Federal actions on opioids to date

Organization: Health Canada

Date published: March 2023

The Government of Canada's actions to address the opioid overdose crisis to help save lives, including government funding for projects, increased access to treatment and harm reduction programs, as well as awareness, prevention and enforcement efforts.

Last updated: March 2023

On this page

• About the opioid overdose crisis
• Recent federal actions
• Government funding
• Enforcement and the toxic illegal drug supply
• Access to treatment
• Access to harm reduction
• Awareness and prevention
• Evidence
• Opioid-related harms in Canada

About the opioid overdose crisis

The opioid overdose crisis continues to have significant impacts on Canadian communities and families. The COVID-19 pandemic has worsened long-standing challenges regarding substance use and the opioid overdose crisis, with some communities reporting record high numbers of overdose deaths, hospitalizations, and emergency medical service calls. People who use drugs are also facing additional barriers and risks, such as:

• the highly toxic and unpredictable illegal drug supply,
• over-burdened health and social services, including life-saving harm reduction and treatment, and
• ongoing stigma surrounding substance use that discourages people from seeking health and social services, and can reduce the quality and availability of services received.

The Government of Canada is committed to a comprehensive public health approach to the overdose crisis that is focused on reducing harms, saving lives, and getting people the supports they desire and need.

Recent federal actions

• Granted a three-year exemption under the Controlled Drugs and Substances Act (CDSA), so that adults 18 years and older in British Columbia will not be subject to criminal charges for personal possession of up to 2.5 grams total of opioids, cocaine, methamphetamine, or MDMA, or some combination thereof, between January 31, 2023 and January 31, 2026 provided certain conditions are met
• Released a report on drug- and alcohol-related acute toxicity deaths in Canada between 2016 and 2017 summarizing the characteristics of the people who died, the circumstances of their deaths, and the substances involved
• Continued a campaign aimed at men working in trades, who are disproportionately affected by the opioid overdose crisis, to promote help-seeking and link to resources and supports
• Held a Knowledge Exchange Series on Safer Supply with key stakeholders to discuss evidence around safer supply and how available evidence can help support and scale up successful models

Government funding

• Committed over $800 million since 2017 to directly address the opioid overdose crisis and help save lives; this includes funding community organizations for projects through the Substance Use and Addictions Program to support people who use drugs. For example by:
  • supporting projects related to treatment including expanding Opioid Agonist Therapy (OAT) services
  • supporting prescriber led safer supply service delivery projects to help save lives by providing people at risk of overdose with prescribed medications instead of the highly toxic and unpredictable illegal drug supply
  • supporting a National Safer Supply Community of Practice and research/knowledge transfer and exchange projects, to help gather and share the evidence around safer supply
  • increasing awareness and access to naloxone through projects that provide training, awareness and distribution of the life saving drug
  • helping to reduce stigma and support families affected by the overdose crisis
  • improving harm reduction initiatives to reach key groups, including Indigenous peoples, youth, post-secondary students, individuals in the correctional system, and healthcare professionals
  • providing better access to peer support and capacity-building projects to support those disproportionately affected by substance use or who face barriers accessing services, including women and youth
  • supporting projects addressing priority actions identified by the Canadian Pain Task Force
• Providing up to $4.5 million over 5 years to support Pain Canada, a national initiative that brings together 14 pain organizations to support national coordination and mobilize resources to build capacity to improve systems of care and supports for people with pain
• Providing over $650 million in 2022-2023 to support culturally grounded community-based mental wellness initiatives which includes funding for substance use prevention and treatment, mental wellness teams, the Hope for Wellness Help Line and more
• Provided funding through the Supporting Pathways to Care for People Who Use Drugs program for projects that support sustainable system-level change to help people access care and reduce barriers

Enforcement and the toxic illegal drug supply

• Former Bill C-5 came into force on November 17, 2022. It repealed mandatory minimum penalties for all drug offences in the CDSA and requires police and prosecutors to consider diversion for simple drug possession offences. It also requires past and future convictions for simple drug possession to be sequestered apart after a certain period of time
• Issued a new Order under the Controlled Drugs and Substances Act to help address the illegal importation and distribution of a group of novel fentanyl precursors that are used in the illegal production of fentanyl and its analogues
• Released guidance to consider alternatives to prosecution for simple drug possession offences, except when there are serious public safety concerns
• Identified opioids 113,467* times from January 2018 to December 2022 in exhibits submitted to the Drug Analysis Service by law enforcement and public health officials (exhibits may contain more than one opioid)
  • *Please note that this number has been adjusted to include Nitazenes which were not included in 2020 and 2021
• Seizing illegal opioids and precursor chemicals that can be used in the production of illegal synthetic drugs
• Providing border services officers with tools to safely identify and interdict fentanyl and other toxic substances at the border, including:
  • Implementing 81 safe examination areas at high-risk ports of entry to help identify and examine shipments suspected to contain opioids
  • Maintaining field drug analysis sites with on-site chemists in Toronto, Montreal and Vancouver
  • Utilizing 6 detector dog teams trained to detect fentanyl and other drugs
• Working with private sector partners to address money laundering of the proceeds of fentanyl trafficking
• Continuing to investigate and charge criminal actors suspected of diverting chemical products for the purpose of manufacturing illicit substances

