National report: Apparent opioid-related deaths in Canada
(released June 2018)
Suggested citation:
Special Advisory Committee on the Epidemic of Opioid Overdoses. National report: Apparent opioid-related deaths in Canada (January 2016 to December 2017) Web-based Report. Ottawa: Public Health Agency of Canada; June 2018.
Key findings
The opioid crisis has affected every part of the country, but there are clear differences in death rates and the substances involved across provinces and territories. According to available data reported as of June 6, 2018:
- there were 3,987 apparent opioid-related deaths in 2017; 92% were accidental (unintentional)
- 72% of accidental apparent opioid-related deaths involved fentanyl or fentanyl analogues, compared to 55% in 2016
- most accidental apparent opioid-related deaths occurred among males (78%) and among individuals between the ages of 30 and 39 (28%)
It is expected that these numbers will change as additional data become available
On this page
- Background
- 1.0 Apparent opioid-related deaths in Canada
- 2.0 Apparent opioid-related deaths by manner of death
- Considerations and Limitations
Background
Canada continues to experience a serious and growing opioid crisis. Across the country, it is having devastating effects on families and communities.
The Government of Canada works closely with the provinces and territories to collect and share data on apparent opioid-related deaths.
Accurate information about the crisis is needed to help guide efforts to reduce opioid-related harms, including deaths.
The data in this report:
- are updated four times a year
- may change based on review and refinement
- have been collected by the provinces and territories from their respective offices of Chief Coroners or Medical Examiners
- have been shared through the Special Advisory Committee on the Epidemic of Opioid Overdoses (SAC)
Changes from the last report include:
- the addition of available preliminary data from October to December 2017
- updates to previously reported data from January 2016 to September 2017
1.0 Apparent opioid-related deaths in Canada
The opioid crisis has affected every part of the country, but some provinces and territories have been impacted more than others. According to data reported as of June 6, 2018:
- there were 3,987 apparent opioid-related deaths in 2017, corresponding to a death rate of 10.9 per 100,000 population in 2017 (Table 1)Footnote a
- the number of apparent opioid-related deaths increased by 34% in 2017 from 2,978 in 2016 (8.2 per 100,000 population) (Table 1)Footnote b
Figure 1. Number and rate (per 100,000 population) of apparent opioid-related deaths by province or territory, 2017.
Text Description
Province or territory | Number of deaths in 2017 | Rate per 100,000 population |
---|---|---|
British ColumbiaFigure 1 Footnote a | 1470 | 30.5 |
Alberta | 759 | 17.7 |
SaskatchewanFigure 1 Footnote b | 46 | 4.0 |
Manitoba | 122 | 9.1 |
Ontario | 1263 | 8.9 |
QuebecFigure 1 Footnote c | 181 | 2.2 |
New Brunswick | 37 | 4.9 |
Nova Scotia | 65 | 6.8 |
Prince Edward IslandFigure 1 Footnote b | 3 | 2.0 |
Newfoundland and LabradorFigure 1 Footnote b | 33 | 6.2 |
YukonFigure 1 Footnote b | 7 | 18.2 |
Northwest Territories | 1 | 2.2 |
Nunavut | Suppressed | Suppressed |
|
2016 | 2017 | ||
---|---|---|---|
Number | 2978 | 3987 | |
Rate per 100,000 population | 8.2 | 10.9 | |
Percent male | 71% | 76% | |
Percent by age group (years) | ≤ 19 | 2% | 2% |
20 to 29 | 18% | 20% | |
30 to 39 | 26% | 27% | |
40 to 49 | 21% | 22% | |
50 to 59 | 23% | 20% | |
60 to 69 | 7% | 8% | |
≥ 70 | 2% | 1% | |
Percent involvingTable 1 Footnote 2 fentanyl or fentanyl analogues | 50% | 68% | |
Percent also involving non-opioid substancesTable 1 Footnote 3 | 74% | 72% | |
|
2.0 Apparent opioid-related deaths by manner of death
The following section presents apparent opioid-related death data according to the manner of death assigned by the coroner or medical examiner during, or following an investigation (Table 2). Collecting data on how deaths occurred, including whether they were intentional or not, is critical in understanding how the opioid crisis is affecting Canadians.
Accident: Deaths with completed investigations where the coroner or medical examiner determined that the death was unintentional. This category also includes deaths with ongoing investigations where the manner of death was believed to be unintentional or had not been assigned at the time of reporting.
