Opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories

Abstract

In Canada, the COVID-19 pandemic occurred in the midst of a growing drug toxicity crisis. Before the emergence of COVID-19, the number of accidental opioid-related deaths across Canada rose from 2470 in 2016 to 3447 in 2019. 1 This was accompanied by rising opioid-related hospital admissions 1 and growing infectious complications associated with substance use. 2 Although both prescription and unregulated opioids contribute to toxicity deaths, 3 the relative contribution of these substances has changed considerably over time, with fentanyl from the unregulated drug supply involved in more than 80% of opioid-related deaths in recent years (2020 to early 2023). 1 In 2021, almost 37 million people lived in Canada across 13 provinces and territories, with almost 40% residing in the province of Ontario, 4 where the first 6 months of the pandemic saw an estimated 17 843 additional years of life lost (YLL) from opioid-related premature death. 5 The observed acceleration in opioid-related harm across Canada has been attributed in part to public health measures implemented to curb the spread of SARS-CoV-2, including reduced access to harm reduction programs and border restrictions that may have increased the toxicity of the drug supply. [6][7][8] In addition, for many, the pandemic exacerbated feelings of anxiety, uncertainty, and loneliness, contributing to increased substance use globally. [9][10][11][12] The intersection of the COVID-19 pandemic with the drug toxicity crisis in Canada has created an urgent need to better understand the patterns of opioid-related deaths across the country to inform targeted public health responses. Therefore, we sought to describe trends in premature opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories. Methods Study design and settingWe conducted a repeated cross-sectional analysis of all opioidrelated deaths in 9 Canadian provinces and territories, with data collected at annual intervals between Jan. 1, 2019, and Dec. 31, 2021. 13 We reported this study using the Reporting of Studies Conducted using Observational Routinely-Collected Data (RECORD) checklist. 14