Author: Samira Prasad

From CBC

Ontario Provincial Police sounded the alarm last week after four people in the Simcoe-Muskoka area died from suspected opioid overdoses in a span of four days.

The warning advised the public that a “highly potent and potentially fatal strain” of illicit opioid may be circulating in Simcoe County and the District Municipality of Muskoka. But experts in the region say the area has been hit hard by the opioid crisis, and four overdose deaths in a week isn’t uncommon. 

Data from the Simcoe-Muskoka health unit at the end of 2022 shows an average of 13 people in the region wind up in emergency rooms each week due to suspected overdoses.

Dr. Lisa Simon, associate medical officer of health for the Simcoe-Muskoka District Health Unit, says like other parts of the country, there has been an escalation in drug-related deaths over the last few years.

“Unfortunately, this is part of an ongoing trend we have seen for several years now of a dramatic loss of life and like these individuals, it’s often young adults,” she said.

Simon says the shift started with the introduction of fentanyl into the street drug supply in 2017, and the number of deaths continued to escalate into 2019.

“At that time, it was clearly unacceptably high levels when alarm bells were already ringing. But then the pandemic hit and the rate of opioid related harms and deaths got even higher,” she said.

Simon added 2021 saw the highest number of suspected overdose deaths on record in the region — 95 in the first six months.

The data recorded 66 confirmed and probable opioid-related deaths in Simcoe-Muskoka in the first six months of 2022. Those numbers are lower than the same period in 2021, but still substantially higher than before the pandemic.

Simon says over the last few months the region has recorded an average of three deaths per week due to drug related overdoses.

The Simcoe Muskoka Drug Strategy — a large partnership of agencies and organizations — continues to work to address opioid related harms in the region.

Drug supply ‘incredibly unpredictable,’ expert warns

Dr. Tara Gomes, the lead principal investigator of the Ontario Drug Policy Research Network housed at Toronto’s St. Michael’s Hospital, says the Simcoe-Muskoka data mirrors what’s happening across the country.

“When we look at what’s happening with the illicit drug supply, which is that it’s incredibly unpredictable, we often see clusters of overdoses that happen,” she said, adding when a more potent fentanyl analog enters the supply, a spate of deaths can happen in a matter of days or hours.

“It might be in a particular city or region because the supply that is there at any given time might be much more potent than people are used to and it can increase the likelihood of overdose,” Gomes explained.

From the Toronto Star

When Dan Shaffer turned up at the St. Michael’s Hospital emergency room, it wasn’t for a medical crisis. In his early 70s, Shaffer had been evicted from his apartment and had nowhere else to go.

ER staff tried to get him into a shelter, but couldn’t. Beds, citywide, were full. They brought him to a small, warmly lit room in a side hallway, with pullout couches and reclining chairs that serve as a stopgap when someone doesn’t have a medical reason to be admitted. Staff offer food and warm clothes and add a tick to a whiteboard every time they can’t find shelter beds.

Shaffer remembers the turmoil of that night. He’d never been homeless, and was at a loss for what came next. “I’ve never been in a situation where my life was taken out of control,” he said.

Hospital staff called the city’s shelter intake line over and over that night. By the next day, they found one room at a north Toronto shelter hotel. Over the ensuing year, as Shaffer feared the remainder of his life would be stuck in the shelter system, a new outreach team from the hospital’s emergency room worked with him to find long-term, stable housing.

This is the reality inside the hallways of St. Michael’s; while Toronto hospitals have struggled with broader pressures on the health care system, their ERs are also on the front lines of the city’s mounting homelessness crisis. Carolyn Snider, the emergency room chief at St. Michael’s, says more than 4,500 homeless Torontonians came through the doors of the downtown trauma centre in the last year, about 15 per cent of them simply because there were no alternative shelter options.

From the Toronto Star

Toronto Council’s decision this week not to open warming centres around-the-clock to provide shelter for the city’s most vulnerable residents was beyond disappointing. It was a disgrace.

Those who objected to making the centres accessible threw up a fog of excuses — cost, staffing — and in the face of real human suffering, offered the most weakest of actions, the promise of further study and a punt to other governments.

On Wednesday, council voted 15-11 against a board of health recommendation to open the centres 24 hours until April 15. Ostensibly oncerned about the lack of funds — remember that councillors ponied up almost $50 million more for the police — council instead supported a motion to ask the federal and provincial governments for more support. And it will investigate the “feasibility of providing 24/7 drop in spaces.”

