Amid a surge in fatal overdoses in northern Ontario, front-line workers, physicians and addiction experts are calling for solutions.
In a statement to CBC News, Public Health Sudbury and Districts said eight people died after overdosing last month.
While the number of calls to paramedics for suspected overdoses has dropped closer to normal levels since late April, the number of overdoses and their severity have not. The exact cause of the increase is unclear, according to the health unit.
In the North Bay-Parry Sound district, 42 people overdosed in April and four people died, according local public health unit.
“This is the highest number of opioid-related overdoses reported to the health unit since the launch of their surveillance program in 2019,” said the North Bay Parry Sound District Health Unit in a Tuesday morning news release.
A drug alert issued in early April remains in place, with a similar alert also active in Sudbury.
Sudbury has seen a “drastic increase” in overdoses and overdoses resulting in death over the past two months, according to Evie Ali, executive director of the Go-Give Project.
The Go-Give Project, which operates the Energy Court encampment warming centre, is transitioning the site into a 12-hour daily cooling centre (down from a 24-hour a day warming centre) following a recent contract extension with the city.
“There have been an unprecedented number of deaths,” Ali said, adding that the increase in deaths is widespread and not limited to a single location in the city.
“These numbers don’t reflect just incidents that have happened at the Energy Court site, as a lot of people would presume or suspect. These numbers include individuals across our community. And sometimes the deaths that are also reported are individuals who are newly housed, but still accessing services.”
She said the rise in deaths is being felt widely across the community.
“Now we have families, loved ones, mothers, sisters, brothers, fathers that are grieving the loss of their child and siblings.”
At Health Sciences North, Dr. Dominique Ansell, chief of emergency medicine, said staff are seeing multiple overdoses each shift.
Ansell said treatment has become more complex as the illicit drug supply becomes more unpredictable — a supply often mixed with multiple substances.
“Naloxone will help if it’s an opioid overdose. but if it’s mixed, which it often is, it may not help with some of the other symptoms that will cause the overdose. So then we’re trying to do a little bit of detective work to be able to help these patients stabilize.”
More community-based supports — including addiction treatment, housing and outreach services — could help reduce the number of people ending up in the emergency department, Ansell argued.
In Greater Sudbury, 14 people are currently on a waitlist to access treatment centres with the Go-Give Project, according to Ali. She said treatment centres in Elliot Lake, North Bay, Timmins, Blind River and French River are all at capacity.
“A lot of these centres, much like we’re trying to do, are taking individuals from various communities as well because people are so desperate.”
Ali said she believes the province needs to declare a state of emergency over the opioid crisis in order to unlock additional funding to help treatment centres and other supports increase their capacity.
In an email to CBC News, a spokesperson for Ontario’s health minister pointed to a $560-million investment to build 29 Homeless and Addictions Recovery Treatment (HART) Hubs across Ontario that replaced “the failed approach of drug injection sites.”
“Instead of giving people tools to use harmful, illegal drugs, our government is helping people break the tragic cycle of drug addiction by making record investments in more mental health and wrap-around supports,” said Ema Popovic.
Det. Staff Sgt. Darin Heffern of the Greater Sudbury Police Service’s the integrated crime section said the service approaches the drug crisis from two directions: enforcement targeting supply and community policing focused on demand.
“We take enforcement action against drug traffickers. The police service as a whole, though, addresses the drug issue more holistically.”
There are units within the police that work on building partnerships with outreach organizations, and officers on foot patrol provide referrals to individuals to access support services, he said.
However, drug alerts or overdose spikes do not substantially change day-to-day policing priorities, he explained.
“For us, the opioid crisis is always at the forefront for us,” Heffern said. “The way we do business, we consider it high priority at all times.”
Still, he describes the work as an “uphill battle.”
Traffickers are often transient and adapt quickly to police techniques, he said adding that drugs change hands multiple times before reaching users, making it difficult to trace their origin.
“Where it’s being made or how it’s being produced, we may not be able to source because the drugs themselves change hands kind of in a hierarchy till they get to the street level. Often it’s difficult for us to track that back to the source.”
Heffern added that traffickers have become increasingly adaptive, adjusting how drugs are distributed in response to police techniques and investigations.
“As we change our investigative techniques, the people that go to court, they get disclosure of, what we did and they learn from it and then they change the way they do business to avoid detection.”
Heffern said police rely heavily on information from the community, and that periods of increased overdoses can sometimes lead to more tips from people concerned about dangerous drugs circulating.
Dr. David Marsh is vice-president of research and graduate studies at NOSM University and research chair in mental health and addiction at the Health Sciences North Research Institute.
Marsh said reducing deaths will require a layered approach that goes beyond treatment alone.
He pointed to opioid agonist treatments such as methadone and buprenorphine, which reduce cravings and prevent withdrawal symptoms without creating the high effect.
“Our own research has shown that while people are taking those medications, their risk of dying from any cause goes down by more than half, and the risk of an overdose death goes down by 80 per cent.”
But he said access to those kinds of medications is limited, meaning additional measures are needed to prevent deaths among people who are still using drugs.
“Supervised consumption sites, for example, have been shown to be very effective in reducing overdose deaths.”
Northern Ontario continues to see high overdose death rates compared to other regions, according to Marsh.
“If we look back 10 or 15 years ago, physicians in northern Ontario were prescribing more opioids per capita than physicians and other parts of Ontario,” he said.
“Historically, we also have a heavy reliance on resource industries, and data has shown that people in construction and other resource industries are at a higher risk of developing opiate use disorder, likely because they’re at higher risk of developing musculoskeletal injuries or chronic pain.”
Geography also presents a major barrier since addiction treatment, support and resources are spread out over such a broad area, Marsh said.
Beyond treatment and supervised consumption, Marsh said, supervised injectable opioid treatment — where pharmaceutical-grade medications are provided in a clinical setting — could also reduce deaths since the toxicity of the street supply is a major driver of fatalities.
“In the samples that were sold as fentanyl, only 30 per cent had fentanyl and nothing else in them,” he said, referencing testing from supervised consumption sites in Ottawa.
He said another factor pushing people further into addiction is stigma.
“The public has the perception that problems with drug use are problems amongst people who are homeless… that is completely false.
“It gets layered into layers of stigma that paints drug users as if they’re not human, as if they’re not somebody’s daughter or somebody’s son.”
