Modelling opioid-related deaths during the COVID-19 outbreak

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Overview

The Public Health Agency of Canada (PHAC) developed a simulation model of opioid-related deaths that provides information on the number of these deaths that might occur during the COVID-19 outbreak in 2020 through to December 2022.

The opioid overdose crisis continues to have significant impacts on people living in Canada, their families, and communities, and remains one of the most serious public health crises in Canada's recent history.

Data from several jurisdictions across Canada and PHAC show a substantial increase in opioid-related harms and deaths since the beginning of the COVID-19 outbreak.

This may be related to:

PHAC publishes data on opioid-related harms quarterly. It helps to provide a national picture, inform decision makers, and guide response efforts. These data are based on complex coroner and medical examiner investigations. At the national level, there is an average 6-month delay between a death occurring and it being included in the data.

Modelling and the opioid overdose crisis

Models use mathematical equations to estimate how many cases of a disease or health event may occur in the coming weeks or months. They help researchers simulate real-world possibilities in a virtual environment.

Models can't predict what will happen, but they can help governments and Canadians understand what might happen in certain scenarios. This can help us plan and act to achieve the best possible outcome.

PHAC developed a simulation model that provides the number of opioid-related deaths that might occur.

Simulations were based on several scenarios, specifically:

Please refer to the Model development section for more information.

Projections

Projections to December 2022

The results of the model suggest that, under some scenarios, the number of opioid-related deaths may remain high or may even increase through to December 2022.

Figure 1: Observed and projected opioid-related deaths, Canada, January 2016 to December 2022
Figure 1: Observed and projected opioid-related deaths, Canada, January 2016 to December 2022
Figure 1: Observed and projected opioid-related deaths, Canada, January 2016 to December 2022
  • Scenario 1: Health interventions prevent the same proportion of deaths, level of fentanyl increases
  • Scenario 2: Health interventions prevent the same proportion of deaths, level of fentanyl remains the same
  • Scenario 3: Health interventions prevent more deaths, level of fentanyl increases
  • Scenario 4: Health interventions prevent more deaths, level of fentanyl remains the same
  • Solid black line: represents the model output for the period from January 2016 to September 2021, which was calibrated to observed data shown by the grey bars. Comparing the real data from the past to the simulated deaths from the model shows us that the model is well set up

Notes

PHAC's model simulates opioid -related deaths in a way that closely matches observed opioid-related deaths from 2016 through September 2021.

As opioid use and related harms have changed significantly over the past years, this model will be published twice a year. Changes between the previous model released on December 15, 2021 and the new model released on June 23, 2022:

Considerations

The simulations presented here reflect a combination of:

When interpreting model results, it is important to recognize that:

PHAC will update its model as it learns more about the effect of the COVID-19 outbreak on the opioid overdose crisis.

Model development

PHAC developed a system dynamics model of opioid-related deaths.

Model parameter values were identified from:

In the model, people using opioids can die from an opioid overdose at different rates depending on the type of opioid use. Mortality rates for non-medical opioid use are also affected by:

Projections for 2022 (released December 2021)

The results of the model suggest that, under some scenarios, the number of opioid-related deaths may remain high or may even increase through to June 2022.

Figure 1: Observed and projected opioid-related deaths, Canada, January 2016 to June 2022
Figure 1: Observed and projected opioid-related deaths, Canada, January 2016 to June 2022
Figure 1 text description: Observed and projected opioid-related deaths, Canada, January 2016 to June 2022
  • Scenario 1: Health interventions prevent the same proportion of deaths, level of fentanyl increases
  • Scenario 2: Health interventions prevent the same proportion of deaths, level of fentanyl remains the same
  • Scenario 3: Health interventions prevent more deaths, level of fentanyl increases
  • Scenario 4: Health interventions prevent more deaths, level of fentanyl remains the same
  • Solid black line: represents the model output for the period from January 2016 to March 2021, which was calibrated to observed data shown by the grey bars. Comparing the real data from the past to the simulated deaths from the model shows us that the model is well set up
  • Scenario 1 (purple line): If health interventions prevent 30% of opioid-related deaths from October 2020 through June 2022 and the level of fentanyl in the drug supply increases after March 2021, then a further increase in deaths may occur through June 2022.
  • Scenario 2 (green line): If health interventions prevent 30% of opioid-related deaths from October 2020 through June 2022, and the level of fentanyl in the drug supply remains the same as in March 2021, then deaths through June 2022 may remain high.
  • Scenario 3 (red line): If health interventions improve after March 2021 to prevent 50% of opioid-related deaths, and the level of fentanyl in the drug supply increases after March 2021, then deaths through June 2022 may be lower than previous levels seen during the COVID-19 period from June 2020 through March 2021.
  • Scenario 4 (blue line): If health interventions improve after March 2021 to prevent 50% of opioid-related deaths, and the level of fentanyl in the drug supply remains the same as in March 2021, then deaths through June 2022 may decrease but not to below levels seen at the peak of the opioid overdose crisis before the onset of COVID-19.

Notes

PHAC's model simulates opioid -related deaths in a way that closely matches observed opioid-related deaths from 2016 through March 2021.

Changes between the previous model released on June 23, 2021 and the new model released on December 15, 2021:

  • The model has been updated with the surveillance data on apparent opioid-related deaths through March 2021.
  • Comparisons between modelling results and the most recent surveillance data released in December 2021 should be made with caution. The model uses data from the September 2021 release, which may vary slightly from the data released in December.
Projections for 2021 (released June 2021)

The model's projections to December 2021 suggest that, under some scenarios, the number of opioid-related deaths may remain high or may even increase through the remainder of 2021.

