Opioid deaths in Ontario rose dramatically in pandemic's first 2 years compared to 2019, early data shows

Opioids killed more people in Ontario in the second year of the pandemic compared to the first, and there was a dramatic jump in deaths both years compared to pre-pandemic, according to newly released data.

The preliminary figures from Ontario's Office of the Chief Coroner also indicate a drop in opioid deaths in the province in March 2022.

About eight people per day died from opioids in the second year of the pandemic. From April 2021 to March 2022, 2,795 opioid-related deaths were recorded, up slightly from 2,727 in the first year of the pandemic, the coroner's office reports.

Those were both large leaps from 2019, when opioids killed 1,559 Ontarians — about four people per day.

"It's ongoing and it's bad, and it got heck of a lot worse during the pandemic," Dr. Dirk Huyer, Ontario's chief coroner, said in an interview.

But the data also indicates the death rate dropped by 10 per cent in the first quarter of 2022 compared to the same period last year.

The data is considered preliminary because it includes both confirmed and probable opioid-related deaths, and is subject to change, Huyer said.

"Should we be celebrating the fact that we've gone down 10 per cent?" Huyer said. "No. We still have a lot of people dying, but, yes, we're not continuing to go up, so that is good."

The number of overall deaths dropped by 31 per cent in March 2022 compared to March 2021. Ontario lifted most COVID-19 restrictions that month, although Huyer said that at this point, that is simply a correlation, not necessarily the cause for the drop.

Overall, the mortality rate for opioid toxicity in 2021 was 19.5 deaths per 100,000 people — more than double the rate of 9.1 deaths per 100,000 people in 2017.

The data suggests to Huyer that the leap in opioid deaths during the pandemic was due to more people using drugs on their own due to fewer services being available in their communities.

"That community is now opening back up, so there's some support from a safety perspective, but also support for mental well-being and, in general, things being better overall," Huyer said.

He also said border closures may have had an effect on the drug supply.

Northern Ontario remains hardest hit in the province, and the problem is getting worse, with more than double the mortality rate in the region.

"Thunder Bay, Sudbury, Algoma, just significant increases," Huyer said.

Thunder Bay District Health Unit had an opioid death rate of 82.1 per 100,000 people in the first quarter — the highest rate in the province and more than four times the provincial rate.

Public Health Sudbury and Districts was next highest, with an opioid death rate of 52.9 per 100,000, while Algoma Public Health — in and around Sault Ste. Marie, Ont. — was third with a death rate of 52 per 100,000.

Men continue to die from opioids at a disproportionate rate, accounting for three out of four deaths in Ontario, the coroner's report says. Men aged 25 to 44 accounted for 54 per cent of deaths in the first quarter of 2022.

Fentanyl remains the most common substance found in those who died from opioids, the data indicates. Fentanyl was involved in 88 per cent of deaths in 2021, up from 86 per cent the year before, which itself was a big jump from 53 per cent in all opioid deaths in 2019.

Tara Gomes, an epidemiologist at Unity Health in Toronto who studies opioid use, is cautious about the recent dip in deaths, reported in March, saying the data remains preliminary.

 "It's so hard to know for certain right now, but it's better than the alternative, which is what we keep seeing during the
pandemic," she said.

"But it's important to remember that eight deaths a day compared to four deaths a day before the pandemic is just such a big change."

Her work has focused on the disparities between cities and rural areas as well as the challenges in northern parts of the province.

"I think that a lot of the harm reduction services that we have are really designed to work well in an urban setting, but in larger areas or rural areas, it's a lot more difficult to plan and manage," she said.

Gomes said the province and the federal government need to relax rules on proven opioid treatments like suboxone and methadone, and vastly expand harm reduction and safe spaces to use drugs, as well as a safe supply of drugs.

Her research has found opioids are disproportionately killing the homeless population and the unemployed during the pandemic. It has also greatly affected construction workers, her research shows.

"We still haven't solved this."