Alcohol & Drugs
Hamilton Opioid Information System
Contact Us
For questions or feedback contact:
Public Health,
Epidemiology & Evaluation
Email [email protected]
Hamilton Public Health Services is collaborating with Hamilton Paramedic Services, Hamilton Health Sciences, St. Joseph’s Healthcare Hamilton, and community partners to provide timely opioid-related information to the public.
During the week of December 29, 2025 to January 2, 2026, the Hamilton Opioid Information System will not be updated. Regularly scheduled updates will resume the week of January 5, 2026
Local Opioid Information
- Opioid-related deaths peaked in 2021, at 167 and have decreased since: 166 in 2022, 150 in 2023, and 129 in 2024.
- By July 31, 2025 there have been 43 confirmed or probable deaths.
As reported in Hamilton's Community Health Status Report, the rate of opioid-related deaths differs by sex and age groups, housing status, and racial identity. For example, 72.2% of opioid-related deaths in 2022 were among males aged 25-64 years. Further, the rate of opioid-related deaths was substantially higher among people whose living arrangements were identified as homeless (1,024.9 deaths per 100,000) compared to those identified as residing in a private dwelling (16.1 deaths per 100,000). The rate of opioid-related deaths was higher among people who identified as White (22.4 deaths per 100,000) and Black (13.4 deaths per 100,000) compared to people who identified as East or Southeast Asian, South Asian, Latin America, or Middle Eastern (racial identities were grouped together for privacy reasons as the number of deaths in each of these populations is low).
Note: Data is preliminary for 2024 and 2025 as it contains confirmed and probable deaths. Data from all years remains subject to change, though the majority of opioid-related deaths are confirmed within 12 months.
Source: Office of the Chief Coroner of Ontario, November 14, 2025
- Suspect drug-related deaths are deaths in which the preliminary coroner investigation indicates drug involvement. The number of deaths in Hamilton that are suspected to be drug-related can be an early indicator of trends in opioid-related deaths.
- Suspect drug-related deaths peaked in 2021, at 221 and have decreased since: 218 in 2022, 219 in 2023, and 207 in 2024.
- By November 30, 2025, there have been 137 suspect drug-related deaths.
Note: Suspect drug-related deaths are not opioid specific and include deaths that could be related to other drugs. Data are preliminary and subject to change.
Source: Office of the Chief Coroner of Ontario, December 4, 2025.
- In 2024 and 2025, most of the suspect drug-related deaths were males (76%).
- The sex distribution of suspect drug-related deaths has not changed substantially in recent years and is comparable to the distribution of suspect drug-related deaths across Ontario.
Source: Office of the Chief Coroner of Ontario, December 4, 2025.
- In 2024 and 2025, almost half of the suspect drug-related deaths were people aged 30 to 39 and 60 to 69.
- The age distribution of suspect drug-related deaths has not changed substantially in recent years and is comparable to the distribution of suspect drug-related deaths across Ontario.
Note: Age groups with fewer than 5 counts will be suppressed.
Source: Office of the Chief Coroner of Ontario, December 4, 2025
In 2024 and 2025, most of the suspect drug-related deaths occurred in a private residence (66%). Other common incident locations include the outdoors (15%) and congregate living (9%).
Source: Office of the Chief Coroner of Ontario, December 4, 2025.
In 2024 and 2025, nearly half of suspect drug-related deaths occurred in L8L neighbourhoods.
Note: Forward Sortation Area (FSA) of the location of the incident, which is a way to designate a geographical unit based on the first three characters in a Canadian postal code. FSAs with fewer than 5 counts have been suppressed.
Source: Office of the Chief Coroner of Ontario, December 4, 2025.
- Between 2005 and 2024, Hamilton had a higher rate of opioid-related deaths when compared to the provincial average.
- In 2024, Hamilton’s rate was 46% higher than the provincial average. This gap decreased between 2018-2021, and again from 2022-2024.
- For more information about opioid-related deaths in Ontario, view Public Health Ontario’s Substance Use and Harms Tool.
Source: Office of the Chief Coroner of Ontario, extracted from PHO’s Substance Use and Harms Tool, August 27, 2025.
- In 2025, Hamilton Paramedic Services responded to 1,095 suspected opioid overdoses up to December 14.
- August and September of 2025 saw the highest monthly counts of opioid-related paramedic responses since reporting began in 2017.
