The Canadian drugs and substances strategy: The Government of Canada’s approach to substance use related harms and the overdose crisis

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Organization: Health Canada

Date published: 2023-19-30

Cat.: H134-35/2023E-PDF

ISBN: 978-0-660-68488-8

Pub.: 230529

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Ministerial message

Canada is in the midst of one of the most serious and deadly public health crises in our country’s history - the toxic and illegal drug and overdose crisis. No community has been left untouched. Since 2016, more than 38,500 people have died of apparent opioid toxicity in Canada.

This crisis is tragic, and I want to recognize and remember the lives of people in Canada we have lost. Every person who overdoses is somebody who has a family and people that care about them and that we must do everything we can to support and protect them.

People who use substances, their families, and the communities around them, need us to use every tool at our disposal to provide compassionate care and maintain community safety. There is so much to be done and no one government, community or family can end this crisis alone.

That is why we are launching a renewed Canadian Drugs and Substances Strategy (CDSS) that has been designed to support a comprehensive and compassionate approach centered on promoting both public health and public safety. This whole-of-government initiative includes timely access to a full range of strategies to help people access the prevention, harm reduction, treatment, or recovery services and supports they need, when and where they need them.

The renewed CDSS is using an integrated approach that brings together prevention and education, substance use services and supports, evidence, and substance controls. New investments include supporting a wide range of activities such as community-based supports; streamlining authorizations for supervised consumption sites and drug checking services; vital data collection on substance-related harms and lab-based analysis of the illegal drug supply; an overdose monitoring platform for law enforcement and other first responders; and further action to work with our partners to disrupt illegal drug production and trafficking and stem the global flow of these devastating substances.

By using a wide-range of tools, we have the best opportunity to end this crisis, protect communities and save lives.

We must continue to work with our partners across all levels of government, communities, people with lived and living experience, and stakeholders to address the complex factors that contribute to substance use and related harms, including links with other issues, such as housing, mental health, economic insecurity, and chronic pain.

That’s the work we are doing, together. Because when people get the right support, there is hope. We are building a safer, healthier and more caring future for all Canadians. One where we embrace one another in the journey towards healing.

The Honourable Ya'ara Saks, P.C., M.P.


Canada is experiencing an unprecedented and unrelenting rate of overdose deaths and harms, largely due to the toxic illegal drug supply that has continued to worsen since the start of the COVID-19 pandemic. National data shows that 38,514 apparent opioid toxicity deaths occurred between January 2016 and March 2023 (see Figure 1). The overdose crisis is complex and caused by many factors (see Box 1). In particular, drug traffickers and criminal organizations are seeking to maximize their profits by contaminating the illegal drug supply with inexpensive fentanyl and other opioids at a cost to Canadian lives. While in 2017 Canada saw a spike in fentanyl detected in the illegal drug supply, the overdose crisis continues to evolve and increasing amounts of other toxic substances are now present. This impacts the ability of first responders to reverse overdoses through the use of naloxone and makes the treatment of substance use disorders more complicated. Just under half (48%) of accidental apparent opioid toxicity deaths in 2023 also involved a stimulant, reflecting the role that the mixing of substances (polysubstance use) plays in this crisis.

Figure 1. Canada's crude rate of total apparent opioid toxicity deaths, per 100,000, 2016 to 2023 (January to March)
This graph illustrates Canada’s crude rate of total apparent opioid toxicity deaths per 100,000 from 2016 to January to March 2023. It shows that the number of total apparent opioid toxicity deaths began increasing in 2016 and declined in 2019 before reaching a peak in 2021.
Figure 1 - Text description
Year Crude rate of total apparent opioid toxicity deaths per 100,000
2016 7.8
2017 10.7
2018 11.4
2019 9.9
2020 16.9
2021 21.0
2022 19.2
2023 (January to March) 20.3

