National report: Apparent opioid-related deaths in Canada (January 2016 to March 2017)

 

 

Summary

Canada is experiencing a serious and growing opioid crisis. Across the country, it is having devastating effects on families and communities.

Accurate information about the crisis will help the efforts to reduce opioid-related harms and deaths.

The Government of Canada works closely with the provinces and territories to collect and share data on apparent opioid-related deaths. The data will be updated four times a year and may change based on review and refinement.

According to data reported as of August 29, 2017:

  • in 2016, sadly there were 2,816 apparent opioid-related deaths in Canada
  • from January to March 2017, there were at least 602 apparent opioid-related deaths and it is expected that this count will rise as additional data become available
  • most apparent opioid-related deaths occurred among males (73%)
  • the number of apparent opioid-related deaths involving fentanyl-related opioids more than doubled in January to March 2017 as compared to the same time period in 2016

The data on this page:

  • are updated on a quarterly basis
  • may change based on review and refinement
  • have been collected by the provinces and territories
  • have been shared through the Special Advisory Committee on the Epidemic of Opioid Overdoses (SAC)

National and regional trends of apparent opioid-related deaths

The opioid epidemic has affected every part of the country, but some provinces and territories have been impacted more than others. The current data indicate that Western Canada has been hardest hit by the crisis; however, several other provinces and territories are reporting increases in apparent opioid-related deaths.

According to data reported as of August 29, 2017:

  • there were 2,816Footnote i, apparent opioid-related deaths in Canada in 2016
  • the national apparent opioid-related death rate in 2016 was 7.8Footnote ii deaths per 100,000 population
  • Western Canada experienced the highest apparent opioid-related death rates in 2016 (Figure 1, Table 1)
  • from January to March 2017, there were at least 602 apparent opioid-related deaths and it is expected that this count will rise as additional data become available (Table 2)

Notes

Footnote i

The previously reported number (2,458) of apparent opioid-related deaths for 2016 did not include data for Quebec and included an estimated number for Ontario based on 2015 data. In addition to other updates to provincial/territorial data, the revised number (2,816) includes preliminary 2016 data for QuebecFootnote 5 and 2016 data for Ontario.

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Footnote ii

The previously reported rate (8.8 per 100,000 population) of apparent opioid-related deaths for 2016 did not include data for Quebec, and included an estimated number for Ontario based on 2015 data. The revised rate (7.8 per 100,000 population) is based on 2016 data and population estimates from all 13 provinces and territories, including Quebec, resulting in a lower annual rate overall.

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Figure 1. Apparent opioid-related death rates (per 100,000 population) by province or territory, 2016 (as of August 29, 2017).

Figure 1. Apparent opioid-related death rates (per 100,000 population) by province or territory, 2016 (as of August 29, 2017). Text description follows.
Figure 1: Apparent opioid-related death rates (per 100,000 population) by province or territory, 2016 (as of August 29, 2017) - Text Description
Provinces and territories Number Rate per 100,000 population
British Columbia
(note: reports on unintentional deaths related to all illicit drugs, including but not limited, to opioids)
978 20.0 and up
Alberta 586 10.0 to 14.9
Saskatchewan 64 5.0 to 9.9
Manitoba 69 5.0 to 9.9
Ontario 865 5.0 to 9.9
Quebec
(expected to rise)
140 0.0 to 4.9
New Brunswick 29 0.0 to 4.9
Nova Scotia 53 5.0 to 9.9
Prince Edward Island 5 0.0 to 4.9
Newfoundland and Labrador 16 0.0 to 4.9
Yukon 6 15.0 to 19.9
Northwest Territories 5 10.0 to 14.9
Nunavut 0 0.0 to 4.9
Total 2816  
Table 1. Number and death rate (per 100,000 population) of apparent opioid-related deaths by province or territory, 2016 (as of August 29, 2017).
Province or territory Number Death rate per 100,000 population
British ColumbiaTable 1 footnote 1 978 20.6
AlbertaTable 1 footnote 2 586 13.8
SaskatchewanTable 1 footnote 3 64 5.6
Manitoba 69 5.2
OntarioTable 1 footnote 4 865 6.2
QuebecTable 1 footnote 5
(expected to rise)
140 1.7
New BrunswickTable 1 footnote 6 29 3.8
Nova Scotia 53 5.6
Prince Edward IslandTable 1 footnote 7 5 3.4
Newfoundland and Labrador 16 3.0
Yukon 6 16.0
Northwest Territories 5 11.2
Nunavut 0 0.0
Total 2816 7.8
Table 1 footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids.

