www.ccsa.ca • www.ccdus.

ca November 2022 Canadian Drug Summary

Opioids
Key Points
• Opioid-related deaths continue to climb across the country. There were at least 30,843 opioid toxicity
deaths in Canada between January 2016 and March 2022, with the highest number of deaths
occurring in the first third of 2021 (n = 5,368). A large concentration (>88%) occurred in British
Columbia, Ontario and Alberta.
• Most opioid-related deaths involve opioids that were nonpharmaceutical in origin and often involve
other substances (e.g., nonmedical benzodiazepines or stimulants).
• The rate of deaths due to apparent opioid toxicity increased by 91% during the first two years of the
COVID-19 pandemic (from April 2020 to March 2022; n = 15,134 deaths).
• The unpredictability and toxicity of the illegal drug supply have increased since the start of COVID-19,
and new synthetic opioids have recently been detected (e.g., nitazenes), which have the potential to
increase opioid-related harms among people who use drugs.
• The rate of hospitalizations and emergency department visits due to opioid poisoning has increased
since the start of COVID-19, with an average of 15 hospitalizations occurring per day in Canada so far
in 2022, up from 12 and 14 in 2019 and 2017, respectively.
• In 2019, opioid pain relievers prescribed or not prescribed for medical or nonmedical purposes were
used by an estimated 14.2% of people living in Canada, an increase from 12% in 2017.
• Among people living in Canada who used opioid pain relievers in 2019, about 6% reported using
them for nonmedical purposes, an increase from 3% in 2017.

Introduction
Opioids are a large class of drugs that bind to opioid receptors. They include natural, synthetic and
semisynthetic substances that exist in both legal and illegal forms. These include heroin, synthetic
opioids (such as fentanyl) and pain relievers primarily used for medical purposes (such as
oxycodone, hydrocodone, codeine and morphine). Opioid medications are used to treat acute pain*
and sometimes chronic pain, † but can also be used to control persistent cough or diarrhea.
Additionally, some opioids are prescribed for the treatment of opioid use disorder, ‡ using methadone
or buprenorphine-naloxone, under the supervision of a trained healthcare practitioner.

* Pain that is experienced in response to change or changes in the body that may serve as a warning of current or future damage and

typically resolves as healing occurs.

† When pain persists for more than 3 months.
‡ Opioid use disorder is defined as a “problematic pattern of opioid use leading to clinically significant impairment or distress, occurring

within a 12-month period.”1

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 1
 Canadian Drug Summary: Opioids

Opioids have the potential for problematic use because they can produce a feeling of well-being or
euphoria — a high. Most of the harms being experienced are due to fentanyl and other synthetic
opioids that are manufactured illegally and are available on the unregulated market. The presence of
fentanyl in other substances on the unregulated market dramatically increases the risk of overdose
as it is an extremely potent drug that can cause death even in small amounts. Understanding the
health and social impacts of opioid use is critical for reducing risks and harms as well as for
controlling access for therapeutic applications.

Medical Use of Prescription Opioids in Canada

Prescription opioids are commonly referred to as pain killers or narcotics and have a variety of generic,
trade and street names. Table 1 lists examples of prescription opioids marketed in Canada. However,
prescription opioids that are not marketed in Canada may be diverted into the country. Prescription
opioids are available in various forms in Canada, including tablets, capsules, syrups, solutions, liquid
for injection, skin patches, transmucosal preparations, suppositories and nasal sprays.
When opioids are carefully prescribed and taken as intended, they can relieve pain and improve the
quality of life of those living with chronic pain. However, in some cases, the use of prescription
opioids can result in an opioid use disorder and death due to opioid poisoning. In decades past,
prescription opioids were falsely promoted as low-risk, nonaddictive and effective treatments for
moderate pain.2 The 2017 Canadian Guideline for Opioid Therapy and Chronic Non-Cancer Pain
reports that opioids were associated with a 5.5% risk of addiction and recommended optimizing
nonopioid pharmacotherapy (e.g., nonsteroidal anti-inflammatory drugs) and nonpharmacological
therapy over the use of opioids for patients with chronic noncancer pain.3 That said, many of these
evidence-based treatment avenues (e.g. physical and psychological therapies) are not accessible to
those with low income or without private insurance, and they are not sufficiently covered under
insurance plans, leaving those with pain with limited pain relief options.4
In this summary, “prescription opioid use” refers to the use of opioids as prescribed. “Nonmedical
prescription opioid use” includes using a prescription opioid:
• Without a prescription written for the individual taking the drug,
• Provided by multiple doctors, nurses or pharmacists (“double doctoring” §),
• For purposes other than those indicated when prescribed (e.g., for euphoric effect),
• In ways other than prescribed, or
• More or less often than prescribed.

