Opioid- and Stimulant-related Harms in Canada Published: (June 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. 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 December 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. 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 36,442 apparent opioid toxicity deaths between January 2016 and December 2022Footnote 1Footnote 2
- A total of 7,328 apparent opioid toxicity deaths occurred in 2022 (January-December). This is an average of 20 deaths per day. In 2019 prior to the COVID-19 pandemic, the average number of deaths per day was 10, which increased to a peak of 22 in 2021.
- The number of total apparent opioid toxicity deaths in Canada reported in 2022 (January-December) has been lower (9%) than 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
- In 2022 (January-December), most (87%) of all 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 (74%) in 2022 (January-December).
- For males and for females, the majority of accidental apparent opioid toxicity deaths were among individuals aged 20 to 59 years.
Why: Among other drivers, toxicity of supply continues to be a major driver of the crisis
- Of all accidental apparent opioid toxicity deaths in 2022 (January-December), 81% involved fentanyl.
- Of all accidental apparent opioid toxicity deaths in 2022 (January-December), 79% involved opioids that were only non-pharmaceuticalFootnote 3Footnote 4.
Data on the polysubstance nature of the overdose crisis
- Available information from eight provinces and territories indicates the number of apparent stimulant toxicity deaths in 2022 (January-December) was high. Almost all (98%) of those deaths were accidental.
- Over half (56%) of accidental apparent opioid toxicity deaths in 2022 (January-December) also involved a stimulant, reflecting the polysubstance nature of this crisis.
- Of the accidental apparent stimulant toxicity deaths in 2022 (January-December), 64% involved cocaine, while 53% involved methamphetamines.
- Of the accidental apparent stimulant toxicity deaths in 2022 (January-December), 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 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 36,233 opioid-related and 15,696 stimulant-related poisoning hospitalizations from January 2016 to December 2022 in Canada (excluding Quebec)
- A total of 5,265 opioid-related poisoning hospitalizations occurred in 2022 (January-December). This is an average of 14 hospitalizations per day. In 2019 prior to the COVID-19 pandemic, the average number of hospitalizations per day was 12, which increased to a peak of 17 in 2021.
- A total of 2,086 stimulant-related poisoning hospitalizations occurred in 2022 (January-December). This is an average of six hospitalizations per day. In 2019 prior to the COVID-19 pandemic, the average number of hospitalizations per day was six, which increased to a peak of seven in 2020.
- The median total length of hospital stay was three days for both opioid- and stimulant-related poisoning hospitalizations in 2022 (January-December).
- The number of opioid-related poisoning hospitalizations in Canada reported in 2022 (January-December) has been lower (16%) than the previous year. This is based on provisional data subject to change and should be interpreted with caution. Based on current national data, analysis of quarterly rates for trend suggested that a significant decrease in rates of opioid-related poisoning hospitalizations occurred between Q3 of 2021 (July – September) and Q4 of 2022 (September – December).
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
- In 2022 (January-December), most of all accidental opioid-related poisoning hospitalizations (90%) and accidental stimulant-related poisoning hospitalizations (90%) in Canada occurred in Ontario, British Columbia, and Alberta.
- In 2022 (January-December), rates of accidental opioid-related hospitalizations in Canada were highest in British Columbia, Alberta, and Saskatchewan, while rates of accidental stimulant-related hospitalizations in Canada were highest in British Columbia, the Territories, and Saskatchewan.
Who: Most accidental poisoning hospitalizations were among males, with varying age distributions
- In 2022 (January-December), males accounted for a higher proportion of accidental opioid-related poisoning hospitalizations (64%) and accidental stimulant-related poisoning hospitalizations (71%) than females.
- In 2022 (January-December), the highest proportion of accidental opioid-related poisoning hospitalizations were among individuals aged 60 years or more (25%), followed by those aged 30 to 39 years (22%). The highest proportion of accidental stimulant-related poisoning hospitalizations were among individuals aged 30 to 39 years (28%), followed by those aged 20 to 29 years (21%) and those aged 40 to 49 years (20%).
Why: Toxicity of supply is contributing to the crisis
- For opioid-related poisoning hospitalizations, fentanyl and its analogues were involved in 34% of accidental opioid-related poisoning hospitalizations, compared to 19% of intentional opioid-related poisoning hospitalizations in 2022 (January-December).
- For stimulant-related poisoning hospitalizations, fentanyl and its analogues were involved in 32% of accidental stimulant-related poisoning hospitalizations, compared to 7% of intentional stimulant-related poisoning hospitalizations in 2022 (January-December).
Data on the polysubstance nature of the overdose crisis
- Among accidental opioid-related poisoning hospitalizations in 2022 (January-December), 17% involved co-poisoning with a stimulant.
- Among accidental stimulant-related poisoning hospitalizations in 2022 (January-December), 53% involved co-poisoning with an opioid.
Emergency Medical Services Download EMS report in .pdf format
What: There were more than 35,900 Emergency Medical Services (EMS) responses to suspected opioid-related overdoses in 2022 (January – December)
- A total of 35,971 EMS responses to suspected opioid-related overdoses in 2022 (January - December), based on available data from nine provinces and territories. Prior to the COVID-19 pandemic for the same nine provinces and territories, there were 21,759 EMS responses in 2019, which increased to a peak of 41,719 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 in 2022 (January – December), 72% were among males.
- The majority of EMS responses for suspected opioid-related overdoses in 2022 (January – December) 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 to December 2022 were not available at the time of this update.
- Footnote 2
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The national overall count from January 2016 to December 2022 includes deaths from British Columbia (2019 to 2022) related to all illicit drugs and Quebec (2021 and 2022) related to drug or opioid-related intoxication.
- Footnote 3
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Based on 2022 data on origin of opioids from deaths with completed investigations from ten 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; June 2023. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/