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Table 1 footnote 2

Alberta reports unintentional apparent opioid-related deaths only.

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Table 1 footnote 3

Saskatchewan reports on closed/certified cases only. Updates to historical data will be provided in subsequent reports. Quarterly data for Saskatchewan for 2016 were not available at the time of this publication.

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Table 1 footnote 4

Ontario data from January to March 2017 were not available at the time of this publication.

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Table 1 footnote 5

Quebec data for individuals 19 years and younger were not available. Quebec data were available for closed/certified cases only. 44% of the cases for 2016 were still under investigation. Updates to historical data will be provided in subsequent reports. Quebec data from January to March 2017 were not available at the time of this publication.

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Table 1 footnote 6

New Brunswick data reported here may differ from published provincial reports as these reports focus on apparent opioid-related deaths that are classified as either accidental or of undetermined intent.

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Table 1 footnote 7

Prince Edward Island reports unintentional deaths only. Prince Edward Island chose to suppress counts less than five.

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Table 2. Number of apparent opioid-related deaths, quarterly, by province or territory, January 2016 to March 2017.
Province or territory 2016 2017
Jan to Mar Apr to Jun Jul to Sep Oct to Dec Total Jan to Mar
British ColumbiaTable 2 footnote 1 223 191 192 372 978 385
AlbertaTable 2 footnote 2 125 142 156 163 586 155
SaskatchewanTable 2 footnote 3 Table 2 footnote N/A Table 2 footnote N/A Table 2 footnote N/A Table 2 footnote N/A 64 3
Manitoba 16 13 15 25 69 30
OntarioTable 2 footnote 4 214 218 194 239 865 Table 2 footnote N/A
QuebecTable 2 footnote 5 50 43 35 12 140 Table 2 footnote N/A
New BrunswickTable 2 footnote 6 12 4 9 4 29 10
Nova Scotia 17 14 17 5 53 19
Prince Edward IslandTable 2 footnote 7 Suppressed Suppressed Suppressed Suppressed 5 Suppressed
Newfoundland and LabradorTable 2 footnote 8 Suppressed Suppressed Suppressed Suppressed 16 Table 2 footnote N/A
YukonTable 2 footnote 9 Suppressed Suppressed Suppressed Suppressed 6 Suppressed
Northwest Territories 2 0 1 2 5 0
Nunavut 0 0 0 0 0 0
Table 2 footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids.

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Table 2 footnote 2

Alberta reports unintentional apparent opioid-related deaths only.

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Table 2 footnote 3

Saskatchewan reports on closed/certified cases only. Updates to historical data will be provided in subsequent reports. Quarterly data for Saskatchewan for 2016 were not available at the time of this publication.

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Table 2 footnote 4

Ontario data from January to March 2017 were not available at the time of this publication.

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Table 2 footnote 5

Quebec data for individuals 19 years and younger were not available. Quebec data were available for closed/certified cases only. 44% of the cases for 2016 were still under investigation. Updates to historical data will be provided in subsequent reports. Quebec data from January to March 2017 were not available at the time of this publication.

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Table 2 footnote 6

New Brunswick data reported here may differ from published provincial reports as these reports focus on apparent opioid-related deaths that are classified as either accidental or of undetermined intent.

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Table 2 footnote 7

Prince Edward Island reports unintentional deaths only. Prince Edward Island chose to suppress counts less than five.

