Opioid- and Stimulant-related Harms in Canada Published: (December 2021)

Context

The COVID-19 outbreak is worsening the already deadly and ongoing public health crisis of opioid overdoses and death. It is having a tragic impact on people who use substances, their families, and communities across Canada. People who use substances, such as opioids, cocaine, and methamphetamine, are experiencing a number of increased risks, with several jurisdictions reporting higher rates of fatal overdoses and other harms.

These updates include available data on overdoses and deaths involving opioids and/or stimulants from January 2016 to June 2021, where available. Recognizing that harms related to opioids, stimulants, and other substances extend beyond overdoses (poisonings) and deaths, we continue to work with federal, provincial and territorial partners to build a broad understanding of harms and substances involved to better respond to the crisis. Additional studies can also help us plan and tailor actions to achieve better possible outcomes.

Deaths Download mortality report in .pdf format

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24,626 apparent opioid toxicity deaths between January 2016 and June 2021Footnote 1Footnote 2

  • 1,720 apparent opioid toxicity deaths occurred between April and June 2021 (approximately 19 deaths per day), similar to the period from January to March 2021 (1,792 deaths), but representing a 2% increase compared to April to June 2020 (1,680 deaths) and a 66% increase compared to April to June 2019 (1,038 deaths).
  • A number of factors have likely contributed to a worsening of the overdose crisis over the course of the pandemic, including the increasingly toxic drug supply, increased feelings of isolation, stress and anxiety and limited availability or accessibility of services for people who use drugs.
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Majority of deaths in British Columbia, Alberta and Ontario; increases observed in other regions

  • While rates continue to remain high in Western Canada, increases have been observed in other regions such as Ontario and Yukon. Several jurisdictions have observed record-breaking numbers and rates in relation to the wider impacts of the COVID-19 pandemic.
  • Between January and June 2021, 90% of all apparent opioid toxicity deaths occurred in British Columbia, Alberta or Ontario.
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Most apparent opioid toxicity deaths among males and individuals aged 20 to 49 years

  • Males accounted for the majority of accidental apparent opioid toxicity deaths (75%) from January to June 2021; for both males and females, the majority of deaths were among individuals aged 20 to 49 years.
  • Individuals between 30 and 39 years accounted for a higher proportion of accidental opioid toxicity deaths where fentanyl (31%) was involved from January to June 2021.
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Fentanyl and fentanyl analogues continue to be major drivers of the crisis

  • 87% of accidental apparent opioid toxicity deaths involved fentanyl in 2021 (Jan to Jun).
  • 90% of accidental apparent opioid toxicity deaths from January to June 2021 involved a non-pharmaceutical opioidFootnote 3Footnote 4.
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Data on apparent opioid and stimulant toxicity deaths based on six reporting provinces and territories

  • Available information from six provinces and territories indicates the number of deaths involving stimulants from April to June 2021 remained high and is similar to the period from January to March 2021. Almost all (96%) of those deaths were accidental.
  • More than half (59%) of accidental opioid toxicity deaths in 2021 (Jan to Jun) also involved a stimulant, reflecting the polysubstance nature of this crisis.
  • 65% of identified accidental apparent stimulant toxicity deaths from January to June 2021 involved cocaine while 50% involved methamphetamines.
  • 86% of accidental apparent stimulant toxicity deaths also involved an opioid in 2021 (Jan to Jun).
  • Males accounted for the majority of accidental apparent stimulant toxicity deaths (74%) from January to June 2021; for males and females, the majority of deaths were among individuals aged 20 to 49 years.

Data on apparent opioid toxicity deaths and stimulant toxicity deaths are not mutually exclusive. A high proportion of deaths involving a stimulant also involved an opioid. Adding up those numbers would result in an overestimation of the burden of opioids and stimulants.

Hospitalizations Download hospitalizations report in .pdf format

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27,604 opioid-related and 12,338 stimulant-related poisoning hospitalizations occurred from January 2016 to June 2021 in Canada (excluding Quebec)

  • 1,464 opioid poisoning hospitalizations occurred between April and June 2021 (approximately 16 hospitalizations per day), similar to the period from January to March 2021, but representing an 11% increase compared to April to June 2020 and a 20% increase compared to April to June 2019 (1,216 hospitalizations).
  • 628 stimulant-related poisoning hospitalizations occurred between April and June 2021 (approximately 7 hospitalizations per day), 17% more compared to the period from January to March 2021, but 13% less compared to April to June 2020.
  • Median total length of hospital stay was three days for opioid-related poisoning hospitalizations and two days for stimulant-related poisoning hospitalizations (January 2016 to June 2021).

