A new report from The Ontario Drug Policy Research Network and Public Health Ontario shows the number of accidental drug and alcohol toxicity-related deaths grew to alarmingly high levels in Ontario during the COVID-19 pandemic.

There were almost 9,000 accidental deaths from substance-related toxicities in the province from 2018 to 2021—reaching an unprecedented rate that was five times higher than the number of deaths due to motor vehicle collisions in Ontario.

The report found that the annual number of substance toxicity deaths nearly doubled in Ontario during this time, reaching nearly 3,000 deaths in 2021, with an average of eight deaths occurring every day that year.

“This report shows the extent to which substance-related harms have worsened during the pandemic,” says senior author Dr. Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital and ICES, and a principal investigator of the ODPRN.

“During the pandemic, for the first time, the number of deaths involving multiple substances surpassed deaths from one substance alone, highlighting the increasing complexity of this issue and the types of responses required to prevent these avoidable harms.”

Deaths linked to multiple substances

The report found over 80% of alcohol, stimulant, benzodiazepine deaths during this time also involved opioids, which can lead to higher fatality rates, suggesting the need for more responsive health care, community-based and harm reduction interventions that address the complex needs of people who use multiple substances.

Gomes says that many of these patterns are driven by the growing opioid overdose crisis that has worsened in the pandemic, but the rising trends aren’t restricted to opioids—with stimulant-related deaths rising and remaining elevated since 2020 as well.

Although much more uncommon than deaths from opioids and stimulants, the report also found there were almost 300 deaths from alcohol toxicities in Ontario in 2021, the majority of which involved another substance. Only 25 of these deaths involved only alcohol.

“These patterns of alcohol-related toxicities in part reflect how risks of harms from alcohol use can be mitigated by the regulation of its sale, in contrast to illicit drugs where supplies are highly unpredictable which can increase the risk of unintentional, fatal overdoses,” Gomes says.

“What is clear across all four of the substances that we studied is that these accidental deaths are occurring across all ages, both men and women, and in all parts of the province, meaning that responses and services need to be made accessible and tailored to these various populations.” The researchers analyzed data from ICES and the Drug and Drug/Alcohol Related Death Database (DDARD), which contains records from investigations completed by the Office of the Chief Coroner/Ontario Forensic Pathology Service.