§ Obtaining a prescription from more than one practitioner without telling the prescribing practitioner about other prescriptions received in

the past 30 days.

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 2
 Canadian Drug Summary: Opioids

Table 1. Common generic, trade and street names for prescription opioids
Generic name Examples of trade names Street names
Buprenorphine BuTrans® bupe, bute
Buprenorphine-naloxone Suboxone® subby, bupe, sobos
Codeine Tylenol®2, 3 and 4 (codeine plus cody, captain cody, T1, T2, T3, T4
acetaminophen)
Fentanyl Abstral®, Duragesic®, Onsolis® patch, sticky, sticker, nerps, beans
Hydrocodone Tussionex®, Vicoprofen® hydro, vike
Hydromorphone Dilaudid® juice, dillies, dust
Meperidine Demerol® demmies
Methadone Methadose®, Metadol® meth, drink, done
Morphine Doloral®, Statex®, M.O.S.® M, morph, red rockets
Oxycodone OxyNEO®, Percocet®, Oxycocet® oxy, hillbilly heroin, percs
Percodan®
Pentazocine Talwin® Ts
Tapentadol Nucynta® —
Tramadol Ultram® Tramacet® Tridural® Durela® chill pills, ultras
Note: OxyContin® is no longer marketed in Canada and was replaced with OxyNEO®. Generic controlled-release oxycodone was
approved by Health Canada. Oxymorphone (Opana®) has been approved by Health Canada but is not marketed in Canada.
—There is no known street name.

Effects of Opioids
Short-Term Effects
Opioids activate opioid receptors in the body’s nervous system, which leads to pain relief and
feelings of well-being, relaxation or euphoria (i.e., high). In addition to pain relief, at sufficiently high
doses, opioids can also cause drowsiness, respiratory depression, coma and, in some cases, death.
Other physical effects include constricted pupils, nausea, vomiting, constipation, loss of appetite and
sweating. Prescription opioids can reduce pain and improve function and quality of life. Prescription
opioids come in both short- and long-acting forms. Short-acting forms of prescription opioids typically
last for three to six hours, while long-acting forms need to be taken every 12 to 24 hours.to maintain
their effects.
Long-Term Effects
Long-term use can lead to the development of physical dependence, which manifests as tolerance to
the effects of the drug and prompts people to increase the dose to reinstate the desired effects. The
severity of symptoms depends on the type of medication used, the amount used, the duration of use
and how abruptly the drug was discontinued. An increased risk of adverse events has also been
reported following the medium- and long-term use of opioids for chronic noncancer pain.5
Those who have developed a physical dependence can also experience withdrawal symptoms and
worsening pain when the dose is lowered. Withdrawal symptoms can include agitation, insomnia,
muscle aches, abdominal cramping, diarrhea and vomiting. Those who are physically dependent
might also experience cravings for the drug and difficulty stopping use, particularly if their pain
persists or worsens.
The potential for the development of an opioid use disorder increases with repeated use of higher
doses. Opioid use disorder includes behaviours reflecting loss of control over use and significant
harms from use in addition to physical dependence, for example.1
Opioids can also increase the risk of sleep apnea, mood changes and decreased sex hormone levels,
which can result in decreased interest in sex and menstrual irregularities. Regular use of large
quantities of opioids during pregnancy increases the risk of premature delivery and withdrawal in the
Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 3
 Canadian Drug Summary: Opioids

infant. If oral opioids are crushed and injected, certain filler chemicals in the pills can permanently
damage veins and organs. Sharing needles or injecting with previously used needles greatly
increases the risk of getting certain infections (e.g., HIV, hepatitis C).

Legal Status of Opioids in Canada

Most prescription opioids are classified as Schedule I drugs under the Controlled Drugs and
Substances Act. Their use is legal when they are prescribed by licensed practitioners and used by the
person for whom they are prescribed. Illegal nonpharmaceutical opioids (e.g., heroin), including other
synthetic opioids that were never approved for human use (e.g., nitazenes, carfentanil) are also
classified as Schedule I drugs. Illegal possession of opioids and double doctoring can result in seven
years imprisonment. Trafficking, importing, exporting or producing opioids, including synthetic
opioids (e.g., fentanyl), can result in life imprisonment.6
An amendment to the Controlled Drugs and Substances Act was passed in 2017, also known as the
Good Samaritan Drug Overdose Act (Bill C-224).7 The amendment exempts an individual from
charges for simple possession (and some other charges) of a controlled substance if they call 911
for a suspected drug poisoning, either for themselves or another person. The bill was passed to
encourage the involvement of emergency medical services to save peoples’ lives in the event of an
overdose, without fear of criminal charges being laid.
More recently, in May 2022, the Government of British Columbia was granted an exemption by
Health Canada to decriminalize the possession of small amounts of some illegal substances among
those 18 years and older, including opioids, cocaine, methamphetamine and MDMA.8 Under this
legislative change, which takes effect in January 2023, individuals will no longer be arrested,
charged or have their drugs seized for possession of amounts of up to 2.5 grams, if it is for personal
use. Trafficking and related offences remain illegal.8

