The rate of opioid deaths in the Sudbury and Manitoulin district decreased significantly in the first half of 2022 compared to the same period of 2021, but that rate is still three times that of the overall Ontario rate. Six of the seven health units at the top of the opioid poisoning death rate are all in Northern Ontario, with Public Health Sudbury and District (PHSD) taking the number two spot.
There is still an opioid crisis in Northern Ontario.
The rate of opioid deaths in Ontario decreased by more than 10 percent in the first two quarters of 2022 compared to the year before, according to data released by the Office of Chief Coroner of Ontario. In 2021, the mortality rate for opioid toxicity in Ontario was 19.7 per 100,000 population, more than double the rate in 2017. In 2022 (to end of June), the mortality rate decreased by 13 percent compared to 2021 (preliminary data) but remains 55 percent higher than the mortality rate in 2019, pre-pandemic.
For Sudbury and district, the rate of opioid deaths per 100,000 population was 67.6 for January to March 2022, an increase of 5.2 over the same period in 2021. The rate was 40.6 for April to June 2022, a decrease from 42.9 over the same period in 2021.
In comparison, the rate for Ontario from January to March 2022 was 17.4 and from April to June was 16.5.
Age groups 30 to 59 continue to be most impacted, accounting for 72 percent of deaths in Ontario in the second quarter of 2022. Deaths decreased by 13 percent for 20 to 29 year olds during the second quarter of 2022 but increased significantly (44 percent) in those 60 years and over.
Since the start of the pandemic, three out of four deaths have been among males. Fentanyl contributes to the majority of opioid toxicity deaths, at 85 percent. Stimulants are involved in three in five opioid toxicity deaths.
“This is a significant and ongoing problem resulting in so much tragic loss, particularly so in the North where the issue is even more pronounced,” Chief Coroner Dirk Huyer told The Expositor. “Any decline is a good thing, but while there has been some decline the number of deaths still far exceeds that seen in past years.”
The Office of the Chief Coroner/Ontario Forensic Pathology Service(OCC/OFPS) undertakes investigations into sudden and unexpected deaths as well as into those that potentially occur from any cause other than disease; for example, acute substance related toxicity, in Ontario. “Deaths from acute effects (toxicity) of substances are investigated by the OCC/OFPS,” Mr. Huyer said. “As part of the investigation we determine the circumstances of the individual tragic death and during the investigative process we collect data/information in a consistent manner across the province. We regularly analyze the aggregate data from all substance related mortality deaths and share this publicly and in response to requests. As our expertise is death investigation and we do not have expertise or skill set in intervention or treatment, we do not determine what should be developed in response to the data but we share the data to inform those who are best positioned to inform intervention, response and/or prevention.”
Mr. Huyer visited Manitoulin last week to share data specific to First Nations on the Island with community leaders and service providers. The coroner’s report provides data that can be analysed within the structure of your own community, said Aundeck Omni Kaning Chief Patsy Corbiere. “It gives you a picture of your community. How many people died? What did they die from? How many males versus females? We’ll sit down and analyze the data and see how can we apply the data so we fix the problem?”
It’s a very complex problem, said Sherry Price, manager of mental health and addictions, Health Promotions Division with PHSD. “Certainly one part of the problem is the toxicity of the drugs,” she said. “We may be looking at a different supply than is in Southern Ontario.”
People in the North are generally less healthy than people in the south. People in Northern Ontario may be using drugs differently than people do in the south. There is a higher percentage of Indigenous people in Northern Ontario and the ongoing trauma of colonialism has been known to lead to increased use of substances, Ms. Price said.
“It’s not just colonialism,” she added. “Anybody can experience trauma. We know that living in the North we have lower income, we have a lot of homelessness, we have food insecurity, we have lack of resources and that’s not just in healthcare, it’s also in things like early childhood development. Those types of issues all can lead to drug use. It’s not just lack of services. There are so many factors that play into this and I’m not really certain that we fully understand yet why they’re so much higher than the rest of the province.”
We don’t need numbers to know there’s a problem but certainly the numbers alert us and indicate the trends, which continue to be upwards. The pandemic has made the situation worse. “It’s created inflation. It’s created trauma. It’s created homelessness for some,” said Ms. Price. “We’re hoping as we inch out of the pandemic things will improve slightly. We’re working towards solutions.”
PHSD has distributed over 700 Naloxone kits on Manitoulin so far this year. The actual number is likely higher, as some PHSD partners distribute kits that are not counted in PHSD tallies. “Naloxone temporarily reverses an overdose and Naloxone saves lives. We’re working with partners and we’re constantly revisiting who we’re partnering with on the Island and other areas to make sure that Naloxone is available to everyone. That’s helpful,” Ms. Price said.
Through its Community Drug Strategy, PHSD is looking to partner with organizations on the Island to see where they can offer support. “We can’t do this alone,” she said. “What can we do? We know that the problem is a toxicity of the drug supply so what can we do to mitigate that? That’s what we’re working towards.”
A big part of the problem is stigma. People who use substances are stigmatized. Ms. Price wants people to be able to reach out. “We want people to get help when they need help. We don’t want someone to die alone. People who die from overdose, from our toxic drug supply, often die alone because they’re stigmatized, because they’re afraid of what people think. That is not a helpful response.”
We need to destigmatize drug use so that people are willing to use in the presence of others, she said. That way, their lives can be saved with Naloxone in the case of a toxic response.
“Every life lost is a life of someone who had friends and family and coworkers,” said Ms. Price. “I don’t like to get lost in numbers. What I like to do is think about each of these people as individuals. What could we have done differently to support them through their lives? That’s where we’re going to start to make a difference. Yes, we have to work on the toxic drug supply, but what we really need to do and what we can do today is destigmatize drug use, let people know that they’re valued and cared for. That’s going to make the difference.”