Access to treatment

• Developing national standards based deliverables for mental health and substance use services to provide an evidence-based framework for service delivery
• Supporting federally-funded treatment centres for First Nations and Inuit to create and enhance their virtual treatment services, allowing for increased reach and accessibility to those who may not otherwise seek treatment
• Supported provinces and territories to improve access to treatment services by providing $150 million via the Emergency Treatment Fund which, when cost-matched by provinces and territories, totals over $300 million
• Supported the development of guidance for health care providers, including:
  • clinical guidelines (PDF document) and operational guidance (PDF document) for injectable opioid agonist treatment
  • national treatment guidelines for opioid use disorders
• Removed barriers to accessing drugs used for the treatment of opioid use disorder by:
  • Issuing a class exemption for patients, practitioners, and pharmacists prescribing and providing controlled substances in Canada to ensure continuity of care
  • Approving injectable hydromorphone and diacetylmorphine as treatment options for patients with severe opioid use disorder
  • Facilitating the prescribing and dispensing of methadone and diacetylmorphine through regulatory amendments
• Supporting Opioid Agonist Therapy wraparound supports in 72 First Nations and Inuit Communities with 11 new sites in development
• Increasing the provision of opioid agonist treatment and implementing SMART (Self-management and Recovery Training) in Canada's correctional institutions

Access to harm reduction

• Supervised consumption sites (SCS) were established in areas where there are high rates of public drug use to provide important health, social and treatment services:
  • Authorized different modes of consumption that include injection, oral (swallowing), intranasal (snorting) and inhalation
  • Authorized supportive services at sites including drug checking and peer assistance consumption
  • Streamlined the exemption application process
  • As of February 2023:
    • there are 38 SCS offering services
    • 4.0 million visits since 2017
    • reversed over 44,000 overdoses
    • made over 227,000 referrals to health and social services
• Improved access to overdose prevention services by allowing provinces and territories to establish temporary spaces where people can consume drugs under supervision to reduce risk of overdose death
• Supported the Good Samaritan Drug Overdose Act, which provides some legal protection for people who seek emergency help during an overdose
• Continued to improve access to naloxone, including to remote and isolated First Nations and Inuit communities and people experiencing homelessness, through the coordination of bulk purchases of naloxone and nasal spray naloxone, increasing access to take-home naloxone kits, and training in their use
• Supported a drug checking technology challenge to promote development of new drug checking technologies, which included awarding a grand prize of $1 million to Scatr Inc.
• Opened the first Overdose Prevention Service in a correctional institution to reduce overdose incidents
• Continuing to support the delivery of harm reduction activities to help reduce risks and connect individuals and families experiencing homelessness with key health and social services through the Reaching Home program

Awareness and prevention

• Expanded public awareness around opioids and the harms of stigma:
  • In November 2018, launched a multi-year campaign to raise awareness of opioids, how to respond to an overdose, the Good Samaritan Drug Overdose Act and the impacts of stigma on people who use drugs
  • Developed and distributed awareness resources for opioids, such as videos, fact sheets, posters, wallet cards, and an audio series
  • Between April 2018 and March 2023, the Know More Opioids awareness program engaged in more than 1,300 in-person and virtual high school sessions, 68 post-secondary school events, 43 events/festivals and over 175,000 interactions with people; and placed awareness products such as posters and wallet cards, in high-traffic areas of 16 post-secondary institutions
  • Reached out to 988 festival organizers to provide information about naloxone and encouraged the distribution of overdose prevention materials to event goers and staff
• Established the Chronic Pain Policy Team to coordinate federal efforts to respond to the Canadian Pain Task Force recommendations for priority actions, so that pain is understood, prevented, and effectively treated
• Supported the development of Soar Above Stigma, a resource that provides outreach support and stigma education for Indigenous community members dealing with addiction or mental health issues
• Shared best practices for addressing substance use stigma within the Canadian health system, including through use of compassionate and non-stigmatizing language
• Continued engagement activities with law enforcement community to promote uptake of an online Drug Stigma Awareness Training module with free access extended to law enforcement members until December 31, 2023
• Developed a toolkit of resources for employers of Canadians working in the trades and related industries to help reduce the harms of substance use
• Developed a Blueprint for Action and policy paper for schools and community organizations that support youth, outlining practical approaches for schools to prevent substance-related harms among youth
• Adopted non-stigmatizing language in Health Services products and reviewing staff training and education aimed at reducing substance-related stigma in Canada's correctional system