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Table 2 footnote 8

Newfoundland and Labrador data from January to March 2017 were not available at the time of this publication. Newfoundland and Labrador chose to suppress counts less than five.

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Table 2 footnote 9

Yukon chose to suppress counts less than five for quarterly data.

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Table 2 footnote N/A

Not available

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Sex- and age-related trends of apparent opioid-related deaths

This crisis has affected Canadians from all walks of life; however, available data indicate that there are some differences by sex and age and between the provinces and territories.

According to data reported as of August 29, 2017:

  • 73% of apparent opioid-related deaths in 2016 occurred among males, however, this varied by province or territory (Figure 2)
  • although age group distribution varied by province or territory:
    • the highest percentage (28%) of apparent opioid-related deaths in 2016 occurred among individuals between the ages of 30 and 39 (Table 3)

Figure 2. Sex distribution of apparent opioid-related deaths by province or territory, 2016.

Figure 2. Sex distribution of apparent opioid-related deaths by province or territory, 2016. Text description follows.
Figure 2: Sex distribution of apparent opioid-related deaths by province or territory, 2016 - Text Description
Province or territory Percentage that are male Percentage that are female
British ColumbiaTable 3 footnote 1 80 20
AlbertaTable 3 footnote 2 73 27
SaskatchewanTable 3 footnote 3 58 42
Manitoba 58 42
OntarioTable 3 footnote 4 69 31
QuebecTable 3 footnote 5 64 36
New BrunswickTable 3 footnote 6 52 48
Nova Scotia 66 34
Prince Edward IslandTable 3 footnote 7 Suppressed Suppressed
Newfoundland and LabradorTable 3 footnote 8 56 44
YukonTable 3 footnote 9 Suppressed Suppressed
Northwest Territories 80 20
Nunavut Not applicable Not applicable
Total 73 27
Table 3 long desc footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids.

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Table 3 footnote 2

Alberta reports unintentional apparent opioid-related deaths only.

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Table 3 footnote 3

Saskatchewan reports on closed/certified cases only. Updates to historical data will be provided in subsequent reports.

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Table 3 footnote 4

Ontario data reported here on age groups may differ from those reported by the province due to the use of alternate age groupings.

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Table 3 footnote 5

Quebec data for individuals 19 years and younger were not available. Quebec data were available for closed/certified cases only. 44% of the cases for 2016 were still under investigation. Updates to historical data will be provided in subsequent reports. Quebec data according to the age groups presented here were not available at the time of this publication.

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Table 3 footnote 6

New Brunswick data reported here may differ from published provincial reports as these reports focus on apparent opioid-related deaths that are classified as either accidental or of undetermined intent.

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Table 3 footnote 7

Prince Edward Island chose to suppress counts less than five for quarterly data, and for data regarding sex and age distribution.

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Table 3 footnote 8

Newfoundland and Labrador chose to suppress counts less than five.

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Table 3 footnote 9

Yukon chose to suppress counts less than five.

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Table 3. Percentage of apparent opioid-related deaths by age group and province or territory, 2016.
Province or territory Age Group
≤ 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 ≥ 70
British ColumbiaTable 3 footnote 1 2.8% 19.5% 26.7% 23.5% 22.7% 4.5% 0.3%
AlbertaTable 3 footnote 2 2.6% 20.8% 35.0% 17.1% 18.3% 5.5% 0.9%
SaskatchewanTable 3 footnote 3 0.0% 15.6% 42.2% 10.9% 21.9% 7.8% 1.6%
Manitoba 2.9% 26.1% 31.9% 14.5% 10.1% 10.1% 4.3%
OntarioTable 3 footnote 4 1.6% 17.5% 22.8% 21.3% 24.9% 9.1% 2.9%
QuebecTable 3 footnote 5 Table 3 footnote N/A Table 3 footnote N/A Table 3 footnote N/A Table 3 footnote N/A Table 3 footnote N/A Table 3 footnote N/A Table 3 footnote N/A
New BrunswickTable 3 footnote 6 0.0% 13.8% 17.2% 27.6% 27.6% 13.8% 0.0%
Nova Scotia 1.9% 18.9% 24.5% 11.3% 18.9% 18.9% 5.7%
Prince Edward IslandTable 3 footnote 7 Suppressed
Newfoundland and LabradorTable 3 footnote 8 Suppressed
YukonTable 3 footnote 9 Suppressed
Northwest Territories 0.0% 60.0% 0.0% 0.0% 20.0% 20.0% 0.0%
Nunavut Not Applicable
Total 2.2% 19.3% 27.5% 20.5% 22.1% 6.9% 1.5%
Table 3 footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids.