Certainly, all levels of government need to step up. But a feasibility study? What doesn’t council know? Doesn’t it know that about 100 people are turned away from temporary shelters every day?

Doesn’t it know that freezing temperatures present serious health risks to unhoused people? Doesn’t it know that unsheltered people are currently seeking refuge in public libraries, at all-night restaurants and on the TTC, and that this is one of the reasons police officers are now patrolling public transit?

Mayor John Tory, who voted against the motion to keep the centres open, has long stressed that permanent supportive housing is a better solution than temporary shelters and warming centres. That’s true, but when it comes to permanent or temporary shelter, this isn’t an either/or proposition.

Although undeniably important, permanent housing won’t be built overnight, which means temporary lodging will still be necessary. And even if there were enough homes to go around, that wouldn’t solve the problem.

Many unhoused people have experienced serious trauma — trauma that led them to the street and trauma that keeps them on the street. And transitioning to permanent housing is, for many, a further stressful experience.

From CBC

During Canada’s unprecedented mpox outbreak last summer, Montreal physician Dr. Antoine Cloutier-Blais noticed a concerning trend: Patients co-infected with advanced HIV were reporting lesions across their bodies, and systemic mpox symptoms.

“It was difficult at that time to confirm that suspicion with the data we had,” he said.

Now, new research in the Lancet medical journal backs up Cloutier-Blais’ early concerns.

The paper, a case study on mpox in individuals with advanced HIV infection, details an aggressive and serious form of the illness formerly known as monkeypox — at times involving skin cell death within lesions, nodules in the lungs, sepsis, and a high rate of death.

This form of mpox appears to be a “very severe skin and mucosal infection with high rates of sepsis and very severe lung complications,” said study author Dr. Chloe Orkin, a professor of HIV/AIDS medicine at Queen Mary University of London, in an email to CBC News.

The researchers studied a cohort of nearly 400 patients from various countries, including Canada, who caught mpox while living with HIV and low CD4 cell counts. (CD4 cells are a type of white blood cell that help fight off infections by triggering the immune system to destroy viruses and other pathogens.)

Mortality was roughly 15 per cent in individuals with advanced HIV-related disease, the researchers wrote, while the death rate for people with the most severe immunosuppression doubled to around 30 per cent, Orkin noted.

The staggering findings matter in large part due to high rates of mpox among individuals living with HIV/AIDS, who account for an estimated 38 to 50 per cent of people diagnosed with mpox.

“I think it’s an important reminder of how we must not get too complacent even in the face of low case counts, because if the virus encounters a person susceptible to such severe manifestations like people living with advanced HIV, then it can be really devastating,” said Dr. Darrell Tan, a clinician-scientist at St. Michael’s Hospital in Toronto, whose team contributed data for the Lancet paper.

Calls for more access to mpox vaccines

The takeaways of her findings, Orkin said, are that health-care workers need to be trained on the high mortality rate associated with mpox and HIV-related immunosuppression. 

“Every person with mpox should have an HIV test and every person with HIV and mpox should be tested for immunosuppression,” Orkin continued, noting those with advanced HIV infection should also be monitored carefully, given the significantly higher risk of death. 

From the Toronto Star

This week on “It’s Political,” we take a look at what’s plaguing the country’s health-care system, from long wait lines in emergency rooms to the lack of family doctors. What will it take to fix health care in Canada?

First, we hear directly from health professionals about the problems they’ve witnessed firsthand and the solutions they’d like to see.

Then, host Althia Raj sits down with Canada’s Health Minister Jean-Yves Duclos to discuss the federal government’s new funding arrangement with the provinces, the minister’s expectations of what the money will buy, and his stance on the increasing presence of for-profit care.

Listen here and follow or subscribe at Apple Podcasts, Spotify, Amazon Music, Google Podcasts or wherever you listen to your favourite podcasts.

