National report: Apparent opioid-related deaths in Canada
(released September 2018)

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We have archived this page and will not be updating it.

View the latest available data.

On this page:

• Background
• 1.0 Apparent opioid-related deaths in Canada
  • 1.1 Apparent opioid-related deaths by manner of death
• 2.0 Accidental apparent opioid-related deaths
  • 2.1 Annual, sex, and age trends of accidental apparent opioid-related deaths
  • 2.2 Fentanyl, fentanyl analogues, and other substances involved in accidental apparent opioid-related deaths
• 3.0 Apparent opioid-related deaths: suicide
• Considerations and Limitations 

Background

Canada continues to experience a serious 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 office of the Chief Coroner or Medical Examiner
• have been shared through the Special Advisory Committee on the Epidemic of Opioid Overdoses

Changes from the last report include:

• the addition of available preliminary data from January to March 2018
• updates to previously reported data from January 2016 to December 2017
• an option to view graphics by year

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 September 12, 2018:

• there were 8,037 apparent opioid-related deaths between January 2016 and March 2018
  • in 2016, there were 3,005 apparent opioid-related deaths (corresponding to a death rate of 8.3 per 100,000 population) and 3,996 in 2017 (corresponding to a death rate of 10.9 per 100,000 population)
  • from January to March 2018, there were at least 1,036 apparent opioid-related deaths (Figure 1, Table 1)
• the number of apparent opioid-related deaths between January and March 2018 increased by 5% compared to the same time period in 2017 and 44% compared to the same time period in 2016

Figure 1. Number and rate (per 100,000 population) of apparent opioid-related deaths by province or territory.

Table 1. Summary of apparent opioid-related deaths, 2016, 2017 and January to March 2018.^{Table 1 Footnote 1}

		2016	2017	2018 (Jan to Mar)
Number		3005	3996	1036
Rate per 100,000 population		8.3	10.9	Not available
Percent male		71%	76%	76%
Percent by age group (years)	19 and under	2%	2%	1%
	20 to 29	18%	20%	20%
	30 to 39	26%	27%	27%
	40 to 49	21%	22%	21%
	50 to 59	23%	20%	22%
	60 to 69	8%	8%	8%
	70 and over	2%	1%	2%
Percent involvingTable 1 Footnote 2 fentanyl or fentanyl analogues		50%	69%	70%
Percent also involving non-opioid substancesTable 1 Footnote 3		75%	72%	71%
Table 1 Footnote 1 Data reported by some provinces and territories do not include all manners of death (accident, suicide, undetermined), stages of investigation (ongoing, completed) or time periods; refer to Table 4 for more details. Updates to previously reported data will be provided in future reports. Data from British Columbia and available data from Quebec for 2017 (June to December) and 2018 include deaths related to all illicit drugs including, but not limited to, opioids. Table 1 Return to footnote 1 referrer Table 1 Footnote 2 Given jurisdictional differences in death classification methods, the term “involving” includes deaths where the substance was either detected and/or directly contributed to the death. Data from British Columbia and available data from Quebec (July to December 2017, 2018) on deaths related to illicit drugs where fentanyl was detected is used here to approximate apparent opioid-related deaths involving fentanyl. Table 1 Return to footnote 2 referrer Table 1 Footnote 3 These percentages do not include data from British Columbia, Quebec, or Nunavut as these data were not available for all time periods. For Alberta, only data on deaths with completed investigations were included in these percentages. Data for non-opioid substances from Ontario between January 2016 and April 2017 were based on their detection and do not include alcohol; as of May 1, 2017, data on non-opioid substances are based on their direct effects and include alcohol. Refer to Opioids and other substances for more details. Table 1 Return to footnote 3 referrer

1.1 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 September 12, 2018, most (94%) apparent opioid-related deaths between January and March 2018 were accidental (unintentional), similar to 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.

Table 2. Number and percent of apparent opioid-related deaths in Canada by manner of death, 2016, 2017 and January to March 2018.^{Table 2 Footnote 1}

Manner of death	2016		2017		2018 (Jan to Mar)
	Number	Percent	Number	Percent	Number	Percent
Accident (unintentional)	2643	88%	3679	92%	973	94%
Suicide	266	9%	194	5%	39	4%
Undetermined	96	3%	123	3%	24	2%
TotalTable 2 Footnote 2	3005	-	3996	-	1036	-
Table 2 Footnote 1 Data reported by some provinces and territories do not include all manners of death (accident, suicide, undetermined), stages of investigation (ongoing, completed) or time periods; refer to Table 4 for more details. Updates to previously reported data will be provided in future reports. Table 2 Return to footnote 1 referrer Table 2 Footnote 2 Data from British Columbia and available data from Quebec for 2017 (June to December) and 2018 include deaths related to all illicit drugs including, but not limited to, opioids. Table 2 Return to footnote 2 referrer

2.0 Accidental apparent opioid-related deaths

The following section provides detailed information on accidental apparent opioid-related deaths, which are 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.

