What’s behind big spike in homeless deaths in Toronto, other cities

David Meyer is trailing an elderly fellow with an unsteady gait; the older man hunches over a shopping cart, his quivering fingers squeezing the handlebars as if he’s holding on for dear life.

“If he drops, I’ll call the ambulance,” Meyer says, half a cigarette dangling out of his mouth, his trusty naloxone kit hanging from his hip.

As if spurred by his words, the sharp squeal of sirens cleaves through the air.

“This damn thing drives by 20 times a day,” Meyer says of a passing firetruck, shaking his head as he leans on a cane. “Every 20 minutes or half an hour, you hear the sirens, and they’re not going to fires — they’re going to another call for another sick person on ‘down’ who’s going to die if they don’t get help.”

The “down” Meyer refers to is illicitly produced fentanyl, believed to be in everything sold on the street as opioids these days.

Those in the know say the tainted drug supply is one of the major causes of a spike in deaths of people experiencing homelessness across multiple cities in this country.

But it’s not the only reason. Experts point to reduced capacity at shelters, more difficulty accessing services, and an overall delayed “pandemic effect” — sickness, long-term health complications and trauma from losing loved ones.

Edmonton saw a 70 per cent increase in homeless deaths — 222 people were identified as having died due to homelessness in 2021, compared to 132 in 2020, and 99 in 2019.

Toronto saw a 50 per cent increase in 2021 from the previous year — 216 Torontonians without a home died, with more than half of those deaths occurring within the shelter system.

Meanwhile the Vancouver Police Department says it saw a 40 per cent increase in sudden-death files for people with no fixed address, responding to 65 such incidents in 2021.

Meyer is standing on 96 Street in Edmonton, less than a block away from a park where three men were found dead in 2021. No public explanation has been provided for how all the men died.

As Meyer looks on, the man with the shopping cart finds haven in kamâmak nihtâwikihcikan, a small Indigenous medicine garden in downtown Edmonton. Meyer tells his friends to try to keep him upright — if he lies all the way down, he might throw up and choke on his own vomit.

Meyer is hoping he won’t have to use his naloxone kit again today — he says he’s already intervened twice to help someone. He often walks up and down this street and keeps an eye on people who are nodding off.

“You can do this all day long, all night long,” Meyer says. “Can I stop? I don’t know that I actually can. But I’m getting tired.”

David Meyer says he's not surprised when he hears of the 70 per cent spike in homeless deaths in Edmonton, and asks aloud how people would react if there was that same increase among staff or students at a local university.

Meyer, who is Iroquois and Métis from the Thunder Bay area, moved to Edmonton some 40 years ago. He drove a truck for roughly 30 years before rolling a tractor-trailer, which he says caused an undiagnosed condition that gives him random blackouts and prevents him from working.

He’s been living on Edmonton’s streets and in the river valley for about four years, which he says is by choice. He gets through by panhandling and collecting bottles and cans; he says he spends about half of what he makes on buying blankets, clothing and tents to give to others.

He’s entirely unsurprised when he hears of the 70 per cent increase in deaths, and asks aloud how people would react if there was that same increase among staff or students at a local university.

“People would lose their f—ing minds,” Meyer says. “People would actually do something about that. But because these people are homeless, because they’re on drugs, because they’re hurting, nobody gives a s—.”

As he sits on a ledge to roll a joint, he runs a hand through the hair on his mostly shaved head.

“People say it’s a drug and alcohol problem down here. That’s bulls—,” Meyer says. “Drugs and alcohol are the aftermath. What we’re dealing with is spiritual, mental, emotional pain these people are hiding from. Some of them have been abused their whole life.”

Diane Chan McNally is seen in front of The Meeting Place, a drop-in centre where she used to be based, at Bathurst and Queen. Throughout the pandemic, she has seen how the trauma many clients carried from their lives was compounded: losing loved ones or those who help them get by to deaths from opioid overdoses or COVID-19.

It’s the kind of trauma Diana Chan McNally regularly encounters or hears about in her time as a community worker and saw at her previous role as a co-ordinator at the Toronto Drop-in Network.

Throughout the pandemic, she has seen how the trauma many clients carried from their lives was compounded: losing their friends, loved ones or those who help them get by to deaths from opioid overdoses or COVID-19.

She says it created a cycle of grief, where people would turn to drugs to deal with loss, and sometimes succumb to overdose themselves.

“It very much resonates with what I hear from people who are constantly surrounded by death and constantly talking about the impacts of that on them,” Chan McNally says. “So yes, the toxic drug supply, but also the fact that the more people are overdosing, the more people use … I do think there’s that kind of snowball effect of grief and trauma.”

She says there were also folks who got sick from COVID and died, as well as people who experienced long-term complications from the acute infection and saw worse health outcomes as a result.

Further, some found it harder to access services and get help. There were lineups, reduced capacity and the overall chaos of the pandemic.

Some drop-in centres, for example, were only offering takeaway meals or supplies, making it harder for people to connect to health and housing workers, Chan McNally says, adding that a lot of those services either never returned or did so at reduced levels.

Some people voluntarily left the shelter system because of overcrowding and fear of COVID-19, while others were forced out due to reduced capacity. As more reports emerged of people dying in Toronto’s shelters, that system didn’t seem a safer alternative to the streets, Chan McNally says.