Opioid Pain Relievers

Self-Reported Use in the Past Year
• General population (age 15 years and older): According to the 2019 Canadian Alcohol and Drugs
Survey (CADS),9 the prevalence of past-year use of opioid pain relievers among the general
population was 14.2%, a significant increase from 12% in 2017 (see Figure 1).10
• Youth and young adults (age 15–24 years): In 2019 among youth aged 15–19 years, the
prevalence of past-year opioid pain reliever use was 9.8%. The rate was higher for young adults
aged 20–24 years at 12.1% (Figure 1). The 2019 estimates for both age groups do not represent
a significant change from the 2017 estimates.9,10
• Postsecondary students (age 17–25 years): Data from the first Canadian Postsecondary Alcohol
and Drug Use Survey (2019–2020) shows that 24.3% of those surveyed reported the use of pain
relievers in the previous 12 months.11 Those in their first and second year of study had a
significantly higher prevalence (25.6%) than those in their third or higher year (22.5%).11
• Adults (age 25 years and older): The prevalence of opioid pain reliever use among adults living in
Canada was 14.7% in 2019, a significant increase from 12.1% in 2017.9,10 The use of opioid
pain reliever medications among adults did not change significantly from 13.6% in 2015
(Figure 1).10,12
• Sex: Data from the 2019 CADS indicate that the past-year prevalence of opioid pain reliever use
was higher among females (16%) than males (12%).9 While the prevalence of use by males was
relatively stable between 2017 and 2019, use by females increased from 11.2% to 12% during
the same period (Figure 2).9,10

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 4
 Canadian Drug Summary: Opioids

Figure 1. Prevalence of self-reported opioid pain reliever use among people living in Canada by age

18
16
*
14 *
12
Percentage

10
8
6
4
2
0
2013 2015 2017 2019
General population (15 years and older)
Youth (15-19 years)
Young adults (20-24 years)
Adults (25 years and older)

Sources: Canadian Tobacco, Alcohol and Drugs Survey (CTADS) 2013,13 CTADS 2015,12 CTADS 2017,10 Canadian Alcohol and
Drugs Survey 2019,9 * = p < .05; significant change from previous year.

Figure 2. Prevalence of self-reported opioid pain reliever use among people living in Canada by sex

18
16 *
14
12
Percentage

10
8
6
4
2
0
2013 2015 2017 2019

Males Females
Source: Canadian Tobacco, Alcohol and Drugs Survey (CTADS) 2013,13CTADS 2015,12 CTADS 2017,10 Canadian Alcohol and
Drugs Survey 2019,9 * = p < .05; significant change from previous year.

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 5
 Canadian Drug Summary: Opioids

Prescribing Trends
A 2017 report found that in the fiscal year 2015–2016, about 1 in 7 people in Ontario (almost
2 million individuals) filled an opioid prescription.14 Data from 2018 prescriptions being filled at
community pharmacies in Ontario, Manitoba, Saskatchewan and British Columbia showed that
almost 1 in 8 people were prescribed opioids.15 A recent analysis revealed that, across Canada,
opioid dispensing peaked between 2011 and 2016, followed by significant declines, with substantial
interprovincial differences.16,17 These changes were largely attributable to changes in regulations and
clinical guidelines about the use of prescription opioids for chronic pain. As a result of such policy
and associated decreases in prescribing, many individuals living with chronic pain have suffered
unintended consequences.4,18
Recent data provided by IQVIA19 show that the proportion of people living in Canada who have received
at least one prescription in a community pharmacy decreased by 1.6% between 2015 and 2020, with
all provinces showing a decreasing trend. British Columbia continued to have the highest prevalence of
opioid prescriptions at 13.3% in 2020, whereas Quebec continued to have the lowest prevalence at
10.0%.19 In contrast, the number of opioid prescriptions dispensed increased by 15.4% during the
same period. This increase was driven mainly by increased prescribing of opioids to treat opioid use
disorder, which includes opioid agonist treatments, such as methadone and buprenorphine-naloxone,
and suggests increased access to the standard of care for opioid use disorder in Canada.19 The
number of people given such opioids for the treatment of opioid use disorder increased by 44%
between 2015 and 2020 in Canada, with the largest increase occurring in Manitoba and
Saskatchewan (287% combined) and the smallest increase occurring in Ontario (14%).19
Injectable hydromorphone and prescription diacetylmorphine (pharmaceutical-grade heroin) have
also been evaluated for the treatment of opioid use disorder in some populations, such as patients
who have not had success with methadone treatment, and have shown some promise.20 Regardless
of treatment approach, evidence-based harm reduction approaches should be offered to all
individuals with an opioid use disorder and integrated throughout the continuum of care.21,22 As
defined by the Canadian Research Initiative in Substance Misuse guidelines, harm reduction
includes education about the safer use of sterile syringes and needles; access to sterile syringes,
needles and other supplies; take-home naloxone kits; and supervised consumption services.21
Naloxone, a fast-acting nasal spray (Narcan®), can be used to temporarily reverse known or
suspected opioid overdoses and was approved by Health Canada for use in 2016. National data on
the availability and frequency with which naloxone is used are not available.

