Opioid- and Stimulant-related Harms in Canada Published: (March 2023): Health Infobase
Context
Canada has seen substantially elevated numbers of opioid-related deaths and other harms since surveillance began in 2016. 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. There is evidence the COVID-19 pandemic has contributed to and exacerbated the crisis, with several jurisdictions reporting 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 September 2022 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. Jennifer Russell, the 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 34,455 apparent opioid toxicity deaths between January 2016 and September 2022Footnote 1Footnote 2
- A total of 5,360 apparent opioid toxicity deaths occurred so far in 2022 (January - September). This is approximately 20 deaths per day. For the same period in 2019 prior to the COVID-19 pandemic, the number of deaths per day was 10, which increased to a peak of 21 in 2021.
- The number of total apparent opioid toxicity deaths in Canada reported so far in 2022 (January - September) has been lower (8%) than the same period in the previous year. This is based on preliminary data subject to change as death investigations are completed and reported. However, based on current national data, analyses show there has been no significant decrease in trend and rates remain high.
Where: A majority of deaths occurred in British Columbia, Alberta, and Ontario; high rates were also observed within other regions
- So far in 2022 (January – September), most (87%) of all accidental apparent opioid toxicity deaths in Canada occurred in British Columbia, Alberta, or 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 (75%) so far in 2022 (January – September).
- For males and for females, the majority of accidental apparent opioid toxicity deaths were among individuals aged 20 to 59 years.
Why: Toxicity of supply continues to be a major driver of the crisis
- Of all accidental apparent opioid toxicity deaths so far in 2022 (January – September), 81% involved fentanyl.
- Of all accidental apparent opioid toxicity deaths so far in 2022 (January – September), 78% involved opioids that were only non-pharmaceuticalFootnote 3Footnote 4.
Data on the polysubstance nature of the overdose crisis
- Available information from seven provinces and territories indicates the number of apparent stimulant toxicity deaths so far in 2022 (January – September) was high. Almost all (98%) of those deaths were accidental.
- Over half (53%) of accidental apparent opioid toxicity deaths so far in 2022 (January – September) also involved a stimulant, reflecting the polysubstance nature of this crisis.
- Of the accidental apparent stimulant toxicity deaths so far in 2022 (January – September), 63% involved cocaine, while 52% involved methamphetamines.
- Of the accidental apparent stimulant toxicity deaths so far in 2022 (January – September), 78% involved an opioid.
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 numbers 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 34,886 opioid-related and 15,172 stimulant-related poisoning hospitalizations from January 2016 to September 2022 in Canada (excluding Quebec)
- A total of 3,917 opioid-related poisoning hospitalizations occurred so far in 2022 (January – September). This is 14 hospitalizations per day. For the same period in 2019 prior to the COVID-19 pandemic, the number of hospitalizations per day was 13, which increased to a peak of 17 in 2021.
- A total of 1,562 stimulant-related poisoning hospitalizations occurred so far in 2022 (January – September). This is approximately six hospitalizations per day. For the same period in 2019 prior to the COVID-19 pandemic, the number of hospitalizations per day was six, which increased to a peak of seven in 2021.
- Median total length of hospital stay was three days for both opioid- and stimulant-related poisoning hospitalizations so far in 2022 (January – September).
- Of all opioid-related poisoning hospitalizations, 31% involved fentanyl or fentanyl analogues so far in 2022 (January - September). Among accidental opioid-related poisoning hospitalizations, a larger proportion involved fentanyl (34%) than among intentional poisonings (18%) so far in 2022 (January - September).
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 numbers would result in an overestimation of the burden of opioids and stimulants.
Where: A majority of hospitalizations occurred in British Columbia, Alberta and Ontario
- Rates of opioid- related poisoning hospitalizations continue to remain highest in British Columbia, Saskatchewan and Alberta while for stimulant-related poisoning hospitalizations the highest rates were observed in the Territories, British Columbia, Saskatchewan, and New Brunswick.
- So far in 2022 (January – September), 88% of poisoning hospitalizations involving opioids and 86% of poisoning hospitalizations involving stimulants occurred in British Columbia, Alberta, and Ontario.
Who: 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 (54%) so far in 2022 (January – September).
- Most accidental stimulant-related poisoning hospitalizations occurred among males (70%) and among individuals aged 20 to 49 years (71%) so far in 2022 (January – September).
Poisoning hospitalizations associated with multiple substances so far in 2022 (January to September)
- Of all opioid-related poisoning hospitalizations, 29% involved co-poisoning with a non-opioid substance; 17% involved co-poisoning with a stimulant.
- Among intentional opioid-related poisoning hospitalizations, a larger proportion involved a co-occurring non-opioid substance (44%) than among accidental poisonings (25%).
- Of all stimulant-related poisoning hospitalizations, 59% involved co-poisoning with a non-stimulant substance; 42% of all stimulant-related poisoning hospitalizations involved co-poisoning with opioids (including fentanyl or fentanyl analogues), while 22% involved specifically fentanyl or fentanyl analogues.
- Among accidental stimulant-related poisoning hospitalizations, a larger proportion involved fentanyl or fentanyl analogues (32%) than among intentional (7%) poisonings.
Emergency Medical Services Download EMS report in .pdf format
What: There were more than 28,000 Emergency Medical Services (EMS) responses to suspected opioid-related overdoses so far in 2022 (January – September)
- A total of 28,197 EMS responses to suspected opioid-related overdoses occurred so far in 2022 (January - September), based on available data from nine provinces and territories. For the same period prior to the COVID-19 pandemic for the same nine provinces and territories, there were 17,442 EMS responses in 2019, which increased to a peak of 30,638 EMS responses in 2021.
Who: Young- to middle-aged males continue to be the most affected
- Of the EMS responses for suspected opioid-related overdoses so far in 2022 (January – September), 72% were among males.
- The majority of EMS responses for suspected opioid-related overdoses so far in 2022 (January – September) 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 January to September 2022 were not available at the time of this update.
- Footnote 2
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The national overall count from January 2016 to September 2022 includes deaths from British Columbia (2019 to 2022 [Jan to Sep]) related to all illicit drugs and Quebec (2021 and 2022 [Jan to Sep]) related to drug or opioid-related intoxication.
- Footnote 3
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Based on 2022 (Jan to Sep) data on origin of opioids from deaths with completed investigations from nine provinces.
- 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; March 2023. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/