- In 2025, the majority of paramedic responses were for males (75%), and the average age was 38 years. These sex and age trends are similar to what has been seen in previous years.
Source: Hamilton Paramedic Services, December 16, 2025. The most recent month is incomplete.
Map of Paramedic Incidents Related to Opioid Overdose
| ward | 2017 | 2018 | 2019 | 2020 | 2021 | 2022 | 2023 | 2024 | 2025 | total | percent |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | 16 | 19 | 24 | 19 | 43 | 27 | 33 | 34 | 23 | 238 | 3.70% |
| 2 | 159 | 171 | 203 | 244 | 449 | 423 | 507 | 380 | 448 | 2984 | 46.44% |
| 3 | 103 | 102 | 190 | 141 | 198 | 175 | 209 | 205 | 281 | 1604 | 24.96% |
| 4 | 40 | 38 | 56 | 37 | 63 | 59 | 58 | 45 | 51 | 447 | 6.96% |
| 5 | 25 | 23 | 23 | 24 | 71 | 36 | 48 | 23 | 28 | 301 | 4.68% |
| 6 | 9 | 8 | 12 | 13 | 9 | 10 | 13 | 8 | 5 | 87 | 1.35% |
| 7 | 14 | 13 | 17 | 24 | 21 | 22 | 27 | 22 | 23 | 183 | 2.85% |
| 8 | 18 | 16 | 11 | 16 | 16 | 11 | 23 | 15 | 18 | 144 | 2.24% |
| 9 | 10 | 12 | 16 | 8 | 12 | 4 | 9 | 7 | 0 | 78 | 1.21% |
| 10 | 5 | 8 | 12 | 9 | 12 | 7 | 9 | 4 | 5 | 71 | 1.11% |
| 11 | 3 | 9 | 3 | 3 | 0 | 7 | 1 | 6 | 1 | 33 | 0.51% |
| 12 | 2 | 4 | 1 | 6 | 6 | 5 | 2 | 9 | 4 | 39 | 0.61% |
| 13 | 8 | 4 | 7 | 7 | 9 | 12 | 16 | 10 | 12 | 85 | 1.32% |
| 14 | 1 | 4 | 9 | 9 | 4 | 8 | 6 | 3 | 9 | 53 | 0.82% |
| 15 | 3 | 7 | 4 | 3 | 1 | 1 | 2 | 1 | 5 | 27 | 0.42% |
| n/a | 13 | 12 | 8 | 2 | 0 | 7 | 1 | 2 | 6 | 51 | 0.79% |
So far in 2025, the majority of opioid-related paramedic responses occurred in Ward 2 (46%) and Ward 3 (25%). The next most common locations include wards 4, 5, 1, and 7.
Source: Hamilton Paramedic Services, extracted October 1, 2025
- In 2025, there were 792 opioid-related emergency room visits up to December 7. September had the highest number of visits, and January had the lowest.
- In 2025, there were 70 opioid-related hospital admissions up to August 31. May had the highest number of visits, and January had the lowest.
Note: There is a 1-week lag for receiving emergency department visit data and a 3-month lag for receiving hospital admission data. The most recent month is incomplete. Data is preliminary and subject to change.
Note: While emergency department and hospitalization data are a useful way to track opioid poisonings, they do not capture every overdose in the community. Many overdoses are managed outside of hospital settings and are not reflected in this data.
Note: Emergency department data reflects visits among Hamilton residents, while hospital admission data reflects those that occur at Hamilton Health Sciences and St. Joseph’s Healthcare Hamilton.
Sources: Ministry of Health and Long-Term Care, National Ambulatory Care Reporting System. Weekly ED visits for opioid overdose. Received December 14, 2025.
Hamilton Health Sciences, Integrated Decision Support. National Ambulatory Care Reporting System. Opioid-related hospitalizations. Received November 10, 2025.
- Naloxone is a medication that reverses the effects of opioid overdose.
- Through Q3 in 2025, Public Health & Naloxone expansion sites distributed 30,312 doses.
- Through Q2 in 2025, Hamilton pharmacies distributed 17,178 doses. Naloxone is available free of charge at many pharmacies.
- In 2024, more than 77,000 doses of naloxone were distributed in Hamilton, which has increased from just over 29,000 in 2018.
Note: Data represents the number of naloxone doses distributed. One kit is equal to 2 doses.
