{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,5]],"date-time":"2026-07-05T09:19:07Z","timestamp":1783243147004,"version":"3.54.6"},"reference-count":36,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"unspecified","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["178163"],"award-info":[{"award-number":["178163"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100021570","name":"Strategy for Patient-Oriented Research","doi-asserted-by":"publisher","award":["Grant number - NA"],"award-info":[{"award-number":["Grant number - NA"]}],"id":[{"id":"10.13039\/100021570","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100025092","name":"Ministry of Health, Ontario","doi-asserted-by":"publisher","award":["0691"],"award-info":[{"award-number":["0691"]}],"id":[{"id":"10.13039\/501100025092","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["bmjph"],"accepted":{"date-parts":[[2025,7,7]]},"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u201416 March 2020) and the COVID-19 pandemic period (17 March 2020\u201531 May 2022) were summarised.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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&lt;\u20090.001). Moreover, benzodiazepine detection in opioid-related toxicity deaths increased during the pandemic (from 27.1% to 56.8%; p&lt;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).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Opioid-related toxicity deaths within Ontario\u2019s 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\u2019s shelter system.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjph-2024-002394","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T07:25:24Z","timestamp":1753687524000},"page":"e002394","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"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"],"prefix":"10.1136","volume":"3","author":[{"given":"Bisola","family":"Hamzat","sequence":"first","affiliation":[{"name":"St Michael\u2019s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada"},{"name":"MAP Centre for Urban Health Solutions, St Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Leece","sequence":"additional","affiliation":[{"name":"University of Toronto Department of Family & Community Medicine, Toronto, Ontario, Canada"},{"name":"Public Health Ontario, Toronto, Ontario, Canada"},{"name":"University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"McCormack","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Holton","sequence":"additional","affiliation":[{"name":"St Michael\u2019s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada"},{"name":"MAP Centre for Urban Health Solutions, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"Royal College of Surgeons in Ireland School of Pharmacy and Biomolecular Sciences, Dublin, Ireland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zo\u00eb","family":"Dodd","sequence":"additional","affiliation":[{"name":"MAP Centre for Urban Health Solutions, St Michael\u2019s Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Firestone","sequence":"additional","affiliation":[{"name":"St Michael\u2019s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Smoke","sequence":"additional","affiliation":[{"name":"Ontario Drug Policy Research Network (ODPRN), Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brett","family":"Wolfson-Stofko","sequence":"additional","affiliation":[{"name":"Homes First Society, Toronto, Ontario, Canada"},{"name":"Center for Drug Use and HIV\/HCV Research, New York University School of Global Public Health, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hayley","family":"Smuts","sequence":"additional","affiliation":[{"name":"Urban Health & Homelessness Services, The Neighbourhood Group Community Services, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Sereda","sequence":"additional","affiliation":[{"name":"DIY Community Health, Timmins, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jase","family":"Watford","sequence":"additional","affiliation":[{"name":"Ontario Drug Policy Research Network (ODPRN), Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler","family":"Watts","sequence":"additional","affiliation":[{"name":"Ontario Drug Policy Research Network (ODPRN), Unity Health Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1468-1965","authenticated-orcid":false,"given":"Tara","family":"Gomes","sequence":"additional","affiliation":[{"name":"St Michael\u2019s Hospital Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada"},{"name":"MAP Centre for Urban Health Solutions, St Michael\u2019s Hospital, Toronto, Ontario, Canada"},{"name":"ICES, Toronto, Ontario, Canada"},{"name":"University of Toronto Leslie Dan Faculty of Pharmacy, Toronto, Ontario, Canada"},{"name":"University of Toronto Institute of Health Policy Management and Evaluation, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,7,27]]},"reference":[{"key":"2026010703055223000_3.2.e002394.1","unstructured":"Public Health Agency of Canada . 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