In this episode: Canada’s Health Minister Jean-Yves Duclos, Toronto Star health reporter Megan Ogilvie, former federal health minister Dr. Jane Philpott, a family doctor, dean of the Faculty of Health Sciences and director of the School of Medicine at Queen’s University, and CEO of the Southeastern Ontario Academic Medical Organization, Dr. Taylor Lougheed, a family, emergency, sport, and cannabinoid physician and chief of emergency medicine services at the North Bay Regional Hospital, longtime registered public health nurse Maureen Cava, who now works with the Safehaven Project for Community Living in Toronto, Dr. Katharine Smart, the past president of the Canadian Medical Association and a pediatrician who works in Whitehorse, Yukon, Dr. Alika LaFontaine, the president of the Canadian Medical Association and an anesthesiologist in Grande Prairie, Alberta, registered nurse Melanie Spence, who works in primary care in a community health centre in Toronto, Dr. Tara Kiran, a family doctor at St Michael’s Hospital, a scientist at the MAP Center for Urban Health Solutions, and the Fidani Chair in Improvement and Innovation at the University of Toronto. Hosted by Althia Raj.

Some of the clips this week were sourced from the CBC, Global, CTV and CPAC.

“It’s Political” is produced by Althia Raj and Michal Stein. Kevin Sexton mixed the program. Our theme music is by Isaac Joel.

From The Globe and Mail

The number of Ontarians without a family doctor rose significantly during the first two years of the pandemic, according to the most comprehensive analysis yet of how access to primary care is deteriorating in Canada’s most populous province.

More than 2.2 million Ontarians were without a regular physician as of March, 2022, up from nearly 1.8 million in March of 2020 – a 24-per-cent increase. That means 14.7 per cent of Ontarians now rely on walk-in clinics and emergency rooms for primary care or go without it altogether, up from just over 12 per cent before COVID struck.

Children, newcomers to Ontario, and patients who live in the poorest and most racialized neighbourhoods were most likely to see their access worsen, but people from all walks of life lost their family doctors during the two-year period, the data show.

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Another is that despite the worsening situation in Ontario, it still outperforms other provinces on access to primary care, according to a survey of just over 9,000 Canadians led by Tara Kiran, a family doctor and researcher at the University of Toronto whose findings jibe with those of Statistics Canada surveys.

“Ontario is, in many ways, doing the best compared to other provinces,” Dr. Kiran said. “I can only imagine what’s happening in other parts of the country.”

Compiling and comparing detailed national data on primary-care access and other key metrics is one of the goals of the federal health funding offer, which premiers accepted on Monday,despite it falling short of their demands.

Family doctor and University of Toronto researcher Rick Glazier, the other co-leader of Inspire, the network of family medicine researchers, said that although Mr. Trudeau named access to family health teams as a prioritylast week,neither the Prime Minister nor his provincial counterparts seem to grasp how dire the shortage of family doctors is about to become – especially in light of population aging and the federal government’s plan to admit nearly 1.5 million new permanent residents by 2025.

“I’m honestly not seeing the sense of urgency in expanding the interprofessional teams and building the environments that new graduates would want to work in,” Dr. Glazier said. “It’s not really as much about spending the money as changing the system.”

From U of T EPIC

Researchers from the University of Toronto and Nigerian Institute of Medical Research have received $3 million from the federal government to launch an international project that will help inform the clinical and public health response to local and global epidemic of mpox (formerly known as monkeypox).

The new funding from the Canadian Institutes of Health Research (CIHR) and International Development Research Centre builds on the collaborative projects and seed funding from the mpox rapid research response launched by the Emerging and Pandemic Infections Consortium (EPIC) earlier this year.

The Canada-Africa Mpox Partnership (CAMP) brings together 68 researchers with multidisciplinary expertise from Canada, Nigeria, the U.S. and U.K. It is co-led by Darrell Tan, an associate professor in the Temerty Faculty of Medicine and infectious disease physician at St. Michael’s Hospital, a site of Unity Health Toronto, and Rosemary Audu, director of research and head of the microbiology department at the Nigerian Institute of Medical Research. Tan is also the operational co-lead of EPIC’s mpox rapid response efforts.

“Our team is honoured to receive this funding to study this previously overlooked infectious disease, and is excited to launch this work,” said Tan.

“Mpox has caused tremendous suffering, stigma and other harms in Canada and worldwide, most notably among gay, bisexual and other men who have sex with men during the 2022 outbreak. The initial support from EPIC was instrumental in allowing us to launch our research within days of the epidemic arriving in Canada and was pivotal to our securing this large grant.”