Table 2a. Number of accidental apparent opioid-related deaths by quarter and province or territory, January 2016 to March 2018.^{Table 2a Footnote 1}

Province or territory	2016				2017				2018
	Jan to Mar	Apr to Jun	Jul to Sep	Oct to Dec	Jan to Mar	Apr to Jun	Jul to Sep	Oct to Dec	Jan to Mar
British ColumbiaTable 2a Footnote 2	218	192	196	371	396	408	325	286	371
Alberta	118	130	144	153	152	162	176	200	195
Saskatchewan	25	14	22	15	20	16	10	11	12
Manitoba	11	15	14	30	28	27	17	14	N/A
Ontario	174	180	174	198	191	276	380	280	287
QuebecTable 2a Footnote 2	46	41	39	30	N/A	N/A	93	88	82
New Brunswick	11	3	6	6	8	7	7	9	5
Nova Scotia	14	8	15	3	17	16	12	13	16
Prince Edward IslandTable 2a Footnote 3	N/A	N/A	N/A	N/A	Suppressed	Suppressed	Suppressed	Suppressed	0
Newfoundland and Labrador	Suppressed	Suppressed	Suppressed	Suppressed	Suppressed	Suppressed	Suppressed	Suppressed	4
Yukon	0	2	0	3	3	0	1	2	0
Northwest Territories	1	0	1	2	0	0	1	0	1
Nunavut	Suppressed	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. Table 2a Footnote 1 Data reported by some provinces and territories do not include all stages of investigation (ongoing, completed); refer to Table 4 for more details. Updates to previously reported data will be provided in future reports. Table 2a Return to footnote 1 referrer Table 2a Footnote 2 Data from British Columbia and available data from Quebec for 2017 (June to December) and 2018 include deaths related to all illicit drugs including, but not limited to, opioids. Table 2a Return to footnote 2 referrer Table 2a Footnote 3 Only annual totals were available for 2016 data from Prince Edward Island; quarterly data were not available at the time of this publication. Table 2a Return to footnote 3 referrer

2.1 Annual, sex, and age trends of accidental apparent opioid-related deaths

This crisis has affected Canadians from all walks of life; however, available data reported as of September 12, 2018 indicate that the impact of the crisis differs by year, sex, and age.

Although these trends vary by province or territory, at the national level:

• there were 973 accidental apparent opioid-related deaths between January to March 2018 (Table 2a, Table 2b)
  • the number of deaths in 2018 increased by 8% compared to the same time period in 2017 and more than doubled compared to the same time period in 2016 (Table 2a)
• in-line with previous trends observed in 2016 and 2017, most (77%) accidental apparent opioid-related deaths from January to March 2018 occurred among males (Figure 2.1)
• the highest percent (27%) of accidental apparent opioid-related deaths between January to March 2018 occurred among individuals between the ages of 30 and 39 (Figure 2.2)

Table 2b. Number and rate (per 100,000 population) of accidental apparent opioid-related deaths, and percent involving fentanyl or fentanyl analogues, by province or territory, 2016, 2017 and January to March 2018.^{Table 2b Footnote 1}

