Decline in opioid-related deaths in Canada:
Potential factors to explain the decline in opioid-related deaths in 2024 compared to 2023.
- Last updated: 2025-12-11
Introduction
After years of increasing opioid-related deaths, Canada had a notable 17% decline in 2024 compared to 2023. This shift mirrors similar patterns in the United States. It represents the first sustained decline since deaths surged during the COVID-19 pandemic. The reasons behind this decline are unclear, and trends differ across provinces and territories.
We explored seven potential factors, or drivers, to help explain the 2024 decline in deaths. We found that no single factor explained the decline. Instead, multiple factors appeared to work together.
Factors
Click the factor you want to learn more about.
Likely factors
Possible factor
Unlikely factors
Changes in the drug supply
- Changes in the illegal drug supply are a likely factor in the recent decline in opioid-related deaths.
- Evidence shows a reduction in fentanyl and high-risk drug combinations (such as opioids mixed with benzodiazepines). This reduction aligns with the decrease in deaths.
- The drug supply varies by region and remains unpredictable. Rapid alert systems for emerging substances help us react to changes in the drug supply. These alert systems could be strengthened to inform clinical and harm reduction responses.
Figure 1. Percentage (%) of substances identified in opioid seizure samples and number of opioid-related deaths, by quarter, Canada, 2016 to 2024
Figure 1: Notes
Note: Drug detection data are from Health Canada: Drug Analysis Service. Opioid-related death data are from the June 2025 update to Opioid- and Stimulant-related Harms in Canada. These findings may differ from other data from the Health Canada Drug Analysis Service as they are presented and analyzed in a different way.
Changes in naloxone availability
- The increased availability of naloxone is a likely factor in the recent decline in opioid-related deaths.
- Over several years, more naloxone was distributed across Canada, reaching high levels by 2024. Regions that distributed more kits experienced larger declines in deaths.
- Continuing to make naloxone available in more locations and to more communities remains a strategic priority for preventing opioid-related deaths.
Figure 2. Quarterly naloxone kit distribution and number of opioid-related deaths in select provinces*, 2016 Q1 to 2024 Q4
Figure 2: Notes
Note: *Data are from provinces with publicly available data (British Columbia, Alberta, Manitoba, and Ontario).
Naloxone data are publicly available from:
- BCCDC Unregulated Drug Poisoning Emergency Dashboard
- Alberta Substance Use Surveillance System
- Manitoba Report on Take-home Naloxone Distribution
- Ontario Opioid Indicator Tool (Harm Reduction Dashboard)
Opioid-related death data are from the June 2025 update to Opioid- and Stimulant-related Harms in Canada. Deaths data for British Columbia after 2018 include deaths related to all illegal drugs. Population data used to calculate number of kits distributed per population are from Statistics Canada: Table 17-10-0009-01, Population estimates, quarterly.
Declining population at risk of opioid-related overdose
- A declining population at risk is a likely factor in the recent decline in opioid-related deaths. Population declines are in part because many lives were lost over previous years.
- Evidence supporting this includes:
- largest declines in deaths were in regions with more previous overdose deaths
- reduced opioid use in youth
- larger declines in deaths were among high-risk groups
- stakeholder observations
- Declining trends are not guaranteed, and we must sustain efforts to prevent new people from becoming at-risk. Continuing to invest in prevention, treatment, recovery and harm reduction is critical.
Figure 3. Quarterly opioid-related death rates per 100,000 population by province, 2016 Q1 to 2024 Q4
Figure 3: Notes
Note: Data are from the June 2025 update to Opioid- and Stimulant-related Harms in Canada. Deaths data for British Columbia after 2018 include deaths related to all illegal drugs. Deaths data for Quebec after 2022 include presumed unintentional deaths related to all drug or opioid intoxications. Population data used to calculate death rate per population are from Statistics Canada: Table 17-10-0009-01, Population estimates, quarterly. Figure only shows data from provinces. Death rates for Prince Edward Island were suppressed due to small sample size.
Figure 4. Quarterly opioid-related death rates per 100,000 population by age group, 2016 Q1 to 2024 Q4
Figure 4: Notes
Note: Data are from the June 2025 update to Opioid- and Stimulant-related Harms in Canada. Population data used to calculate death rate per population are from Statistics Canada: Table 17-10-0009-01, Population estimates, quarterly.
Changes in consumption behaviours
- Changes in how people use drugs are a possible factor in the recent decline in opioid-related deaths.
- More people smoke opioids rather than inject them (smoking has a lower overdose risk).
- Communities have also adopted practices that protect against overdose, such as not using drugs alone and providing peer support.
- Harm reduction services that build on community-led safety practices could further reduce opioid-related deaths.
Figure 5. Percentage (%) of fentanyl and heroin use by mode of consumption reported in the past 3 days from harm reduction sites in Canada, January 2021 to April 2023
Figure 5: Notes
Note: Figure from Canadian Centre on Substance Use and Addiction (2024). Community Urinalysis and Self-Report Project: Cross-Canada Trends in Opioid Use, 2021–2023, Figure 2, p. 4. Reproduced with permission. The Peel Region in Ontario includes Brampton, Mississauga, and Caledon.
Figure 6. Percentage (%) of drugs use behaviours among people who inject drugs, 2019 vs. 2024
Figure 6: Notes
Note: Data are from the Tracks Survey of People who Inject Drugs, Phase 4 (2019) and Phase 5 (2024; pending publication).
Drug checking services (DCSs)
- DCSs are unlikely to be a factor in the recent decline in opioid-related deaths.
- Deaths declined even in regions with few or no DCSs, suggesting that these services cannot explain the broad declines in deaths.
- DCSs provide important benefits for people who use them but need to be available in more communities to prevent more deaths.
Figure 7. Percentage (%) change in opioid-related deaths (2024 vs. 2023) and number of drug checking sites per million population (2024) in Canada
Figure 7: Notes
Note: Data on drug-checking sites are from the Canadian Centre on Substance Use and Addiction's Environmental scan of drug-checking services in Canada (2024). Opioid-related death data are from the June 2025 update to Opioid- and Stimulant-related Harms in Canada. Deaths data for Nunavut were unavailable. Deaths data for British Columbia after 2018 include deaths related to all illegal drugs. Deaths data for Quebec after 2022 include presumed unintentional deaths related to all drug or opioid intoxications. Population data used to calculate number of samples per population are from Statistics Canada: Table 17-10-0009-01, Population estimates, quarterly.
Supervised consumption sites (SCSs) and overdose prevention sites (OPSs)
- SCSs and OPSs are unlikely to be a factor in the recent decline in opioid-related deaths.
- Most of these sites opened before 2022, but deaths did not decline until 2024. The limited number of sites also cannot account for the broad reduction in deaths across multiple provinces and territories.
- SCSs and OPSs provide significant benefits for people who use them. However, they need to be combined with other approaches to reduce deaths more widely.
Figure 8. Monthly number of supervised consumption (SCSs) and overdose prevention (OPSs) sites, Canada, March 2020 to December 2024
Figure 8: Notes
Note: Data are from Health Canada supervised consumption site dashboard and status of applications table, OPS websites, and media articles.
Opioid agonist therapy (OAT)
- OAT is unlikely to be a factor in the recent decline in opioid-related deaths.
- The number of people receiving OAT was stable or declining when deaths decreased. Provinces where more people received OAT still experienced high death rates.
- OAT remains an effective treatment that helps individuals. However, current treatment levels cannot explain the broad decline in deaths. This suggests a need for strategies that combine OAT with other interventions.
Figure 9. Number of opioid agonist therapy (OAT) patients and number of opioid-related deaths by province, 2018 to 2024
Figure 9: Notes
Note: OAT patient data are publicly available from: BCCDC Unregulated Drug Poisoning Emergency Dashboard, Alberta Substance Use Surveillance System, Annual Reports from Saskatchewan's OAT Program, Ontario Opioid Indicator Tool (OAT Dashboard). For Saskatchewan, buprenorphine/naloxone includes both buprenorphine and buprenorphine/naloxone, and OAT data are not available from January to April, 2023, and after March 2024. Opioid-related death data are from the Public Health Agency of Canada, June 2025 release: Opioid- and Stimulant-related Harms in Canada. Deaths data for British Columbia after 2018 include deaths related to all illegal drugs.
Methods and limitations
The seven factors were identified through consultations with:
- federal partners
- provinces and territories
- academic experts
- stakeholders
To assess how likely each factor contributed to the decline in deaths, many sources of information were used:
- literature reviews
- data analysis
- input from stakeholders, including people with lived and living experience
When interpreting the findings, the following should be considered:
- These findings do not prove cause and effect due to concurrent interventions and data limitations.
- Factors may vary across regions. Some regions experienced decreases in deaths of over 40%, while others had increases of over 20%.
- This study focused on the 2024 decline specifically, not the effectiveness of the interventions.
- Mortality is only 1 dimension of harm, and people continue to experience serious consequences from toxic substances.
Declines in opioid-related deaths are encouraging where observed. However, they do not guarantee progress or protect against future increases in this ongoing public health emergency.
Suggested citation
Public Health Agency of Canada. Decline in opioid-related deaths in Canada: Potential factors to explain the decline in opioid-related deaths in 2024 compared to 2023. Ottawa: Public Health Agency of Canada; December 11, 2025. https://health-infobase.canada.ca/substances/harms/decline-opioid-related-deaths/
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