Suicide: Deaths with completed investigations where the coroner or medical examiner determined that the opioids were consumed with the intent to die. This category also includes deaths with ongoing investigations where suicide was believed to be the manner of death at the time of reporting.
Undetermined: Deaths with completed investigations where a specific manner of death (e.g. accident, suicide) could not be assigned based on available or competing information.
According to available data reported as of June 6, 2018, most apparent opioid-related deaths were accidental (unintentional) in both 2016 (88%) and 2017 (92%) (Table 2).
In other words, these data indicate that the vast majority of apparent opioid-related deaths were of individuals who did not intend to die. This distinction is important to inform an appropriate public health response. For example, the high percent of unintended deaths reinforces the concern that a variety of street drugs are tainted with toxic substances, such as fentanyl, without the knowledge of the people consuming them. Public health officials will be able to use this information in developing strategies to address these hidden risks in order to reduce harms and effectively prevent unintended apparent opioid-related deaths.
Manner of death | 2016 | 2017 | ||
---|---|---|---|---|
Number | Percent | Number | Percent | |
Accident (unintentional) | 2624 | 88% | 3671 | 92% |
Suicide | 258 | 9% | 173 | 4% |
Undetermined | 96 | 3% | 143 | 4% |
TotalTable 2 Footnote 2 | 2978 | 3987 | ||
|
2.1 National and regional trends of accidental apparent opioid-related deaths
The following section provides detailed information on accidental apparent opioid-related deaths, which also shows that some provinces and territories have been impacted more than others.
According to data reported as of June 6, 2018:
- there were 3,671 accidental apparent opioid-related deaths in 2017, corresponding to a death rate of 10.0 per 100,000 population (Table 2a)Footnote a
- this represents a 40% increase from 2,624 apparent opioid-related deaths in 2016 (7.2 per 100,000 population) (Table 2a)Footnote b
Province or territory | 2016 | 2017 | ||
---|---|---|---|---|
Number | Rate | Number | Rate | |
British ColumbiaTable 2a Footnote 2 | 974 | 20.5 | 1399 | 29.0 |
Alberta | 548 | 12.9 | 714 | 16.7 |
Saskatchewan | 75 | 6.5 | 41 | 3.5 |
Manitoba | 70 | 5.3 | 86 | 6.4 |
Ontario | 726 | 5.2 | 1125 | 7.9 |
QuebecTable 2a Footnote 2 | 138 | 1.7 | 181 | 2.2 |
New Brunswick | 26 | 3.4 | 33 | 4.3 |
Nova Scotia | 40 | 4.2 | 59 | 6.2 |
Prince Edward Island | 5 | 3.3 | 3 | 2.0 |
Newfoundland and Labrador | 13 | 2.5 | 23 | 4.3 |
Yukon | 5 | 13.1 | 6 | 15.6 |
Northwest Territories | 4 | 9.0 | 1 | 2.2 |
Nunavut | Suppressed | Suppressed | Suppressed | Suppressed |
Total | 2624 | 7.2 | 3671 | 10.0 |
Suppressed – Data may be suppressed in provinces or territories with low numbers of cases. Please see Considerations and Limitations for more information.
|
Province or territory | 2016 | 2017 | ||||||
---|---|---|---|---|---|---|---|---|
Jan to Mar | Apr to Jun | Jul to Sep | Oct to Dec | Jan to Mar | Apr to Jun | Jul to Sep | Oct to Dec | |
British ColumbiaTable 2b Footnote 2 | 218 | 191 | 193 | 372 | 395 | 401 | 324 | 279 |
Alberta | 117 | 135 | 142 | 154 | 154 | 169 | 187 | 204 |
Saskatchewan | 25 | 14 | 22 | 14 | 17 | 14 | 7 | 3 |
Manitoba | 11 | 15 | 14 | 30 | 28 | 27 | 17 | 14 |
Ontario | 174 | 180 | 174 | 198 | 191 | 271 | 374 | 289 |
QuebecTable 2b Footnote 2 | 41 | 39 | 35 | 23 | N/A | N/A | 93 | 88 |
New Brunswick | 11 | 3 | 6 | 6 | 8 | 8 | 9 | 8 |
Nova Scotia | 14 | 8 | 15 | 3 | 17 | 15 | 12 | 15 |
Prince Edward IslandTable 2b Footnote 3 | N/A | N/A | N/A | N/A | Suppressed | Suppressed | Suppressed | Suppressed |
Newfoundland and Labrador | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed |
Yukon | 0 | 2 | 0 | 3 | 3 | 0 | 1 | 2 |
Northwest Territories | 1 | 0 | 1 | 2 | 0 | 0 | 1 | 0 |
Nunavut | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed |
N/A – Data were not available at the time of this publication. Suppressed – Data may be suppressed in provinces or territories with low numbers of cases. Please see Considerations and Limitations for more information.
|
2.2 Sex and age trends of accidental apparent opioid-related deaths
This crisis has affected Canadians from all walks of life. However, available data for 2017, reported as of June 6, 2018, indicate there are differences by sex and age.
