Multi-drug combinations in opioid- or stimulant-related toxicity deaths in Canada: Infographic

January 2018 to December 2023.

What are multi-drug combinations?

Multi-drug combinations are the involvement (detection and/or contribution) of more than 1 psychoactive substance or substance class in a death. The number of substances involved in opioid or stimulant toxicity deaths in Canada has increased, along with changes in the toxicity of the drug supply and polysubstance use (intentional or unintentional). ^{Footnote 1 Footnote 2 Footnote 3}

Impact in Canada

Based on available data, from 10 provinces and territories, there were 20,438 opioid- or stimulant-related toxicity deaths between 2018 and 2023.^{Footnote *}

Multi-drug deaths with 3 or more substances have doubled in the last 5 years.

• In 2018, 1 in 5 deaths involved three or more substances.
• In 2023, 2 in 5 deaths involved three or more substances.

Multi-drug combinations on the rise

Deaths involving a single substance or group have declined, while those involving multiple – especially fentanyl combinations – have increased.

• Non-fentanyl opioids with other psychoactive substances has decreased since 2018.
• Fentanyl alone has decreased since 2020.
• Non-fentanyl opioids alone has decreased since 2018.
• Fentanyl with cocaine and methamphetamine has increased since 2019.
• Fentanyl with methamphetamine, fentanyl analogues, and other psychoactive substances has increased since 2018.

Suppr. = Suppressed due to small counts (<5)
"Other psychoactive substances" is a broad category of substances that do not fit in the established substance groups, and may include alcohol, benzodiazepines, etc.

Drug combinations differ across the country

In the Yukon and Ontario, over 30% of deaths involved opioids and stimulants.
In Saskatchewan, 67% of deaths involved opioids, stimulants, and other psychoactive substances.

Suppr. = Suppressed
n/a = Not available