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 and 2021.

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

Recent data from several jurisdictions across Canada and PHAC show a worrying 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 every three months. 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 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 the remainder of 2021.

Figure 1: Observed and projected opioid-related deaths, Canada, January 2016 to December 2021
Figure 1. Text version below.

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).

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:

Considerations

The simulations presented here reflect a combination of:

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

PHAC will update its models 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 opioid overdose at different rates depending on the type of opioid use. Mortality rates for problematic and non-medical opioid use are also affected by:

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.
Projections for 2020 (released October 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

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 December 2019 before the onset of the COVID-19 outbreak, then deaths for April through December in 2020 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, 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, 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.

Canada's approach to the opioid overdose crisis

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