Sentinel Surveillance of Substance Use-related Injuries and Poisonings in Canada Published: (2020-06-30)

Substance use-related poisonings and injuries in Canada have received increasing attention in recent years, due to emerging public health threats most notably associated with the opioids overdose crisis, cannabis use, and the emergence of electronic cigarettes on the Canadian market.

This data blog is the first within a series presenting statistics on substance use-related injuries and poisonings reported by the Canadian Hospitals Injury Reporting and Prevention Program.

This first data blog synthesizes key findings from recent and forthcoming surveillance studies based on analyses of the eCHIRPP. Subsequent data blogs will present near-real time eCHIRPP statistics on a variety of substances at regular intervals throughout 2020-2021.

Opioids

Context: Between January 2016 and December 2019 there were more than 15,300 apparent opioid-related deaths in Canada, and 72% of deaths involved one or more types of non-opioid substances^{Footnote 1}. Many fatal overdoses result from the illegal drug supply containing highly toxic synthetic opioids like fentanyl and fentanyl analogue^{Footnote 2}. Between January 2016 and December 2019, 19,377 opioid-related poisoning hospitalizations occurred in Canada (excluding Quebec)^{Footnote 1}. There is little evidence that the crisis is abating. More information on the actions taken by the Government of Canada to address the opioid crisis can be found under Federal Actions on Opioids-Overview^{Footnote 3}.

What we know from a CHIRPP study ^{Footnote 4} on opioids :

• Between March 2011 and June 2017, 583 suspected opioid-related poisoning/injury cases were identified in eCHIRPP.
• Recreational use of opioids was most common among adults.
• Compared to all types of injuries reported in the eCHIRPP database, opioid-related cases were more likely to:
  • be among females
  • be self-harm
  • have occurred at home or in a residential institution
  • have occurred between 12:00 a.m. and 7:59 a.m.
  • have resulted in observation in the emergency room
  • have resulted in a hospital admission.
• The most common factor contributing to opioid-related poisoning among young children (aged <5 years) was access to medication combined with lack of supervision (e.g. an unsupervised child found pills).
• Suicide attempt accounted for the largest proportion of cases in youth aged 10 to 19 years (33%), followed by older adults aged 50 years and older (28%) and adults aged 20 to 49 years (9%).

Methamphetamine

Context: Use of methamphetamine, a highly addictive stimulant that can have harmful effects on the central nervous system^{Footnote 5Footnote 6}, is also an emerging public health issue alongside the opioids overdose crisis. There has been an increase in the availability, use and harms associated with methamphetamine use across Canada in the last 10 years^{Footnote 7}.

What we know from a CHIRPP study^{Footnote 5}on methamphetamine :

• Between April 1, 2011 and August 9, 2019, 1,093 patients (97.6 per 100,000 eCHIRPP cases) with methamphetamine-related injuries and poisonings were identified in eCHIRPP.
• Of these, 649 (59.4%) were male. Among those aged 10 to 14 and 15 to 19 years, females accounted for the majority of cases (71.4% and 63.7%, respectively). Of those aged 20 years and older, males accounted for 70.4% of cases.
• Just over a third of cases (n=404, 37%) involved methamphetamine use on its own. Of the 689 cases where additional substances were involved, 40.9% involved using two or more other substances with methamphetamine.
• When only one other substance was used with methamphetamine, the distribution was:
  • alcohol (24.4%)
  • cannabis (10.7%)
  • cocaine (7.7%)
  • heroin (5.4%)
  • opiates (3.6%)
  • other substances (e.g. LSD, ecstasy, psychoactive medications) (7.3%)
• Among the 1,093 patients identified, there were a total of 1,389 injuries and poisonings (27.1% had multiple injuries).
  • Multiple injuries occurred more frequently in males (32.8% vs. 18.7% for females; p <.001)
  • More poisonings were seen in female patients (71% vs. 57.4% for males; p <.001)
  • Multiple injuries were seen more frequently in male patients (32.8% vs. 18.7% for females; p <.001).