“Especially when you know that your friends and your family are dying in there all the time.”

As a result, more people were sleeping rough. Add to that a toxic drug supply, an increasing cost of living and a housing crisis, and it created “a perfect storm of lethal danger” for vulnerable people, says Tim Richter, CEO of the Canadian Alliance to End Homelessness.

“I think this unfortunately was kind of out of sight and out of mind,” Richter said. “And people who have been invisible to society forever also died invisibly.”

Toronto’s monitoring of shelter deaths goes back to 2007. Between that year and 2019, there is not a single month where shelter deaths reached double digits. It happened in July 2020 for the first time, when 13 people died in city-run shelters. In 2021, it was common — deaths reached double digits every month in eight months out of 12.

Overall, deaths in city-run shelters increased by 78 per cent from 2020 to 2021.

Toronto has the most comprehensive data set for its homeless population, which it pegged at 7,347 in 2021, but the true number of people is still unknown. In 2018, the Ontario government introduced legislation requiring all municipalities in the province to conduct a homeless count every two years.

But there is little data for when people experiencing homelessness die. Housing status is generally not noted in hospital records or death certificates. In Alberta, the Edmonton Coalition on Housing and Homelessness tracks homeless deaths by contacting all the shelters to find out if any of their clients died, then cross-referencing for duplications.

Jim Garnett, with the coalition, said most of those deaths aren’t caused by what is typically characterized as a “homeless death,” generally, exposure to the elements.

“I really think the reason we’re seeing more people die, unique things like drug poisoning aside, is simply that we have more and more people who have been stuck in homelessness way too long,” Garnett said. “And they’re just being slowly destroyed by it.”

Doug Johnson Hatlem, a street pastor at drop-in centre Sanctuary Toronto, strongly agrees. He watches as freezing deaths capture headlines every winter — but deaths caused by the long-term impacts of chronic homelessness receive little attention.

“There’s a kind of Canadian-versus-the-natural-elements drama built into our national identity, and I think those deaths do shock and get at people’s most basic sense of compassion,” Hatlem said.

“But they are relatively rare compared to the regular old heart attacks and the opioid deaths.”

Statistics show the average life expectancy for a person experiencing chronic homelessness is about 50, compared to 80 for the average Canadian.

Data from Toronto Public Health shows drug toxicity was by far the leading cause of death (55 per cent) among people experiencing homelessness in 2021. The percentage of deaths caused by drug toxicity hovered around 30 per cent for years until 2020, when it jumped to 53 per cent.

The second leading cause of death was cardiovascular disease, while about one-fifth of deaths were attributed to unknown causes.

In an emailed statement, Toronto Public Health said it’s taking a multi-pronged approach to address the increase in homeless deaths, including developing a Toronto Drug Strategy consisting of four integrated parts: prevention, harm reduction, treatment and enforcement. It is also working more closely with shelters to ensure that they have harm reduction supplies and naloxone available and staff trained in overdose prevention.

It noted that TPH submitted a request to Health Canada to decriminalize personal possession of drugs as part of recognition that “drug use is a public health issue.” Toronto Public Health added that it’s more accurate to characterize the drug supply emergency as a drug poisoning crisis, not an opioid crisis, because of the sheer number of other drugs, such as benzodiazepines (a sedative) that are being sold as opioids and contributing to overdose deaths.

“We are also very concerned about the impact that COVID-19 is having on people who use drugs. The dual public health crises of drug poisonings and COVID-19 are having significant and increasingly dire impacts on people who use drugs, their families and communities,” TPH said in a statement.

When not at the drop-in, Hatlem, the pastor, spends much of his time bargaining with city police to not take down homeless encampments. He says the city’s fixation on encampments points to its priorities.

“It’s gutting. And it just keeps growing. The city’s priorities are all wrong. They don’t care how many people die, it seems,” Hatlem said. “They care about how many tents there are.”

One of the most significant changes in 2021 was the city moving people from standard shelters into emergency hotel shelters to provide single-occupancy rooms, as Toronto faced a lawsuit about physical distancing in the shelter system.

In the second half of 2021, which Hatlem says is when the hotel shelters really started ramping up, there was a 35 per cent increase in deaths compared to the previous six months. While the winter season does generally see higher mortality rates, it’s believed the isolation of the shelter hotels contributed to more people using — and dying — alone.

It’s why Meyer, back in Edmonton, says he chooses to stay on the streets. He says he feels he has a duty to look out for others and believes he’s making a small difference.

But he has also lost count of how many bedsides he has stood by as people took their last breath. He has also had instances where he tried to resuscitate someone in the midst of an overdose, but was too late.

“After a while, you become numb to it,” he says. “But you carry it with you. After a while, you have dreams and nightmares about this s—.”

Meyer is off to catch supper at a local shelter before returning to his tent in Edmonton’s river valley later this evening.

While he contends living in a tent is his choice, he acknowledges he doesn’t currently have many options. He says he can’t work because of his undiagnosed injury, and even if he were on social assistance, the $866 he would receive monthly wouldn’t cover rent and damage deposit.

As of now, he has no hope to get into housing.

“The whole system is flawed,” Meyer says. “They’ll pay $200 a day to keep someone in jail. But they can’t give me 50 bucks a day to f—ing live.”


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