Opioid- and Stimulant-related Harms in Canada Published: (June 2022)

Context

There is evidence the COVID-19 pandemic is contributing to the already deadly and ongoing national public health overdose crisis. This crisis 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.

These updates include available data on overdoses and deaths involving opioids and/or stimulants from January 2016 to December 2021, 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 the joint statement.

Deaths Download mortality report in .pdf format

What: There was a total of 29,052 apparent opioid toxicity deaths between January 2016 and December 2021Footnote 1Footnote 2

  • During the first year of the pandemic, there was a 96% increase in apparent opioid toxicity deaths (April 2020 – March 2021, 7,362 deaths), compared to the year before (April 2019 – March 2020, 3,747 deaths). Since then, deaths have remained high.
  • A total of 7,560 apparent opioid toxicity deaths occurred in 2021 (January – December). This is approximately 21 deaths per day. In the years prior to the pandemic, there were between 8 (in 2016) and 12 (in 2018) deaths per day.
  • A number of factors may have contributed to a worsening of the overdose crisis over the course of the pandemic, including the increasingly toxic drug supply, increased feelings of isolation, stress and anxiety, and changes in the availability or accessibility of services for people who use drugs.

Where: A majority of deaths occurred in British Columbia, Alberta, and Ontario; increases observed in other regions

  • Several jurisdictions have observed record-breaking numbers and rates in relation to the wider impacts of the COVID-19 pandemic.
  • In 2021 (January – December), 88% of all accidental apparent opioid toxicity deaths occurred in British Columbia, Alberta, or Ontario.
  • Elevated rates have also been observed in other areas, including Yukon and Saskatchewan.

Who: Most apparent opioid toxicity deaths among young- to middle-aged males

  • Males accounted for the majority of accidental apparent opioid toxicity deaths (74%) in 2021 (January – December).
  • 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 in 2021 (January – December), 86% involved fentanyl.
  • Of all accidental apparent opioid toxicity deaths in 2021 (January – December), 81% involved opioids that were only non-pharmaceuticalFootnote 3Footnote 4.

Data on the polysubstance nature of the overdose crisis

  • Available information from six provinces and territories indicates the number of apparent stimulant toxicity deaths in 2021 (January – December) was high. Almost all (98%) of those deaths were accidental.
  • More than half (59%) of accidental apparent opioid toxicity deaths in 2021 (January – December) also involved a stimulant, reflecting the polysubstance nature of this crisis.
  • Of the accidental apparent stimulant toxicity deaths in 2021 (January – December), 62% involved cocaine, while 55% involved methamphetamines.
  • Of the accidental apparent stimulant toxicity deaths in 2021 (January – December), 86% involved an opioid.

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

What: There was a total of 30,860 opioid-related and 13,575 stimulant-related poisoning hospitalizations from January 2016 to December 2021 in Canada (excluding Quebec)

  • During the first year of the pandemic, there was a 27% increase in opioid-related poisoning hospitalizations (April 2020 – March 2021, 5,599 hospitalizations), compared to the year before (April 2019 – March 2020, 4,426 hospitalizations). Since then, opioid-related poisoning hospitalizations have continued to increase.
  • A total of 6,164 opioid-related poisoning hospitalizations occurred in 2021 (January – December). This is approximately 17 hospitalizations per day. In the years prior to the pandemic, there were between 12 (in 2019) and 14 (in 2017) hospitalizations per day.
  • A total of 2,387 stimulant-related poisoning hospitalizations occurred in 2021 (January – December). This is approximately seven hospitalizations per day. In the years prior to the pandemic, there were between five (in 2016) and six (in 2019) hospitalizations per day.
  • Median total length of hospital stay was three days for both opioid- and stimulant-related poisoning hospitalizations in 2021 (January – December).
  • Of all opioid-related poisoning hospitalizations, 32% involved fentanyl or fentanyl analogues. Among accidental opioid-related poisoning hospitalizations, a larger proportion involved fentanyl (35%) than among intentional poisonings (18%) in 2021 (January – December).

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.

Where: A majority of hospitalizations occurred in British Columbia, Alberta and Ontario

  • Rates of opioid- and stimulant-related poisoning hospitalizations continue to remain highest in British Columbia, Saskatchewan and Alberta, followed by Territories and Ontario.
  • In 2021 (January – December), 88% of poisoning hospitalizations involving opioids and 85% of poisoning hospitalizations involving stimulants occurred in British Columbia, Alberta, or 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 (58%) in 2021 (January – December).
  • Most accidental stimulant-related poisoning hospitalizations occurred among males (68%) and among individuals aged 20 to 49 years (72%) in 2021 (January – December).

Poisoning hospitalizations associated with multiple substances in 2021 (January to December)

  • Of all opioid-related poisoning hospitalizations, 28% 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 (43%) than among accidental poisonings (24%).
  • Of all stimulant-related poisoning hospitalizations, 61% involved co-poisoning with a non-stimulant substance; 43% of all stimulant-related poisoning hospitalizations involved co-poisoning with opioids (including fentanyl or fentanyl analogues), while 24% involved specifically fentanyl or fentanyl analogues.
    • Among accidental stimulant-related poisoning hospitalizations, a larger proportion involved fentanyl or fentanyl analogues (32%) than among intentional (8%) poisonings.

Emergency Medical Services Download EMS report in .pdf format

What: There were more than 41,600 Emergency Medical Services (EMS) responses to suspected opioid-related overdoses in 2021 (January to December)

  • A total of 41,686 EMS responses to suspected opioid-related overdoses occurred in 2021 (January – December), based on available data from nine provinces and territories. For a similar timeframe in 2019, before the pandemic, there were 21,759 EMS responses; this represents a 92% increase.
  • A number of factors have likely contributed to a worsening of the overdose crisis over the course of the pandemic, including the increasingly toxic drug supply, increased feelings of isolation, stress and anxiety, and changes in the availability or accessibility of services for people who use drugs.

Who: Young- to middle-aged males continue to be the most affected

  • Of the EMS responses for suspected opioid-related overdoses in 2021 (January – December), 73% were among males.
  • The majority of EMS responses for suspected opioid-related overdoses in 2021 (January – December) were among those aged 20 to 49 years; however, variations are apparent between provinces and territories.

Footnotes

Footnote 1

Manitoba data from January to December 2021 were not available at the time of this update.

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Footnote 2

National overall count from January 2016 to December 2021 includes deaths from British Columbia (2018 to 2021) and Quebec (2020 to 2021) related to all illicit drugs including, but not limited to opioids.

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Footnote 3

Based on 2021 data on origin of opioids from deaths with completed investigations from eight provinces.

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Footnote 4

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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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

Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid- and Stimulant-related Harms in Canada. Ottawa: Public Health Agency of Canada; June 2022. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants


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