Opioid- and Stimulant-related Harms in Canada Published: (September 2023): Health Infobase
Context
Canada has seen substantially elevated numbers of opioid-related deaths and other harms since surveillance began in 2016 by the Public Health Agency of Canada. This public health crisis is having a tragic impact on people who use substances, their families, and communities across the country, and is shaped by a wide range of factors. The COVID-19 pandemic may have exacerbated the crisis, as several jurisdictions reported higher rates of fatal overdoses and other harms following the onset of the pandemic.
Presented here are the most recent available data on overdoses and deaths involving opioids and/or stimulants from January 2016 to March 2023 in Canada, 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 this public health crisis. Additional studies can also help us plan and tailor actions to achieve better possible outcomes. Dr. Theresa Tam, Canada's Chief Public Health Officer, and Dr. Yves Léger, the Acting Chief Medical Officer of Health of New Brunswick, share their perspectives on these data, the overdose crisis and actions needed to prevent further substance-related harms in Canada in this joint statement.
Deaths Download mortality report in .pdf format
What: There was a total of 38,514 apparent opioid toxicity deaths between January 2016 and March 2023Footnote 1Footnote 2
- A total of 1,904 apparent opioid toxicity deaths occurred so far in 2023 (January-March). This is an average of 21 deaths per day.
- The number of total apparent opioid toxicity deaths in Canada reported so far in 2023 (January-March) was similar (within 5%) compared to the same period in 2022. This is based on preliminary data subject to change as death investigations are completed and reported. However, crude rates continue to remain higher than pre-pandemic levels.
Where: The majority of deaths occurred in British Columbia, Alberta, and Ontario; high rates were also observed within other regions
- So far in 2023 (January-March), most (90%) of the accidental apparent opioid toxicity deaths in Canada occurred in British Columbia, Alberta, and Ontario.
- Elevated mortality rates have also been observed in other areas with smaller population sizes, including Saskatchewan and Yukon.
Who: Most apparent opioid toxicity deaths among young- to middle-aged males
- Males accounted for the majority of accidental apparent opioid toxicity deaths (73%) so far in 2023 (January-March).
- For males and for females, the majority of accidental apparent opioid toxicity deaths were among individuals aged 20 to 59 years.
Why: Among other reasons, the toxicity of supply continues to be a major driver of the overdose crisis
- Of all accidental apparent opioid toxicity deaths so far in 2023 (January-March), 81% involved fentanyl. This percentage has increased by 42% since 2016 when national surveillance began but appears to have stabilized in recent years.
- Of all accidental apparent opioid toxicity deaths so far in 2023 (January-March), 77% involved opioids that were only non-pharmaceuticalFootnote 3Footnote 4. This percentage has increased by 17% since 2018 when national surveillance began but appears to have stabilized in recent years.
Multi-drug toxicity is a contributing factor to the crisis
- Available information from eight provinces and territories indicates that almost all (99%) apparent stimulant toxicity deaths so far in 2023 (January-March) were accidental.
- Just under half (48%) of accidental apparent opioid toxicity deaths so far in 2023 (January-Mach) also involved a stimulant.
- Of the accidental apparent stimulant toxicity deaths so far in 2023 (January-March), 79% involved an opioid, 70% involved cocaine, and 49% involved methamphetamines.
Data on apparent opioid and stimulant toxicity deaths are not mutually exclusive. A high proportion of deaths involving a stimulant also involved an opioid. Adding up those values would result in an overestimation of the burden of opioids and stimulants.
Hospitalizations Download hospitalizations report in .pdf format
What: There was a total of 37,697 opioid-related and 16,231 stimulant-related poisoning hospitalizations from January 2016 to March 2023 in Canada (excluding Quebec)
- A total of 1,309 opioid-related poisoning hospitalizations occurred so far in 2023 (January-March). This is an average of 15 hospitalizations per day.
- A total of 479 stimulant-related poisoning hospitalizations occurred so far in 2023 (January-March). This is an average of five hospitalizations per day.
- The median total length of hospital stay was three days for both opioid- and stimulant-related poisoning hospitalizations so far in 2023 (January-March).
