Sentinel Surveillance of Substance-Related Poisonings in Canada: Spotlight on Methamphetamine Published: ()
Key findings
- Of all poisoning cases reported in the electronic Canadian Hospitals Injury Reporting and Prevention Program (eCHIRPP) database, 41% of poisoning cases involved at least one of the following substances: alcohol, cannabis, methamphetamine, opioids, cocaine, and e-cigarette/ vaping products.
- Alcohol was the most commonly reported substance.
- Where the use of more than one substance was reported, the most frequent combination was alcohol with cannabis.
- Among substance-related poisonings, adults aged 20 years and older represented a rate of 2,963 cases per 100,000 eCHIRPP records, compared to children and youth aged 0 to 19 years at 714 cases per 100,000 eCHIRPP records.
- Hospital admission was required for 8% of all substance-related poisoning cases compared to 6% of methamphetamine-related poisonings.
- Intentional self-harm (including suicide attempt) was reported among 21% of all substance-related poisoning cases, compared to 18% of methamphetamine-related poisoning cases (including polysubstance use).
Substance-related poisonings and injuries in Canada have received increasing attention in recent years due to emerging public health threats, such as the opioids overdose crisis, the introduction of potent synthetic cannabinoids to the illicit market and the emergence of electronic cigarettes on the Canadian market. The surveillance of injuries and poisonings by Canadian Hospitals Injury Reporting and Prevention Program (CHIRPP) and other initiatives have continued throughout the COVID-19 pandemic, and future surveillance studies will consider its impacts on the burden of substance-related poisonings and other contexts.
This data blog presents statistics on poisonings from select substances, and includes a spotlight on methamphetamine, a substance also commonly referred to as crystal meth, speed or crank. It is the third in a data blog series presenting statistics on substance-related poisonings reported by CHIRPP. The first data blog presented key findings from surveillance studies based on analyses of the electronic CHIRPP database (eCHIRPP), and the second data blog presented statistics on poisonings from select substances, and included a spotlight on opioids.
Subsequent data blogs will present timely eCHIRPP statistics on a variety of substances throughout 2021, and more detailed scientific papers are also planned. This work helps to shed light on substance-related harms in Canada and complements information from other data sources. More information on opioid- and stimulant-related harms in Canada is available. .
Methamphetamine use and hospitalizations in Canada
Methamphetamine is a powerful synthetic stimulant, and its use can have lethal consequences.Footnote 1Footnote 2 Poor physical and mental health outcomes have also been documented, particularly when methamphetamine is used frequently. These include a fast and irregular heart beat, increased breathing, restlessness, anxiety and psychosis.Footnote 1 Footnote 3 According to the Canadian Tobacco, Alcohol and Drugs Survey, the prevalence of past-year use of methamphetamine among the general public in 2015 was 0.2%Footnote * [95% confidence interval: 0.1–0.3%], representing approximately 59,000 Canadians aged 15 years or older (excluding residents of the country’s territories).Footnote 4
In fiscal year 2018-2019, of all hospitalizationsFootnote ** associated with substance-related harms among Canadians aged 10 years and older, it was estimated that 12.9% were caused by stimulants (excluding cocaine), which include methamphetamine.Footnote 5 Among youths, Canadians in the 18 to 24-year age group represented higher hospitalizations associated with stimulants (excluding cocaine)Footnote 6 reflecting the need for targeted public health interventions.
More information on problematic substance use and related initiatives taken by the Government of Canada is available.
What we know about substance-related poisonings from eCHIRPP
How cases were identified
A search in the eCHIRPP database was conducted to select all unintentional and intentional cases that were recorded up to and including October 31, 2020 with an injury date of April 1, 2011 onward, and where the first (most severe) diagnosis was a poisoning (N = 39,877, representing 2.9% of eCHIRPP records).
