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National Report: Apparent Opioid-related Deaths in Canada Published: (April 2019)
The opioid crisis has affected every part of the country, but there are clear differences in death rates and the substances involved across provinces and territories. The national-level key findings below are based on available data reported as of March 5, 2019. It is expected that these numbers will change as additional data become available.
More than 10,300 apparent opioid-related deaths occurred between January 2016 and September 2018:
- 3,017 deaths occured in 2016, 4,034 occured in 2017
- 3,286 deaths occured between January and September 2018; 93% were accidental (unintentional)
For more details about apparent opioid-related mortality please click here.
Sex and age group trends
Between January and September 2018:
- Most accidental apparent opioid-related deaths occured among males (75%); however this varied by province or territory
- Age group patterns also vary by region; however, the vast majority of deaths were among young and middle aged adults
For more details about sex and age group trends please click here.
Fentanyl and other fentanyl-related substances continue to be a major driver of this crisis:
- From January to September 2018, 73% of accidental apparent opioid-related deaths involved fentanyl or fentanyl analogues
For more details about fentanyl-related opioid mortality please click here.
Canada continues to experience a serious opioid crisis. Across the country, it is having devastating effects on families and communities. The Public Health Agency of Canada works closely with the provinces and territories to collect and share data on apparent opioid-related deaths. Accurate information about the crisis is needed to help guide efforts to reduce opioid-related harms and deaths.
The data in this report are updated four times a year and may change based on review and refinement.
Apparent opioid-related deaths in Canada
The opioid crisis has affected every part of the country, but some provinces and territories have been impacted more than others. According to data reported as of March 5, 2018:
- there were 10,337 apparent opioid-related deaths between January 2016 and September 2018
- in 2016, there were 3,017 apparent opioid-related deaths (corresponding to a death rate of 8.4 per 100,000 population) and 4,034 in 2017 (corresponding to a death rate of 11.1 per 100,000 population)
- from January to September 2018, there were 3,286 apparent opioid-related deaths, corresponding to a death rate of 11.8 per 100,000 population (Figure 1, Table 1)
Apparent opioid-related deaths by manner of death
The following section presents summary data on apparent opioid-related deaths according to the manner of death assigned by the coroner or medical examiner during, or following an investigation (Table 1). Collecting data on how deaths occurred, including whether they were intentional or not, is critical in understanding how the opioid crisis is affecting Canadians.
Accident: Deaths with completed investigations where the coroner or medical examiner determined that the death was unintentional. This category also includes deaths with ongoing investigations where the manner of death was believed to be unintentional or had not been assigned at the time of reporting.
Suicide: Deaths with completed investigations where the coroner or medical examiner determined that the opioids were consumed with the intent to die. This category also includes deaths with ongoing investigations where suicide was believed to be the manner of death at the time of reporting.
Undetermined: Deaths with completed investigations where a specific manner of death (e.g. accident, suicide) could not be assigned based on available or competing information.
According to available data reported as of March 5, 2019, most (93%) apparent opioid-related deaths between January and September 2018 were accidental (unintentional), similar to both 2016 (88%) and 2017 (93%) (Table 1).
In other words, these data indicate that the vast majority of apparent opioid-related deaths were of individuals who did not intend to die. This distinction is important to inform an appropriate public health response. For example, the high percent of unintended deaths reinforces the concern that a variety of street drugs are tainted with toxic substances, such as fentanyl, without the knowledge of the people consuming them. Public health officials will be able to use this information in developing strategies to address these hidden risks in order to reduce harms and effectively prevent unintended apparent opioid-related deaths.
Accidental apparent opioid-related deaths
The following section provides detailed information on accidental apparent opioid-related deaths, which are deaths with completed investigations where the coroner or medical examiner determined that the death was unintentional. This category also includes deaths with ongoing investigations where the manner of death was believed to be unintentional or had not been assigned at the time of reporting.
Sex and age trends of accidental apparent opioid-related deaths
This crisis has affected Canadians from all walks of life; however, available data reported as of March 5, 2019 indicate that the impact of the crisis differs by sex, and age.
Although these trends vary by province or territory, at the national level:
- most (75%) accidental apparent opioid-related deaths from January to September 2018 occurred among males, similar to previous trends observed in 2016 and 2017 (Figure 2)
- from January to September 2018, most accidental apparent opioid-related deaths were among young and middle aged adults; the highest percent (27%) occurred among individuals between the ages of 30 and 39; 20% were between 20 and 29 years, 21% were between 40 and 49 years and 21% were between 50 and 59 years (select age group in Figure 2 demographic drop-down list)
Fentanyl, fentanyl analogues, and other substances involved in accidental apparent opioid-related deaths
Apparent opioid-related deaths often involveApparent opioid-related death involving fentanyl and other substances footnote a multiple substances including one or more opioids as well as non-opioid substances. Knowing the opioid and non-opioid substances involved in these deaths can help public health officials and other government agencies communicate risks and target harm reduction efforts.
