Opioid deaths, ER visits down in 2023, but London still in throes of deadly crisis: health officials

Figures going before the Middlesex-London Health Unit's board of health this week show local opioid-related emergency department visits and deaths fell for a second straight year in 2023, with early data appearing to show the trend continue into early 2024.

Local frontline agencies and health officials, however, warn the region remains in a deadly opioid crisis, with overdose deaths and hospitalization rates still surpassing the provincial average when adjusted for population.

"It's certainly good to see the trend going downwards, but we're still feeling like we're in the midst of crisis," said Scott Courtice, executive director of London InterCommunity Health Centre.

"We still lost more than 100 people [in 2023]. We know those folks, each one of those deaths impacts the community."

The agency provides health and social services to Londoners experiencing homelessness and poverty, and operates Canada's longest-running safer opioid supply program, which helps around 220 people at present. 

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According to the report, being tabled at Thursday's board of health meeting, opioid-related hospitalizations fell 16 per cent from 2022, while deaths fell 18 per cent. 

There were still more than 650 hospitalizations and over 100 deaths, and local rates are still higher than Ontario's when adjusted by population, the report underscores.

"The burden of illness associated with the opioid crisis remains significant in Middlesex-London, requiring an ongoing comprehensive community approach along the four pillars of prevention, treatment, harm reduction and enforcement," the report says. 

Preliminary numbers from Public Health Ontario, subject to change, show fewer hospitalizations in the first two quarters of 2024, while early death figures show a slight uptick in the second quarter.

The region declared an opioid crisis in 2017 amid a surge in overdoses, driven largely by a toxic street supply of fentanyl, say harm reduction experts. Deaths and hospitalizations spiked during the COVID-19 pandemic, peaking in 2021.

While the declines since are encouraging, rates are still well above where the region was a decade ago, said Dr. Alex Summers, medical officer of health for London and Middlesex.

"This trend is being seen in other parts of North America, and some of the early suggestions ... is related to an improvement in the toxicity of the drug supply," Summers said.

"Whatever is causing the decline, we're glad to see it. But we need to highlight the burden is still high."

Summers said it wasn't entirely clear why the region's numbers fell more compared to similarly-sized health units and the province overall.

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Martin McIntosh, executive director of Regional HIV/AIDS Connection, said the findings mark a "good time to reflect and understand the narrative that pits harm reduction against treatment."

Harm reduction, he said, remains part of a "continuum of supports that are needed and crucial to continuing to see positive trends in this direction."

McIntosh's agency operates London's Carepoint Consumption and Treatment Service. Also known as supervised consumption, it allows people to take and test their own drugs under supervision to reduce the risk of an overdose and directs them to additional supports.

Harm reduction strategies like it and safer opioid supply have taken heat from the provincial and federal conservatives, who claim they have helped fuel the crisis.

Carepoint played a "significant role" in reducing deaths and hospitalizations, McIntosh said, arguing it's crucial that it continue to do so alongside prevention, enforcement and treatment, a position echoed by Courtice and Summers.

The facility recorded more than 16,000 visits, prevented 173 deaths and made more than 16,000 referrals in 2023, according to its own numbers. Earlier this year, testing at the facility revealed a sedative and animal tranquilizer in the street fentanyl supply, prompting community alerts.

Ultimately, however, housing remains key to solving the crisis, they said.

"People's use of drugs changes when they become housed," said Courtice. "Housing is, and will always be, the fundamental thing that will help us turn the tide."

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On Monday, the province tabled legislation to close 10 supervised consumption sites in Ontario and replace them with homelessness and addiction recovery treatment hubs. No new sites will be allowed, Health Minister Sylvia Jones says. 

London's Carepoint site will remain open.

The bill will also require municipalities to get provincial approval to participate in the federal safer supply program.

Federal Conservative Leader Pierre Poilievre has likened supervised consumption sites to "drug dens" and has pledged to divert federal funding for them, and safer supply, to recovery and treatment.