Canada’s overdose crisis and the toxic illegal drug supply

Information on Canada's overdose crisis, the toxic illegal drug supply and federal actions to help address the crisis.

On this page

• About the overdose crisis
• Opioid- and stimulant-related harms in Canada
• Toxic illegal drug supply
• What we're doing

About the overdose crisis

An overdose can happen when a person knowingly or mistakenly takes too much of a drug, like an opioid. This can lead to unconsciousness and even death. Although other substances can cause an overdose, opioids are the leading cause of overdose deaths in Canada.

Some opioids are prescription drugs, used to treat pain and other medical conditions. However, most of the overdose deaths in Canada involve opioids produced illegally, and consuming illegal drugs can carry significant risks. The overdose crisis is a complex public health issue that has significant impacts on people who use drugs and their loved ones.

Timeline

In the late 1990s and early 2000s, there was a dramatic increase in the number of people being exposed to opioids. Opioid medications were more available than before and being prescribed regularly for pain. Over time, some people became dependent and turned to the illegal drug supply. This increases a person's risk of harm as the dose and contents of illegal drugs is unknown.

From 2010 to 2015, there was an increase in diverted or illegally produced opioids sold illegally. This also increased the amount of people using drugs who were being exposed to opioids.

The illegal drug supply became contaminated with more potent opioids, like fentanyl and other substances. The increased potency of the illegal drug supply caused overdose-related deaths to suddenly increase around 2016, and they've been high ever since.

The COVID-19 pandemic reversed progress made to help reduce overdoses and substance-related harms. This made the overdose crisis much worse due to:

• an increasingly toxic illegal drug supply
• reduced access to health and social services
• people being more likely to use drugs alone

Since 2020, the overdose crisis has continued to worsen and the highly potent opioid, fentanyl, makes up most of the illegal drug supply. Benzodiazepines and other drugs are also being mixed with fentanyl in Canada, which:

• complicates treatment
• reduces the effectiveness of naloxone
• increases the risk of overdose and harms

What's contributing to the overdose crisis

One of the factors contributing to Canada's high rates of opioid-related overdoses is the toxic and unpredictable illegal drug supply. Potent opioid and non-opioid substances keep being mixed into the supply. This creates more uncertainty about the type and amount of drugs that are circulating and being consumed. No one who takes illegal drugs can be sure of what's in them without proper drug checking services.

Another factor is that people who seek help for their drug use face barriers in accessing:

• harm reduction services
• treatment services and supports

Stigma surrounding substance use can lead people to hide their drug use or use drugs alone, which:

• puts them at risk of dying if they have an overdose
• discourages them from seeking health and social services
• can reduce the quality and availability of those services

We're committed to a comprehensive public health and public safety approach to the overdose crisis that's focused on:

• saving lives
• reducing harms
• getting people the supports they want and need

Learn more:

• Signs and symptoms of an opioid overdose
• How to respond to an overdose
• Stigma around drug use
• What is drug checking?
• Canadian Drugs and Substances Strategy

Opioid- and stimulant-related harms in Canada

There have been over 40,000 opioid-related deaths in Canada since 2016. In that same time, there have been:

• almost the same amount of opioid-related hospitalizations
• even more calls to paramedics and ambulances because of opioid-related overdoses

An average of 21 lives were lost each day in Canada because of opioid-related overdoses in 2022.

Using more than one drug or substance at a time is a contributing factor to the crisis. Data shows that many opioid-related deaths and hospitalizations also included other substances, such as stimulants like cocaine and methamphetamines.

Recent data on opioid- and stimulant-related harms in Canada

Toxic illegal drug supply

In recent years, Canada's illegal drug supply has become tainted with:

• powerful opioids, such as fentanyl
• other drugs, such as benzodiazepines and xylazine

The increasing toxicity of the illegal drug supply means that people who use drugs are at greater risk for:

• overdose
• other substance-related harms
• death

The types and amounts of drugs in the illegal drug supply can vary and aren't always known. You might expect a drug from the illegal supply to contain a certain drug, like fentanyl, but it could also contain others, like benzodiazepines or xylazine.