Nonmedical Use of Prescription Opioids

Self-Reported Use in the Past Year
• General population (aged 15 years and older) ‖: Data from the 2019 CADS revealed that 1% of
people living in Canada used opioid pain relievers for nonmedical purposes in the past year, with
no differences between males (1%) and females (1%).9 Among those who used opioid pain
relievers in the past year, 6% (or about 269,000 people living in Canada) reported using them for
nonmedical purposes, a significant increase from 3% (or about 100,000 people) in 2017.9,10
• Students (grades 7 to 9¶ and 10 to 12#): The 2018–2019 Canadian Student Tobacco, Alcohol
and Drug Survey (CSTADS) found that 1.8% of students in grades 7 to 9 in Canada (up from 1.2%
in 2016–2017) and 4.7% of students in grades 10 to 12 (unchanged from 2016–2017)
reported past-year use of pain relievers to get high, and not for medical purposes (Figure 3).23,24
A greater proportion of males (4.0%) than females (2.5%) in grades 7 to 12 reported past-year

‖ Data on nonmedical opioid use was not reportable for those aged 15 to 19 years in the overall population due to the small sample size.
¶ Secondary I-III in Quebec.
# Secondary IV-V in Quebec.

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 6
 Canadian Drug Summary: Opioids

use of pain relievers to get high.23 The proportion of males reporting nonmedical use of pain
relievers has remained stable since 2017 (3.5%), as has the proportion of females reporting
such use (2.4%), as shown in Figure 3.23,24
• Postsecondary students (age 17 to 25 years): Data from the 2019-2020 Canadian
Postsecondary Alcohol and Drug Use Survey shows that 22.5% of students surveyed reported
using pain relievers nonmedically.11 No significant differences were found between males
(20.4%) and females (24.1%), nor between those in their first or second year (23.3%) compared
with those in their third year or higher (20.9%).11
Figure 3. Prevalence of self-reported past year opioid pain reliever use among students in Canada by grade and sex

5
4.5
4
3.5
Percentage

3
2.5
2
1.5
1
0.5
0
Total Grades 7-9 Grades 10-12 Male Female

2014-2015 2016-2017 2018-2019

Source: CSTADS 2014-2015,26 CSTADS 2016-2017,21 CSTADS 2018- 201920

Past-Year Nonmedical Use Internationally

• United States: In 2020**, the past-year prevalence of nonmedical use of prescription pain
relievers was 3.3% among those aged 12 years and older, with the highest prevalence (4.1%)
reported among those aged 18 to 25 years.25
• Australia: Data from 2019 show that 2.7% of those aged 14 years and older reported
nonmedical use of any type of opioid in the previous 12 months, a decrease from 3.6% observed
in 2016.26 This decrease appeared to be driven by a decline in the use of codeine for
nonmedical purposes, which was down from 3.0% in 2016 to 1.5% in 2019. This decline aligned
with codeine becoming available only by prescription in 2018. ††26

Wastewater-based Estimates for Opioids

Measuring opioid levels in wastewater samples is challenging as many degrade quickly, and different
opioids transform into the same end product (e.g., morphine), making it difficult to identify which
opioid the measured morphine was derived from. Despite these challenges, a study by Statistics

** The National Survey on Drug Use and Heath (NSDUH) Report (2021), from which these statistics are taken, cautions against comparing

estimates from the 2020 findings to previous survey cycles due to methodological changes implemented in 2020. Therefore, no
comparison of the estimate to previous years was made.
†† In February 2018, medications containing codeine were reclassified to schedule 4 drugs, meaning they could no longer be purchased

from a pharmacy without a prescription.26

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 7
 Canadian Drug Summary: Opioids

