{
  "abstract": "Introduction 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.",
  "authors": [
    {
      "affiliations": [
        "St Michael’s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada",
        "MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Bisola Hamzat"
    },
    {
      "affiliations": [
        "University of Toronto Department of Family & Community Medicine, Toronto, Ontario, Canada",
        "Public Health Ontario, Toronto, Ontario, Canada",
        "University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada"
      ],
      "name": "Pamela Leece"
    },
    {
      "affiliations": [
        "ICES, Toronto, Ontario, Canada"
      ],
      "name": "Daniel McCormack"
    },
    {
      "affiliations": [
        "St Michael’s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada",
        "MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada",
        "Royal College of Surgeons in Ireland School of Pharmacy and Biomolecular Sciences, Dublin, Ireland"
      ],
      "name": "Alice Holton"
    },
    {
      "affiliations": [
        "MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada"
      ],
      "name": "Zoë Dodd"
    },
    {
      "affiliations": [
        "St Michael’s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada"
      ],
      "name": "Michelle Firestone"
    },
    {
      "affiliations": [
        "Ontario Drug Policy Research Network (ODPRN), Unity Health Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Ashley Smoke"
    },
    {
      "affiliations": [
        "Homes First Society, Toronto, Ontario, Canada",
        "Center for Drug Use and HIV/HCV Research, New York University School of Global Public Health, New York, New York, USA"
      ],
      "name": "Brett Wolfson-Stofko"
    },
    {
      "affiliations": [
        "Urban Health & Homelessness Services, The Neighbourhood Group Community Services, Toronto, Ontario, Canada"
      ],
      "name": "Hayley Smuts"
    },
    {
      "affiliations": [
        "DIY Community Health, Timmins, Ontario, Canada"
      ],
      "name": "Jason Sereda"
    },
    {
      "affiliations": [
        "Ontario Drug Policy Research Network (ODPRN), Unity Health Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Jase Watford"
    },
    {
      "affiliations": [
        "Ontario Drug Policy Research Network (ODPRN), Unity Health Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Tyler Watts"
    },
    {
      "affiliations": [
        "St Michael’s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada",
        "MAP Centre for Urban Health Solutions, St Michael’s Hospital, Toronto, Ontario, Canada",
        "ICES, Toronto, Ontario, Canada",
        "University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada",
        "University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada"
      ],
      "name": "Tara Gomes"
    }
  ],
  "title": "Circumstances surrounding opioid toxicity deaths within shelters in Ontario, Canada, before and during the COVID-19 pandemic: a population-based descriptive cross-sectional study",
  "uid": "ab839d97-05b6-5123-a48f-f77ea02d4c9d"
}