Toronto Public Health releases 2022 data for deaths of people experiencing homelessness

Today, Toronto Public Health (TPH) released data related to the deaths of people experiencing homelessness in 2022 (www.toronto.ca/community-people/health-wellness-care/health-inspections-monitoring/monitoring-deaths-of-homeless-people/). Overall, homelessness continues to negatively impact health outcomes of individuals, resulting in 187 reported deaths in 2022. This total is lower than the 223 deaths reported in 2021 but remains higher than the 128 deaths reported before the COVID-19 pandemic in 2019.

People experiencing homelessness are at increased risk of dying prematurely. The median age of death of people experiencing homelessness in 2022 was 55 years of age for males and 42 years of age for females. For comparison, the median age for the general population in Toronto is 79 years of age for males and 84 years of age for females.

Drug toxicity is the leading cause of death for people experiencing homelessness in Toronto in 2022, resulting in approximately half – or 47 per cent – of reported deaths in this population. This is slightly lower than the 52 per cent reported in 2020 and the 59 per cent reported in 2021. The cause of death is unknown or pending in 29 per cent of cases, therefore deaths due to drug toxicity may rise when pending coroner reports are received. The other leading causes of death for people experiencing homelessness include cardiovascular disease (10 per cent), cancer (5 per cent), unintentional injuries (4 per cent) and suicide (3 per cent).

Data is collected from three primary sources (these sets of data are analyzed to rule out duplications):
•       Participating agencies who serve the homeless and under-housed communities
•       The City of Toronto’s Shelter, Support and Housing Administration (SSHA) division
•       Reports submitted by The Toronto Homeless Memorial

A subset of the data included in today’s data release are numbers from SSHA on deaths among shelter residents. Although 2022 saw an increased demand for shelter services compared to 2021, there has not been an increase in the number of deaths of shelter residents. In fact, the number of deaths of shelter residents has decreased from 132 in 2021 to 110 in 2022. Shelter operators do not have access to official cause of death information for their clients, but where possible, they do report a suspected cause of death. Based on these reports, opioid overdose remains the leading suspected cause of death of shelter residents.

During the COVID-19 pandemic, there was a substantial rise in non-fatal and fatal overdoses in the shelter system as well as in the broader community. In response, in December 2020, the Integrated Prevention and Harm Reduction Initiative (www.toronto.ca/community-people/health-wellness-care/health-programs-advice/overdose-prevention-and-response/iphare-program/) or iPHARE, was established as a multi-pronged effort by the City and community agencies to address opioid-related deaths in Toronto’s shelter system.

A decrease in overdose deaths has been observed since 2021. This may be in part due to harm reduction measures implemented in the City’s shelter system, as well as other factors including the unpredictable nature of the unregulated drug supply and lack of access to safe supply. This is consistent with data from the Ontario Office of the Chief Coroner (www.toronto.ca/city-government/data-research-maps/research-reports/housing-and-homelessness-research-and-reports/overdoses-in-homelessness-services-settings/) that also indicates a reduction in opioid overdose deaths in homelessness service settings.

As reported in TPH’s 2023 Population Health Profile (www.toronto.ca/HealthCheck), the worsening drug poisoning crisis continues to be an urgent public health issue in Toronto. TPH continues to implement the Toronto Drug Strategy (www.toronto.ca/community-people/health-wellness-care/health-programs-advice/alcohol-and-other-drugs/toronto-drug-strategy-2/) by providing harm reduction and treatment services as outlined in the Toronto Overdose Action Plan (www.toronto.ca/community-people/health-wellness-care/health-programs-advice/alcohol-and-other-drugs/toronto-drug-strategy-2/), including providing supervised consumption services, a drug checking service and an Injectable Opioid Agonist Treatment (iOAT) program through The Works. In addition, TPH is partnering with Unity Health and the University Health Network (www.toronto.ca/news/toronto-public-health-unity-health-toronto-and-the-university-health-network-strike-bold-partnerships-to-address-the-drug-poisoning-crisis/) to provide a continuum of care from community-based harm reduction services to hospital-based health care services.

TPH supports a public health approach to substance use and harm reduction and continues to work with Health Canada, people with lived or living experience of substance use and community partners to refine the submission to Health Canada made on January 4, 2022 (www.toronto.ca/wp-content/uploads/2022/01/943b-TPH-Exemption-Request-Jan-4-2022-FNLAODA.pdf) for an exemption to the Controlled Drugs and Substances Act to allow the possession of drugs for personal use.

SOURCE City of Toronto