Item - 2017.HL21.12

The Board of Health recommends that:

1.  City Council appoint or designate the Medical Officer of Health as Overdose Coordinator with the authority to direct and coordinate the City’s response across divisions and agencies.

The Board of Health also:

1.  Requested the Premier of Ontario to immediately declare an emergency under the Emergency Management and Civil Protection Act in response to the marked increase in opioid overdoses and related deaths throughout Ontario.

2.  Requested the Medical Officer of Health to implement an ongoing evidence-based overdose public education campaign across the city to include exploring the potential to use City of Toronto advertising space (e.g. TTC stations and vehicles) and broad distribution of resources, including to pharmacies, physician offices and hospital emergency departments.  
 

3.  Requested the Minister of Health and Long-Term Care to expand the distribution of naloxone to community service providers to include in their first aid kits.
 

4.  Requested the Minister of Health and Long-Term Care to ensure both intramuscular and intranasal formulations of naloxone are available through the community naloxone programs to ensure people have access to the formulation that best meets their needs.

 
5.  Requested the Minister of Health and Long-Term Care to target the new funding for harm reduction services, announced in August 2017, to peer outreach services and expanding the capacity of harm reduction service delivery across the city. 
 

6.  Requested the Minister of Health and Long-Term Care, as part of their recent announcement of new funding for treatment, to ensure funds are allocated to residential withdrawal management and other residential and outpatient treatment services.
 

7.  Requested the Minister of Health and Long-Term Care to immediately address barriers to collecting and reporting “real-time” overdose data, including more accurate emergency department visit data, as part of its commitment to improve monitoring to support early warning activities. 

 
8.  Requested the Minister of Community Safety and Correctional Services to appropriately resource and mandate the Office of the Chief Coroner for Ontario to provide monthly reports on opioid overdose deaths.

9.  Requested the Medical Officer of Health to explore the need for additional supervised injection service sites in Toronto, with consideration given to the growth in the overdose crisis in the city, diversity of program models, and potential organizational capacity and support to deliver these services.

10.  Requested the Medical Officer of Health to explore and consider supervised inhalation services, including a jurisdictional scan and literature review.

11.  Requested the Medical Officer of Health to work with the Out of the Cold network to scale up our overdose response for the 2017/2018 season.

 The Board of Health considered items HL21.1, HL21.12 and HL21.13 together.

The Toronto Drug Strategy Implementation Panel met on August 10, 2017 to discuss the state of the overdose emergency in Toronto and additional measures that must be taken, especially in the short-term. While we do not have “real-time” information about overdoses, we know from community service providers, including people who use drugs, that many more overdoses are happening and too many people are dying as a result. In the first week of August alone there were four officially reported overdose deaths in Toronto although community estimates are higher.

Some additional action has been taken since the Panel meeting. On August 12, 2017, volunteers in the community opened an Overdose Prevention Site in Moss Park in response to rising overdoses in that neighbourhood. On August 21, 2017, Toronto Public Health opened an interim supervised injection service (SIS) that will operate until the permanent facility opens in early fall. The other two community health centre SISs are also working to open their services as soon as possible. Toronto Public Health has also begun to implement the expanded naloxone program that will enable distribution of naloxone to people who use drugs through more services, including shelters, treatment, and others.  

On August 28, 2017, over 700 concerned individuals and organizations across Ontario submitted an open letter to the Premier asking her to "immediately declare an emergency under the Emergency Management and Civil Protection Act in response to the marked increase in opioid overdoses and related deaths throughout Ontario."

On August 29, 2017, the Minister of Health and Long-Term Care announced additional funding for initiatives to prevent and respond to overdose across Ontario. The new announcements included increased funding for harm reduction services, boosting the capacity of withdrawal management and treatment services (including youth treatment), making nasal naloxone more widely available (including out of hospital emergency departments), and improvements to data collection and monitoring. Details about this funding are still pending, including any new resources for Toronto.

The Board of Health (BOH) approved, Toronto Overdose Action Plan, contains many measures that will help address the overdose crisis but they are not being implemented fast enough to address the current situation. We need action now to save lives.

In his role as Chair of the Toronto Drug Strategy Implementation Panel (the Panel), Councillor Cressy submitted nine motions to the Board of Health (BOH) for consideration at its September 25, 2017 meeting. The motions represent measures the Panel members feel are urgently needed to address the overdose crisis in Toronto.

Overall, Toronto Public Health (TPH) is supportive of the recommendations made by the Panel. This staff report provides some additional information related to three of the recommendations.