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National Report: Apparent Opioid-related Deaths in Canada Published: ()

Suggested citation

Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: Apparent opioid-related deaths in Canada (January 2016 to June 2018). Web Based Report. Ottawa: Public Health Agency of Canada; December 2018. https://infobase.phac-aspc.gc.ca/datalab/national-surveillance-opioid-harms-mortality.html

Acknowledgment

This report would not be possible without the collaboration and dedication of provincial and territorial (PT) offices of Chief Coroners and Medical Examiners as well as PT public health and health partners.


Key findings

The opioid crisis has affected every part of the country, but there are clear differences in death rates and the substances involved across provinces and territories. According to available data reported as of November 16, 2018:

  • between January 2016 and June 2018 there were 9,078 apparent opioid-related deaths, including 3,014 in 2016 and 3,998 in 2017
  • from January to June 2018, there were 2,066 apparent opioid-related deaths; 94% were accidental (unintentional)

Although trends vary by province or territory, at the national level, trends for the first half of 2018 (January to June) continue to reflect those observed in 2017. Most accidental apparent opioid-related deaths:

  • involved fentanyl or fentanyl analogues (72%)
  • occured among males (76%)
  • were among young and middle aged adults with 27% between the ages of 30 and 39; 20% between 20 and 29; 21% between 40 and 49 and 22% between 50 and 59.

It is expected that these numbers will change as additional data become available.



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Background

Canada continues to experience a serious opioid crisis. Across the country, it is having devastating effects on families and communities. The Government of Canada works closely with the provinces and territories to collect and share data on apparent opioid-related deaths. Accurate information about the crisis is needed to help guide efforts to reduce opioid-related harms, including deaths.

The data in this report:

  • are updated four times a year
  • may change based on review and refinement
  • have been collected by the provinces and territories from their respective office of the Chief Coroner or Medical Examiner
  • have been shared through the Special Advisory Committee on the Epidemic of Opioid Overdoses

Changes from the last report include:

  • the addition of available preliminary data from April to June 2018
  • updates to previously reported data from January 2016 to March 2018
  • the use of InfoBase as a reporting tool to increase interactivity with the data presented

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1.0. Apparent opioid-related deaths in Canada

The opioid crisis has affected every part of the country, but some provinces and territories have been impacted more than others. According to data reported as of November 16, 2018:

  • there were 9,078 apparent opioid-related deaths between January 2016 and June 2018
    • in 2016, there were 3,014 apparent opioid-related deaths (corresponding to a death rate of 8.3 per 100,000 population) and 3,998 occurred in 2017 (corresponding to a death rate of 10.9 per 100,000 population)
    • from January to June 2018, there were 2,066 apparent opioid-related deaths, corresponding to a death rate of 11.2 per 100,000 population (Figure 1, Table 1)
  • a notable increase in the number of apparent opioid related deaths was observed between January and June 2017 compared to the same time period in 2016Apparent opioid-related death footnote a. Available data suggest that, although regional variation exists, the trends have remained relatively stable into 2018 - the number of apparent opioid-related deaths between January and June 2018 was similar compared to the same time period in 2017.Apparent opioid-related death footnote a

Figure 1. Number and rate (per 100,000 population) of apparent opioid-related deaths by province or territory, in

Figure 1 navigation

Use the map below to see the number and rate of apparent opioid-related deaths. Navigate the map using Tab or Hover. Once a province is selected, Zoom using Click (when hovering) or Spacebar (when tabbing).

In 2018 (Jan to Jun), the number of total apparent opioid-related deaths in Canada was 2,066.

The death rate in Canada was 11.2 per 100,000 population for the selected year.

These quarterly counts do not include data from Prince Edward Island, Newfoundland and Labrador, and Nunavut.



Notes
  • Suppressed (suppr.) – Data may be suppressed in provinces or territories with low numbers of cases. Please see Considerations and Limitations for more information.



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1.1 Apparent opioid-related deaths by manner of death

Collecting data on how deaths occurred, including whether they were intentional or not, is critical in understanding how the opioid crisis is affecting Canadians. The following section presents summary data on apparent opioid-related deaths according to the manner of death assigned by the coroner or medical examiner during, or following an investigation (Table 1).

Accident: Deaths with completed investigations where the coroner or medical examiner determined that the death was unintentional. This category also includes deaths with ongoing investigations where the manner of death was believed to be unintentional or had not been assigned at the time of reporting.

Suicide: Deaths with completed investigations where the coroner or medical examiner determined that the opioids were consumed with the intent to die. This category also includes deaths with ongoing investigations where suicide was believed to be the manner of death at the time of reporting.

Undetermined: Deaths with completed investigations where a specific manner of death (e.g. accident, suicide) could not be assigned based on available or competing information.

According to available data reported as of November 16, 2018, most (94%) apparent opioid-related deaths between January and June 2018 were accidental (unintentional), similar to both 2016 (88%) and 2017 (93%) (Table 1).