Although these trends vary by province or territory, at the national level:
- most (78%) accidental apparent opioid-related deaths occurred among males (Figure 2.1)
- the highest percent (28%) of accidental apparent opioid-related deaths occurred among individuals between the ages of 30 and 39 (Table 2c)
Figure 2.1 Sex distribution of accidental apparent opioid-related deaths by province or territory, 2017.Figure 2.1 Footnote 1
- Data reported by some provinces and territories do not include all stages of investigation (ongoing, completed) or time periods; refer to Table 3 for more details. Updates to previously reported data will be provided in future reports.
- Data from British Columbia and Quebec (July to December) include deaths related to all illicit drugs including, but not limited to, opioids.
Text Description
Province or territory | Percent of apparent opioid-related deaths | |
---|---|---|
% male | % female | |
British ColumbiaFigure 2.1 Footnote 2 | 83% | 17% |
Alberta | 75% | 25% |
Saskatchewan | 56% | 44% |
Manitoba | 72% | 28% |
Ontario | 76% | 24% |
QuebecFigure 2.1 Footnote 2 | 74% | 26% |
New Brunswick | 61% | 39% |
Nova Scotia | 68% | 32% |
Prince Edward Island | Suppressed | Suppressed |
Newfoundland and Labrador | 70% | 30% |
Yukon | Suppressed | Suppressed |
Northwest Territories | Suppressed | Suppressed |
Nunavut | Suppressed | Suppressed |
Total | 78% | 22% |
Suppressed – Data may be suppressed in provinces or territories with low numbers of cases. Please see Considerations and Limitations for more information.
|
Province or territory | Age group | ||||||
---|---|---|---|---|---|---|---|
≤ 19 | 20 to 29 | 30 to 39 | 40 to 49 | 50 to 59 | 60 to 69 | ≥ 70 | |
British ColumbiaTable 2c Footnote 2 | 2% | 18% | 28% | 24% | 20% | 8% | 1% |
Alberta | 3% | 24% | 32% | 19% | 18% | 4% | 1% |
Saskatchewan | 7% | 29% | 22% | 17% | 17% | 7% | 0% |
Manitoba | 1% | 30% | 29% | 21% | 8% | 8% | 2% |
Ontario | 2% | 21% | 27% | 22% | 20% | 7% | 1% |
QuebecTable 2c Footnote 3 | Suppressed | 13% | 23% | 25% | 24% | 11% | Suppressed |
New Brunswick | 3% | 21% | 21% | 18% | 21% | 9% | 6% |
Nova Scotia | 5% | 10% | 27% | 22% | 29% | 5% | 2% |
Prince Edward Island | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed |
Newfoundland and Labrador | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed |
Yukon | 0% | 17% | 67% | 17% | 0% | 0% | 0% |
Northwest Territories | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed |
Nunavut | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed | Suppressed |
Total | 2% | 20% | 28% | 22% | 19% | 7% | 1% |
Suppressed – Data may be suppressed in provinces or territories with low numbers of cases. Please see Considerations and Limitations for more information.
|
2.3 Fentanyl, fentanyl analogues, and other substances involved in accidental apparent opioid-related deaths
Apparent opioid-related deaths often involveFootnote c multiple substances including one or more opioids as well as non-opioid substances. Knowing the type(s) 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.
Available data reported as of June 6, 2018, suggest that more accidental apparent opioid-related deaths have involved fentanyl or fentanyl analogues over time (Table 2d, Figure 2.2):
- the percent of accidental apparent opioid-related deaths involving fentanyl or fentanyl analogues increased from 55% in 2016 to 72% in 2017Footnote a
- the number of accidental apparent opioid-related deaths involving fentanyl or fentanyl analogues increased by 81% between 2016 and 2017
In addition, available data suggest that approximately 71% of accidental apparent opioid-related deaths in 2017Footnote d also involved one or more types of non-opioid substances.