Source: Federal, provincial, and territorial Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid- and Stimulant-related Harms in Canada. Ottawa: Public Health Agency of Canada; September 2023

The increasing toxicity and unpredictability of the illegal drug supply means that anyone is at risk for an overdose, whether they are trying drugs for the first time, or have been using drugs frequently. While anyone is at risk of a drug overdose, some populations in Canada have been disproportionately impacted by the crisis. Males accounted for the majority of apparent opioid toxicity deaths in Canada (70% to 75% since 2016). People living with co-occurring health conditions are also at increased risk of an overdose, including those with mental health conditions and chronic pain. Approximately 20% of Canadians with a substance use disorder (SUD) also have a co-occurring mental health disorder. Meanwhile, up to 55% of people who use drugs are also living with chronic pain.

Box 1. The overdose crisis has been driven by a dynamic and complex set of factors-but can generally be divided into four phases

The late 1990s to 2010 marked phase one of the overdose crisis which consisted of an overreliance on opioid prescriptions. During this phase, opioids were considered legitimate medications prescribed to treat acute or chronic paint, but the healthcare system’s overreliance on opioids resulted in a large numbers of Canadians being exposed to medications with high potential for higher risk use. The years 2010 to 2015 marked the second phase of the overdose crisis, which was characterized by an increase in diverted or illegally produced opioids. During this time period, there was an increase in diverted or illegally produced opioids bought and sold on the illegal market, which enabled opioid exposure among people who use drugs. The years 2015 to 2020 marked the third phase of the crisis where there was an unprecedented rise in synthetic opioids and analogues. During this phase, highly toxic synthetic opioids like fentanyl and its analogues were increasingly contaminating the illegal drug supply and driving the increasing mortality rates. From 2020 to the present is the fourth phase of the crisis where there is fentanyl dominance and widespread toxicity and unpredictability in the illegal drug supply. Currently, fentanyl continues to dominate the illegal drug market. The illegal supply remains highly unpredictable, with the introduction of stimulants, depressants and other emerging contaminants. There is increasing uncertainty as to what drugs are circulating in the illegal supply. In 2023, the illegal drug supply is more toxic than ever with fentanyl being widespread, both as a drug of choice as well as one of many contaminants found in other substances.

Indigenous populations in Canada also face an increased risk of overdose deaths and other substance use related harms. According to the First Nations Health Authority, First Nations people died of opioid toxicity deaths at 5.9 times the rate of other residents in British Columbia in 2022, a disproportionate impact on Indigenous populations that has also been seen across other provinces and territories. Historical and intergenerational trauma, including the impact of colonization, loss of traditional culture and language, and experiences with Indian Residential Schools, have contributed significantly to the elevated risk of overdose death and broader substance use related harms amongst Indigenous Peoples. Systemic racism arising from Canada's colonial history has also created inequities for African, Caribbean and Black populations, which has resulted in higher rates of poverty, unemployment, and precarious housing among these populations, placing them at greater risk of substance use harms.

In addition to the overdose crisis, Canada continues to see harms from other substances, such as tobacco and alcohol. In addition to the overdose crisis, Canada continues to see harms from other substances, such as tobacco and alcohol. According to the Canadian Costs of Substance Use and Harms 2007-2020 report, substance use and its related harms from all substances cost Canadians more than $49 billion and led to the loss of nearly 74,000 lives or 200 lives per day in 2020 (see Figure 2). In 2020, tobacco use was the leading cause of substance attributable deaths with 46,366 deaths in 2020, followed by alcohol use with 17,098 deaths and opioid use with 6,491 deaths. The harms related to substance use are not limited to the loss of lives alone, but also include increased costs to our health care system, from hospitalizations, emergency visits and specialized treatment for substance use disorders, which amounted to $13.4 billion in 2020. Substance use also has economic impacts due to lost productivity from premature deaths and time off work due to disability, which cost $22.4 billion in 2020. The enforcement of substance use laws cost Canada’s criminal justice system $10.0 billion in 2020.