In other words, these data indicate that the vast majority of apparent opioid-related deaths were of individuals who did not intend to die. This distinction is important to inform an appropriate public health response. For example, the high percent of unintended deaths reinforces the concern that a variety of street drugs are tainted with toxic substances, such as fentanyl, without the knowledge of the people consuming them. Public health officials will be able to use this information in developing strategies to address these hidden risks in order to reduce harms and effectively prevent unintended apparent opioid-related deaths.

Table 1. Summary of apparent opioid-related deaths in 2016, 2017 and January to June 2018.Apparent opioid-related death footnote 1


2.0 Accidental apparent opioid-related deaths

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The following section provides detailed information on accidental apparent opioid-related deaths, which are deaths with completed investigations where the coroner or medical examiner determined that the death was unintentional. This category also includes deaths with ongoing investigations where the manner of death was believed to be unintentional or had not been assigned at the time of reporting.

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2.1 Annual, sex, and age trends of accidental apparent opioid-related deaths

This crisis has affected Canadians from all walks of life; however, available data reported as of November 16, 2018 indicate that the impact of the crisis differs by year, sex, and age.

Although these trends vary by province or territory, at the national level:

  • there were 1,938 accidental apparent opioid-related deaths between January to June 2018 (Table 2)
  • available data suggest that the trends have remained relatively stable between January and June 2018 compared to the same time period in 2017Apparent opioid-related death footnote a (Table 2). A 56% increase in the number of accidental apparent opioid related deaths was observed between January and June 2017 compared to the same time period in 2016.Apparent opioid-related death footnote a
  • most (76%) accidental apparent opioid-related deaths from January to June 2018 occurred among males, similar to previous trends observed in 2016 and 2017 (Figure 2)
  • between January and June 2018, most accidental apparent opioid-related deaths were among young and middle aged adults: the highest percent (27%) occurred among individuals between the ages of 30 and 39; 20% were between 20 and 29 years, 21% were between 40 and 49 years and 22% were between 50 and 59 years (select age group in Figure 2 title drop-down list)

Figure 2. distribution of accidental apparent opioid-related deaths by province or territory, in

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2.2 Fentanyl, fentanyl analogues, and other substances involved in accidental apparent opioid-related deaths

Apparent opioid-related deaths often involveApparent opioid-related death involving fentanyl and other substances footnote b multiple substances including one or more opioids as well as non-opioid substances. Knowing the opioid and non-opioid substances involved in these deaths can help public health officials and other government agencies communicate risks and target harm reduction efforts.

Although regional variation exists, available data reported as of November 16, 2018, suggest that:

In addition, available data suggest approximately 76% of accidental apparent opioid-related deaths between January 2016 and June 2018Apparent opioid-related death involving fentanyl and other substances footnote c also involved one or more types of non-opioid substances.

Figure 3a. of accidental apparent opioid-related deaths involving or not involving fentanyl or fentanyl analogues by quarter, in Canada, January 2016 to June 2018.Accidental apparent opioid-related deaths involving or not involving fentanyl or fentanyl analogues footnote 1Accidental apparent opioid-related deaths involving or not involving fentanyl or fentanyl analogues footnote 2

Figure 3b. Percentage of accidental apparent opioid-related deaths involving fentanyl or fentanyl analogues, by province or territory, 2016, 2017 and January to June 2018.Accidental apparent opioid-related deaths involving or not involving fentanyl or fentanyl analogues footnote 1Accidental apparent opioid-related deaths involving or not involving fentanyl or fentanyl analogues footnote 2


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Considerations and Limitations

Definition of an apparent opioid-related death

An apparent opioid-related death is a death caused by an intoxication/toxicity (poisoning) resulting from substance use, where one or more of the substances is an opioid, regardless of how it was obtained (e.g. illegally or through personal prescription).

How apparent opioid-related deaths are counted

Counts are provided by the provinces and territories that collect data from their respective offices of Chief Coroners or Medical Examiners. Rates are calculated using the most current population data from Statistics Canada.

The data provided by the provinces and territories can include deaths:

  • with completed or ongoing investigations
  • where manner of death is classified as accident, suicide, or undetermined

These data do not include deaths due to:

  • the medical consequences of long term substance use or overuse (for example, alcoholic cirrhosis)
  • medical assistance in dying
  • trauma where use of the substance(s) contributed to the circumstances of the injury that lead to the death, but was not directly involved in the death
  • homicide

However, some provincial and territorial differences remain in the type of data reported and in the time periods for which data are available (refer to Table 3).

