There are calls for Toronto to expand and improve services within its already strained shelter system to avert a deadly uptick in opioid overdoses, a situation that appears to be threatening the city this winter.
Toronto recorded 132 suspected opioid overdose deaths between April 1 and Sept. 30, nearly double the rate of deaths recorded in the prior two years.
Of those deaths, 18 took place within city-operated shelters, which has prompted calls for improvements to prevent more people from dying as the shelter system is expected to buckle in the coming months.
"It's scary," said Roxie Danielson, a downtown Toronto street nurse. "A lot more folks are dying."
Danielson said the pandemic has worsened the city's opioid crisis on multiple fronts. Harm reduction services and safe consumption sites have cut down their hours and capacity, she explained, while more people are experiencing homelessness and isolation as a result of economic disruption and other restrictions.
Those who have turned to shelters have received inadequate support, Danielson said, adding that people are too often "using alone in the washroom" rather than in a supervised environment with health-care workers present.
"It would be nice to get more health care and harm reduction services embedded within the shelter system," Danielson told CBC Toronto.
Supervised consumption sites are regulated by the provincial government. The city operates a safe consumption site at The Works, but similar services are not available in shelters.
Toronto has temporarily expanded its shelter system during the pandemic, adding nearly 2,300 additional beds. Many of them are in hotels and motels, which may be contributing to the rising overdose deaths.
In a statement, the city said those spaces "can be more isolating than traditional congregate settings. This can exacerbate addiction issues and lead to an increase in overdoses."
Shelters users 'don't just need a safe place to sleep'
The Toronto Board of Health on Monday adopted a number of new measures to combat the opioid crisis, including a call for "urgently expanding" the overdose prevention and harm reduction programs available in shelters.
The Board of Health Chair, Coun. Joe Cressy, said the number of opioid deaths in Toronto could "skyrocket" this winter without improvements to health services and additional funding.
He said an enhanced shelter system must be part of any strategy to prevent deadly overdoses.
"People in our shelter system don't just need a safe place to sleep," Cressy said. "They need wraparound health-care supports, and that's urgent now."
Cressy pointed to a $7.7-million investment the city has made to expand harm reduction services in shelters during the pandemic, but said the province must step in with additional funding and regulatory changes.
He accused the Ford government of an "ideological rejection of public-health advice" in its handling of the opioid crisis.
Toronto Medical Officer of Health Dr. Eileen de Villa has made similar recommendations for provincial changes. In a report this month, she said the province should convene an emergency overdose task force and expand supervised consumption services.
Ontario to invest $3.8B in mental health, addiction programs
In an email to CBC Toronto, Ontario's Ministry of Health did not indicate that it would consider the changes proposed by Toronto to bolster services within the city's shelter system.
"We know the impacts of the COVID-19 outbreak have been challenging for many people and families across Ontario, especially among those living with mental health and addictions challenges," wrote a ministry spokesperson.
The province instead highlighted its "Roadmap to Wellness" plan, a $3.8 billion, 10-year commitment to improve Ontario's mental health and addictions programs. The plan was introduced before the first wave of the pandemic.
The Ontario government said it would continue funding the 21 supervised consumption sites permitted to operate across the province.
Danielson, the street nurse, said solutions that would prevent further overdose deaths are clear and well-known, but she worries that government inaction will ultimately prevail.
"I'm doubtful on the political side that things will change," she said.