Province or territory	2016			2017			2018 (Jan to Mar)
	Number	Rate	Percent involving fentanyl or fentanyl analogues	Number	Rate	Percent involving fentanyl or fentanyl analogues	Number	Percent involving fentanyl or fentanyl analogues
British ColumbiaTable 2b Footnote 2	977	20.5	67%	1415	29.4	84%	371	86%
Alberta	545	12.9	64%	690	16.1	81%	195	87%
Saskatchewan	76	6.6	11%	57	4.9	23%	12	50%
Manitoba	70	5.3	46%	86	6.4	49%	N/A	N/A
Ontario	726	5.2	45%	1127	7.9	69%	287	67%
QuebecTable 2b Footnote 2	156	1.9	22%	181	2.2	16%	82	12%
New Brunswick	26	3.4	15%	31	4.1	23%	5	0%
Nova Scotia	40	4.2	18%	58	6.1	12%	16	19%
Prince Edward Island	5	3.3	20%	4	2.6	0%	0	Not applicable
Newfoundland and Labrador	13	2.5	Suppressed	23	4.3	Suppressed	4	Suppressed
Yukon	5	13.1	80%	6	15.6	83%	0	Not applicable
Northwest Territories	4	9.0	25%	1	2.2	0%	1	0%
Nunavut	Suppressed	Suppressed	Suppressed	Suppressed	Suppressed	Suppressed	Suppressed	Suppressed
Total	2643	7.3	54%	3679	10.0	72%	973	73%
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. Table 2b Footnote 1 Data reported by some provinces and territories do not include all stages of investigation (ongoing, completed) or time periods; refer to Table 4 for more details. Updates to previously reported data will be provided in future reports. Table 2b Return to footnote 1 referrer Table 2b Footnote 2 Data from British Columbia and available data from Quebec for 2017 (June to December) and 2018 include deaths related to all illicit drugs including, but not limited to, opioids. Table 2b Return to footnote 2 referrer

Figure 2.1 Sex distribution of accidental apparent opioid-related deaths by province or territory.^{Footnote 1}

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 Percent of accidental apparent opioid-related deaths by age group and province or territory.^{Footnote 1}

Suppressed – Data may be suppressed in provinces or territories with low numbers of cases. Please see Considerations and Limitations for more information.

2.2 Fentanyl, fentanyl analogues, and other substances involved in accidental apparent opioid-related deaths

Apparent opioid-related deaths often involve^{Footnote a} multiple substances including one or more opioids as well as non-opioid substances. Knowing the 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 September 12, 2018, suggest that:

• between January and March 2018, 73% of accidental apparent opioid-related deaths involved fentanyl or fentanyl analogues (Table 2a, Figure 2.3)
• the number of accidental apparent opioid-related deaths involving fentanyl or fentanyl analogues increased by 16% compared to the same time frame in 2017, and doubled compared to the same time frame in 2016 (Figure 2.3)

In addition, available data suggest approximately 76% of accidental apparent opioid-related deaths between January 2016 and March 2018^{Footnote b} also involved one or more types of non-opioid substances.

Figure 2.3. Number of accidental apparent opioid-related deaths involving or not involving fentanyl or fentanyl analogues by quarter, January 2016 to March 2018.^{Figure 2.3 Footnote 1Figure 2.3 Footnote 2}

Text Description

Figure 2.3 data^{Figure 2.3 Footnote 1 Figure 2.3 Footnote 2}

Year and quarter		Number of apparent opioid-related deaths
		Deaths not involving fentanyl or fentanyl analogues	Deaths involving fentanyl or fentanyl analogues
2016	Jan to Mar	332	286
	Apr to Jun	275	310
	Jul to Sep	322	289
	Oct to Dec	271	540
2017	Jan to Mar	247	568
	Apr to Jun	229	683
	Jul to Sep	281	741
	Oct to Dec	279	624
2018	Jan to Mar	311	658
Figure 2.3 Footnote 1 Data reported by some provinces and territories do not include all stages of investigation (ongoing, completed) or time periods; refer to Table 4 for more details. Updates to previously reported data will be provided in future reports. This graph does not include data from Prince Edward Island, Newfoundland and Labrador, or Nunavut. Data from British Columbia and available data from Quebec for 2017 (June to December) and 2018 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. Figure 2.3 Return to footnote 1 referrer Figure 2.3 Footnote 2 These data are preliminary and subject to change; observed trends should be interpreted with caution until additional data become available. Figure 2.3 Return to footnote 2 referrer

3.0 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.

Table 3. Summary of apparent opioid-related deaths classified as, or believed to be suicide, in Canada, 2016, 2017, and January to March 2018.^{Table 3 Footnote 1}