Figure 2. Costs of substance use and harms in Canada, in billions of dollars
This bar graph shows the costs of substance use and harms in Canada by different substance, including alcohol, tobacco, cannabis, other CNS depressants, cocaine, other CNS stimulants and other substances. Substances with the highest costs are alcohol, tobacco, opioids, followed by cocaine, stimulants, cannabis, depressants and other substances.
Figure 2 - Text description
Substance Cost in billions of dollars
Alcohol $19.7
Tobacco $11.2
Cannabis $2.4
Opioids $7.1
Other CNS depressants $1.4
Cocaine $4.2
Other CNS stimulants $3.0
Other substances $0.2

Source: Canadian Substance Use Costs and Harms Scientific Working Group. (2023). Canada Profile: Canadian Substance Use Costs and Harms (2007–2020). (Prepared by the Canadian Institute for Substance Use Research and the Canadian Centre on Substance Use and Addiction.) Ottawa, Ont.: Canadian Centre on Substance Use and Addiction. Information generated by the online data visualization tool

People use substances for many different reasons, such as medical purposes, personal enjoyment, religious or ceremonial purposes, or to cope with stress, trauma or pain. Substance use looks different for everyone and has varying stages of benefits and harms. Substance use related harms occur when substances are used in a manner, situation, amount, or frequency that harms the person using the substance or those around them. Examples of substance use related harms can include infection, hospitalization, risk of mental health disorders, including the risk of a substance use disorder; and the loss of income or housing. Harms may also occur in the illegal production, processing, and distribution of those substances such as community violence that disproportionately affects marginalized populations. Social and economic factors also impact a person's substance use, such as unemployment, housing insecurity or homelessness, poverty, trauma, colonialism, systemic racism, and stigma and can contribute to their marginalization from society.

Addressing this crisis therefore requires a holistic approach, centered on promoting public health and protecting public safety. People who use substances, their families and communities around them are counting on us to use every tool at our disposal to provide compassionate care and maintain community safety. We also cannot end this crisis alone. It requires all levels of government, Indigenous communities and people with lived and living experience and partners from law and border enforcement and health and social systems to come together to save lives. Our collective work to address this crisis will guided by our world leading renewed Canadian Drugs and Substances Strategy (CDSS).

About the strategy

The CDSS is the federal government's comprehensive response to substance use related harms and the overdose crisis in Canada. The CDSS is an all-substances, public health and public safety strategy that covers a broad range of legal and illegal substances, such as tobacco, cannabis, alcohol opioids and stimulants. The goal of the CDSS is to improve the health and safety of all Canadians by minimizing substance-related harms for individuals, families, and communities. In particular, it prioritizes children and youth who are more susceptible to the negative impacts of substance use as they are still growing and developing and focuses on providing them the supports, tools and help they need to prevent, delay and lower the rates of substance use related harms. It also focuses on connecting people to evidence based substance use services and supports, while also keeping communities safe by taking action against criminal organizations who are trafficking and producing illegal drugs.

The CDSS is a horizontal initiative that is led by the Minister of Mental Health and Addictions and Associate Minister of Health, who is supported by Health Canada and over 15 federal government departments and agencies. As addressing substance use related harms is a shared responsibility between federal, provincial and territorial governments, the CDSS focuses on areas of federal jurisdiction, such as:

Budget 2023 provided $359.2 million in new funding to support the implementation of the renewed CDSS. The renewal of the CDSS has been informed by national public consultations in 2018 and on-going stakeholder roundtable discussions where we have heard from communities, provinces and territories, Indigenous leaders, professional and regulatory bodies and health care providers. It has also been informed by the findings and recommendations made the Expert Task Force on Substance Use (please see Appendix for list of members), which focused on how we could strengthen the CDSS moving forward as well as potential alternatives to criminal penalties for personal possession of controlled substances. The renewal of our strategy also reflects the findings and recommendations of the Canadian Pain Task Force, which examined how pain could be better understood and effectively prevented and treated in Canada. It has also been guided by our on-going analysis of data and evidence that we have collected since the strategy was first introduced in 2016.