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Table 3 footnote 2

Alberta reports unintentional apparent opioid-related deaths only.

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Table 3 footnote 3

Saskatchewan reports on closed/certified cases only. Updates to historical data will be provided in subsequent reports.

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Table 3 footnote 4

Ontario data reported here on age groups may differ from those reported by the province due to the use of alternate age groupings.

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Table 3 footnote 5

Quebec data for individuals 19 years and younger were not available. Quebec data were available for closed/certified cases only. 44% of the cases for 2016 were still under investigation. Updates to historical data will be provided in subsequent reports. Quebec data according to the age groups presented here were not available at the time of this publication.

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Table 3 footnote 6

New Brunswick data reported here may differ from published provincial reports as these reports focus on apparent opioid-related deaths that are classified as either accidental or of undetermined intent.

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Table 3 footnote 7

Prince Edward Island chose to suppress counts less than five for quarterly data, and for data regarding sex and age distribution.

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Table 3 footnote 8

Newfoundland and Labrador chose to suppress counts less than five.

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Table 3 footnote 9

Yukon chose to suppress counts less than five.

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Table 3 footnote N/A

Not available

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Fentanyl-related opioids and other substances involved in apparent opioid-related deaths

Apparent opioid-related deaths often involve a mix of substances, including one or more opioids as well as non-opioid substances. Knowing the type and/or mix of opioid and non-opioid substances involved in these deaths can help public health officials and other government agencies communicate risks and target harm-reduction efforts.

We are seeing more fentanyl involved (or detectedFootnote 1) in apparent opioid-related deaths. Available data on apparent opioid-related, or illicit drug-relatedFootnote 1, deaths involving fentanyl, or where fentanyl was detected, show that:

  • the number of deaths more than doubled in January to March 2017 as compared to the same time period in 2016 (Table 4)
  • the percentage of deaths was 52% in 2016
  • British Columbia, Alberta, Manitoba and Ontario reported higher percentages of deaths compared to Eastern Canada (Table 5)
  • the death rate in 2016 ranged across the country from 0.0 to 13.8 per 100,000 population (Table 5)

Non-Opioid Substances

We can also highlight the involvement and mix of opioid and non-opioid substances in apparent opioid-related deaths. According to available dataFootnote a, in 2016 approximately 84% of apparent opioid-related deaths also involved one or more types of non-opioid substances.

Non-opioid substances were also involved in deaths involving:

  • only fentanyl-related opioids (74%)
  • only non-fentanyl related opioids (88%)
  • a mix of both fentanyl-related and non-fentanyl-related opioids (88%)

Data regarding the specific types of non-opioid substances that were involved are not available at this time.

Notes

Footnote a

Data were not available in these three categories from British Columbia, Saskatchewan, Quebec and Yukon, and were available from Alberta for closed cases only.