		2016	2017	2018 (Jan to Mar)
Number		266	194	39
Rate per 100,000 population		0.7	0.5	Not available
Percent male		46%	52%	62%
Percent by age group (years)	19 and under	2%	1%	3%
	20 to 29	8%	12%	15%
	30 to 39	12%	15%	10%
	40 to 49	19%	15%	13%
	50 to 59	29%	28%	33%
	60 to 69	22%	18%	18%
	70 and greater	10%	11%	8%
Percent involvingTable 3 Footnote 2 fentanyl or fentanyl analoguesTable 3 Footnote 3		13%	16%	18%
Percent also involving non-opioid substancesTable 3 Footnote 4		83%	79%	64%
Table 3 Footnote 1 Data reported by some provinces and territories do not include all stages of investigation (ongoing, completed) or time periods; refer to Table 4 for more details. Suicide data from Quebec (July to December 2017, 2018), Prince Edward Island, and Nunavut were not available at the time of this publication. British Columbia reports deaths related to all illicit drugs including, but not limited to, opioids. Updates to previously reported data will be provided in future reports. Table 3 Return to footnote 1 referrer Table 3 Footnote 2 Given jurisdictional differences in death classification methods, the term “involving” includes deaths where the substance was either detected and/or directly contributed to the death. Table 3 Return to footnote 2 referrer Table 3 Footnote 3 These percentages do not include data from Quebec, Prince Edward Island, or Nunavut as these data were not available for both time periods. Table 3 Return to footnote 3 referrer Table 3 Footnote 4 These percentages do not include data from British Columbia, Quebec, Prince Edward Island, and Nunavut as these data were not available for all time periods. For Alberta and Ontario, only data on deaths with completed investigations were included in these percentages. Data for non-opioid substances from Ontario between January 2016 and April 2017 were based on their detection and do not include alcohol; as of May 1, 2017, data on non-opioid substances were based on their direct effects and include alcohol. Refer to Opioids and other substances for more details. Table 3 Return to footnote 4 referrer

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 4).

Table 4. Reporting periods and manners of death included in apparent opioid-related deaths data used for this report by province or territory.

		BCTable 4 Footnote 1	AB	SK	MB	ONTable 4 Footnote 2	QCTable 4 Footnote 3	NB	NS	PE	NLTable 4 Footnote 4	YT	NT	NUTable 4 Footnote 5
Reporting period (as of September 12, 2018)
2016	January to December			(C)			(C)			(C)	(C)	(C)
2017	January to December			(C)			INC			(C)	(C)	(C)
2018	January to March			(C)	N/A					(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 deathTable 4 Footnote 6										N/A				N/A
These data have been reported by the province or territory and are reflected in this report, unless otherwise specified (C) Data includes deaths with completed investigations only INC Data were not reported for the full time period - The classification is not used in the province or territory N/A Data were not available at the time of this publication Table 4 Footnote 1 British Columbia reports deaths related to all illicit drugs (including opioids) used alone or in combination with prescribed/diverted medication. Table 4 Return to footnote 1 referrer Table 4 Footnote 2 As of May 1, 2017, apparent opioid-related death data in Ontario were captured using an enhanced data collection tool by the Office of the Chief Coroner. Table 4 Return to footnote 2 referrer Table 4 Footnote 3 Data from Quebec for 2016 were available for deaths with completed investigations only; 12% of deaths for 2016 were under investigation. Following the launch of Québec’s opioid surveillance system, data on apparent opioid-related deaths with ongoing investigations, where manner of death was believed to be unintentional, were reported from July to December 2017; data from January to June 2017 were not available at the time of this publication. The available 2017 and 2018 data include deaths related to all illicit drugs including, but not limited to, opioids. Preliminary data for deaths related to all illicit drugs, for which toxicology information was available, indicate that 59% of deaths between July 2017 and March 2018 involved an opioid. Updates to previously reported data will be provided in future reports. Table 4 Return to footnote 3 referrer Table 4 Footnote 4 Available 2018 data from Newfoundland and Labrador included accidental deaths with completed investigations only. Table 4 Return to footnote 4 referrer Table 4 Footnote 5 Data from Nunavut were not included in national counts, rates, or percentages. Table 4 Return to footnote 5 referrer Table 4 Footnote 6 For this manner of death category, provinces and territories report only completed investigations with the exception of British Columbia which also includes data from ongoing investigations. Table 4 Return to footnote 6 referrer

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 between one and four for quarterly data, and for any data related to sex or age distribution.
• Newfoundland and Labrador suppressed counts between one and four for quarterly data, and data related to substances involved and sex or age distribution.
• Quebec suppressed counts less than five for deaths with ongoing investigations (July to December 2017, 2018).
• 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
• cyclopropyl fentanyl
• despropionyl-fentanyl
• fentanyl
• furanylfentanyl
• methoxyacetylfentanyl
• 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
• gabapentin
• 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 September 12, 2018. New or revised data reported 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.