The CAMP project focuses on three main topics across diverse epidemiological, geo-social, and health system contexts: mpox transmission, treatment and vaccines.

In the first sub-project, the Mpox Prospective Observational Cohort Study, CAMP researchers are working to understand transmission from multiple angles. This will include looking at how the virus is spread between humans, including those who are asymptomatic or presymptomatic, between humans and animals, and from contaminated surfaces. A key component of this work involves mathematical modelling to study how factors like differences in size and features of sexual and social networks, health care access and vaccines might shape the differences in outbreak dynamics across regions within each country, and differences in outbreaks between the two countries.

For the second sub-project, the team is conducting a randomized controlled trial to assess the safety and effectiveness of the smallpox drug tecovirimat as a treatment for mpox. Currently, no drugs have been directly tested and shown to be effective against mpox in humans. By using the same design and measuring the same outcomes as similar trials in other countries, this trial, which also received funding support from the Public Health Agency of Canada and CIHR Canadian HIV Trials Network, will contribute to global data on the efficacy of tecovirimat.

Similar to the lack of human efficacy data on mpox treatments, there is also a need for high quality data on the safety and effectiveness of the smallpox vaccine Imvamune that is currently being offered to individuals at high-risk to protect against mpox. The last sub-project focuses on evaluating the role of the Imvamune vaccine to prevent mpox infection in humans. The team is using observational data to determine the vaccine’s safety and effectiveness, including how the effectiveness changes based on the number and timing of doses, amount of time since vaccination and patient subgroup.

From The Catholic Register

As Canada’s largest city panics over a series of random stranger attacks, there is sudden media and political attention on Toronto’s exploding homeless population, especially the homeless who appear to be addicted or mentally ill.

“I have no doubt that these incidents have been taking place, but I think they are being over-reported,” Common Table volunteer Paul Pynchoski told The Catholic Register. “Certain aspects of them are repeated over and over again.”

The Common Table at Redeemer Anglican Church in downtown Toronto functions as a kind of community centre for Toronto’s homeless, providing meals, nursing, a book club, art and craft activities and a warm place to sit and talk.

Whether or not the attackers in nine headline-grabbing instances of stranger violence since Dec. 8 are homeless, or mentally ill, or addicted is mostly unknown. In one of the highest-profile cases, a homeless man, Ken Lee, was killed in an alleged swarming attack by eight teenaged girls between the ages of 13 and 16.

Media focus on the homeless, mentally ill and addicted has been everywhere.

“Are Toronto’s attacks linked to homelessness? Not necessarily,” Toronto Star columnist Bruce Arthur wrote in his Jan. 29 take on the situation. “But we know Toronto closed three of its 23 shelter hotels late in 2022 and plans to close five more in 2023; the pandemic increase in funding that accounts for 30 per cent of shelter beds has dried up.”

On Jan. 28, Toronto Sun columnist Warren Kinsella called Toronto “a scene out of Stanley Kubrick’s dystopian Clockwork Orange” and blamed the deinstitutionalization of the mentally ill.

“We have jettisoned the moral duty we owe those fellow citizens who desperately need psychiatric help. People who were protected, and helped, in psychiatric hospitals,” Kinsell wrote. “We’ve dropped them into the back alleys.”

A dangerous increase in the toxicity of street drugs gets the blame in a Jan. 27 Globe and Mail column by Gary Mason, headlined “Random acts of violence? Better get used to it.”

Toronto Mayor John Tory has dispatched 80 more police officers to patrol the transit system. He has called for a national conference on the issue and told CP24 Breakfast he’s “not timid” about drawing connections between mental health and violence in public places. 

Tory’s plan also adds security guards and “Community Safety Ambassadors” working in the TTC system who are directed to deal with the city’s homeless population.

The mayor is pushing to add $48.3 million to Toronto’s police budget to cover about 200 more officers and programs addressing youth violence. The actual link between mental illness, homelessness and violence may not be so straightforward, pointed out psychiatrist Jack Haggarty. People suffering psychosis are at times a risk to others, he said.

“But they actually die from other causes 15 years earlier than the average person, and they have a higher risk of actually being victimized by others,” Haggarty told The Catholic Register.

Their treatment at the hands of others, their vulnerability to physical ailments and the risk of suicide make the mentally ill on the street vulnerable. A media picture of the homeless as a threat to the rest of us bothers Pynchoski, who leads a book club for the homeless.