The foundational elements

The Canadian Drugs and Substances strategy includes four elements: prevention and education, evidence, substance use services and supports, and substance controls. It is also equitable, comprehensive, collaborative and compassionate.

The CDSS has four integrated priority areas for action called foundational elements, including:

Guiding principles

The CDSS is led by four guiding principles. It is:

Our priorities for action under the Canadian drugs and substances strategy

Prevention and education

Prevention and education initiatives support communities, and raise awareness to influence the health and wellbeing of people living in Canada. They aim to:

Addressing known risk and protective factors, especially early in life, is key in reversing the current trends of substance use related harms (see Figure 3). Risk factors are characteristics or experiences that increase the likelihood of a negative health outcome or harm due to substance use, whereas protective factors promote an person's overall health and well-being and decrease their likelihood of experiencing harms related to their substance use.

Figure 3. Risk and protective factors for substance use related harms

Risk factors

  • Trauma
  • Childhood adversity
  • Mental illness
  • Poverty
  • Unstable housing
  • Drug availability
  • Chronic pain

Protective factors

  • Caregiver involvement
  • Coping skills
  • Social inclusion
  • Safe neighbourhoods
  • Quality school environment
  • Permanent housing

Factors like sex, gender, age, race, pre-existing health conditions, socioeconomic status, ability, sexual orientation, migration status, and geography, may also interact with each other to create multiple experiences of stigma, discrimination and marginalization for some individuals and population groups, such as 2SLGBTQIA+ populations, placing them at greater risk for negative mental health and substance use outcomes, while also limiting their access to health-related resources that could prevent substance use related harms. Experiences of discrimination, racism and intergenerational trauma arising from Canada's history of colonialism are also important determinants of health for certain groups in Canada such as Indigenous Peoples and Black Canadians.

What is the Government of Canada doing?

To prevent substance use related harms among youth, at risk and other marginalized populations and disproportionately impacted populations, we are:

Investing in community-led programs
Raising awareness of substance use related harms, including stigma, through public education and outreach activities

We are raising awareness of substance use related harms and ways to reduce them, and the importance of reducing stigma, through public education, outreach activities and awareness campaigns. Stigma leads people to hide their substance use and prevents them from getting help for fear of reprisals, being labelled or judged. Examples of our campaigns include:

Box 2. Reducing stigma around substance use disorders

The Substance Use and Addictions Program (SUAP) supports projects that aim to reduce stigma associated with substance use disorders through public education, capacity building and research. With support from SUAP, the Sinai Health System redeveloped Effective Prescribing of Opioids for Chronic Pain (EPOCH), a training programfor primary health care providers to help build their competencies in treating substance use disorder. Beyond Stigma is a public and professional education program focused on stigma that complements the EPOCH training program and includes two videos:

Working with our partners to address the root causes of substance use related harms

We will work with our partners to leverage existing federal initiatives to address underlying inequities that are the root causes of substance use related harms and support the provision of social services, such as:

To address the role that unmanaged chronic pain plays in substance use related harms, we will also continue to work across all levels of government and with professional organizations and other key stakeholders to advance the priorities identified by the Canadian Pain Task Force, including ensuring that people living in Canada, including those who use substances, have better access to pain management services. Since 2018, there have been over 25 pain related projects funded through the Substance Use and Addictions Program to support the mental health and wellbeing of people who live with chronic pain in Canada.