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Opioids and other involved drugs

Fentanyl-related opioids include:

  • fentanyl
  • carfentanil
  • norfentanyl
  • acetylfentanyl
  • butyrylfentanyl
  • furanyl-fentanyl
  • 3-methylfentanyl
  • despropionyl-fentanyl

Non-fentanyl-related opioids include:

  • heroin
  • codeine
  • U-47700
  • tramadol
  • morphine
  • tapentadol
  • oxycodone
  • loperamide
  • meperidine
  • methadone
  • hydrocodone
  • normeperidine
  • dihydrocodeine
  • hydromorphone
  • monoacetylmorphine
  • buprenorphine metabolites

Other substances include, but are not limited to:

  • W-18
  • alcohol
  • cocaine
  • benzodiazepines
Table 4. Number of apparent opioid-related deaths involving fentanyl-related opioids (or where fentanyl was detectedNote de bas de page 1), quarterly, by province or territory, January 2016 to March 2017.
Province or territory 2016 2017
Jan to Mar Apr to Jun Jul to Sep Oct to Dec 2016 Total Jan to Mar
British ColumbiaTable 4 footnote 1 123 128 119 286 656 310
AlbertaTable 4 footnote 2 71 85 91 121 368 122
SaskatchewanTable 4 footnote 3 Table 4 footnote N/A Table 4 footnote N/A Table 4 footnote N/A Table 4 footnote N/A 7 1
Manitoba 8 2 8 15 33 14
OntarioTable 4 footnote 4 76 94 72 110 352 Table 4 footnote N/A
QuebecTable 4 footnote 5 10 9 6 2 27 Table 4 footnote N/A
New BrunswickTable 4 footnote 6 2 0 1 1 4 4
Nova Scotia 4 2 2 0 8 1
Prince Edward IslandTable 4 footnote 7 Suppressed Suppressed Suppressed Suppressed 1 Suppressed
Newfoundland and LabradorTable 4 footnote 8 Suppressed Suppressed Suppressed Suppressed Suppressed Table 4 footnote N/A
YukonTable 4 footnote 9 Suppressed Suppressed Suppressed Suppressed Suppressed Suppressed
Northwest Territories 0 0 0 1 1 0
Nunavut 0 0 0 0 0 0
Table 4 footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to opioids. British Columbia data in the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories were not available at the time of this publication. However, British Columbia data on deaths related to illicit drugs where fentanyl was detected is used here as a proxy for apparent opioid-related deaths involving fentanyl.

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Table 4 footnote 2

Alberta reports unintentional apparent opioid-related deaths only. Alberta data in the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories represents closed/certified cases only. For Table 4 and 5, Alberta data regarding deaths involving fentanyl-related opioids includes both open and closed/certified cases.

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Table 4 footnote 3

Saskatchewan data in the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories were not available at the time of this publication.

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Table 4 footnote 4

Ontario data regarding 'non-opioid substances' for the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl'-related opioids categories do not include alcohol as one of the non-opioid substances.

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Table 4 footnote 5

Quebec data for individuals 19 years and younger were not available at the time of this publication. Quebec data were available for closed/certified cases only; 44% of the cases for 2016 were still under investigation. Updates to historical data will be provided in subsequent reports. Quebec data in the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories were not available as data reported represents the single 'chiefly responsible' drug only.

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Table 4 footnote 6

New Brunswick data reported here may differ from published provincial reports as these reports focus on apparent opioid-related deaths that are classified as either accidental or of undetermined intent.

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Table 4 footnote 7

Prince Edward Island reports unintentional deaths only. Prince Edward Island chose to suppress quarterly counts less than five in the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories.

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Table 4 footnote 8

Newfoundland and Labrador chose to suppress counts less than five.

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Table 4 footnote 9

Yukon chose to suppress counts less than five.

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Table 4 footnote N/A

Not available

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Table 5. Number, percentage, and death rate (per 100,000 population) of apparent opioid-related deaths involving fentanyl-related opioids (or where fentanyl was detectedNote de bas de page 1), by province or territory, 2016.
Province or territory Number Percentage Death rate per 100,000 population
British ColumbiaTable 5 footnote 1 656 67% 13.8
AlbertaTable 5 footnote 2 368 63% 8.7
SaskatchewanTable 5 footnote 3 7 11% 0.6
Manitoba 33 48% 2.5
OntarioTable 5 footnote 4 352 41% 2.5
QuebecTable 5 footnote 5 27 19% 0.3
New BrunswickTable 5 footnote 6 4 14% 0.5
Nova Scotia 8 15% 0.8
Prince Edward IslandTable 5 footnote 7 1 20% 0.7
Newfoundland and LabradorTable 5 footnote 8 Suppressed Suppressed Suppressed
YukonTable 5 footnote 9 Suppressed Suppressed Suppressed
Northwest Territories 1 20% 2.2
Nunavut 0 Not Applicable 0.0
Table 5 footnote 1

British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids. British Columbia data in the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories were not available at the time of this publication. However, British Columbia data on deaths related to illicit drugs where fentanyl was detected is used here as a proxy for apparent opioid-related deaths involving fentanyl.

