Opioid-related deaths in Ontario up among younger men during pandemic, report says

The worst day of Lee Farnell's life came just under two weeks ago.

On Oct. 28, her partner of five years, Steve Koehler, was found dead in his west-end Toronto apartment. She believes he died of a fentanyl-related overdose. 

Koehler's family contacted CBC Toronto after the publication of this story disputing the nature of Steve's death, saying in an email the cause was never confirmed. "Our brother was a very private person," they said in an email.

"He was a valued member of society."

Farnell says Koehler was addicted to crack cocaine, had been using drugs alone and had a naloxone kit in his apartment.

"I know Steve was dealing with this addiction. And it was something we were both coping with," she told CBC Toronto. "I don't think any of us could have fathomed how fast it happened. So having the kit really didn't do anything," she said. 

Though the cause of Koehler's death still hasn't been confirmed — the Koehler family does not have a coroner's report —  his story is one of hundreds in Ontario that show the devastating impact of drug use during the COVID-19 pandemic.

Finding the patterns in opioid-related deaths

A new report prepared by several groups, including the Ontario Drug Policy Research Network (ODPRN), and released on Tuesday, reveals the preliminary patterns in the province's rising tide of opioid-related deaths. 

In Ontario, the report says, 695 people died of confirmed or suspected opioid-related causes in the first three-and-a-half months of the pandemic, an increase of 38 per cent compared to the same period of time before the pandemic began. 

"If those numbers continue, we expect there will be about 2,200 opioid-related deaths across the province of Ontario this year, which is much higher than we've seen in any previous year," said Dr. Tara Gomes, an epidemiologist and chief investigator at the ODPRN.

Not only are deaths up — the demographics of who is dying is also shifting subtly. 

"They are occurring very frequently in younger age groups and predominantly young men," said Gomes. 

The proportion of opioid-related deaths among men went from 70 per cent pre-pandemic, to 78 per cent after.

As for what's driving the rise in deaths, the report notes several causes related to the COVID-19 lockdown, including more people using drugs alone due to physical distancing measures and an "increasingly toxic unregulated drug supply during the pandemic" — including more instances in which fentanyl and cocaine contributed directly to deaths.  

"With some of the border closures ... drug trafficking patterns might be changing and that can really influence the drug supply," said Gomes. 

Large and medium-sized urban areas hardest hit 

The three public health units with the greatest increases provincially are Toronto, Peel, and Hamilton.

But other areas outside of the GTHA are also seeing statistically significant rate increases, including Ottawa Public Health, North Bay Parry Sound District Health, and Wellington-Dufferin-Guelph Public Health. 

The specific neighbourhoods where deaths are taking place are also changing. 

"Importantly, during the pandemic, we observed a shift towards opioid-related deaths occurring more frequently within communities with higher concentrations of people who are recent immigrants and or racialized," said the report. 

Finally, the specific venues where overdoses occur have shifted. Though the majority still happen in private residences, since the pandemic, more have happened outdoors and at hotels, inn, and motels — potentially due to municipal supportive housing and quarantine programs. 

"If there aren't harm reduction services available within these hotels that are providing alternative housing, it can create quite a dangerous situation for people who use drugs," said Gomes. 

What comes next?

Farnell has spent the last two weeks mourning Koehler, and struggling to shake off what she describes as "appalling" behaviour by the authorities who arrived after he had died.

"They treated me like a criminal and a drug user," she said.

When asked what could improve the situation for people dealing with addiction, she didn't hesitate: "Safe supply and decriminalization. And more supports."

Her thoughts are in line with calls from groups like the Toronto Overdose Prevention Society, who advocate for more funding for harm reduction programs, expanded funding for safer opioid supply programs, and decriminalization of simple possession and use of all drugs. 

Similar solutions were also proposed by Toronto's Medical Officer of Health Eileen de Villa last week. 

When Premier Doug Ford was asked this month if he'd consider that kind of decriminalization, he was unequivocal: "absolutely not," he said.  

As for Gomes, she agrees harm reduction services are important, and also says keeping drug users safe should be part of any new COVID-19 measures or policies.