s chief public health officer, has pointed to similar overdose trends across the country.
Back when COVID-19 was first declared a pandemic in March, a woman CBC News is calling Lisa to protect her identity was living in a tent in downtown Toronto. When people were ordered to stay inside, she said there were few places to go. Her struggle with street opioids deepened.
“I OD’ed three times and woke up alone because I was using alone,” Lisa said, referring to overdoses.
Lisa relies on overdose prevention sites; her health-care provider worked with a pharmacist to offer methadone or Suboxone as well as safe supplies as part of harm reduction services.
“I see a lot more deaths in my circles,” Lisa said.
‘Disaster of epic proportions’
Guy Felicella, a peer clinical adviser at the BC Centre for Substance Use in Vancouver, blames increasingly toxic street drugs, usually laced with fentanyl or its analogues, for the increase in deadly overdoses. The direct relationships users had to get drugs from dealers were cut off in the pandemic.
“You add COVID into the mix, I mean it’s just a disaster of epic proportions,” Felicella said.
In pandemic prescribing, Felicella said a medical version of a drug is offered to users instead of the tainted street version. But that doesn’t address what most people who use substances are seeking in order not to feel sick from withdrawal, he added.
Dr. Jennifer Brasch leads addiction psychiatry at St. Joseph’s Healthcare in Hamilton, Ont. She’s heard from patients that it is harder to access their substance of choice during COVID-19.
“It’s very stressful to be socially isolated and fearful of catching COVID-19,” said Brasch, who also works at the Hamilton Clinic, a medical service provider. “When people are stressed and anxious, they may use more substances in order to cope.”
Health Canada has temporarily eased restrictions on some medications used for treatment of addictions. Brasch said some doctors are also prescribing slow-release morphine with methadone to protect patients from fentanyl in street supplies.