Canada collected wastewater in five major Canadian cities from March to December 2019 and
March to December 2020 (Figure 4).27 Per-capita loads of morphine in Montreal and Toronto were
the lowest (with average levels of 34 and 44 grams per million people per day, respectively, in
2020). Vancouver and Edmonton were the highest (at 188 and 118 g per million people per day,
respectively, in 2020).27
Figure 4. Wastewater-based estimates of morphine use in Canada (2019 and 2020)

Combined 5 cities
Vancouver
Edmonton
Toronto
Montreal
Halifax

0 50 100 150 200

Load per capita (grams per million people per day)

March to December 2020 March to December 2019

Source: Statistics Canada, 202127

Per-capita loads of fentanyl in Montreal and Halifax wastewater were estimated to be zero in 2019
and 2020.27 Vancouver had the highest estimates of fentanyl from March to December of 2019 at
15 g per million people per day and increased by 34.8% (to 23 g per million people per day) from
March to December 2020. Toronto observed the highest increase from 2019 to 2020, with an 80%
increase in estimates followed by Edmonton, which saw a 60% increase in the same period (see
Figure 5).27
Figure 5. Wastewater-based estimates of fentanyl use in Canada (2019 and 2020)

Combined 5 cities
Vancouver
Edmonton
Toronto
Montreal
Halifax

0 5 10 15 20 25
Load per capita (grams per 1 million people per day)

March to December 2020 March to December 2019

Source: Statistics Canada, 202127

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 8
 Canadian Drug Summary: Opioids

Prevalence Among Individuals Accessing Treatment and

Harm Reduction Services
While all federal, provincial and territorial agencies collect data on their treatment systems, there are
no national-level data available for prescription drug-related treatment in Canada. According to the
2018 National Treatment Indicators report, ‡‡ opioids were the second-most reported substance for
which treatment was sought in Nova Scotia.28 The Atlantic provinces have a higher proportion of people
reporting opioids as problem substances than in other jurisdictions.28 Across Canada, the number of
individuals reporting opioids as a problem substance remained relatively constant between 2016
and 2018.28 This report underestimates the number of individuals accessing specialized, publicly
funded treatment for opioids as estimates largely exclude opioid agonist treatment.
The Community Urinalysis and Self-Report Project (CUSP)29 was developed to provide standardized
information about the use of drugs from the unregulated supply. CUSP surveys people accessing
harm reduction services about their recent drug use (reported) and compares that data with urine
toxicology results (detected) in seven jurisdictions across Canada §§. Standardized data from spring
2019 to spring 2021 at 49 harm reduction sites showed that half of the participants reported using
at least one opioid and at least one stimulant in the previous three days, suggesting that the use of
both types of substances close in time is common.29 The extent to which individuals were using
opioids (e.g., fentanyl) expectedly (that is, reported and detected) or unexpectedly (that is, not
reported but detected) varied across Canada. The use of opioids was more expected in western
regions and unexpected use was more commonly seen in eastern regions.29

Opioids in the Unregulated Drug Supply

Many of the national surveys that provide estimates on the prevalence of opioid use gather data
mainly on prescription and over-the-counter medications containing opioids and differentiate
between their use for medical or nonmedical purposes. While valuable, these data are generally
unable to generate prevalence estimates on the use of other opioids obtained from the unregulated
market. In recent years, the Public Health Agency of Canada has begun to differentiate between
opioids with pharmaceutical and nonpharmaceutical origin in all apparent opioid-related apparent
deaths in Canada, though details on where the substances were obtained are not always available.
Such data are sometimes available in periodically released jurisdictional reports or regular updates
from health authorities or public health units in which rates of drug toxicity deaths are high (e.g.,
British Columbia, Ontario and Alberta). Most opioid-related harms, including deaths, do not involve
individuals who are taking a prescription opioid as prescribed for pain or other medical reasons.
Where available, these data are described in the section on harms below.
The risks associated with substance use are significantly increased for drugs obtained from the
illegal market as there are no quality control measures and no information is provided about their
contents. This unpredictability places people who use drugs at increased risk of poisoning (overdose)
and death. Since the onset of the COVID-19 pandemic, substances from the unregulated supply have
become even more unpredictable in terms of contents, strength and quality.31,30 For example,
psychoactive substances that people are unaccustomed to using or that have never been approved
for human use are being detected at drug checking sites or in seizure data. Some of these include:

‡‡ The latest National Treatment Indicators report provides 2016-2018 fiscal years’ data on public, specialized substance use treatment

from Newfoundland and Labrador, Prince Edward Island, Nova Scotia, Ontario, Manitoba, Saskatchewan, Alberta and Northwest
Territories.
§§ Jurisdictions
included British Columbia (multiple sites), Edmonton (Alberta), Manitoba (multiple sites), Thunder Bay (Ontario), Montreal
and Laval (Quebec), and Halifax (Nova Scotia).