Cannabis

Context: The prevalence of cannabis use has increased in Canada in recent decades, including since the legalization of non-medical cannabis use in 2018^{Footnote 8}. Cannabis edible products and concentrates have been legal for sale in Canada as of October 17, 2019^{Footnote 9}. Adverse health outcomes of cannabis use are known to include fatal and non-fatal injuries from motor vehicle collisions involving cannabis-related impairment^{Footnote 10}; acute ingestions among children causing altered levels of consciousness and other symptoms^{Footnote 11}; and in adults, gastrointestinal ailments, intoxication and psychiatric symptoms, among others^{Footnote 12}.

What we know from a CHIRPP study^{Footnote 8} on cannabis:

• Between April 1, 2011 and August 9, 2019, there were 2,823 cannabis-related cases reported in eCHIRPP (252.3 cases per 100,000 eCHIRPP cases). Nearly two-thirds of these (63.1%) involved cannabis in combination with one or more other substances (polysubstance use). Approximately one-third of cases involved cannabis alone (31.3%), and cannabis edibles were reported among 5.6% of cases.
• Cases ranged from 0 to 79 years of age. Children ≤17 years of age represented the majority (67.8%) of cannabis-related cases.
• For all cannabis categories combined (cannabis alone, polysubstance use, and edibles), males represented a higher proportion of cases across all age groups with the exception of females aged 10 to 14 years, who were near equal to males at 50.3%.
• Significant increases in annual percent change (APC) were identified in the study period. Overall, there was a 30.1% APC between 2015 and 2018. A 27.9% annual percent change (APC) was noted among adults between 2013 and 2018, and among children there was a 35.6% APC between 2016 and 2018.

E-cigarettes and vaping substances

Context: Vaping is the use of an electronic cigarette (e-cigarette) or similar device to inhale vapour produced by heating vaping liquid or 'e-juice' which can contain nicotine^{Footnote 13Footnote 14} and/or tetrahydrocannabinol (THC)^{Footnote 14}. Research has also shown e-cigarettes are being used by some to deliver other substances such as methamphetamine and heroin^{Footnote 15Footnote 16}. Prevalence of vaping has also been on the rise in Canada in recent years. It is more prevalent in youth than adults aged 25 and over, and prevalence among youth has increased^{Footnote 17Footnote 18Footnote 19}. One study reported the prevalence of vaping among adolescents aged 16 to 19 years, nearly doubled between 2017 and 2018^{Footnote 19}. Since the emergence of electronic cigarettes on the Canadian market in 2018 there have been new injuries^{Footnote 20}. Children have been poisoned by ingesting vaping liquid as it is often flavoured^{Footnote 21Footnote 22Footnote 23}, and packaging of e-liquids also look very similar to snacks for children, increasing their appeal^{Footnote 24}.There are also reports of vaping device malfunctions such as overheating batteries causing explosions and burns^{Footnote 22}. More recently, vaping-associated lung illness has emerged as a new public health threat^{Footnote 25}.

What we know from a CHIRPP study^{Footnote 22} on e-cigarettes and vaping :

• Between April 1, 2011 and October 4, 2019, there were 68 cases of injury or poisoning related to e-cigarette use or vaping reported in eCHIRPP. Of these cases, 37 (54.4%) were males.
• Just over half of the cases (52.9%) were children under the age of five who either inhaled from the device or ingested the vaping liquid.
• Two adults were injured/burned when the battery of their e-cigarette exploded in their pockets.
• There were three reported traumatic brain injuries resulting from falls that occurred after vaping.
• More than half of the cases (n=35, 51.5%) occurred in 2018 and 2019. Between 2013 and 2019, there was an annual percent change (APC) of 50.7% (95% CI: 15.9–96.1).

More about the data source

CHIRPP is an injury and poisoning sentinel surveillance system currently operating in the emergency departments of 11 paediatric and nine general hospitals across Canada^{Footnote 26Footnote 27}. It collects patients’ accounts of pre-event injury circumstances (“What happened?”), and clinical information is added to the data collection form by hospital staff^{Footnote 26Footnote 27}. The CHIRPPcaptures 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 27}.

The results from CHIRPP presented above should be interpreted with caution as they do not represent all substance use-related injuries and poisonings in Canada. CHIRPP is a sentinel surveillance system and collects data from select emergency departments across Canada. Teenagers older than 18 years of age, Aboriginal persons 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.