Among those, poisoning cases related to alcohol, cannabis, methamphetamine, opioids (including codeine, oxycodone, morphine, heroin, fentanyl, and others), cocaine, and e-cigarette/vaping products were then identified using bilingual search terms.
How many substance-related poisoning cases were there, and what was the distribution of the substances used?
Overall, 40.8% of poisoning cases (16,289 out of 39,877 poisoning cases) involved at least one of the following substances: alcohol, cannabis, methamphetamine, opioids, cocaine, and e-cigarette/ vaping products. This equalled to 1.2% of all eCHIRPP records during the study period.
Alcohol was the most commonly reported substance, and the ranking of all six substances is as follows:
- Alcohol (n = 11,579, 71.1% of cases)
- Cannabis (n = 3,325, 20.4% of cases)
- Opioids (n = 2,009, 12.3% of cases)
- Methamphetamine (n = 1,941, 11.9% of cases)
- Cocaine (n = 1,148, 7.1% of cases)
- E-cigarette/vaping products (n = 127, 0.8% of cases)
Note that these percentages do not add to 100% because many patients reported using more than one substance at a time (polysubstance use).
Sex and age
Sex and age statistics are presented as rates in relation to all cases in the eCHIRPP database.
Among all substance-related poisonings (including those involving methamphetamine), females represented 1,240.7 cases per 100,000 eCHIRPP records compared to males at 1,123.0 cases.
Among methamphetamine-related poisonings (including polysubstance use), males represented 153.6 cases per 100,000 eCHIRPP records, compared to females at 122.3 cases.
Among substance-related poisonings (including those involving methamphetamine) adults aged 20 years and older represented a rate of 2,963.0 cases per 100,000 eCHIRPP records, compared to children and youth aged 0 to 19 years at 714.4 cases. The rates for each age group are presented in Table 1.
| Age group | Number of cases | Cases/100,000 eCHIRPP records |
|---|---|---|
| 0 to 19 years | 7,888 | 714.4 |
| 0 to 4 years | 587 | 159.0 |
| 5 to 9 years | 94 | 37.0 |
| 10 to 14 years | 1,898 | 611.6 |
| 15 to 19 years | 5,309 | 3,210.1 |
| 20+ years | 8,389 | 2,963.0 |
| 20 to 29 years | 2,288 | 3,167.9 |
| 30 to 39 years | 2,057 | 4,231.1 |
| 40 to 49 years | 1,592 | 3,928.1 |
| 50 to 64 years | 1,865 | 3,024.4 |
| 65+ years | 587 | 976.9 |
| Total*** | 16,277 | 1,174.0 |
Regarding methamphetamine-related poisonings among children vs. adults, adults aged 20 years and older represented a rate of 510.4 cases per 100,000 eCHIRPP records, compared to children and youth aged 0 to 19 years at 44.2 cases. Rates for each age group are presented in Table 2.
| Age group | Number of cases | Cases/100,000 eCHIRPP records |
|---|---|---|
| 0 to 19 years | 488 | 44.2 |
| 0 to 9 years | 18 | 2.9 |
| 10 to 14 years | 79 | 25.5 |
| 15 to 19 years | 391 | 236.4 |
| 20+ years | 1,445 | 510.4 |
| 20 to 29 years | 477 | 660.4 |
| 30 to 39 years | 530 | 1090.2 |
| 40 to 49 years | 275 | 678.5 |
| 50 to 64 years | 153 | 248.1 |
| 65+ years | 10 | 16.6 |
| Total*** | 1,933 | 139.3 |
When considering age and sex together, among all substance-related poisonings (including those involving methamphetamine) males aged 30 to 39 years represented a rate of 4,390.2 cases per 100,000 eCHIRPP records, followed by males aged 40 to 49 years at 4,361.3 cases and females aged 15 to 19 years at 4,215.0 cases per 100,000 eCHIRPP records.
