Opioid- and Stimulant-related Harms in Canada Published: (December 2020)

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 available data on deaths, hospitalizations and Emergency Medical Services responses involving opioids and/or stimulants between January 2016 and June 2020, where available. Recognizing that harms related to opioids, stimulants, and other substances extend beyond overdoses (poisonings) and deaths, we continue to work with the provinces and territories to build a broad understanding of harms and substances involved to better respond to the crisis.

Deaths

Opioid deaths icon

17,602 apparent opioid toxicity deaths between January 2016 and June 2020Footnote 1Footnote 2

  • 1,628 apparent opioid toxicity deaths occurred between April and June 2020, representing the highest quarterly count since national surveillance began in 2016. This number also represents a 58% increase compared to January to March 2020 (1,029 deaths) and a 54% increase from the same time frame in 2019 (1,059 deaths).
  • In 2020 (January to June), 97% of apparent opioid toxicity deaths were accidental (unintentional).
Opioid deaths icon

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, recent increases have been reported by several jurisdictions in relation to impacts of the COVID-19 outbreak.
  • Available information indicate at least five provinces and territories have observed record-breaking numbers of deaths in April to June 2020.
  • Between January and June 2020, 86% of all opioid toxicity deaths occurred in British Columbia, Alberta or Ontario.
Opioid deaths icon

Deaths most common among males and individuals aged 20 to 49 years

  • Males accounted for the majority of accidental apparent opioid toxicity deaths (77%) from January to June 2020; for 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 deaths where fentanyl (31%) was involved from January to June 2020.
  • Among females, one third (33%) of accidental opioid toxicity deaths involved at least one pharmaceutical opioidFootnote 3 , compared to 16% among malesFootnote 4.
Opioid deaths icon

Fentanyl and fentanyl analogues continue to be major drivers of the crisis

  • 75% of accidental apparent opioid toxicity deaths involved fentanyl in 2020 (January to June).
  • The majority of the fentanyl detected in opioid toxicity deaths was non-pharmaceutical (99%)Footnote 3Footnote 4.
  • 85% of accidental apparent opioid toxicity deaths from January to June 2020 involved a non-pharmaceutical opioidFootnote 3Footnote 4.
Opioid deaths icon

New data on opioid and stimulant toxicity deaths based on six reporting jurisdictions

  • Available information from six provinces and territories indicates a 65% increase in number of deaths involving stimulants from April to June compared to the period from January to March 2020. 98% of those deaths were accidentalFootnote 5.
  • About half (52%) of accidental opioid toxicity deaths in 2020 (January to June) also involved a stimulant, reflecting the polysubstance nature of this crisis.
  • 70% of identified apparent stimulant toxicity deaths from January to June 2020 involved cocaine while 48% involved methamphetamines.
  • 84% of identified apparent stimulant toxicity deaths also involved an opioid in 2020 (January to June).
  • Males accounted for the majority of accidental apparent stimulant toxicity deaths (77%) from January to June 2020; for males and females, the majority of deaths were among individuals aged 20 to 49 years.

Hospitalizations

Opioid hospitalization icon

21,824 opioid-related and 9,869 stimulant-related poisoning hospitalizations occurred from January 2016 to June 2020 in Canada (excluding Quebec)

  • In 2020 (January to June), 2,368 opioid-related poisoning hospitalizations occurred, of which 66% were accidental (unintentional).
  • Based on preliminary data, 1,301 opioid poisoning hospitalizations occurred between April and June 2020, representing a 22% increase compared to January to March 2020 and a 7% increase compared to April to June 2019. Note that opioid poisoning hospitalizations from January to March 2020 decreased by 7% from the same period in 2019.
  • In 2020 (January to June) 1,197 stimulant-related poisoning hospitalizations occurred, of which 57% were accidental (unintentional).
  • Based on preliminary data, 711 stimulant-related poisoning hospitalizations occurred between April and June 2020, representing a 46% increase compared to January to March 2020 and a 20% increase compared to April to June 2019. Note that stimulant poisoning hospitalizations from January to March 2020 decreased by 8% from the same period in 2019.
  • 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 2020).
Opioid hospitalization icon

Western provinces, Ontario and Territories most impacted

  • While nearly 90% of poisoning hospitalizations involving opioids or stimulants occurred in British Columbia, Alberta, and Ontario in 2020 (January to June), the Western provinces and the Territories continue to be the regions most impacted per 100,000 people.
Opioid hospitalization icon

Most accidental poisoning hospitalizations among males and individuals aged 20 to 49 years

  • Most accidental opioid-related poisoning hospitalizations occurred among males (64%) and among individuals aged 20 to 49 years (52%) (2020 January to June).
  • Most accidental stimulant-related poisoning hospitalizations occurred among males (71%) and among individuals aged 20 to 49 years (75%) (2020 January to June).
Opioid hospitalization icon

Types of opioids and stimulants in 2020 (January to June)

  • 29% of opioid-related poisoning hospitalizations involved fentanyl or fentanyl analogues.
  • 57% of stimulant-related poisoning hospitalizations involved cocaine and 58% involved other psychostimulants.
  • 29% of opioid-related poisoning hospitalizations involved non-opioid polysubstance use, while 65% of stimulant-related poisoning hospitalizations involved non-stimulant polysubstance use.

Emergency Medical Services

Opioid hospitalization icon

More than 12,100 Emergency Medical Services (EMS) responses to suspected opioid overdoses based on available data from nine provinces and territories between January and June 2020

  • An increase of 68% in suspected opioid overdoses was observed between January to March and April to June of 2020, and a 27% increase compared to the same time frame in 2019.
  • Similar to other harms, higher proportions of EMS responses for suspected opioid overdoses occurred in some provinces including British Columbia, Alberta and Ontario.
Opioid hospitalization icon

Middle aged males continue to be most impacted

  • 73% of EMS responses for suspected opioid overdoses between January to June 2020 were among males.
  • 77% were among individuals aged between 20 and 49 years.

Footnotes

Footnote 1

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

Return to footnote 1 referrer

Footnote 2

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

Return to footnote 2 referrer

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).

Return to footnote 3 referrer

Footnote 4

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

Return to footnote 4 referrer

Footnote 5

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.

Return to footnote 5 referrer



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-related poisoning hospitalizations.

Suggested Citation

Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioids and stimulant-related Harms in Canada. Ottawa: Public Health Agency of Canada; December 2020. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants


Date modified: