Good afternoon. Thank you, Mr. Chair and members of the committee, for the opportunity to speak with you today.
As you've heard, my name is Dr. Eileen de Villa and I am the Medical Officer of Health for the City of Toronto. In that capacity I and my organization, Toronto Public Health, serve a population of about 2.8 million people. I am joined today by my colleague Jayne Caldwell. She's a policy development officer in Toronto Public Health and works quite actively in the work we do at Toronto Public Health in respect of drugs and drug use among those who live in our city.
It's my understanding that you have been studying the impacts of methamphetamine use in Canada since November and have heard quite a bit of evidence from a variety of experts on these issues. For the purposes of our remarks today, we will focus largely on Toronto.
As you are aware, just as a little bit of a reminder, methamphetamine is a stimulant, along with other illicit drugs such as powder and crack cocaine and pharmaceutical drugs such as amphetamines. Historically, here in the city of Toronto, we've seen more harms resulting from the use of cocaine, although we can say that methamphetamine use has been increasing and has risen in recent years.
Looking at the impacts of any substance use, methamphetamine included, we need to actually understand why people use drugs and the context in which they use them. Looking at our particular data, I can say that rates of stimulant use are low in the general population, particularly for methamphetamine. The most recent Canadian community health survey data tell us that 4% of Toronto adults have used methamphetamine in their lifetime. The use of cocaine, by contrast, was more frequent, with 2% of Toronto adults having used it in the past year and 9% of Toronto residents indicating that they've tried it at least once in their lifetime.
We know through our practice here that, when people have issues with alcohol and with other drug use, it's often a symptom of much larger issues. For example, the prevalence of substance use is much higher among people who are experiencing homelessness than it is among those in the mainstream population, and this is certainly the case in Toronto. It is, however, important to note that substance use, in and of itself, is not necessarily a cause of homelessness, particularly for most people in Toronto. In fact, last April, when the City of Toronto, with its partners, conducted a count and survey of its homeless populations, only 5% of people surveyed noted addiction or substance use as a reason for their being homeless. Substance use among people who are experiencing homelessness is often associated with unmet health care needs, and over half of the respondents in this survey reported at least one type of health condition. Specifically, it was 57%.
Our harm reduction program in Toronto Public Health provides a range of health services to vulnerable people who use drugs. People can receive nursing care, methadone treatment, care for communicable diseases such as hepatitis C and HIV, and much more. We also operate a supervised injection service, where people can consume pre-obtained drugs under supervision. Between October 1 and December 31 of 2018, there were 9,460 visits to our supervised injection service. The data from the Works, our supervised injection service here in Toronto, show that in about three-quarters of the 9,460 visits to that service, people actually used opioids. ln about one-third of visits, people used amphetamines or methamphetamine, and cocaine stimulants were used 4% of the time, with other drugs being used about 3% of the time.
These data are consistent with a Health Canada survey of Toronto adults who were street-involved and used drugs; some 30% of them reported crystal meth use in the past year. However, crack cocaine use was much more prevalent, used by 75% of those adults. Historically, methamphetamine use in Toronto has been more frequent among street-involved youth. ln a 2013 study, 54% of street youth in Toronto reported using crystal meth.
While each person's motivation is different, some people use stimulants such as methamphetamine for practical reasons, to help them stay awake, to have more energy and to focus on tasks. This is true for people from all walks of life. For example, here in our city, we know that women who are homeless have said that they use crystal meth to stay awake at night because they fear of being vulnerable if they fall asleep. People also use stimulants to boost their confidence, to enhance sociability, as we've heard from other presenters today, and to enhance sexual activities. We've also heard today that crystal meth is sometimes used by gay, bisexual and other men who have sex with men to maximize pleasure and sociability with sex partners. We also know that some people use various drugs, including stimulants, to help them get through opioid withdrawal symptoms.
There is indeed the potential for harm as a result of methamphetamine use. As I am sure this group would know, both those via video conference and those of you in the committee room, our illicit drug supply has become increasingly toxic with potent opioids and many other drugs. Many people are coming to our supervised injection service here is Toronto because of fear of overdose from the current drug supply. In Toronto, for example, there have been occasional reports of opioid overdoses following the use of drugs that the individual believed to be a stimulant.
People also intentionally combine the use of drugs, including stimulants and depressants. They do this for a variety of reasons, including to help modulate the effects of one drug over the other. However, drugs can combine in a person's body and act together to cause severe reactions, and even death. While most accidental deaths are now caused by non-pharmaceutical, illicit fentanyl, in some cases, stimulants are also a contributing cause of death with opioids.
In fact, between May 2017 and March 2018, preliminary coroner's data on accidental deaths caused by fentanyl in Ontario shows that cocaine contributed to just over one-third of these deaths, and methamphetamine contributed to about 14%. In Toronto, however, cocaine contributed to over a half of accidental deaths caused by fentanyl— that's 53%—and methamphetamine contributed to 12% of these deaths.
In fact, in most cases of deaths in Ontario in which stimulants were a cause, other drugs also contributed to the person's death. In preliminary coroner's data for 2017, 90% of deaths in Ontario caused by methamphetamine, and 86% of deaths caused by cocaine also had another substance contributing to the death.
The number of deaths in Ontario where cocaine or methamphetamine either directly caused the death or was one of the drugs causing death has risen sharply. In 2012, 14 deaths across the province included methamphetamine as a cause of death. This number rose to 217 in 2017. And just a reminder, this is preliminary coroner's data. The number of deaths by cocaine toxicity alone or in combination with other drugs also increased during this time period from 142 deaths in 2012 to 587 deaths in 2017. Again, I'll remind you that this is preliminary coroner's data that I am giving you.
Some people struggling with substance use do seek help from treatment programs. For several years in Toronto, crack cocaine has been the most common stimulant for which people sought treatment. While this is still true, the number of treatment admissions for crack cocaine use declined by 4% between 2012 and 2018, from 32% to 27%; and there was a rise in admissions for issues with cocaine powder, from 16% to 23%, and methamphetamine, from 4% to 12%.
In addition to treatment programs, Toronto has other dedicated supports for people who use stimulants. Many harm reduction programs that provide education and supplies for safer drug use have focused efforts on educating people about stimulant overdose.
There are also resources for gay, bisexual and queer men. For example, the AIDS Committee of Toronto has health promotion materials and support groups specifically targeted at these groups of men.
In Toronto's downtown west end, St. Stephen's Community House has a new crystal meth pilot project to support people who frequently use withdrawal management services and hospital emergency departments. In addition to providing case management support and connections with health services, front-line workers are trained in how to support people who use crystal meth.
The Ontario Harm Reduction Network also plays a critical role in this issue. It brings together evidence from cross-sector experts, including people with lived experience, to train people around the province on many issues related to substance use. Last year, it held webinars focused on methamphetamine and was overwhelmed by the demand for these sessions.