The rate of opioid–related deaths in Ontario has increased almost four–fold (285 per cent) over the past 25 years, according to a new report by researchers at the Institute for Clinical Evaluative Sciences (ICES), St. Michael’s Hospital and the Ontario Drug Policy Research Network (ODPRN).

“According to the most recent data from the Ontario coroner, 734 people died of an opioid–related cause in 2015, which averages to more than two people every day in Ontario,” says Tara Gomes, a scientist at ICES and the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and a principal investigator of ODPRN.

The report published on the ODPRN website shows that opioid–related deaths often involved other drugs (both legal and illicit) that could have contributed to these deaths. Post–mortem toxicology identified benzodiazepine in the system of over half (51 per cent) of individuals and cocaine in nearly one–third (32 per cent.

“The presence of these other drugs may be indicative of the concerning practice of combining cocaine with illicitly produced fentanyl, which is relatively inexpensive, to extend the drug supply. The findings highlight an important public safety issue that needs ongoing focus given the high degree of accidental opioid overdoses that we’re seeing across the province,” adds Gomes.

The researchers also found that prior to 2012, oxycodone was the opioid type most commonly involved in opioid–related deaths. However, after the introduction of a tamper–deterrent formulation in 2012, oxycodone involvement in these deaths decreased, and other opioids became increasingly involved. In particular, fentanyl involvement increased by 548 per cent between 2006 and 2015 and is now the opioid most commonly involved in opioid–related deaths. The involvement of hydromorphone also increased by 232 per cent over this time period to become the second most commonly involved opioid. Despite small numbers overall, heroin involvement in opioid–related deaths has increased by 975 per cent over this same period.

“The introduction of tamper–deterrent long–acting oxycodone appears not to have led to any reductions in opioid–related deaths in the province, and instead seems to have shifted opioid use to alternatives, both illicit and prescribed, that do not have these tamper–deterrent properties. This underlines the challenges in dealing with the opioid crisis we are currently facing,” adds Gomes.

The report also shows that more than 80 per cent of all opioid–related deaths in 2015 were accidental. The researchers were able to break down the accidental deaths by age, showing almost 60 per cent of accidental deaths occurred among youth and younger adults (15 to 44 years). However, the researchers found nearly 80 per cent of opioid–related suicide deaths occurred among older adults (45 years and older).

The researchers add that opioid–related deaths are increasingly occurring among all ages, income brackets, and in both sexes, highlighting the pervasiveness of this public health problem. However, the report shows, on average, individuals who died of an opioid–related cause in 2015 were male, middle aged and living in lower income, urban settings.