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 9
 Canadian Drug Summary: Opioids

• Nitazenes are synthetic opioids that can be several times more potent than fentanyl. Nitazenes
can appear unexpectedly in drugs expected to contain other, more common opioids
(e.g., fentanyl or “down”) and can increase the risk of accidental poisoning deaths.30
• Nonmedical benzodiazepines are sedatives that can have a calming effect or act as a sleep aid
but have never been approved as medicines in the pharmaceutical industry because of safety
concerns. Nonmedical benzodiazepines have been found more frequently in the unregulated
supply of opioids and are a concern as they may complicate the overdose response efficacy
because benzodiazepines do not respond to naloxone.31
• Xylazine is a tranquilizer used in veterinary medicine that has analgesic and muscle relaxant
effects. It has recently emerged as a common cutting agent‖‖ and is sometimes added to opioids,
particularly fentanyl, which can exacerbate lowered blood pressure, heart rate and breathing,
increasing the risk of an accidental drug poisoning death.32
Seizures in Canada
Drug seizure data provide a supply-related indicator of the availability of drugs in the illegal market.
National: The United Nations Office on Drugs and Crime reported that in 2019, about 98 kilograms
of heroin, 571 kg of opium and 295 kg of pharmaceutical opioids were seized in Canada. That was
an increase of about 12% for heroin, 49.6% for opium and 75.6% for pharmaceutical opioids from
2018.33
Drug Analysis Service: The service analyses suspected illegal drugs seized by Canadian law
enforcement agencies. The drugs analyzed do not represent all of the substances seized and should
not be used to estimate the number or types of drugs available on the market. A single sample can
contain more than one substance. Results indicate that the number of samples containing opioids
increased by 15% from 2020 to 2021 (from 20,549 samples to 24,173).34 The proportion of
samples containing fentanyl during the same period increased by three percentage points from 69%
in 2020 to 72% in 2021.34 Fentanyl is the most detected opioid across samples. Nitazenes and
brorphine were first seized and analyzed in Canada in 2019. Since then, several substances
belonging to this group have been analyzed.35 Several opioids continue to emerge, and the group
may become an important part of the illegal market in the coming years.36 Further, on a national
level, the number of heroin samples analyzed over the last decade has steadily decreased. The
number of heroin samples that contain fentanyl has also steadily declined since 2020 when 62% of
heroin samples also contained fentanyl.34 From January to March 2022, 25% of heroin-containing
samples also contained fentanyl. From April to June 2022, 20% of heroin samples contained
fentanyl.34
Provincial and territorial differences: The detection of opioids in seized samples was not consistent
across the country. Results from the Drug Analysis Service indicated that more opioid samples were
identified in 2021¶¶ from Ontario (12,305 samples), British Columbia (6,007 samples) and Alberta
(3,512 samples), whereas fewer samples were found in the territories (20 samples).34 Further, the
percentage of opioid samples containing fentanyl or fentanyl analogues was highest in the territories
(95%), followed by British Columbia (85%) and Alberta (84%). The percentage generally declined
moving from west to east.34 Fentanyl was the most-commonly detected opioid in many regions;
however, hydromorphone was the most-commonly detected opioid in Quebec, New Brunswick, Nova
Scotia and Prince Edward Island, and oxycodone was most-commonly detected in Newfoundland and
Labrador.34

‖‖ The term cutting agent refers to adulterants or cooccurring substances that are not psychoactive and unlikely to contribute to substance-

related poisoning deaths, although some can be associated with other health risks.
¶¶ While DAS data for January to June 2022 exist, we report on the most recent full year of data available, which is 2021.

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 10
 Canadian Drug Summary: Opioids

