The Overdose Crisis Up Close

“Almost everyone you know is touched by substance use in some way.”

August 31 is International Overdose Awareness Day—a time when people around the world come together to take action on this critical and life-threatening issue.

We spoke with Dr. Tara Gomes, an epidemiologist and scientist at St. Michael’s Hospital’s MAP Centre for Urban Health Solutions, Canada Research Chair in Drug Policy and Substance Use Research, and lead of the Ontario Drug Policy Research Network, to learn about the current state of this crisis in Canada, what’s being done about it, and what people should know about drug use.

The vital work of Dr. Gomes and her team is only possible with the generous support of our donors. Thank you for advancing exceptional care for people living with addiction and everyone in our community.

What inspired you to pursue a career in drug research?

I’ve always been interested in understanding the social determinants of health—how employment, income, education, race and ethnicity, housing, social supports, and other factors influence people’s long-term health trajectories.

When we started seeing rising opioid overdoses across Canada, I realized just how critical these factors are in determining a person’s risk of opioid-related harm, whether they’re able to access support, and how we provide care.

My work now focuses not only the risks and harms of substance use broadly, but we also try to understand the needs of people who use drugs so we can co-develop evidence and identify programs and services that will support them in the most effective way possible.

What are some of the trends you’re seeing right now when it comes to substance use in Canada?

It’s an evolving landscape. In 2016, we saw the rate of opioid-related deaths start to spike when fentanyl came into the illicit drug supply. Then, when the pandemic hit in 2020, we saw changes in the way people were able to engage with health services and treatment, which made the situation even more complex. Unfortunately, this led to drug-related deaths rising again—reaching levels that we couldn’t have even imagined a decade previously.

Over the last six months to a year, we’ve started to see some reduction in opioid-related deaths in parts of Canada. We’re trying to understand what’s driving this change, which seems mainly related to the drug supply having less fentanyl in it right now. But unfortunately, this pattern isn’t consistent across the country, and with the unpredictability of the drug supply, we don’t know how long it will last and what’s to come.

Another factor that’s harder to talk about is that a lot of people who were susceptible to drug overdoses have already died. So, while it’s easy to want to celebrate the reduction in deaths that we are currently seeing, we need to remember that tens of thousands of lives have already been lost. It’s important for us to honour and remember those we have lost, and do everything in our power to not become complacent in our efforts to prevent even more deaths happening in the future.

What are some of the key research or policy projects you’re working on right now?

We’re focused on two areas right now.

The first relates to the reduced access to safer supply programs and supervised consumption sites that we’re seeing across the province due to funding and legislative changes. These changes have been devastating for a lot of people in the community, who relied heavily on those services, and past work by our team and my colleagues demonstrates the benefits of these services.

So—while we know this is a difficult moment for many—we’re collaborating with researchers here at St. Michael’s and throughout Ontario to evaluate the impact of those changes.

We want to understand where people are going if they can’t access a safer supply program and what that means for their well-being. If we can rigorously show the impact of these changes for people in the community, we can help illuminate a pathway forward based on evidence and community expertise.

The other project we’re working on relates to residential treatment for opioid addiction, an area that is seeing increasing government investments despite these services lacking standardization, which can lead to inconsistent quality and accessibility. We want to understand what kind of services are provided in these settings, how consistent policies are, and how these impact people’s outcomes.

Our goal is to generate evidence that will help guide funding and services that help people get the most effective, impactful support that meets their needs at the time as quickly as possible.

What is St. Michael’s Hospital doing to tackle this issue?

A lot of people are shocked to learn that not every hospital in Ontario has clinicians on staff who are trained in addiction medicine. This is an area where St. Michael’s is absolutely leading the way.

We have an Addiction Medicine Consult Service, which helps ensure that there are healthcare providers in the hospital trained to provide the best possible care to anyone who uses drugs who enters its doors. The service also helps coordinate transitions back to the community with the right supports when they leave the hospital.

We also have services and outreach programs for specific populations experiencing addiction, including individuals who are pregnant, unhoused, living with HIV, and others.

Our work is unique among hospitals in Ontario, but this model should be available everywhere. We’re trying to lead research that can help support the expansion of these types of programs and services so that they can be integrated into all hospitals—thereby ensuring that people have equitable access to high quality care whenever they seek care in a hospital across Ontario.

What do you want people to know about substance use?

I think it is fair to say that almost everyone in our lives has been touched by addictions or substance use in some way. It might be from opioids, it might be from stimulants like cocaine, or it might be from alcohol. All of us are affected in some way by this issue, and we need to move past the stigma that is so frequently placed on people who use drugs.

We also need to accept that this is an incredibly complex issue without simple solutions.

This is why I think it is so important that we really listen to people directly impacted by drug-related harms to understand the type of support they need. If we did this more consistenty across research, clinical care and policy, we would achieve so much more and the quality and impact of the solutions identified would go so much further towards supporting the wellness and health of people in our community.

What advice do you have for parents concerned about their children being impacted by drugs?

I think about this a lot. I have two children and they’re getting older, which means they will encounter drugs in their social circles that are far more dangerous than what was around when I was young.

First, don’t shy away from talking about this issue with them. Being communicative with your kids about substance use, and the fact that they will likely be exposed to drugs as they get older, will help them make better decisions for themselves.

For example, there’s a rising prevalence of counterfeit tablets containing fentanyl in Canada right now. Kids should know that something that looks like a pill may not actually contain what they think it does; it could contain substances they’re not aware of, and those could be incredibly dangerous.

The other thing I urge everyone to do is to get naloxone and carry it with you. This is a medication that is used to reverse opioid overdoses; it’s easy to use, completely safe, and can save someone’s life. You can pick it up for free at pharmacies across Ontario without providing ID.

Given everything you know about substance use, addictions, and drug policy, do you have hope for the future?

For the immediate future, I’m really concerned that we’re going to be facing challenges due to the pullback on harm reduction services and political polarization of this issue.

But for the longer-term future, I do have hope because of the resilience, commitment, and compassion that I see every day among the people who work on the front lines. There are so many people providing clinical care, working directly at the community level, doing research, and working within the government who care and are working tirelessly to address this issue.

So I do have hope for the future, but I think it's going to be a bumpy ride.

Thank you, Dr. Gomes!

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