Substance use services and supports

Substance use is different for each person and there is no single service that will meet the needs of everyone. The Government of Canada is therefore focusing on supporting equitable access to a continuum of effective, culturally appropriate and trauma informed evidence-based health services and supports to meet the diverse needs of individuals who use substances, including:

Box 3. Spotlight on the Eastside Movement for Business and Economic Renewal Society

People who use substances need a range of integrated health and social services to support their health and wellbeing. Funded through the Substance Use and Addictions Program, the Eastside Movement for Business and Economic Renewal Society's Support and Employment Program provides rapid access, long-term substance use care to people who have gained employment and are now ready to better manage their substance use in order to maintain their employment and stabilize their overall lives. Evaluations of this project found that achieving employment goals was positively correlated with reduced risk of substance use related harms and improvements in physical and mental health.

What is the Government of Canada doing?

Supporting equitable access to a continuum of substance use services and supports

Though the delivery of substance use services and supports is primarily the responsibility of the provinces and territories, we are playing a critical role by improving equitable access to these services through investments, such as:

In addition, we are investing $2 billion over 10 years to address unique challenges Indigenous Peoples face when it comes to fair and equitable access to quality and culturally safe health care services.

The Substance Use and Addictions Program (SUAP) also provides grant and contribution funding to other levels of government, community-led and not-for-profit organizations, for innovative evidence-based harm reduction, treatment and recovery projects that focus on at risk and disproportionately impacted populations, such as young and middle-aged men, Indigenous People, people experiencing chronic pain, 2SLGBTQIA+ populations and Black Canadians. This program has also supported building the evidence base for innovative approaches to harm reduction such as safer supply. SUAP is currently funding 29 safer supply pilot projects across the country. Safer supply is a promising harm reduction practice that involves health care practitioners providing prescription drugs as an alternative to highly toxic street drugs, with the goal of helping to reduce overdoses for those most at risk.

Box 4. Spotlight on Somerset West Community Health Centre's Drug Overdose Prevention and Education Program

Somerset West Community Health Centre's Drug Overdose Prevention and Education (DOPE) Project provides peer outreach to isolated people who use drugs in Ottawa, who otherwise may not have access to services and supports. This peer based program uses the knowledge, expertise and social networks of people who use drugs or have used drugs to provide support, resources and training on overdose prevention and response, including the use of Naloxone, a medication that can be used to reverse an opioid overdose. Since 2019, this Substance Use and Addictions Program funded project has:

  • Conducted 441 injectable and 401 nasal naloxone training sessions
  • Provided 1296 injectable and 1789 nasal naloxone kits
  • Administered naloxone to community members 75 times

We will also streamline authorizations for supervised consumption sites, urgent public health need sites and drug checking services to create a new authorization process with clear public health and public safety requirements for organizations seeking to provide these evidence-based life saving services to Canadians.

Providing substance use services and supports for populations served by the federal government

We support the provision of substance use services and supports to some populations both directly and indirectly served by the federal government, such as:

Box 5. Supporting access to culturally grounded mental wellness and substance use services and supports in partnership with Indigenous communities

Indigenous Services Canada (ISC) recognizes that accessibility of quality federally funded health services is key to achieving physical and mental wellness for Indigenous Peoples. ISC continues to prioritize the implementation of distinctions-based mental wellness initiatives. The department works collaboratively with partners to improve access to high quality culturally grounded community based mental health and substance use services and supports for First Nations, Inuit and Métis, including: life promotion and suicide prevention programs, including on-the-land activities, mental wellness teams, the Hope for Wellness Help Line, as well as funding for a network of 45 treatment centres and drug and alcohol use prevention services. ISC also supports the provision of essential cultural, emotional and mental health supports to Survivors of Indian Residential Schools and Federal Indian Day Schools and families of former students, as well as those affected by the issue of Missing and Murdered Indigenous Women, Girls, and 2SLGBTQIA+ people. These initiatives are guided by the First Nations Mental Wellness Continuum Framework, and the National Inuit Suicide Prevention Strategy, which are holistic frameworks developed by and with Indigenous partners.


Accurate, timely, reliable data and research are essential to policy development and decision making. They allow us to:

What is the Government of Canada doing?