Harms Associated with Use

Hospitalization and Emergency Department Visits
There are numerous harms from opioids## that can result in hospitalization, including opioid poisoning,
opioid use disorder and neonatal withdrawal.37 Between January 2016 and March 2022, there were
32,319 opioid-related poisoning hospitalizations in Canada (not including Quebec).38 In the first two
years of the COVID-19 pandemic, there was a 24% increase in hospitalizations compared with the
previous two years (11,760 from April 2020 to March 2022, compared with 9,470 from April 2018 to
March 2020).38 Between January and March 2022, 1,350 opioid-related poisoning hospitalizations
occurred, about 15 hospitalizations per day. That was up from about 12 per day in 2019 and 14 per
day in 2017.38
Across Canada, the age-adjusted rate of hospitalizations *** in 2021 ranged from 3.3 (Nova Scotia) to
26.0 (British Columbia) per 100,000.38 In 2021, most hospitalizations for opioid poisoning occurred
in British Columbia, Alberta and Ontario (88%), and among individuals aged 20 to 49 years of age
(58%).38
In the first three months of 2022, 68% of those being hospitalized for opioid-related poisoning were
male and 32% were female.38 Hospitalizations were highest among those aged 20 to 49 years (54%)
between January and March 2022.38
In 2021, the Canadian Institute for Health Information (CIHI) released a report examining the impact
on harms caused by substance use††† during the early stages of the pandemic (March to September
2020). The report found that both hospitalizations and emergency department (ED) visits involving
opioids increased, compared with the same period in 2019.39 Hospitalizations involving opioid harms
during those seven months rose by 7%, whereas ED visits rose by 8%.39 CIHI’s follow-up report
revealed that from October 2020 to June 2021 (nine months), ED visits for opioid-related harms rose
by 36% and hospitalizations by 30%.40 Further, men experienced a greater increase in harms due to
opioids, experiencing 33% more hospitalizations compared with 5% more among women.40
Between 2010 and 2020, 16,920 hospitalizations related to neonatal withdrawal occurred, an
increase of 73% from 2010 to 2020 and a 5% increase from 2019 to 2020.41
Mortality
There are no national-level data on opioid-related deaths before 2016. Between January 2016 and
March 2022, 30,843 apparent opioid-related deaths occurred in Canada. 38 There was a 91%
increase in apparent opioid toxicity deaths in the first two years of the pandemic compared with the
two years prior. As in 2021, in the first three months of 2022 there have been about 21 deaths per
day, compared with 8 and 11 deaths per day in 2016 and 2018, respectively.38
Most deaths were accidental (94%) and involved opioids that were nonpharmaceutical in origin
(81%). ‡‡‡,38 Eighty-five per cent of deaths in January to March 2022 involved fentanyl. 38 From
January to March 2022, just less than half of the apparent opioid-related deaths also involved a
stimulant (e.g., cocaine [61%], methamphetamines [52%]).38 In addition, about two-thirds of deaths
caused by opioids involved at least one other substance in 2017, compared with only half in 2014.42

## Opioid-related harms can be caused by prescription or illicit opioids, or a combination of both.

***The age-adjusted rate accounts for variation in age distribution in the different regions. The age-adjusted rate was calculated using the
direct standardization process, with the 2016 population representing the standard population.38
††† Harms examined in this report, as they relate to opioids, included substance use disorders and poisonings.
‡‡‡ Opioids with a pharmaceutical origin refer to opioids that were manufactured by a pharmaceutical company and approved for medical
purposes in humans. Pharmaceutical origin does not indicate how the opioids were obtained (e.g., through personal prescription or by
other means).26 This estimate was based on data from 2021 on the origin of opioids from deaths with completed investigations and
reflects data from eight provinces.

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 11
 Canadian Drug Summary: Opioids

Seventy-six per cent of accidental deaths between January and March 2022 occurred among males.
The highest proportion of deaths for both males and females were among those aged 20 to 59
years.38 Estimated province-specific crude rates of opioid or illicit drug-related deaths ranged from
6.6 (Northwest Territories) to 53.5 per 100,000 (Yukon) in 2021. §§§,38 Continuing the trend from
2021, during the first three months of 2022, 90% of all accidental apparent opioid toxicity deaths
occurred in British Columbia, Alberta and Ontario, and increasing rates were observed in both Yukon
and Saskatchewan.38
• Ontario: An average of 34 deaths per week occurred in the 15 weeks before the pandemic, most
of which continued to be accidental. During the first 15 weeks of the pandemic, this number
increased by 38% to an average of 46 deaths per week.43 Between March and December 2020,
there were 1,808 opioid-related deaths in Ontario. An increasing proportion of these deaths
involved only nonpharmaceutical opioids from the unregulated drug supply (from 65%
prepandemic to 79% during the pandemic), of which 99% involved fentanyl or its analogues.44
• Alberta: In 2019, 626 opioid-related deaths occurred, climbing to 1,180 in 2020, 1,623 in 2021
and 562 in the first four months of 2022.45 In 2021, an average of four individuals died each day
in Alberta due to an accidental opioid poisoning.45
• British Columbia: Deaths related to drug toxicity in British Columbia includes all unintentional
illicit drug toxicity deaths, including confirmed and suspected drug toxicity deaths. ‖‖‖ The most
recent estimate for 2021 shows that the number of illicit drug toxicity deaths averages about 6
deaths per day (2,236), compared with 2.7 deaths per day (981) in 2019.46,47 As has been the
case since the declaration of the overdose crisis in 2016, males have accounted for most deaths
in 2022 (76%). Similar to recent years, 72% of the deaths in 2022 (January to April) were among
those aged 30 to 59 years.47 Fentanyl and its analogues were detected in 85% of illicit drug
toxicity deaths between August 2017 and July 2021. With the emergence of COVID-19
restrictions, an increase in the concentration of fentanyl was also observed, with 13% of deaths
having extreme fentanyl concentrations (> 50 ug/l) in March 2020, compared with 8% in January
2019.
• Nova Scotia: In 2021, there were 229 opioid-related deaths, compared with 298 in 2020 and
334 in 2019.48 From January to May 2022, there were 34 opioid-related deaths.48 The rate of
opioid-related deaths involving pharmaceutical opioids has decreased steadily between 2019
and 2021, from 68.9 per 100,000 to 36 per 100,000, respectively.48 For nonpharmaceutical
opioid-related deaths, the rate was 4.6 per 100,000 in 2019, 11.5 per 100,000 in 2020 and 9.9
per 100,000 in 2021.48 To date, there are no estimates about pharmaceutical and
nonpharmaceutical opioid-related deaths in 2022.
Impaired Driving
There is evidence that opioid use can increase the risk of driving impairment when used in combination
with other drugs or alcohol, when used nonmedically or when used therapeutically by individuals who
are unaccustomed to using opioids.49,50 Opioids are one of the most common classes of prescription
drugs found among drivers during roadside impaired driving surveys, along with
benzodiazepines.49,51 Recent findings from the National Drug Driving Study (which collected data
from 2018 to 2021 from 4,976 injured drivers treated in one of 15 trauma centres across Canada)
show that opiates were detected in 1 in 9 injured drivers (11.1%), and were detected more
frequently in males than in females.52