- The number of opioid-related poisoning hospitalizations in Canada reported so far in 2023 (January-March) was similar (within 5%) compared to the same period in 2022. This is based on provisional data subject to change and should be interpreted with caution.
Data on opioid- and stimulant-related poisoning hospitalizations are not mutually exclusive. A high proportion of poisoning hospitalizations involving a stimulant also involved an opioid. Adding up those values would result in an overestimation of the burden of opioids and stimulants.
Where: A majority of accidental poisoning hospitalizations occurred in Ontario, British Columbia, and Alberta
- So far in 2023 (January-March), most of the accidental opioid-related poisoning hospitalizations (92%) and accidental stimulant-related poisoning hospitalizations (92%) in Canada occurred in Ontario, British Columbia, and Alberta.
- So far in 2023 (January-March), rates of accidental opioid-related hospitalizations in Canada were highest in British Columbia, Alberta, and the territories, while rates of accidental stimulant-related hospitalizations in Canada were highest in British Columbia, Alberta, and Saskatchewan.
Who: Most accidental poisoning hospitalizations were among males, with varying age distributions
- So far in 2023 (January-March), males accounted for a higher proportion of accidental opioid-related poisoning hospitalizations (67%) and accidental stimulant-related poisoning hospitalizations (70%) than females.
- So far in 2023 (January-March), the highest proportion of accidental opioid-related poisoning hospitalizations were among individuals aged 30 to 39 years (24%), followed by those aged 60 years or more (23%). The highest proportion of accidental stimulant-related poisoning hospitalizations were among individuals aged 30 to 39 years (29%), followed by those aged 40 to 49 years (26%).
Why: Toxicity of supply is contributing to the crisis
- For opioid-related poisoning hospitalizations, fentanyl and its analogues were involved in 36% of accidental opioid-related poisoning hospitalizations, compared to 19% of intentional opioid-related poisoning hospitalizations so far in 2023 (January-March). The percentage of all opioid-related poisoning hospitalizations that involved fentanyl and its analogues has increased 106% since 2018 when national surveillance began, but appears to have stabilized in recent years.
- For stimulant-related poisoning hospitalizations, fentanyl and its analogues were involved in 40% of accidental stimulant-related poisoning hospitalizations, compared to 7% of intentional stimulant-related poisoning hospitalizations so far in 2023 (January-March). The percentage of all stimulant-related poisoning hospitalizations that involved fentanyl and its analogues has increased 173% since 2018 when national surveillance began, but appears to have stabilized in recent years.
Multi-drug toxicity is a contributing factor to the crisis
- Among accidental opioid-related poisoning hospitalizations so far in 2023 (January-March), 19% involved co-poisoning with a stimulant.
- Among accidental stimulant-related poisoning hospitalizations so far in 2023 (January-March), 62% involved co-poisoning with an opioid.
Emergency Medical Services Download EMS report in .pdf format
What: There were more than 9,000 Emergency Medical Services (EMS) responses to suspected opioid-related overdoses so far in 2023 (January – March)
- A total of 9,287 EMS responses to suspected opioid-related overdoses occurred so far in 2023 (January - March), based on available data from nine provinces and territories.
Who: Young- to middle-aged males continue to be the most affected
- Of the EMS responses for suspected opioid-related overdoses so far in 2023 (January – March), 72% were among males.
- The majority of EMS responses for suspected opioid-related overdoses so far in 2023 (January – March) were among those aged 20 to 49 years; however, variations are apparent between provinces and territories.
Footnotes
- Footnote 1
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Manitoba data from April 2022 to March 2023 were not available at the time of this update.
- Footnote 2
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The national overall count from January 2016 to March 2023 includes deaths from British Columbia (2019 to 2023 [Jan to Mar]) related to all illicit drugs and Quebec (2021 to 2023 [Jan to Mar]) related to drug or opioid-related intoxication.
- Footnote 3
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Based on 2023 (Jan to Mar) data on origin of opioids from deaths with completed investigations from eight provinces or territories.
- Footnote 4
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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).
Acknowledgments
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
Federal, provincial, and territorial Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid- and Stimulant-related Harms in Canada. Ottawa: Public Health Agency of Canada; September 2023. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/