Source: Hamilton Public Health Services, October 27, 2025; Ministry of Health, Health Network System, August 28, 2025
- Fentanyl and xylazine test strips are tools that allow people who use drugs to check for the presence of these toxic substance in the unregulated drug supply.
- In 2025, 1,751 fentanyl test strip kits and 1,615 xylazine test strip kits were distributed in Hamilton.
Note: Each test strip kit contains 5 test strips. The current month of data is incomplete.
Source: NEO360, December 10, 2025
About the Opioid Information System
This system provides timely and locally relevant information to monitor opioid-related harms and guide public health action in Hamilton. The content is organized into five main tabs, each updated on a weekly basis with available data, with varying data lags depending on the source.
Overview
The Overview tab presents a high-level summary of opioid-related trends in Hamilton, including key messages, contextual considerations, and recent drug alerts. This tab is updated weekly.
Deaths
The Deaths tab includes data on both confirmed and suspect drug-related deaths. Confirmed opioid-related deaths are updated monthly with an estimated 4-month data lag. Suspect drug-related deaths—used as an early warning indicator—are updated weekly and reflect more current trends in substance-related mortality.
Paramedic Responses & Hospital Visits
This tab captures health system impacts, including paramedic responses, opioid-related emergency department visits and hospital admissions. Paramedic data is updated weekly. Emergency department data, which is subject to a 1-week data lag is updated weekly, and hospitalization data, with a 3-month lag, is updated quarterly. These indicators reflect patterns in overdose severity and service use.
Naloxone & Drug Test Strips
The Naloxone and Drug Test Strip tab reports on the distribution of naloxone doses through public health, expansion sites, and pharmacies, as well as the dissemination of fentanyl and xylazine test strip kits. These key harm reduction tools help reduce fatal overdoses and detect toxic substances in the unregulated drug supply. Naloxone distribution is updated quarterly, and test strip data is updated monthly.
Data Notes
The Data Notes tab provides essential guidance, including data definitions, known limitations, and clarification of how indicators are measured. This tab supports accurate understanding and use of the system's outputs.
When reviewing the data presented in this system, the following considerations should be kept in mind to support appropriate interpretation and decision-making.
Data timeliness and lags
Although many indicators are updated weekly, there are inherent delays in data availability. For example, confirmed opioid-related deaths are subject to a 4-month data lag due to the time required for coroner investigations and toxicology. Hospitalization data also has a 3-month lag, and even emergency department data may reflect a 1-week delay. Apparent decreases in recent weeks may reflect delays in data processing rather than true declines.
Preliminary and evolving data
Some data, such as suspect drug-related deaths and probable opioid toxicity deaths, are preliminary and may change as investigations are completed. This means trends in recent weeks should be interpreted with caution.
Use trends over time, not isolated points
Week-to-week fluctuations can occur due to reporting delays or small numbers. Interpreting trends over several weeks or months provides a more stable and meaningful picture of opioid-related harms.
Definition and classification differences
Differences in case definitions, data collection methods, and coding practices across sources (e.g., paramedic incidents, hospital visits, coroner reports) may affect consistency. For example, a paramedic incident may be classified as an opioid overdose based on clinical impression but may not result in a confirmed opioid-related death.
Geographic specificity
Some indicators reflect where an event occurred (e.g., paramedic incidents), while others reflect a person’s place of residence. This may affect comparability across data sources. This distinction affects how local patterns are interpreted and should guide decisions about resource allocation or targeted interventions.
Different indicators reflect different stages of harm
Paramedic calls, emergency department visits, hospitalizations, and deaths represent different stages in the severity of overdose events. They should not be viewed as the same measure, but rather as parts of a broader picture. Increases in hospitalizations or deaths can show when overdoses are becoming more severe, which may sometimes be linked to changes in the drug supply.
Health equity data
Opioid-related harms in Hamilton occur within the broader context of social and structural inequities that shape health outcomes. Substance use is not experienced equally across the population, but is influenced by intersecting factors such as poverty, housing instability, and racism. [1]The opioid crisis continues to disproportionately impact equity-deserving populations, including those who are unhoused, Indigenous, and racialized.[2][3] Stigma, discrimination and systemic gaps create barriers to prevention of substance use and access to harm reduction services, care, and treatment.
While some geographic analyses are included (e.g., by FSA or ward), broader sociodemographic data beyond age and sex (e.g., income, race, housing status) are not consistently available across datasets, limiting the ability to fully assess equity impacts at the local level.