Although regional variation exists, available data reported as of March 5, 2019, suggest that:
- between January and September 2018, 73% of accidental apparent opioid-related deaths involved fentanyl or fentanyl analogues (Figures 3a and 3b)
- the number of accidental apparent opioid-related deaths involving fentanyl or fentanyl analogues was similar between January and September 2018 (2,097) compared to the same time period in 2017 (1,995).Apparent opioid-related death involving fentanyl and other substances footnote b The number of accidental apparent opioid-related deaths involving fentanyl or fentanyl analogues more than doubled in January to September 2017 compared to the same time frame in 2016 (856) (Figure 3b)Apparent opioid-related death involving fentanyl and other substances footnote b.
In addition, available data suggest approximately 75% of accidental apparent opioid-related deaths between January 2016 and September 2018Apparent opioid-related death involving fentanyl and other substances footnote c also involved one or more types of non-opioid substances.
Considerations and Limitations
Definition of an apparent opioid-related death
An apparent opioid-related death is a death caused by an intoxication/toxicity (poisoning) resulting from substance use, where one or more of the substances is an opioid, regardless of how it was obtained (e.g. illegally or through personal prescription).
How apparent opioid-related deaths are counted
Counts are provided by the provinces and territories that collect data from their respective offices of Chief Coroners or Medical Examiners. Rates are calculated using the most current population data from Statistics Canada.
The data provided by the provinces and territories can include deaths:
- with completed or ongoing investigations
- where manner of death is classified as accident, suicide, or undetermined
These data do not include deaths due to:
- the medical consequences of long term substance use or overuse (for example, alcoholic cirrhosis)
- medical assistance in dying
- trauma where use of the substance(s) contributed to the circumstances of the injury that lead to the death, but was not directly involved in the death
However, some provincial and territorial differences remain in the type of data reported and in the time periods for which data are available (refer to Table 3).
|BCTable 3 Footnote 1||AB||SK||MB||ONTable 3 Footnote 2||QCTable 3 Footnote 3||NB||NS||PE||NLTable 3 Footnote 4||YT||NT||NUTable 3 Footnote 5|
|Reporting period (as of February 20, 2019)|
|2016||January to December||(C)||(C)||(C)||(C)||(C)|
|2017||January to December||(C)||INC||(C)||(C)||(C)|
|2018||January to March||(C)||(C)||(C)||(C)|
|2018||April to June||(C)||(C)||(C)||(C)|
|2018||July to September||(C)||(C)||(C)||(C)|
|Classification of deaths included in the reported data|
|Ongoing investigations where manner of death was believed to be unintentional||-||N/A||-||N/A||N/A||N/A||N/A|
|Ongoing investigations where manner of death had not been assigned at the time of reporting||-||N/A||N/A||N/A||-||-||N/A|
|Ongoing investigations where the manner of death was believed to be suicide||N/A||N/A||-||N/A||N/A||N/A||N/A||N/A|
|Deaths with completed investigations and an undetermined manner of deathTable 3 Footnote 6||N/A||N/A|
The suppression of data in this report are based on the preferences of individual provinces or territories to address concerns around releasing small numbers for their jurisdiction.
- Prince Edward Island suppressed counts between one and four for quarterly data, and for any data related to sex or age distribution.
- Newfoundland and Labrador suppressed counts between one and four for quarterly data, and data related to substances involved and sex or age distribution.
- Quebec suppressed counts less than five for deaths with ongoing investigations (July 2017 to September 2018).
- Nunavut suppressed all counts less than five.
In addition, suppression was applied in some instances where all data for a province or territory fell in a single category of a given table or figure.
Opioids and other substances
Fentanyl and fentanyl analogues include, but are not limited to:
- cyclopropyl fentanyl
- fluoroisobutyrlfentanyl (FIBF)
Non-fentanyl-related opioids include, but are not limited to:
- buprenorphine metabolites
Non-opioid substances include, but are not limited to:
Limitations of these apparent opioid-related deaths data
Data presented in this report should be interpreted with caution.
- This report is based on data submitted to the Public Health Agency of Canada on or before March 5, 2019. New or revised data reported after this date will be reflected in future reports.
- Data released by provinces and territories may differ from the data provided in this report due to the availability of updated data, differences in the type of data reported (e.g. manners of death), the use of alternate age groupings, differences in time periods presented and/or population estimates used for calculations, etc.
- As some data are based on ongoing investigations by coroners and medical examiners, they are considered preliminary and subject to change. The time required to complete an investigation and related administrative processes is case-dependent and can range from approximately three to twenty-four months.
- This report is based on data that do not specify how the opioids were obtained (e.g. illegally or through personal prescription); the level of toxicity may differ depending on the opioid (substance(s) involved, concentration, and dosage).
- Jurisdictional differences in the death investigation process, death classification method, toxicology testing, and the manners of death reported may impact the interpretation and comparability of the data presented in this report.
- Information related to changes over time at the national level is based only on jurisdictions where data were available for all time periods of interest.
- Rates reported here have not been adjusted for existing differences in provincial and territorial age distributions.
- Rates for jurisdictions with relatively smaller populations may change substantially with even slight changes in the number of deaths. As a result, comparisons over time and between provinces and territories should be interpreted with caution.
Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: Apparent opioid-related deaths in Canada (January 2016 to September 2018). Web Based Report. Ottawa: Public Health Agency of Canada; April 2019. https://health-infobase.canada.ca/datalab/national-surveillance-opioid-mortality.html
This report would not be possible without the collaboration and dedication of provincial and territorial (PT) offices of Chief Coroners and Medical Examiners as well as PT public health and health partners.
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