“I don’t think the media is intentionally doing this, but I think we’re being pushed toward, ‘Oh God, we have to get tough on crime,’” he said. “It’s not a response of ‘What are the needs that are not being met here?’ We want to deal with the symptoms but we never want to deal with the problem.”

Just before the drumbeat of violent incidents grabbed the spotlight, Toronto’s Catholic hospital system put out a note to the city about how they’re dealing with the problem of Toronto’s 8,000 to 10,000 homeless people.

“We are seeing an increasing number of people with cold-related injuries. Routinely, we care for people who are homeless and suffering direct complications of cold weather: hypothermia, frostbite, swelling and infections, and exacerbation of pre-existing conditions,” said the Jan. 17 note on the Unity Health website. “We also see patients who require medical assistance because of the strategies used to survive outside in unpredictable weather. These include injuries from sleeping in unsafe areas or overdoses from substance use. We are also seeing many unhoused patients coming into our emergency departments simply looking for a space to shelter.”

Hospitals can’t solve Toronto’s homelessness problem, said St. Michael’s Hospital research scientist Dr. Stephen Hwang, an internationally renowned expert on health and homelessness.

“There’s no sense in which the health care system, or hospitals, can solve homelessness,” he told The Catholic Register. 

“What we’re seeing is that the failures and gaps in our system are causing people to end up on the doorstep of our hospitals. Hospitals are simply the place of last resort for many people.”

Looking at a problem that has spread and deepened decade after decade since the 1980s, Hwang does not believe Toronto or Canada should just resign itself to the inevitability of tent cities, people in sleeping bags on city streets, open drug use on the subway and thousands in the shelter system with no way out.

“This is a problem that is definitely solvable. We didn’t get into this situation in months, or just 15 years,” said Hwang. “It’s been a problem that’s been building for a long time. It’s going to take us a while to turn this ship around, but it is possible to do so.”

Hwang’s prescription for a solution begins with an honest look at the problem. Even if many homeless people are obviously mentally ill or addicted or both, homelessness is not primarily a mental health issue, he said.

From Unity Health Toronto

Clinical trial led by University of Alberta and Unity Health Toronto paves way for approval

Federal regulators have approved the licensure of an all-in-one rapid device that allows Canadians to simultaneously be tested for HIV and syphilis. Canada is the first country to approve and implement a dual-target device in North America that can produce results in as little as 60 seconds.

The approval was made possible, in part, by the results of a two-year clinical trial led by researchers at the University of Alberta and St. Michael’s Hospital, a site of Unity Health Toronto. The results were included as part of the device manufacturer’s submission to Health Canada and were necessary for the regulators’ review and approval.

A recent report by the Public Health Agency of Canada showed spiking rates of syphilis in the country, primarily among young women. From 2017 to 2021, rates of syphilis among females increased by 729 per cent, compared with 96 per cent among males. Syphilis infection can increase the risk of HIV acquisition and transmission, and co-infection creates a high risk of neurological problems. Cases of congenital syphilis – which is present at birth – are at crisis levels for young mothers, particularly those from persons of First Nations ethnicity. Ninety-six cases of congenital syphilis were reported in 2021, compared with seven cases in 2017.

“We need urgent actions to mobilize testing, treatment and connections to care for syphilis and HIV that are culturally appropriate, and that can reach and meet people where they are. They won’t come to us because the health and public health system has failed them – we need to go to them,” says Dr. Sean B. Rourke, a scientist at MAP Centre for Urban Health Solutions, a world-leading research centre housed at St. Michael’s Hospital, and the Director of REACH Nexus, a national research group working on how to address access and treatment for HIV, Hepatitis C and other sexually transmitted and blood-borne infections.

Rourke spearheaded the cross-Canada clinical trial which evaluated and proved the accuracy of HIV-self tests. Health Canada approved the tests for use in November 2020 based on the results of the trial.

The Point of care Tests for Syphilis and HIV (PoSH) Study launched in August 2020 and analyzed two different test devices among over 1,500 participants in clinical settings in Edmonton and northern Alberta. The study found both devices to be 100 per cent accurate in identifying HIV infection, and more than 98 per cent accurate in detecting active syphilis. Both test kits provide a test result in under five minutes using a fingerstick blood specimen.

