Project 462231

Canada has the world's most rapidly accelerating overdose epidemic, with per capita mortality opioid overdose mortality increasing by 117% since 2016. Toronto is North America's fourth-largest city and the urban area with the highest level of income disparity in the country. In 2020, 823 people died of an overdose in Toronto, more than twice as many as in any other jurisdiction in Canada, and higher than those recorded in major American cities. The goal of the ongoing Toronto Disparities, Overdose and Treatment (T-DOT) study is to understand whether rapid implementation of new opioid agonist treatments and an impending drug decriminalization policy change are effective in reducing overdose risk among people who inject drugs who are experiencing severe socioeconomic disparities. To do that, the T-DOT study will link behavioral data collected over time from a cohort of people who inject drugs in Toronto with administrative datasets that include comprehensive clinical data from all Ontarians. This is important because currently, data from people who inject drugs about their treatment and other clinical experiences is almost always collected as self-report, making it difficult to confirm clinical outcomes. However, high-quality, comprehensive clinical data is needed to chart an evidence-based pathway to end the overdose epidemic in Canada and across North America, particularly for people who inject drugs experiencing socioeconomic disparities.