Data on opioid-related and stimulant-related poisoning hospitalizations are not mutually exclusive. A proportion of poisoning hospitalizations involving a stimulant also involved an opioid. Adding up those numbers would result in an overestimation of the burden of opioids and stimulants.

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Majority of hospitalizations in Western provinces and Ontario

  • Rates of opioid-related poisoning hospitalizations continue to remain high in the Western provinces and Ontario. For stimulant-related poisoning hospitalizations, Ontario, followed by the Western provinces, continue to be the regions with the highest rates.
  • Nearly 90% of poisoning hospitalizations involving opioids or stimulants occurred in British Columbia, Alberta, and Ontario in 2020 and in 2021 (January to June).
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Most accidental poisoning hospitalizations among males and individuals aged 20 to 49 years

  • Most accidental opioid-related poisoning hospitalizations occurred among males (65%) and among individuals aged 20 to 49 years (57%) from January to June 2021.
  • Most accidental stimulant-related poisoning hospitalizations occurred among males (62%) and among individuals aged 20 to 49 years (71%) from January to June 2021.
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Types of polysubstance use among opioids and stimulants in 2021 (January to June)

  • 31% of opioid-related poisoning hospitalizations involved fentanyl or fentanyl analogues and 16% involved stimulants.
    • More accidental opioid-related poisoning hospitalizations involved fentanyl (34%) than intentional (18%) poisonings.
  • 43% of stimulant-related poisoning hospitalizations involved opioids (including fentanyl or fentanyl analogues), while 23% involved fentanyl or fentanyl analogues.
    • More accidental stimulant-related poisoning hospitalizations involved fentanyl or fentanyl analogues (31%) than intentional (26%) poisonings.
  • 48% of stimulant-related poisoning hospitalizations involved cocaine and 65% involved other psychostimulants.
    • More accidental stimulant-related poisoning hospitalizations involved cocaine (53%) than intentional (32%).
    • More intentional stimulant-related poisoning hospitalizations involved psychostimulants (76%) than accidental (61%).
  • 28% of opioid-related poisoning hospitalizations involved a co-poisoning with a non-opioid substance, while 60% of stimulant-related poisoning hospitalizations involved a co-poisoning with a non-stimulant substance.

Emergency Medical Services Download EMS report in .pdf format

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There were more than 17,400 Emergency Medical Services (EMS) responses to suspected opioid-related overdoses based on available data from nine provinces and territories between January and June 2021

  • 9,782 EMS responses to suspected opioid-related overdoses occurred between April and June 2021, which was 27% higher than the period from January to March 2021. This also represents a 31% increase from April to June 2020 (7,461) and a 63% increase compared to April to June 2019 (6,000).
  • A number of factors have likely contributed to a worsening of the overdose crisis over the course of the pandemic, including the increasingly toxic drug supply, increased feelings of isolation, stress and anxiety and limited availability or accessibility of services for people who use drugs.
  • Similar to other harms, higher numbers of EMS responses for suspected opioid-related overdoses occurred in some provinces including British Columbia, Alberta and Ontario.
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Middle aged males continue to be most impacted

  • 73% of EMS responses for suspected opioid-related overdoses between January and June 2021 were among males.
  • 78% of EMS responses were among individuals aged between 20 and 49 years.

Footnotes

Footnote 1

Manitoba data from April 2020 to June 2021 were not available at the time of this update.

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Footnote 2

National overall count from January 2016 to June 2021 includes deaths from British Columbia (2018 to 2021) and Quebec (2020 to 2021) related to all illicit drugs including, but not limited to opioids.

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Footnote 3

Based on 2021 (Jan to Jun) data on origin of opioids from deaths with completed investigations from seven provinces.

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Footnote 4

Opioids with a pharmaceutical origin refer to opioids that were manufactured by a pharmaceutical company and approved for medical purposes in humans. Pharmaceutical origin does not indicate how the opioids were obtained (e.g. through personal prescription or by other means).

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Acknowledgements

This update would not be possible without the collaboration and dedication of provincial and territorial (PT) offices of Chief Coroners and Chief Medical Examiners as well as PT public health and health partners and Emergency Medical Services data providers. We would also like to acknowledge the Canadian Institute for Health Information (CIHI) for collecting and providing the data used for reporting opioid and stimulant related poisoning hospitalizations.

Suggested Citation

Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid and Stimulant-related Harms in Canada. Ottawa: Public Health Agency of Canada; December 2021. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants


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