Figure 1: Observed and projected opioid-related deaths, Canada, January 2016 to December 2021
Figure 1 text description: Observed and projected opioid-related deaths, Canada, January 2016 to December 2021
  • Scenario 1: health interventions prevent the same proportion of deaths, level of fentanyl increases
  • Scenario 2: health interventions prevent the same proportion of deaths, level of fentanyl remains the same
  • Scenario 3: health interventions prevent more deaths, level of fentanyl increases
  • Scenario 4: health interventions prevent more deaths, level of fentanyl remains the same
  • Solid black line: represents the model output for the period from January 2016 to September 2020, which was calibrated to observed data shown by the solid grey bars. Comparing the real data from the past to the simulated deaths from the model shows us that the model is well set up (i.e. properly calibrated).
  • Scenario 1 (purple line): If health interventions prevent 20% of opioid-related deaths, as was estimated from June through September 2020 during the COVID-19 outbreak, and the level of fentanyl in the drug supply increases, then even further increases in deaths may occur through December 2021.
  • Scenario 2 (green line): If health interventions prevent 20% of opioid-related deaths (starting in April 2020), and the level of fentanyl in the drug supply remains the same, then quarterly deaths are projected to meet or surpass the levels seen at the height of the opioid overdose crisis in 2018.
  • Scenario 3 (red line): If health interventions improve after September 2020 to prevent 40% of opioid-related deaths, and the level of fentanyl in the drug supply increases, then deaths from October 2020 through December 2021 may remain similar to levels seen during the COVID-19 period from April through September 2020.
  • Scenario 4 (blue line): If health interventions improve after September 2020 to prevent 40% of opioid overdose deaths, and the level of fentanyl in the drug supply remains the same, then deaths through December 2021 may decrease but not to levels seen before the onset of COVID-19.

Notes

PHAC's model simulates opioid-related deaths in a way that closely matches observed opioid-related deaths from 2016 through September 2020.

Changes between the model released on December 16, 2020 and the new model released on June 23, 2021:

  • The June model no longer uses data from the Public Health Agency of Canada's Opioid-and Stimulant-related Harms Surveillance for information on the level of fentanyl in the drug supply. Health Canada's Drug Analysis Service (DAS) data are used for this. DAS for 2019. The original October model used data from DAS for 2018 and applied these data to 2019.
  • The June model incorporates data from Health Canada's Drug Analysis Service (DAS) for 2020. The December model used data from DAS for 2019 and applied these data to 2020.
  • The June model has been updated with the surveillance data on apparent opioid-related deaths from April through September 2020.
  • Comparisons between modelling results and the most recent surveillance data released in June 2021 should be made with caution. The model uses data from the March 2021 release, which may vary slightly from the data released in June.
Projections for 2020 (released December 2020)

The model's projections for April to December 2020 suggest that, under some scenarios, the opioid overdose crisis may resurge or surpass levels seen at the height of the opioid overdose crisis in late 2018.

Figure 1: Observed and projected opioid overdose deaths, Canada, 2016 to 2020
Figure 1 text description: Observed and projected opioids overdose deaths, Canada, 2016 to 2020
  • Scenario 1: Public health measures prevent 60% of deaths
  • Scenario 2: Public health measures prevent 40% of deaths
  • Scenario 3: Public health measures prevent 20% of deaths

Within each scenario, there can be varying levels of fentanyl.

  • Dotted line: reflects when fentanyl in the illegal drug supply accounts for 80% of overdose deaths
  • Dashed line: reflects when fentanyl in the illegal drug supply accounts for 85% of overdose deaths
  • Solid line: reflects when fentanyl in the illegal drug supply accounts for 90% of overdose deaths
  • Solid black line: represents the model output for the period from January 2016 to December 2019, which was calibrated to observed data shown by the grey bars. Comparing the real data from the past to the simulated deaths from the model shows us that the model is well set up (i.e. properly calibrated).
  • Scenario 1 (purple lines): If public health measures continue to prevent 60% of opioid overdose deaths, as was estimated in October to March 2020 before the onset of the COVID-19 outbreak, then deaths for April through June 2021 will remain similar to those observed at the end of 2019.
  • Scenario 2 (green lines): If public health measures prevent 40% of opioid overdose deaths (starting in April 2020), then quarterly deaths are projected to meet or surpass the levels seen at the height of the opioid overdose crisis in 2018.
  • Scenario 3 (red lines): If public health measures prevent only 20% of opioid overdose deaths (starting in April 2020), then quarterly deaths are projected to be substantially higher than observed in any previous quarter.
  • The level of fentanyl in the illegal drug supply also has an effect on the number of deaths, as shown by the dotted, dashed and full lines.

Notes

PHAC's model simulates opioid overdose deaths in a way that closely matches observed opioid overdose deaths from 2016 through early 2020.

Changes between the model released on October 26, 2020 and the new model released on December 16, 2020:

  • The December model incorporates data from Health Canada's Drug Analysis Service (DAS) for 2019. The original October model used data from DAS for 2018 and applied these data to 2019.
  • The December model has been updated with the statistics on apparent opioid-related deaths from January to March 2020.
  • Comparisons between modelling results and the most recent surveillance data released in December 2020 should be made with caution due to changes in the way data are reported by some jurisdictions for the December 2020 release.

Canada's approach to the opioid overdose crisis

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