Using multiple drugs at the same time, like opioids and alcohol, can be dangerous. This is sometimes called multi-drug or polysubstance use. It can increase the risk of overdose and death.

Giving naloxone to someone who's overdosing reverses the effects of opioids temporarily and can restore breathing, even if they remain unconscious.

Naloxone does not counteract the effects of non-opioid drugs, like benzodiazepines and xylazine. However, these substances are often mixed with opioids. Naloxone is safe to give to someone who's taken both opioid and non-opioid drugs, so you should always give it to them if they're overdosing. It causes no harm and could save their life. In some cases, they may need to go to a hospital.

Treating all illegal drugs as though they're contaminated with unknown deadly substances, and using every precaution, can help to prevent a fatal overdose.

Substances in the current toxic illegal drug supply include:

Fentanyl

Fentanyl is a very potent opioid pain reliever. It's a legal prescription drug, but it can also be made and sold illegally. This is extremely dangerous because of how strong it is.

Fentanyl is commonly found in the toxic illegal drug supply and is the main driver of overdose-related harms and deaths in Canada. You can't see, taste or smell fentanyl, and a few grains can be enough to kill you.

Fentanyl

Benzodiazepines

Benzodiazepines are a group of drugs that are often used as sedatives and tranquilizers. Some benzodiazepines are legal prescription drugs, but others are illegal. Both legal and illegal benzodiazepines pose a risk of overdose and developing a substance use disorder.

Combining benzodiazepines with other substances can be very dangerous, especially other depressant drugs such as alcohol or opioids. People who use drugs may not know that they might also be taking benzodiazepines. Most benzodiazepine-related overdose deaths result from mixing benzodiazepines with opioids, intentionally or unintentionally.

Learn more:

• Benzodiazepines
• CCENDU Bulletin: Risks and Harms Associated with the Nonmedical Use of Benzodiazepines in the Unregulated Drug Supply in Canada (PDF, 565 KB, Canadian Centre on Substance Use and Addiction)

Xylazine

Xylazine is a prescription veterinary drug given to animals as a sedative, relaxant and pain reliever. It is not approved for human use in Canada.

People who use drugs may not know that they might also be taking xylazine. It has recently emerged in the illegal drug supply and is often mixed with opioids, like fentanyl. This increases the risk of overdose and other negative effects as xylazine and opioids can both affect breathing.

Xylazine can cause:

• difficulty breathing
• loss of consciousness
• decreased heart rate and blood pressure
• severe skin wounds and tissue damage that, if left untreated, may result in amputation

The presence of xylazine in illegal drugs has been increasing in Canada and the United States.

Learn more:

• The emergence of xylazine in Canada
• Drug checking trends: Xylazine (PDF, 5.3 MB, St. John's Ambulance)
• CCENDU Bulletin: An Update on Xylazine in the Unregulated Drug Supply (PDF, 1.4 MB, Canadian Centre on Substance Use and Addiction)

What we're doing

As part of the Canadian Drugs and Substances Strategy, we've taken many actions to help address the overdose crisis and support people who use drugs, including:

• prevention and education efforts to prevent, delay or reduce substance use-related harms
• using evidence to:
  • inform decision-making
  • develop programs and policies related to substance use
• working with all levels of government and partners to improve substance use services and supports, like increased access to treatment and harm reduction programs
• substance controls like laws and regulations that:
  • put strict controls in place to protect public health and safety
  • allow for legitimate uses of some substances, such as medical and scientific uses

Learn more:

• Federal actions on the overdose crisis
• Canadian Drugs and Substances Strategy

Related links

• Opioids
• Get help with substance use
• Naloxone
• Chronic pain
• Using medications safely
• Awareness resources for opioids
• Supervised consumption sites and services