Item - 2020.HL17.2

The Board of Health:

1.  Urged the federal Minister of Health to:

a.  grant an exemption under the Controlled Drugs and Substances Act to permit the

possession of all drugs for personal use for all Canadians, at least for the duration of the

COVID-19 pandemic, and to immediately scale up prevention, harm reduction, and treatment services;

b.  approve funding for Toronto Public Health's proposed injectable opioid agonist therapy (iOAT) at The Works to support the addition of this treatment option to the spectrum of safer supply initiatives available in Toronto; and

c.  support evidence-based knowledge exchange and capacity-building responses that reduce the harms of benzodiazepines and opioids.

2.  Reiterated its request urging the federal Minister of Health to increase funding for a spectrum of safer supply initiatives, including enhanced and flexible injectable and oral hydromorphone programs.

3.  Urged the provincial Minister of Health to:

a.  convene a multi-sectoral opioid overdose task force comprised of public health officials, community-based service providers, people with lived and living experience of drug use, and family members;

b.  expand the criteria for naloxone distribution to allow any organization that has clients who use drugs to distribute naloxone;

c.  provide funding to pilot and evaluate virtual and/or telephone-based supervised consumption services to complement the current in-person service options;

d.  remove the current cap of 21 Consumption and Treatment Services permitted for Ontario and utilize the federal class exemption granted to provinces during the COVID-19 pandemic to increase the availability of these lifesaving services in a variety of settings;

e.  provide funding to treatment and harm reduction services to enable them to adapt their services to adhere to COVID-19 public health requirements;

f.  support the increased use of virtual care for substance use treatment services for the duration of the COVID-19 pandemic;

g.  dedicate funding for grief and trauma supports specifically for overdoses; and

h.  consult with harm reduction services, health care providers, first responders, treatment providers, police, and people with lived and living experience of drug use to develop responses to benzodiazepine and opioid-related issues.

4.  Reiterated its request urging the provincial Minister of Health to support the implementation of managed opioid/safer supply programs, including by adding the required formulation of hydromorphone (i.e., 50 milligrams/milliliters and 100 milligrams/milliliters hydromorphone) to the Ontario Drug Benefit Formulary to enable injectable hydromorphone programs to operate.

5.  Urged the Office of the Chief Coroner for Ontario to report on the role of COVID-19 as a possible contributing factor in opioid toxicity deaths.

6.  Urged the Toronto Central Local Health Integration Network to increase funding for comprehensive crisis services for people who use drugs in Toronto.

7.  Requested the Medical Officer of Health, in consultation with the Director, Office of Emergency Management, City of Toronto, to ensure that Overdose Prevention Sites and Community Health Centres in Toronto, which are not currently receiving support from the Province of Ontario, are provided with Personal Protective Equipment through the local Community Cluster Coordinator or other appropriate means.

The Manager, Toronto Drug Strategy Secretariat, gave a presentation on Toronto Overdose Action Plan: Status Report 2020.

The ongoing opioid poisoning crisis in Toronto and across Canada has intensified and been further compounded by the COVID-19 global pandemic. These dual public health crises are having significant impacts on people who use drugs in our community as well as their families, friends and loved ones. Services that people rely on, many of them lifesaving, have closed or significantly reduced their service hours and/or capacity. During the first four months of 2020, paramedics responded to 1,307 suspected opioid overdose calls, including 71 calls involving deaths. In April 2020, paramedics responded to the highest number of suspected opioid overdose deaths (25) since September 2017.

This staff report highlights actions taken to implement the Toronto Overdose Action Plan since the last status report in June 2019 and includes issues related to the COVID-19 pandemic. The report also recommends additional urgent actions that are needed to address the opioid poisoning crisis, especially in the context of the pandemic and the increasingly toxic unregulated drug supply. The need for a fundamental change toward a public health approach remains critical to improving the health outcomes of people who use drugs.

Toronto Public Health remains committed to working with our community and institutional partners to improve our collective overdose prevention and response efforts, and to improving the health and well-being of people who use drugs, which is even more of an imperative during this time of dual public health crises.