Province or territory | 2016 | 2017 | ||
---|---|---|---|---|
Number | Percent | Number | Percent | |
British ColumbiaTable 2d Footnote 2 | 656 | 67% | 1174 | 84% |
Alberta | 352 | 64% | 567 | 79% |
Saskatchewan | 8 | 11% | 9 | 22% |
Manitoba | 32 | 46% | 42 | 49% |
Ontario | 330 | 45% | 743 | 68% |
QuebecTable 2d Footnote 2 | 30 | 22% | 25 | 15% |
New Brunswick | 3 | 12% | 8 | 24% |
Nova Scotia | 7 | 18% | 6 | 10% |
Prince Edward Island | 1 | 20% | 0 | 0% |
Newfoundland and Labrador | Suppressed | Suppressed | Suppressed | Suppressed |
Yukon | 4 | 80% | 5 | 83% |
Northwest Territories | 1 | 25% | 0 | 0% |
Nunavut | Suppressed | Suppressed | Suppressed | Suppressed |
Total | 1424 | 55% | 2579 | 72% |
Suppressed – Data may be suppressed in provinces or territories with low numbers of cases. Please see Considerations and Limitations for more information.
|
Figure 2.2. Number of accidental apparent opioid-related deaths involving fentanyl or fentanyl analogues by quarter, January 2016 to December 2017.Figure 2.2 Footnote 1
- Data reported by some provinces and territories do not include all stages of investigation (ongoing, completed) or time periods; refer to Table 3 for more details. Updates to previously reported data will be provided in future reports. Data from British Columbia and available 2017 data from Quebec (July to December) include deaths related to all illicit drugs including, but not limited to, opioids; data on deaths related to illicit drugs where fentanyl was detected is used here to approximate apparent opioid-related deaths involving fentanyl. Only annual totals were available for 2016 data from Prince Edward Island; quarterly data were not available at the time of this publication.
- These data are preliminary and subject to change; the observed decrease in apparent opioid-related deaths involving fentanyl or fentanyl analogues in October to December 2017 should be interpreted with caution until additional data become available.
Text Description
Year and quarter | Number of apparent opioid-related deaths | |
---|---|---|
2016 | January to March | 284 |
April to June | 311 | |
July to September | 290 | |
October to December | 538 | |
2017 | January to March | 566 |
April to June | 673 | |
July to September | 740 | |
October to December | 600Figure 2.2 Footnote 2 | |
|
2.4 Apparent opioid-related deaths: suicide
The following section provides information on apparent opioid-related deaths where the coroner or medical examiner determined that the opioids were consumed with the intent to die. This section also includes deaths with ongoing investigations where the manner of death was believed to be suicide at the time of reporting.
2016 | 2017 | ||
---|---|---|---|
Number | 258 | 173 | |
Rate per 100,000 population | 0.7 | 0.5 | |
Percent male | 47% | 53% | |
Percent by age group (years) | ≤ 19 | 2% | 1% |
20 to 29 | 8% | 10% | |
30 to 39 | 11% | 14% | |
40 to 49 | 19% | 18% | |
50 to 59 | 28% | 28% | |
60 to 69 | 22% | 17% | |
≥ 70 | 10% | 12% | |
Percent involvingTable 2e Footnote 2 fentanyl or fentanyl analoguesTable 2e Footnote 3 | 13% | 17% | |
Percent also involving non-opioid substancesTable 2e Footnote 4 | 63% | 82% | |
|
Considerations and Limitations
Definition of an apparent opioid-related death
An apparent opioid-related death is a death caused by an intoxication/toxicity (poisoning) resulting from substance use, where one or more of the substances is an opioid, regardless of how it was obtained (e.g. illegally or through personal prescription).
How apparent opioid-related deaths are counted
Counts are provided by the provinces and territories that collect data from their respective offices of Chief Coroners or Medical Examiners. Rates are calculated using the most current population data from Statistics Canada.
The data provided by the provinces and territories can include deaths:
- with completed or ongoing investigations
- where manner of death is classified as accident, suicide, or undetermined
These data do not include deaths due to:
- the medical consequences of long term substance use or overuse (for example, alcoholic cirrhosis)
- medical assistance in dying
- trauma where use of the substance(s) contributed to the circumstances of the injury that lead to the death, but was not directly involved in the death
- homicide
However, some provincial and territorial differences remain in the type of data reported and in the time periods for which data are available (refer to Table 3).
