Opioid- and Stimulant-related Harms in Canada Published: (June 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.

This update includes data on deaths, hospitalizations and Emergency Medical Services responses involving opioids and/or stimulants between January 2016 and December 2020, 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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21,174 apparent opioid toxicity deaths between January 2016 and December 2020Footnote 1Footnote 2

  • In 2020, 6,214 apparent opioid toxicity deaths occurred (approximately 17 deaths per day), of which 96% were accidental (unintentional).
  • 1,766 apparent opioid toxicity deaths occurred between October and December 2020, similar to July to September (1,716). This number represents the highest quarterly count since national surveillance began in 2016. This number also represents a 100% increase from the same time frame in 2019 (885 deaths).
  • Since the onset of the COVID-19 pandemic, 5,148 apparent opioid toxicity deaths occurred (April to December 2020), representing a 89% increase from the same time period in 2019 (2,722 deaths).
  • A number of factors have likely contributed to a worsening of the overdose crisis, 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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Western Canada most impacted yet increases observed across the country

  • While Western Canada continues to be the most impacted region of the country since 2016, rates have increased in other Canadian regions, including in Ontario. However, several jurisdictions have observed record-breaking numbers in relation to impacts of the COVID-19 outbreak.
  • Between January and December 2020, 85% of all 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 (77%) from January to December 2020; 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 (30%) was involved from January to December 2020.
  • Among females, almost one third (30%) of accidental opioid toxicity deaths involved at least one pharmaceutical opioidFootnote 3 , compared to 16% among malesFootnote 4.
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Fentanyl and fentanyl analogues continue to be major drivers of the crisis

  • 82% of accidental apparent opioid toxicity deaths involved fentanyl in 2020.
  • The majority of fentanyl detected in opioid toxicity deaths was non-pharmaceutical (99%)Footnote 3Footnote 4.
  • 84% of accidental apparent opioid toxicity deaths from January to December 2020 involved a non-pharmaceutical opioidFootnote 3Footnote 4.
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Data on 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 October to December 2020 remained high and is similar to the period from July to September. 98% of those deaths were accidental.
  • Half (52%) of accidental opioid toxicity deaths in 2020 also involved a stimulant, reflecting the polysubstance nature of this crisis.
  • 68% of identified apparent stimulant toxicity deaths from January to December 2020 involved cocaine while 47% involved methamphetamine.
  • 84% of apparent stimulant toxicity deaths also involved an opioid in 2020.
  • Males accounted for the majority of accidental apparent stimulant toxicity deaths (77%) from January to December 2020; 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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24,671 opioid-related and 11,176 stimulant-related poisoning hospitalizations occurred from January 2016 to December 2020 in Canada (excluding Quebec)

  • In 2020, 5,215 opioid-related poisoning hospitalizations occurred (approximately 14 hospitalizations per day), of which 68% were accidental (unintentional).
  • Based on preliminary data, 1,406 opioid poisoning hospitalizations occurred between October and December 2020, similar to the period from July to September 2020, but representing a 40% increase compared to October to December 2019.
  • Since the onset of the COVID-19 pandemic, 4,123 opioid-related poisoning hospitalizations occurred (April to December 2020), representing a 23% increase from the same time period in 2019 (3,348 hospitalizations).
  • In 2020, 2,504 stimulant-related poisoning hospitalizations occurred (approximately 7 hospitalizations per day), of which 58% were accidental (unintentional).
  • Based on preliminary data, 627 stimulant-related poisoning hospitalizations occurred between October and December 2020, similar to the period from July to September 2020, but representing a 20% increase compared to October to December 2019.
  • Since the onset of the COVID-19 pandemic, 1,989 stimulant-related poisoning hospitalizations occurred (April to December 2020), representing a 22% increase from the same time period in 2019 (1,624).
  • 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 December 2020).

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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Western provinces, Ontario and Territories most impacted

  • Nearly 90% of poisoning hospitalizations involving opioids or stimulants occurred in British Columbia, Alberta, and Ontario in 2020.
  • For opioid-related poisoning hospitalizations, the Western provinces are the most impacted per 100,000 people. The Territories, followed by the Western provinces, continue to be regions most impacted per 100,000 people for stimulant-related poisoning hospitalizations.
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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 (63%) and among individuals aged 20 to 49 years (53%) (2020).
  • Most accidental stimulant-related poisoning hospitalizations occurred among males (71%) and among individuals aged 20 to 49 years (74%) (2020).
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Types of polysubstance use among opioids and stimulants in 2020

  • 28% of opioid-related poisoning hospitalizations involved fentanyl or fentanyl analogues and 20% involved stimulants.
    • More accidental opioid-related poisoning hospitalizations involved fentanyl (32%) than intentional (14%) poisonings.
  • 42% of stimulant-related poisoning hospitalizations involved opioids (including fentanyl), while 18% involved fentanyl or fentanyl analogues.
    • More accidental stimulant-related poisoning hospitalizations involved fentanyl (26%) than intentional (5%) poisonings.
  • 50% of stimulant-related poisoning hospitalizations involved cocaine and 63% involved other psychostimulants.
    • More accidental stimulant-related poisoning hospitalizations involved cocaine (58%) than intentional (31%).
    • More intentional stimulant-related poisoning hospitalizations involved psychostimulants (75%) than accidental (57%).
  • 33% of opioid-related poisoning hospitalizations involved non-opioid polysubstance use, while 62% of stimulant-related poisoning hospitalizations involved non-stimulant polysubstance use.

Emergency Medical Services Download EMS report in .pdf format

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More than 28,800 Emergency Medical Services (EMS) responses to suspected opioid-related overdoses based on available data from nine provinces and territories between January and December 2020

  • Since the onset of the COVID-19 pandemic, 24,286 EMS responses to suspected overdoses occurred (April to December 2020), representing a 61% increase from the same period in 2019 (15,133 EMS responses).
  • 8,086 EMS responses to suspected opioid-related overdoses occurred between October and December 2020, similar to July to September (8,591). This number represents the second-highest quarterly count since national surveillance of EMS responses began in 2017. This number also represents a 94% increase from the same period in 2019 (4,160 EMS responses).
  • A number of factors have likely contributed to a worsening of the overdose crisis, 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 December 2020 were among males.
  • 77% were among individuals aged between 20 and 49 years.

Footnotes

Footnote 1

Manitoba data from October 2019 to December 2020 were not available at the time of this update.

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Footnote 2

National overall count from January 2016 to December 2020 includes deaths from British Columbia (2018 to 2020) and Quebec (2019 and 2020) related to all illicit drugs including, but not limited to opioids.

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Footnote 3

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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Footnote 4

Based on 2020 data on origin of opioids from deaths with completed investigations from six provinces.

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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; June 2021. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants


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