ArticleBMJ public health2025
Circumstances surrounding opioid toxicity deaths within shelters in Ontario, Canada, before and during the COVID-19 pandemic: a population-based descriptive cross-sectional study.
Article in BMJ public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
abstractIntroduction: Evidence suggests growing opioid-related toxicity deaths within shelters that has been exacerbated by the COVID-19 pandemic. We sought to characterise opioid-related toxicity deaths within Ontario shelters before and during the pandemic. Methods: A descriptive cross-sectional study of people who died of an accidental opioid toxicity, where the location of the incident (ie, toxicity) was within a shelter in Ontario, Canada, was conducted. The primary analysis was restricted to conventional shelter spaces as classified by the coroner (ie, excluding temporary COVID-19 emergency shelters in hotels). Characteristics, circumstances surrounding death and patterns of healthcare use preceding death in the pre-pandemic period (1 January 2018-16 March 2020) and the COVID-19 pandemic period (17 March 2020-31 May 2022) were summarised. Results: Overall, opioid-related toxicity deaths within Ontario shelters more than tripled when comparing the pre-pandemic (n=48) with the pandemic period (n=162). Fentanyl directly contributed to the majority of these deaths, and its role as a direct contributor to death rose during the pandemic (from 85.4% to 94.4%; p=0.04), as did those of any stimulants (from 43.8% to 71.0%; p< 0.001). Moreover, benzodiazepine detection in opioid-related toxicity deaths increased during the pandemic (from 27.1% to 56.8%; p<0.001). In both the pre-pandemic and pandemic periods, more than half of the recorded deaths occurred among people with a diagnosis of an opioid use disorder (59.6% vs 53.5%; p=0.46), and a large percentage of people had a healthcare encounter in the week before death (46.8% vs 43.9%; p=0.73). Conclusions: Opioid-related toxicity deaths within Ontario's shelters have increased rapidly over the study period, with notable changes in the circumstances of death and patterns of non-pharmaceutical opioid involvement during the COVID-19 pandemic period. This study demonstrates the urgent need to expand programme and policy interventions tailored toward harm reduction within Ontario's shelter system.
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