We are building our capacity to collect, analyze and disseminate disaggregated data in a timely manner and conduct research to support equity informed, evidence-based decision making to address the overdose crisis and substance use related harms. The new CDSS Data and Evidence Framework will guide these efforts by prioritizing the following activities:

Substance controls

The Government of Canada has various laws in place that regulate access to controlled substances, precursor chemicals, cannabis, alcohol and tobacco and vaping products to mitigate their public health and safety risks while supporting access to them for legitimate purposes. These include:

The Government of Canada also has obligations under international drug control conventions, including measures to ensure the availability of drugs and substances for medical and scientific purposes while also preventing their diversion into the illegal market and collaborating with international partners to combat drug trafficking:

What is the Government of Canada doing?

To support the administration and enforcement of our substance control laws, we are focusing our efforts on authorizing activities with controlled substances and precursor chemicals for legitimate purposes, such as clinical trials or medical uses, while also giving health inspectors, law enforcement and border control authorities the tools that they need to enforce the laws that keep people living in Canada safe and address the harms of the illegal drug trade. To achieve this objective, we will:

Provide law enforcement and public health officials with new tools to respond to the overdose crisis

Law enforcement interact daily with people who use substances and have crucial role to play in supporting a public health approach to substance use related harms. We are supporting law enforcement in this role by:

Target organized drug crime

We are working with law and border enforcement partners across the country to address the role of organized crime in the production, diversion and trafficking of toxic illegal drugs. Our activities include:

Support the diversion of people away from the criminal justice system and towards the health and social services

To address the harms that people who use substances experience as result of their interactions with the criminal justice system, such as stigma, loss of income and employment and loss of housing, and the over representation of Indigenous, racialized and diverse populations within the criminal justice system, we have introduced a number of measures:

We will continue to support policies and approaches that divert people who use substances away from the criminal justice system and towards health and social services by:

Facilitate access to controlled substances for medical and scientific purposes and/or in the public interest

We will also continue to facilitate the use of controlled substances in scientific research and medical treatment, or when it is in the public interest, with appropriate controls in place by providing exemptions under subsection 56(1) of the CDSA.

Advance a coordinated global approach to substance related harms and the illegal drug supply

We are also participating in international forums to advance a coordinated and global approach to substance use related harms that balances public health and public safety interests through information sharing and joint action. Key international forums include:

Box 6. Spotlight on the Canada-United States Joint Action Plan on Opioids

Launched in January 2020, the Canada-United States Joint Action Plan on Opioids brings our two countries together to find solutions to the overdose crisis, which continues to take a tragic toll on families, loved ones and communities on both sides of the border. Through the Action Plan, Canada and the United States are taking steps in law enforcement, border security and health to address this tragic crisis. Together, we are:

  • sharing information and best practices
  • collaborating to stop trafficking in opioids, including fentanyl, and their precursor chemicals
  • addressing the health consequences of harmful opioid use

Implementation: monitoring and reporting on our progress

Our shared goal is to reduce overall rates of substance use related harms and overdose deaths in Canada. Long-term success will be measured through our ability to decrease substance related deaths and hospitalizations. Over the next five years, we will evaluate the impact of the activities under the Strategy by monitoring progress towards:

  1. Greater awareness, knowledge, skills and resources related to substance use and related harms
  2. More equitable access to services and supports to reduce substance use related harms
  3. Access to population specific data and evidence on substance use related harms and the illegal drug supply to make informed decisions
  4. Law enforcement and health authorities have the tools they need to administer and enforce our laws and regulations related to controlled substances and precursor chemicals

Our success in achieving these results will depend on our ability to collaborate with many partners and stakeholders. We are committed to publicly reporting our progress, including impacts on at risk and marginalized populations, Indigenous Peoples and racialized communities.

Appendix: List of members of the Expert Task Force on Substance Use

The following people were members of the Expert Task Force on Substance Use:

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