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A man prepares to inject himself with heroin at a supervised injection site in the Downtown Eastside of Vancouver, B.C., on Oct. 25, 2016.DARRYL DYCK/The Globe and Mail

Toronto police are warning the public about a sudden spike in suspected fentanyl overdoses throughout the city's downtown core.

On Saturday afternoon, city police attributed four deaths and 20 overdoses to the potent opioid over the previous three-day period.

Throughout the weekend, Toronto Public Health increased its distribution of naloxone, the opioid reversal agent. "We had two vans out, in addition to responding to regular calls, our staff are focusing efforts on connecting people in the downtown core to ensure they have naloxone," Eileen de Villa, Toronto's medical officer of health, said in an e-mailed statement.

The first reported victim, a 27-year-old man, died on Thursday, according to police. Investigators suspect he bought fentanyl-laced heroin in the Yonge and Dundas area of the city. He later died near the intersection of Queen Street West and Bathurst Street.

On Friday, a second man died within blocks of the first. And on Saturday, a woman was discovered in a Moss Park-area stairwell. First responders pronounced her dead on the scene. Police released no details about the fourth death.

Constable Craig Brister said only a lengthy testing process can confirm definitively whether the overdoses are related, but all exhibited similarities.

Toronto Public Health issued an alert about the overdoses on Friday, noting the particular toxicity of the street drug in question. "Some people who overdosed were thought to be tolerant opioid users," it stated. "Some people had injected, and some had snorted the drug."

Public health officials are urging drug users to carry naloxone and to use drugs only in the presence of another person.

The number of deaths related to fentanyl has risen rapidly in Toronto over recent years, but has yet to reach the high rates being recorded in Vancouver. Between 2008 and 2015, the number of yearly fentanyl-related deaths in Toronto rose from zero to 42. In the first five months of 2017, the BC Coroners Service attributed 121 deaths in the Vancouver area to fentanyl.

Earlier this year, Toronto released its Overdose Action Plan, which recommends a series of steps to improve the response to the overdose outbreaks. The document calls for the creation of three supervised drug-use sites. The first of those is expected to open this fall.

The Action Plan also called on local hospitals and other stakeholders to produce up-to-date data on overdose admissions. The most recent available figures show there were 358 emergency-room visits owing to substance use in the week ending July 2, the highest weekly total so far recorded. The number includes visits related to intoxication, addiction, overdose and withdrawal.

In March, police and public health officials in Southern Ontario issued warnings about the arrival of carfentanil in regional street drugs. The substance is used as an elephant tranquillizer and is said to be 10,000 times stronger than morphine.

"We continue to be extremely concerned about the number of people we are losing to overdoses," Dr. de Villa said. "These deaths are preventable and this issue is having a devastating impact on individuals, families and communities."

At the Sunshine Coast Health Centre in Powell River, B.C., men in treatment for addiction say stigma about substance abuse make it harder to get help. One client says men at the facility are trying to 'become good people again.'

The Canadian Press

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