Among the study participants, 24 tested positive for HIV on both devices and were confirmed by a lab test – four of those were new diagnoses. Acting on the device’s instantaneous nature, connecting participants to care and early treatment was a key priority of the study. Of the 20 people previously diagnosed with HIV, nine were on antiretroviral therapy, and all 24 participants were linked or relinked to care. There were 202 cases of infectious syphilis and the majority (87.4 per cent) were treated immediately following point of care test positive results. An additional 32 of 34 (94.1 per cent) participants with infectious syphilis who did not receive treatment at the test visit were treated within a median of four days.

“These extremely rapid point of care tests for the diagnosis of syphilis and HIV are much needed and a game changer for Canada. We were able to save costs associated with an additional clinic visit, reducing the number of cases lost to follow up, and prevent ongoing disease transmission,” says Dr. Ameeta Singh, the study’s principal investigator and an infectious disease physician with the University of Alberta.

Health Canada is approving the INSTI® Multiplex HIV-1/2 Syphilis Antibody Test, which is manufactured by bioLytical Laboratories Inc. in British Columbia. To do the test, a health provider obtains a fingerstick blood specimen, places a single drop of blood with the materials provided in the kit, follows the simple procedure instructions provided in the package, and reads the result in as little as one minute. The health provider can then offer treatment or linkage to care based on the test result. In February 2023, a dual-target device that produces results in 15 minutes was approved in the United States.

The study was jointly funded by Canadian Institutes of Health Research (CIHR) Centre for REACH Nexus at MAP St. Michael’s Hospital, Canadian Foundation for AIDS Research (CANFAR), Indigenous Services Canada, Alberta Health and Alberta Health Services.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in more than 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the Hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

About Unity Health Toronto

Unity Health Toronto, comprised of Providence Healthcare, St. Joseph’s Health Centre and St. Michael’s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit www.unityhealth.to.

About the University of Alberta

The University of Alberta in Edmonton is one of the top teaching and research universities in Canada, with an international reputation for excellence across the humanities, sciences, creative arts, business, engineering and health sciences. The university and its people remain dedicated to the promise made in 1908 by founding president Henry Marshall Tory that knowledge shall be used for “uplifting the whole people.” www.ualberta.ca

From the Toronto Star article

More than three homeless Torontonians died every week last year, new public health data shows — a total of 187 lives lost while battling with housing precarity in Canada’s largest city.

Lives were taken by cancers and cardiovascular diseases, by pneumonia and accidents. More than anything, people died because of toxic drug supply — identified as the cause of 47 per cent of the deaths among the homeless population that were known to public health in 2022.

The new numbers underscore a grim reality — that, if you are homeless in Toronto, your life expectancy is decades less than the general population. For men, Toronto Public Health found the median age of deaths among people facing homelessness last year was 55 years of age, versus 79 years in the overall city population. For women, the median age of deaths amid housing precarity was just 42 years old, versus an overall life expectancy citywide of 84.

And at least three of the deaths last year were people age 19 or younger, the data shows. “The idea that people are dying without housing as teenagers, I think it speaks to structural failures, systemic failures,” said Greg Cook, an outreach worker with Sanctuary Toronto. “For someone to die a preventable death as a teenager I think is really, really unjust — it’s not just tragic.”

Overall, he sees the death toll as evidence of a crisis that has mounted for years, as Toronto’s homeless population has soared to more than 10,800 people. “Everybody should be able to have housing that they feel secure and safe in, and that’s obviously not the case,” he said.

The worst year for homeless deaths in recent memory was 2021, when Toronto set a despairing record of 223 deaths, or more than four a week. While last year had slightly fewer, the toll is still worse than it was in the recent past, with 144 deaths in 2020, 128 in 2019 and 94 in 2018.

With far more deaths owing to overdoses than any other single cause, Cook urged all levels of government to adopt more urgency on addressing the city’s toxic street drug supply. Toronto’s drug checking service, which measures the contents of illicit substances, has warned that almost all their recent samples of fentanyl are mixed with other highly potent opioids like carfentanil as well as benzodiazepine-related drugs.

Harm reduction advocate Zoe Dodd said current responses to Toronto’s drug toxicity have felt like “a patchwork,” and urged mandatory training on prevention and responses in homeless service settings. “It’s devastating, because death brings more death, and grief brings more grief.”