Opioid crisis in Oshawa and Durham needs action with no ‘one-size-fits-all’ solution available

There is no ‘one-size fits all’ solution to the opioid crisis plaguing Oshawa and other Ontario cities but using “evidence-based strategies” to develop a local opioid response plan with an early warning and surveillance system and getting life-saving naloxone in the hands of more support groups is the next step in getting addicts the help they need.

“Substance use is complex,” said a spokesperson with Durham Region’s Health department, adding there is no single method for preventing or reducing its harms. “Substance use exists across a spectrum with varying stages of benefits and harms. Substance use is different from one person to another, and a person’s pattern of use can change over time.”

The stark numbers were at their worst in the middle of the pandemic in 2021, with support services in Durham stretched to the limit and a humanitarian crisis on the streets with those suffering from addictions facing decreased access to services, lockdown measures and social distancing – which increased the likelihood of engaging in drug use alone – as well as the “negative impact” the pandemic may have had on an individual’s mental health.

“This is also something that’s been seen in other health unit jurisdictions across the province,” the department said.

There were nearly a thousand suspected opioid overdose paramedic service calls in Durham that year, with 878 opioid poisoning emergency department visits and 128 opioid toxicity deaths.

The peak happened in September, with 129 overdose calls, 97 suspected emergency room visits and a dozen deaths. Nearly three-quarters of those numbers happened in Oshawa, the epicentre of the crisis in Durham with most of the shelters and services located in the region’s biggest city.

The month prior was actually the worst in Oshawa, with 95 overdose calls and 69 emergency room visits.

Oshawa Councillor Derek Giberson, who is the former Director of the downtown Back Door Mission, cautioned that while having the support services in the city does have a bearing on the numbers, economic factors play a far bigger role.

“The existence of services isn’t the primary predicate for overdoses, although that narrative has certainly taken hold in some circles in recent years,” he explained. “The primary correlation is found in the socio-economic profiles of the neighbourhoods. We know that areas with factors like lower incomes, higher rates of single-parent households, housing poverty, and other distresses in public health data will also have higher overdose rates, among other concurrent challenges.”

The Region agreed, noting that the opioid crisis is a complex public health issue and is the result of “multiple complicated factors” including:

• A misunderstanding of the addictive risk of prescription opioids.
• Psychological, social and biological risk factors such as genetics, mental health, early life experiences, trauma, poverty, lack of secure housing and other social determinants of health.
• Stigma towards substance use disorders.
• Frequent opioid prescribing and high amounts being prescribed for pain relief.
• Lack of awareness or access to alternative treatments for pain.
• Use of prescription opioids by individuals to whom they are not prescribed, such as friends and family members.
• Lack of access to prescription opioids leading to illicit opioid use.
• Illegal drugs that are laced with fentanyl and its analogues.
• A lack of comprehensive care to respond to all the mental and physical health needs of an individual

“The opioid crisis can impact anyone,” the health department spokesperson noted, citing a statement from the Canadian Mental Health Association which declared addiction “disproportionately impacts individuals living in low-income situations, individuals who are unemployed, people with disabilities, and Indigenous communities contending with systemic racism, trauma, and intergenerational trauma.”

Since the worst of times in the fall of 2021 the numbers went on the decline, dropping to 32 paramedic calls, 29 suspected opioid poisonings and five deaths by February of 2023, but have been increasing since then, rising back to 98 paramedic calls (65 from Oshawa), 65 suspected opioid overdoses (44 from Oshawa) and seven deaths by December.

It’s also worth stating that paramedic calls and emergency department visits underestimate the true number of overdoses in Durham as emergency services are not sought for all opioid poisonings.

This year it’s been a mixed bag of results, with the overdose numbers falling in June (54 paramedic calls region-wide), before rising again in August to 84 emergency calls and 25 suspected overdoses. September’s numbers fell slightly to 61 paramedic calls and 18 suspected opioid poisonings but whether that is a positive sign for the future is unknown.

Of those 54 paramedic calls in June, 34 were from Oshawa and ten were from Ajax. Clarington reported four calls and Whitby three, with Pickering, Scugog and Brock reporting one each.

Durham Health is also reporting a 34 per cent increase year-over-year in the paramedic calls from January to August this year.

“It is too soon to know the cause for this increase and if it is temporary. With that said, a decline in the number of paramedic calls was experienced in September compared to August,” the health department said. “It is important to note that while there have been fluctuations in hospital Emergency Department visits, over time the preliminary data have been decreasing. We have also seen fluctuations with deaths but overall the preliminary counts are still lower than what we saw in 2021.”

Getting naloxone in the hands of more support groups is crucial to bringing those overdose numbers down, the department added, with the Region serving as distribution lead and training provider to community organizations such as community health centres, outreach organizations, shelters, Aboriginal Health Access Centres, HIV/AIDS service organizations, and withdrawal management programs.

The early warning and surveillance system is also an important future goal. Currently the Durham Region Opioid dashboard focuses on time trends, but more demographic information will be added in 2025.

The opioid response plan the Region and other communities around Ontario are working on, which will integrate important areas of focus across the system (health and social systems, the criminal justice system and law and border enforcement) is gaining support from municipalities around the province as the Solve the Crisis campaign makes its way around municipal and regional councils.

The Town of Whitby passed a resolution earlier this month calling on the provincial government to commit to “immediate action” as the numbers of unhoused individuals and those suffering with mental health and addictions grows “exponentially.”

More than 3,200 people died from overdoses in Ontario in 2023.

The resolution acknowledged the additional funding recently provided for mental health, addictions and homelessness programs but said it does not adequately address the growing crisis and the financial and social impact on municipalities and regions across the province.

“Municipalities and regions are stepping up and working with community partners to put in place community-specific solutions to address this crisis, but lack the expertise, capacity, and resources to address these increasingly complex health care and housing issues alone.”

Council wants the Province to officially make homelessness a health priority by appointing a minister “with the appropriate funding and powers” as a single point of contact to address the “full spectrum of housing needs as well as mental health, addictions and wrap around supports” and strike a task force to develop a ‘Made in Ontario’ action plan to try and solve the crisis.