Evidence

• Updated modelling projections on opioid-related deaths through mid-2023 to understand and plan for potential scenarios
• Renewed $17 million investment in research to address substance use in Canada to ensure the continuation and expansion of the Canadian Research Initiative in Substance Misuse (CRISM) research and knowledge mobilization activities focused on substance use harms, such as opioids
• Invested $2.8 million over 5 years to support an independent, scientific evaluation led by CRISM of the impacts of the section 56 exemption in British Columbia
• Continued collection of the Canadian Wastewater Survey with information on drugs and drug metabolites in wastewater samples collected and expanded coverage to include more screening and more cities
• Established an Expert Task Force on Substance Use that provided independent, expert recommendations on the federal government's drug policy and potential alternatives to criminal penalties for personal possession
• Continued collaboration with provinces and territories to support ongoing quarterly reporting of national data on opioid- and stimulant-related deaths, hospitalizations and Emergency Medical Services responses
• Published a toolkit with resources for stakeholders to respond to a need for information on medications for people at risk of overdose during the pandemic
• Funded the development of a series of national guidance documents and a national qualitative assessment identifying the needs and challenges of people who use drugs during COVID-19
• Funded a qualitative assessment of 10 safer supply projects through surveys and interviews with safer supply program leads, staff and participants to capture early learnings, including effective strategies for program delivery
• Invested over $2 million to evaluate program implementation and impacts of safer supply pilot projects, and to assess the public health impacts of supervised consumption sites located in British Columbia, the Prairies, Ontario and Quebec-Atlantic
• Released several reports related to furthering knowledge around opioids

Learn more at Canada.ca/Opioids

Opioid-related harms in Canada

From January 2016 to September 2022 there have been:

• 34,455 total apparent opioid-related deaths
• 34,886 total hospitalizations for opioid-related overdoses

From January to September 2022, the majority of deaths (87%) occurred in British Columbia, Alberta, and Ontario; high rates were also observed in other regions.

Deaths

• 5,360 apparent opioid-related deaths occurred from January to September 2022. This is approximately 20 deaths per day. For the same period in 2019 prior to the COVID-19 pandemic, the number of deaths per day was 10, which increased to a peak of 21 in 2022.
• From January to September 2022, 96% apparent opioid-related deaths were accidental.

Among accidental apparent opioid-related deaths from January to September 2022:

• 3 in 4 were male
• 88% were among young- to middle-aged adults (20 to 59 years)
• 81% involved fentanyl
• 78% involved opioids that were only non-pharmaceutical (among deaths with completed investigations from 9 provinces)
• 53% of accidental opioid-related deaths also involved a stimulant, reflecting the polysubstance nature of this crisis (based on information from 9 provinces and territories)

Hospitalizations

• 3,917 opioid-related poisoning hospitalizations occurred from January to September 2022. This is approximately 14 hospitalizations per day. For the same period in 2019 prior to the COVID-19 pandemic, the number of hospitalizations per day was 13, which increased to a peak of 17 in 2021.
• From January to September 2022, 70% hospitalizations for opioid-related overdoses were accidental.

Among accidental hospitalizations for opioid-related overdoses from January to September 2022:

• Nearly 2 in 3 were male
• 54% were among young and middle aged adults (20 to 49 years)
• 34% involved fentanyl or fentanyl analogues
• 17% involved one or more stimulants

Emergency Medical Services (EMS)

• 28,197 EMS responses to suspected opioid-related overdoses occurred from January to September 2022, based on available data from 9 provinces and territories.
• For the same period prior to the COVID-19 pandemic for the same 9 provinces and territories, there were 17,442 EMS responses in 2019, which increased to a peak of 30,638 EMS responses in 2021.

Among EMS responses to suspected opioid-related overdoses from January to September 2022:

• Nearly 3 in 4 were male
• The majority were among young and middle aged adults (20 to 49 years)

Notes on data

• Data on opioid- and stimulant-related harms in Canada are updated quarterly. Refer to the technical notes for more information.