PhD Candidate Leslie Dan Faculty of Pharmacy, University of Toronto, Canada
Background: The overdose crisis has continued to accelerate across Canada, with rapid increases in the rate of opioid-related harms observed nationally following the declaration of the COVID-19 pandemic. Currently, there is a critical need to better understand the burden of opioid toxicity deaths in Canada over recent years and during the COVID-19 pandemic.
Objectives: To examine trends in the burden of opioid-related mortality in Canada, overall and by age, sex, and province/territory.
Methods: We conducted a repeated cross-sectional analysis of all opioid toxicity deaths that occurred between January 1, 2019, and December 31, 2021, across nine Canadian provinces/territories. We used publicly available, aggregate data from the Public Health Agency of Canada and Statistics Canada, including the annual counts of all opioid fatalities for which age and sex information were available. Our primary measure was the toll of opioid-related deaths, which we quantified by calculating the years of life lost (YLL) overall and by province/territory using methods adapted from the Global Burden of Disease Study. We assessed the YLL separately across age and sex by multiplying the number of opioid toxicity deaths by the standard life expectancy, adjusting for average age at death within each age group. We used national and provincial/territorial population estimates to calculate YLL per 1,000. Our secondary measure was the proportion of all-cause deaths in each age group related to opioid toxicities. We used the Cochrane-Armitage trend test to look for significant changes in each age group over time.
Results: Over the study period, the number of opioid toxicity deaths identified across Canada grew more than two-fold (2,991 to 6,005). Overall, the YLL due to opioid-related death nearly doubled over the three-year study period, from 124,012 to 247,777 between 2019 and 2021 (3.4 to 6.6 YLL per 1,000). The highest burden of deaths was observed among males (175,680 YLL), and young adults in 2021. We observed similar trends across age and sex for all years in both the overall and stratified analyses. Across the provinces/territories, the YLL ranged substantially from 1.4 (Nova Scotia) to 15.6 (Alberta) per 1,000 at the end of the study period. Significant increases were also observed in the proportion of all-cause deaths attributable to opioid toxicities in all age groups (p <.001), most notably among those aged 20-29 and 30-39.
Conclusions: Across Canada the burden of premature opioid-related death has continued to grow over the past three years and throughout the COVID-19 pandemic. The disproportionate rates observed among males and younger adults highlights the critical need for the development of policies and programs targeted to these demographics.
