Accidental drug and alcohol-related deaths rising in Ontario, especially those involving multiple substances: report

The latest data shows over 25% of people admitted to hospital, and 1 in 7 who visited an ER, left before medically advised in week before death.

A new report from researchers at the Ontario Drug Policy Research Network and Public Health Ontario shows the number of accidental drug and alcohol toxicity-related deaths continued to rise dramatically from 2018 to 2022.

Ontario saw a significant rise in the number of accidental substance-related toxicity deaths across the province – increasing from an average of 4.5 substance-related deaths per day in 2018 to a total of eight deaths per day in 2022.

There were 12,115 accidental deaths from substance-related toxicities over the 5-year period, with the annual number of deaths increasing by 68 per cent from 2018 (N=1,660) to 2022 (N=2,796).

Deaths involving one substance increased by 75 per cent, deaths involving two substances increased by 167 per cent, while deaths involving three or more substances increased by an alarmingly high 186 per cent from 2018 to 2022.

Substance-related toxicity deaths involving three or more substances in 2022 also accounted for a total of 11 per cent of all deaths, further highlighting the evolving dynamics of toxicity deaths involving multiple unregulated drugs over time.

The most common combination of substances involved in toxicity deaths was opioids with stimulants – rising from 30 per cent in 2018 to 42 per cent of all substance-related toxicity deaths in 2022.

“The volatility of the illicit drug supply and increased exposure to multiple substances has led to unprecedented harm across the province” says senior author Dr. Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and ICES, and a principal investigator of the ODPRN. “With rising deaths involving stimulants, benzodiazepines and alcohol, there is a clear need for a comprehensive response to the drug toxicity crisis that extends beyond opioids alone and considers the dynamic nature of substance use and harms across the country.”

The report also found a high prevalence of concurrent mental health-related diagnoses and recent Hepatitis C diagnoses among people experiencing fatal substance-related toxicities, reinforcing the potential benefits of integrated-care models that support people with both substance use disorders and other health care needs.

Finally, almost one-third of people who died of a substance-related toxicity had a health care encounter in the week before death, and those with recent hospital visits had a high prevalence of leaving before medically advised.

This reveals the challenges and missed opportunities for the health-care system to engage with this vulnerable population with timely interventions and supports at critical junctures.

“People who use drugs are often highly reliant on our hospitals and emergency departments for their healthcare needs, but that system is not sufficiently prepared or resourced to meet those needs,” says Dr. Gomes. “With inconsistent and inadequate access to specialized addictions medicine services throughout our hospital system, people who use drugs often face stigma and sub-optimal care, leading them to leave hospital before receiving the care they are seeking.”

In 2022, over one-quarter of people admitted to hospital and one in seven people visiting an emergency department left before medically advised in the week before death.

This is the final report in a series dedicated to expanding the understanding of circumstances around substance-related toxicity deaths in Ontario. Overall, it finds that substance toxicity death rates continue to grow, particularly those involving multiple substances, and that these deaths continue despite high engagement with the healthcare system in the week before death.