Among methamphetamine-related poisonings (including polysubstance use), males aged 30 to 39 years represented a rate of 1,241.0 cases per 100,000 eCHIRPP records, followed by females aged 30 to 39 years at 851.3 cases and males aged 40 to 49 years at 836.6 cases per 100,000 eCHIRPP records.
What level of in-hospital treatment was needed?
Hospital admission was required for 8.3% of all substance-related poisoning cases (including those involving methamphetamine), compared to 6.1% of methamphetamine-related poisonings (including polysubstance use).
Where did the substance-related poisonings happen?
Location information was unknown in 45.3% of all substance-related poisoning cases. Among cases where location was known (n = 8,909), the most commonly reported location of substance-related poisonings was at a private residence, either the patient’s own home (41.5%, n = 3,696) or someone else’s home (14.5%, n = 1,296).
Location information was unknown in 65.3% of methamphetamine-related cases. Among cases where location was known (n = 673), just over half of methamphetamine-related poisonings occurred at a private residence, either at the patient’s own home (39.4%, n = 265) or someone else’s home (13.7%, n = 92).
How common was using more than one substance at a time?
The use of more than one substance at a time (polysubstance use) was reported in 20.0% (n = 3,262) of substance-related poisonings cases. The following top three polysubstance use combinations each involved two substances:
- Alcohol with cannabis, in 37.3% (n = 1,217) of polysubstance use cases (and in 7.5% of all substance-related poisonings).
- Alcohol with methamphetamine, in 12.3% (n = 401) of polysubstance use cases (and in 2.5% of all substance-related poisonings).
- Alcohol with cocaine, in 11.5% (n = 374) of polysubstance use cases (and in 2.3% of all substance-related poisonings).
What proportion of cases were intentional self-harm?
Intentional self-harm (including suicide attempt) was reported among 21.3% of all substance-related poisoning cases (including those involving methamphetamine), compared to 18.2% of methamphetamine-related poisoning cases (including polysubstance use).
What was the intent of using only methamphetamine, vs. combined with other substances?
Among methamphetamine cases, intent was determined in 57.7% (n = 1,119) of cases. The remaining cases were coded as “Event of undetermined intent”. When considering intent alongside methamphetamine without other substances vs. methamphetamine in combination with other substances, the top three most common circumstances reported for both groups were:
Methamphetamine without other substances:
- Undetermined intent at 17.9% of all cases (n = 348).
- Unintentional poisoning at 17.5% of all cases (n = 338)
- Intentional self-harm including suicide attempt at 7.6% of all cases (n = 146)
Methamphetamine in combination with other substances:
- Undetermined intent at 24.3% of all cases (n = 470).
- Unintentional poisoning at 20.4% of all cases (n = 395)
- Intentional self-harm including suicide attempt at 10.6% of all cases (n = 205)
More about the data source
CHIRPP is an injury and poisoning sentinel surveillance system currently operating in the emergency departments of 11 paediatric and ten general hospitals across Canada. It collects patients’ accounts of pre-event injury circumstances (“What happened?”), and clinical information is added to the data collection form by hospital staffFootnote 7Footnote 8 CHIRPP captures a more complete picture of the injury event than hospital administrative or mortality data alone, and also identifies less serious injury cases that do not require hospitalization.Footnote 7
This study does not represent all substance-related poisonings in Canada, because CHIRPP operates at select Canadian hospitals, and because this study focussed only on select substances where a poisoning was the most severe diagnosis (in the event of other injuries besides poisoning having been sustained, or the only diagnosis). Adults older than 18 years of age, Indigenous peoples including Inuit, Metis and First Nations, and people who live in rural areas may be under-represented in the eCHIRPP database, as most CHIRPP sites are paediatric hospitals located in major cities. Fatal injuries are also under-represented in the eCHIRPP database because the emergency department data do not capture people who died before they could be taken to hospital or those who died after being admitted via another department. Information is continuously being entered into the eCHIRPP database; therefore, some years do not yet have complete data.