BCTable 3 Footnote 1 | AB | SK | MB | ONTable 3 Footnote 2 | QCTable 3 Footnote 3 | NB | NS | PE | NL | YT | NT | NU | ||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Reporting period (as of June 6, 2018) | ||||||||||||||
2016 | January to December | (C) | (C) | (C) | (C) | (C) | ||||||||
2017 | January to December | (C) | INC | (C) | (C) | (C) | ||||||||
Classification of deaths included in the reported data | ||||||||||||||
Accident | Completed investigations | N/A | ||||||||||||
Ongoing investigations where manner of death was believed to be unintentional | N/A | N/A | N/A | N/A | N/A | |||||||||
Ongoing investigations where manner of death had not been assigned at the time of reporting | N/A | N/A | N/A | N/A | ||||||||||
Suicide | Completed investigations | N/A | N/A | |||||||||||
Ongoing investigations where the manner of death was believed to be suicide | N/A | N/A | N/A | N/A | N/A | N/A | N/A | |||||||
Deaths with completed investigations and an undetermined manner of death | N/A | N/A | ||||||||||||
|
Data suppression
The suppression of data in this report is based on the preferences of individual provinces or territories to address concerns around releasing small numbers for their jurisdiction.
- Prince Edward Island suppressed counts less than five for quarterly data, and for any data related to sex and age distribution.
- Newfoundland and Labrador suppressed all counts between one and four.
- Quebec suppressed counts less than five for deaths with ongoing investigations (July to December 2017).
- Nunavut suppressed all counts less than five.
In addition, suppression was applied in some instances where all data for a province or territory fell in a single category of a given table or figure.
Opioids and other substances
Fentanyl and fentanyl analogues include, but are not limited to:
- 3-methylfentanyl
- acetylfentanyl
- butyrylfentanyl
- carfentanil
- despropionyl-fentanyl
- fentanyl
- furanyl-fentanyl
- norfentanyl
Non-fentanyl-related opioids include, but are not limited to:
- buprenorphine metabolites
- codeine
- dihydrocodeine
- heroin
- hydrocodone
- hydromorphone
- loperamide
- meperidine
- methadone
- monoacetylmorphine
- morphine
- normeperidine
- oxycodone
- tapentadol
- tramadol
- U-47700
Non-opioid substances include, but are not limited to:
- alcohol
- benzodiazepines
- cocaine
- methamphetamine
- W-18
Limitations of these apparent opioid-related deaths data
Data presented in this report should be interpreted with caution.
- This report is based on data submitted to the Public Health Agency of Canada on or before June 6, 2018. New or revised data submitted after this date will be reflected in future reports.
- Data released by provinces and territories may differ from the data provided in this report due to the availability of updated data, differences in the type of data reported (e.g. manners of death), the use of alternate age groupings, differences in time periods presented and/or population estimates used for calculations, etc.
- As some data are based on ongoing investigations by coroners and medical examiners, they are considered preliminary and subject to change. The time required to complete an investigation and related administrative processes is case-dependent and can range from approximately three to twenty-four months.
- This report is based on data that do not specify how the opioids were obtained (e.g. illegally or through personal prescription); the level of toxicity may differ depending on the opioid (substance(s) involved, concentration, and dosage).
- Jurisdictional differences in the death investigation process, death classification method, toxicology testing, and the manners of death reported may impact the interpretation and comparability of the data presented in this report.
- Information related to changes over time at the national level is based only on jurisdictions where data were available for all time periods of interest.
- Rates reported here have not been adjusted for existing differences in provincial and territorial age distributions.
- Rates for jurisdictions with relatively smaller populations may change substantially with even slight changes in the number of deaths. As a result, comparisons over time and between provinces and territories should be interpreted with caution.
Footnotes
- Footnote a
-
These values do not include data from Nunavut.
- Footnote b
-
Changes to previously reported counts and rates of apparent opioid-related deaths reflect updates to provincial or territorial data.
- Footnote c
-
Given jurisdictional differences in death classification methods, the term "involve" includes deaths where the substance was either detected and/or directly contributed to the death.
- Footnote d
-
Data were not available from British Columbia, Quebec, or Nunavut. For Alberta, only data on deaths with completed investigations were included in these percentages. Data for non-opioid substances from Ontario between January 2017 and April 2017 were based on their detection and do not include alcohol; from May 2017 to December 2017, data on non-opioid substances were based on their direct effects and include alcohol.
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