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Table 5 footnote 2

Alberta reports unintentional apparent opioid-related deaths only. Alberta data in the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories represents closed/certified cases only. For Table 4 and 5, Alberta data regarding deaths involving fentanyl-related opioids includes both open and closed/certified cases.

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Table 5 footnote 3

Saskatchewan data in the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories were not available at the time of this publication.

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Table 5 footnote 4

Ontario data regarding ‘non-opioid substances’ for the ‘non-fentanyl-related’, ‘fentanyl-related’, and ‘both fentanyl-related and non-fentanyl’-related opioids categories do not include alcohol as one of the non-opioid substances.

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Table 5 footnote 5

Quebec data for individuals 19 years and younger were not available at the time of this publication. Quebec data were available for closed/certified cases only; 44% of the cases for 2016 were still under investigation. Updates to historical data will be provided in subsequent reports. Quebec data in the 'non-fentanyl-related', 'fentanyl-related', and 'both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories were not available as data reported represents the single 'chiefly responsible' drug only.

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Table 5 footnote 6

New Brunswick data reported here may differ from published provincial reports as these reports focus on apparent opioid-related deaths that are classified as either accidental or of undetermined intent.

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Table 5 footnote 7

Prince Edward Island reports unintentional deaths only. Prince Edward Island chose to suppress quarterly counts less than five in the ‘non-fentanyl-related’, ‘fentanyl-related’, and ‘both fentanyl-related and non-fentanyl-related' opioids (with or without non-opioid substances) categories.

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Table 5 footnote 8

Newfoundland and Labrador chose to suppress counts less than five.

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Table 5 footnote 9

Yukon chose to suppress counts less than five.

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Table 5 footnote N/A

Not available

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Definition of apparent opioid-related death

An apparent opioid-related death is a death caused by intoxication/toxicity (poisoning) as a result of drug use, where one or more of the drugs is an opioid.

The term "opioid-related death" is used instead of "opioid overdose death" in order to avoid any suggestion that all the deaths were intentional, which is sometimes associated with the term "overdose".

How apparent opioid-related deaths are counted

The data include:

  • open (preliminary) and closed (certified) cases, unless specified
  • non-natural manners of death (both intentional and unintentional, unless specified)
  • individuals with or without personal prescriptions

The data do not include deaths due to:

  • chronic substance use (for example, the medical consequences of long term use or overuse of an exogenous (external) substance(s), such as alcoholic cirrhosis)
  • medical assistance in dying
  • trauma where an exogenous (external) substance contributed to the circumstances of the injury

Limitations of these apparent opioid-related deaths data

Data presented in this report must be interpreted with caution.

This report is based on data submitted to the Public Health Agency of Canada on or before August 29, 2017. New or revised data submitted after this date will be reflected in future updates.

Data released by provinces and territories after this date may differ from the data provided here.

As some data are based on ongoing investigations by coroners and medical examiners, they are considered preliminary and subject to change.

Data are considered closed (certified) after completion of the death investigation by the coroner/medical examiner.

The time required to complete an investigation and related administrative processes is case-dependent and can range from approximately 3 to 24 months.

Rates reported here have not been age-standardized and therefore have not been adjusted for existing differences in provincial and territorial age distributions.

Rates for jurisdictions with relatively small populations may change substantially with even small changes in counts.

This report does not distinguish between prescription and non-prescription drugs or pharmaceutical and non-pharmaceutical fentanyl.

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