Opioid- and Stimulant-related Harms in Canada Published: (March 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 September 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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19,355 apparent opioid toxicity deaths between January 2016 and September 2020Footnote 1Footnote 2

  • 1,705 apparent opioid toxicity deaths occurred between July and September 2020, similar to April to June 2020 (1,646). This represents the highest quarterly count since national surveillance began in 2016. This number also represents a 120% increase from the same time frame in 2019 (776 deaths).
  • In the six months following the implementation of the COVID-19 prevention measures (April to September 2020) there were 3,351 apparent opioid toxicity deaths, representing a 74% increase from the six months prior (October 2019 to March 2020 – 1,923 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.
  • 96% of deaths from January to September 2020 were accidental (unintentional).
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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 September 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 September 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 September 2020.
  • Among females, one fifth (22%) of accidental opioid toxicity deaths involved at least one pharmaceutical opioidFootnote 3 , compared to 10% 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 (January to September).
  • The majority of fentanyl detected in opioid toxicity deaths was non-pharmaceutical (99%)Footnote 3Footnote 4.
  • 86% of accidental apparent opioid toxicity deaths from January to September 2020 involved a non-pharmaceutical opioidFootnote 3Footnote 4.
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New 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 July to September remained high and is similar to the period from April to June. 98% of those deaths were accidental.
  • More than half (60%) of accidental opioid toxicity deaths in 2020 (January to September) also involved a stimulant, reflecting the polysubstance nature of this crisis.
  • 71% of identified apparent stimulant toxicity deaths from January to September 2020 involved cocaine while 46% involved methamphetamines.
  • 81% of deaths identified as apparent stimulant toxicity deaths also involved an opioid in 2020 (January to September).
  • Males accounted for the majority of accidental apparent stimulant toxicity deaths (77%) from January to September 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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23,240 opioid-related and 10,518 stimulant-related poisoning hospitalizations occurred from January 2016 to September 2020 in Canada (excluding Quebec)

  • In 2020 (January to September), 3,784 opioid-related poisoning hospitalizations occurred, of which 67% were accidental (unintentional).
  • Based on preliminary data, 1,400 opioid poisoning hospitalizations occurred between July and September 2020, representing a 7% increase compared to April to June 2020 and a 31% increase compared to January to March 2020. Note that opioid poisoning hospitalizations from July to September 2020 increased by 23% from the same period in 2019.
  • In 2020 (January to September) 1,846 stimulant-related poisoning hospitalizations occurred, of which 58% were accidental (unintentional).
  • Based on preliminary data, 629 stimulant-related poisoning hospitalizations occurred between July and September 2020, representing a decline of 12% compared to April to June 2020 and a 31% increase compared to January to March 2020. Note that stimulant poisoning hospitalizations from July to September 2020 increased by 20% 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 September 2020).
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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 September), the Western provinces and the Territories continue to be the regions most impacted per 100,000 people.
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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 (64%) and among individuals aged 20 to 49 years (53%) (2020 January to September).
  • Most accidental stimulant-related poisoning hospitalizations occurred among males (70%) and among individuals aged 20 to 49 years (74%) (2020 January to September).
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Types of polysubstance use among opioids and stimulants in 2020 (January to September)

  • 27% of opioid-related poisoning hospitalizations involved fentanyl or fentanyl analogues and 20% involved stimulants.
    • More accidental opioid-related poisoning hospitalizations involved fentanyl (31%) than intentional (14%) poisonings.
  • 42% of stimulant-related poisoning hospitalizations involved opioids (including fentanyl), while 17% involved fentanyl or fentanyl analogues.
    • More accidental stimulant-related poisoning hospitalizations involved fentanyl (25%) than intentional (5%) poisonings.
  • 50% of stimulant-related poisoning hospitalizations involved cocaine and 62% involved other psychostimulants.
  • 33% of opioid-related poisoning hospitalizations involved non-opioid polysubstance use, while 61% 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 20,700 Emergency Medical Services (EMS) responses to suspected opioid overdoses based on available data from nine provinces and territories between January and September 2020

  • 8,591 EMS responses to suspected opioid overdoses occurred between July and September 2020, representing a small increase of 13% compared to April to June (7,608). This number represents the highest quarterly count since national surveillance of EMS responses began in 2017. This number also represents a 73% increase from the same time frame in 2019 (4,975 EMS responses).
  • In the six months following the implementation of COVID-19 prevention measures (April to September 2020), 16,200 EMS responses to suspected opioid-related overdoses occurred, representing an 86% increase from the six months prior (October 2019-March 2020 – 8,689 EMS responses).
  • Similar to other harms, higher numbers of EMS responses for suspected opioid-related overdoses occurred in some provinces including British Columbia, Alberta and Ontario.
  • 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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Middle aged males continue to be most impacted

  • 75% of EMS responses for suspected opioid-related overdoses between January and September 2020 were among males.
  • 77% were among individuals aged between 20 and 49 years.

Footnotes

Footnote 1

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

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Footnote 2

National overall counts from January 2016 to September 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. Opioids and Stimulant-related Harms in Canada. Ottawa: Public Health Agency of Canada; March 2021. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants


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