Although fentanyl remains the leading cause of opioid death in Ontario, updated data shows that the prescription painkiller hydromorphone sits as the second-deadliest drug when it comes to fatal overdoses in the province.
Hydromorphone caused 119 deaths in 2015, compared to fentanyl's 166, according to preliminary numbers from the chief coroner's office. Data for that year is about 95 per cent complete, while the early figures for 2016 will come trickling in partway through 2017.
When combined with alcohol, hydromorphone caused 37 fatalities in 2015 — the same number of people found to have overdosed on a combination of fentanyl and liquor.
Similar to heroin
Hydromorphone is similar to heroin and goes by the trade name Dilaudid. It's extremely addictive and used to treat moderate to severe pain.
But unlike in eastern Canada where it's made headlines, the drug isn't getting the same level of media attention as fentanyl here, perhaps because it's neither as new nor as potent.
"Hydromorphone has been around for a while," Shaun Hopkins, the manager at Toronto Public Health's needle exchange program said. "It's similar to heroin [and] if people don't have access to one opioid, they might switch to the other."
Heroin itself, however, was the sixth-most deadly drug in 2015, according to the report. The preliminary figures show that 59 people had a fatal overdose on the street drug.
Hydromorphone comes in a pill that, like heroin, can be ground into powder, dissolved in liquid and injected. The potency of the two drugs is almost identical, Hopkins said.
The big problem, she said, is when either gets laced with another substance, like fentanyl.
"So people who normally aren't opioid users mistakenly take it, their bodies aren't used to it and they can overdose," Hopkins said.
Toronto awaiting safe injection sites
On Monday, the city is holding its first meeting with several municipal groups, including hospitals and police, to draft a plan to deal with fentanyl overdoses.
"Overdose deaths have gone up 77 per cent in the last 10 years," said Coun. Joe Cressy, chair of Toronto's drug strategy. "These deaths are preventable. If we do increased work on treatment, prevention and harm reduction, we can save lives."
One of the measures Cressy wants to see is supervised injection sites. City council has approved three, but is awaiting Ottawa's final approval and the province's commitment to fund the sites, the Ward 20 Trinity-Spadina councillor said.