Pubdate: Fri, 04 Aug 2017
Source: Toronto Star (CN ON)
Copyright: 2017 The Toronto Star
Page: A12


Last weekend was a particularly dangerous one for opioid users in
Toronto. It was so perilous, in fact, that Toronto police put out a
safety alert after the city saw four drug-related deaths and 20
overdoses in just two days.

Authorities believe the deaths and overdoses were from heroin laced
with fentanyl, an opioid that is 50 times stronger than heroin.

Sadly, things did not get better from there. On Tuesday the bodies of
two teenage girls were found in an Etobicoke condominium. Police
suspect they, too, died of overdoses.

In fact, from July 26 to July 31 alone, there were 79 visits to
Toronto emergency departments for suspected overdoses.

The only good news from this frightening toll is that it spurred Mayor
John Tory to meet with senior police, fire and paramedic officers and
Toronto's chief medical officer of health to identify ways to stem the
tide of overdoses.

The bad news is that they did not come up with a bold enough plan to
fight the crisis, despite the fact that Councillor Joe Cressy, head of
the city's drug prevention strategy, pointed out that "every day lost
is a potential life lost."

This is a fast-moving crisis and it's clear from trends in British
Columbia, where opioid use is even more pronounced, that it is almost
certain to get worse. The city must move much more quickly and nimbly
to prevent the rising tide of overdoses in Toronto and do better than
the tepid plan it came up with on Thursday.

For example, in a tragic twist, two of the four weekend overdose
victims died within steps of the Queen West Central Toronto Community
Health Centre at Queen St. West and Bathurst St.

That's one of three city locations that received federal approval to
offer supervised injection services aimed at preventing overdose
deaths. But according to Toronto Public Health, none of the three are
slated to open before late this fall.

One of the obvious recommendations, then, from Thursday's meeting was
to speed up the opening of the three supervised injection sites at
Queen West, South Riverdale Community Health Centre and the needle
exchange at Yonge and Dundas Sts.

A better idea comes from harm reduction workers at the sites who argue
that while the centres are being renovated for supervised injection
services, temporary or mobile sites should be opened now.

Pop-up clinics like that would be in line with how the city responds
to a flu outbreak. So why, workers sensibly ask, not respond the same
way to an overdose crisis?

The idea is not new. More than 20 temporary supervised injection sites
were opened in Vancouver, Victoria and across British Columbia in the
last year. Meanwhile, a mobile medical unit was deployed in
Vancouver's Downtown East Side with life-saving naloxone and trained
staff to contain the crisis there.

Another recommendation from Thursday's meeting was a simple request
for police to consider carrying naloxone, an antidote to opioid
overdoses, as police in Vancouver do.

And why not? Toronto paramedics already carry naloxone, and
firefighters will do that by the fall. Even front-line TTC workers
have access to it. But the Toronto Police Service is refusing to equip
its officers with the life-saving drug, saying only that "paramedics
are the best way to protect people in overdose situations."

Dr. David Juurlink, head of clinical pharmacology and toxicology at
the University of Toronto, strongly disagrees. "All first-responders
should have it on them," he argues. In light of all this, Toronto
police should reconsider their decision. Another weak idea proposed on
Thursday was to try to get better overdose information by tracking
when paramedics used naloxone.

A better proposal would be to monitor overdoses in real time, as B.C.
does, city by city. Then Toronto would have a more accurate idea of
what is headed this way.

And if what has happened in British Columbia is any indication, it is
a tsunami of deaths. In 2016 the overdose crisis was responsible for
922 deaths, with some addicts actually overdosing multiple times a

Unbelievably, the most recent data available for Toronto dates from
2015. That year there were 730 opioid-related deaths in Ontario, or
roughly two a day, 137 of which were in Toronto. That number has risen
steadily since 2012, when there were 585 deaths in Ontario, 85 of them
in Toronto. But what are this city's year-to-date figures, never mind
last year's? No one knows.

The country, never mind this city, needs up-to-date data of the kind
collected in British Columbia if it is going to fight this crisis with
the urgency and effectiveness it requires. Toronto should be compiling
it, not relying on paramedics to simply share naloxone

There are further lessons that Toronto can learn from other cities to
save lives.

One is to take supervised injection sites to drug users. Montreal
already has Canada's first mobile supervised injection service up and

Another is to target resources to specific drug users. Vancouver has
opened up a safe injection site that serves only women who won't use
sites frequented by men.

Vancouver is also providing in-home addiction treatment for opioid
users and has increased the number of emergency beds at the city's
detox facility.

Toronto would do well to follow suit.

Last weekend was an eye-opener on how Toronto needs to deal quickly
and effectively with its drug overdose crisis. It's not enough to wait
until supervised sites are opened this fall. Real action is needed
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MAP posted-by: Matt