Table 3. Reporting periods and manners of death included in apparent opioid-related deaths data used for this report by province or territory.
  BCTable 3 Footnote 1 AB SK MB ONTable 3 Footnote 2 QCTable 3 Footnote 3 NB NS PE NLTable 3 Footnote 4 YT NT NUTable 3 Footnote 5
Reporting period (as of November 16, 2018)
2016 January to December (C) (C) (C) (C) (C)
2017 January to December (C) INC (C) (C) (C)
2018 January to March (C) (C) (C)
2018 April to June (C) (C) (C)
Classification of deaths included in the reported data
Accident Completed investigations N/A
Ongoing investigations where manner of death was believed to be unintentional - N/A - N/A N/A N/A N/A
Ongoing investigations where manner of death had not been assigned at the time of reporting - N/A N/A N/A - - N/A
Suicide Completed investigations N/A N/A
Ongoing investigations where the manner of death was believed to be suicide N/A N/A - N/A N/A N/A N/A N/A
Deaths with completed investigations and an undetermined manner of deathTable 3 Footnote 6 N/A N/A
  •   These data have been reported by the province or territory and are reflected in this report, unless otherwise specified
  • (C) Data includes deaths with completed investigations only
  • INC Data were not reported for the full time period
  • - The classification is not used in the province or territory
  • N/A Data were not available at the time of this publication
Table 3 Footnote 1

British Columbia reports deaths related to all illicit drugs (including opioids) used alone or in combination with prescribed/diverted medication.

Table 3 Return to footnote 1 referrer

Table 3 Footnote 2

As of May 1, 2017, apparent opioid-related death data in Ontario were captured using an enhanced data collection tool by the Office of the Chief Coroner.

Table 3 Return to footnote 2 referrer

Table 3 Footnote 3

Data from Quebec for 2016 were available for deaths with completed investigations only; 8% of the investigations for deaths that occurred in 2016 were underway. Data from January to June 2017 were not available at the time of publication. The available 2017 and 2018 data include deaths related to all illicit drugs including, but not limited to, opioids. Preliminary data for drug-related poisoning, for which toxicology information was available, indicate that 52% of deaths between July 2017 and June 2018 involved an opioid. Updates to previously reported data will be provided in future reports.

Table 3 Return to footnote 3 referrer

Table 3 Footnote 4

Available 2018 data from Newfoundland and Labrador included accidental deaths with completed investigations only.

Table 3 Return to footnote 4 referrer

Table 3 Footnote 5

Data from Nunavut were not included in national counts, rates, or percentages.

Table 3 Return to footnote 5 referrer

Table 3 Footnote 6

For this manner of death category, provinces and territories report only completed investigations with the exception of British Columbia which also includes data from ongoing investigations.

Table 3 Return to footnote 6 referrer

Data suppression

The suppression of data in this report are based on the preferences of individual provinces or territories to address concerns around releasing small numbers for their jurisdiction.

  • Prince Edward Island suppressed counts between one and four for quarterly data, and for any data related to sex or age distribution.
  • Newfoundland and Labrador suppressed counts between one and four for quarterly data, and data related to substances involved and sex or age distribution.
  • Quebec suppressed counts less than five for deaths with ongoing investigations (July to December 2017, 2018).
  • Nunavut suppressed all counts less than five.

In addition, suppression was applied in some instances where all data for a province or territory fell in a single category of a given table or figure.

Opioids and other substances

Fentanyl and fentanyl analogues include, but are not limited to:

  • 3-methylfentanyl
  • acetylfentanyl
  • acrylfentanyl
  • butyrylfentanyl
  • carfentanyl
  • cyclopropyl fentanyl
  • despropionyl-fentanyl
  • fentanyl
  • fluoroisobutyrlfentanyl (FIBF)
  • furanylfentanyl
  • methoxyacetylfentanyl
  • norfentanyl

Non-fentanyl-related opioids include, but are not limited to:

  • buprenorphine metabolites
  • codeine
  • dihydrocodeine
  • heroin
  • hydrocodone
  • hydromorphone
  • loperamide
  • meperidine
  • methadone
  • monoacetylmprophine
  • morphine
  • normeperidine
  • oxycodone
  • tapentadol
  • tramadol
  • U-47700

Non-opioid substances include, but are not limited to:

  • alcohol
  • benzodiazepines
  • cocaine
  • gabapentin
  • methamphetamine
  • W-18

Limitations of these apparent opioid-related deaths data

Data presented in this report should be interpreted with caution.

  • This report is based on data submitted to the Public Health Agency of Canada on or before November 16, 2018. New or revised data reported after this date will be reflected in future reports.
  • Data released by provinces and territories may differ from the data provided in this report due to the availability of updated data, differences in the type of data reported (e.g. manners of death), the use of alternate age groupings, differences in time periods presented and/or population estimates used for calculations, etc.
  • As some data are based on ongoing investigations by coroners and medical examiners, they are considered preliminary and subject to change. The time required to complete an investigation and related administrative processes is case-dependent and can range from approximately three to twenty-four months.
  • This report is based on data that do not specify how the opioids were obtained (e.g. illegally or through personal prescription); the level of toxicity may differ depending on the opioid (substance(s) involved, concentration, and dosage).
  • Jurisdictional differences in the death investigation process, death classification method, toxicology testing, and the manners of death reported may impact the interpretation and comparability of the data presented in this report.
  • Information related to changes over time at the national level is based only on jurisdictions where data were available for all time periods of interest.
  • Rates reported here have not been adjusted for existing differences in provincial and territorial age distributions.
  • Rates for jurisdictions with relatively smaller populations may change substantially with even slight changes in the number of deaths. As a result, comparisons over time and between provinces and territories should be interpreted with caution.


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