Under detection of non-opioid substances
The focus on opioids may underrepresent the contribution of other toxic substances, such as xylazine or benzodiazepines, particularly in suspect drug-related deaths where full toxicology results are pending or not available.
[1] Amaro H, Sanchez M, Bautista T, Cox R. Social vulnerabilities for substance use: Stressors, socially toxic environments, and discrimination and racism. Neuropharmacology [Internet]. 2022 May 1 [cited 2025 Jul 28]; 188: 108518. DOI: 10.1016/j.neuropharm.2021.108518
[2] Alsabbagh W, Cooke M, Elliot S J, Chang F, Shah N-U-L, Ghobrial M. Stepping up to the Canadian opioid crisis: A longitudinal analysis of the correlation between socioeconomic status and population rates of opioid-related mortality, hospitalization, and emergency department visits (2000-2017). HPCDP Journal [Internet]. 2022 June. [cited 2025 Jul 28]; 42(6). DOI: 10.24095/hpcdp.42.6.01
[3] Laballey J, Kastor S, Valleriani J, McNeil R. Reconciliation and Canada’s overdose crisis: Responding to the needs of Indigenous Peoples. CMAJ [Internet]. 2018 Dec 17 [cited 2025 Jul 28]; 190(50): E1466-E167. DOI: 10.1503/cmaj.181093
The following data sources are used to compile the indicators in this system. Each source contributes unique information across the spectrum of opioid-related harms, from emergency response to fatal outcomes.
Hamilton Paramedic Services
Provides weekly data on suspected opioid overdose incidents attended by paramedics in Hamilton. Data are based on clinical impressions and recorded at the time of service. This source is used for real-time monitoring of overdoses in the community.
Hamilton Public Health Services, Mental Health & Harm Reduction Program
Supplies data on naloxone and test strip kit distribution through public health and naloxone expansion sites. These indicators reflect community-level harm reduction efforts and are updated weekly.
Ministry of Health (MOH), Drugs and Devices Division – Health Network System
Reports naloxone distribution through pharmacies in Hamilton. This data is used to capture access to naloxone via healthcare settings and complements the public health distribution data.
Ministry of Health and Long-Term Care, National Ambulatory Care Reporting System. Provides emergency department (ED) visit data related to opioid poisoning. ED data are updated weekly with a one-week lag.
Hamilton Health Sciences, Integrated Decision Support. National Ambulatory Care Reporting System. Provides hospitalization data related to opioid poisoning. hospitalization data are updated quarterly with a three-month lag.
Office of the Chief Coroner of Ontario
Supplies data on both confirmed and suspect drug-related deaths. Confirmed opioid-related deaths are based on toxicology and coroner investigation findings (with a four-month lag), while suspect deaths are used as early warning indicators and updated weekly.
Public Health Ontario Interactive Opioid Tool
Offers contextual data for comparing Hamilton’s opioid-related death rates to the provincial average. Data extracted from this tool are used to understand regional differences and trends over time.
Opioids: A class of drugs that are chemicals, natural or synthetic, that interact with nerve cells that have the potential to reduce pain. They can become addictive because they not only dull pain, but also produce a sense of euphoria.
Naloxone: Naloxone is a fast-acting medication used to temporarily reverse the effects of opioid overdoses, also called an opioid poisoning.
Suspect drug-related deaths: Deaths where the coroner indicated that they suspect the death may be drug-related based on preliminary investigation (e.g. drugs or drug use equipment were found at the scene, history of drug use or naloxone use, physical signs of drug use, etc.). These deaths exclude death associated with trauma (e.g. injuries) and medical assistance in dying cases.
Probable opioid toxicity deaths: Suspect drug-related deaths where conclusions on cause of death are pending, and toxicology is positive for opioids.
Confirmed opioid toxicity deaths: Deaths for which a coroner or forensic pathologist determined the cause of death to be drug toxicity with opioid involvement. These may include drug toxicity deaths involving multiple substances.
Forward Sortation Area: A way to designate a geographical unit based on the first three characters in a Canadian postal code.
Paramedic incident related to suspected opioid overdose: An emergency response by Hamilton Paramedic Services to a suspected opioid overdose, based on signs and symptoms observed at the scene. These incidents are identified through standardized coding and clinical impression documented by paramedics at the time of the call.
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