§§§ An opioid-related death is a death caused by poisoning because of drug use, where at least one of the drugs is an opioid. A fentanyl-

related death is a death caused by poisoning because of drug use, where one of the drugs is fentanyl.31
‖‖‖ These may include deaths due to street drugs (controlled and illegal), medications not prescribed to the deceased but obtained on the

street with unknown origin, or combinations of the above with prescribed medications.

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 12
 Canadian Drug Summary: Opioids

Costs Associated with Use

Healthcare costs include inpatient hospitalizations, day surgeries, ED visits, substance use
treatment, visits to family physicians and the use of prescription drugs. Between 2015 and 2017,
the per-person overall healthcare costs associated with opioids¶¶¶ increased by 20.9%, the second
largest increase after central nervous system stimulants (excluding cocaine), which increased by
22.1%.65 In 2017, opioids were responsible for the third largest proportion of costs attributable to
substance use across Canada. ### In the same year, $438.6 million in healthcare costs were
attributable to opioids, representing about 3.4% of all healthcare costs associated with
substances.65

Additional Resources
• CCENDU Drug Alert: Nitazenes
• CCENDU Alert: Changes Related to COVID-19 in the Illegal Drug Supply and Access to Services,
and Resulting Health Harms
• Community Urinalysis and Self-Report Project: Cross-Canada Report on the Use of Drugs from the
Unregulated Supply, 2019–2021 Data
• Impacts of the COVID-19 Pandemic on People Who Use Substances: What We Heard
• Polysubstance Use and Poisoning Deaths in Canada
• Exploring Response Options to Opioid Harms: Case Studies from Four Canadian Clinics
• Canadian Substance Use Costs and Harms: 2015 to 2017
• National Treatment Indicators Report: 2016-2018 Data
• First Do No Harm: Responding to Canada’s Prescription Drug Crisis

¶¶¶ Estimates from the Canadian Substance Use Costs and Harms (CSUCH) report include data on all opioids, including prescription

opioids.
### At the time of this report, some healthcare-related data were not available for the province of Quebec, so no meaningful estimates of

overall healthcare costs could be generated for Quebec.

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 13
 Canadian Drug Summary: Opioids

References
1 American Psychiatric Association. (2013). Diagnostic and statistical manual of mental
disorders (5th ed.). Washington, D. C.: Author.
https://doi.org/10.1176/appi.books.9780890425596
2 Canadian Pain Task Force. (2020). Working together to better understand, prevent and manage
chronic pain: What we heard. Ottawa, Ont.: Health Canada. https://www.canada.ca/en/health-
canada/corporate/about-health-canada/public-engagement/external-advisory-bodies/canadian-
pain-task-force/report-2020.html
3 Busse, J. W., Craigie, S., Juurlink, D. N., Buckley, D. N., Wang, L., Couban, R. J., … Guyatt, G. H.
(2017). Guideline for opioid therapy and chronic noncancer pain. CMAJ, 189(18), E659–E666.
https://doi.org/10.1503/cmaj.170363
4 Dassieu, L., Heino, A., Develay, É., Kaboré, J.-L., Pagé, M. G., Moor, G., Hudspith, M., & Choinière,
M. (2021). “They think you’re trying to get the drug”: Qualitative investigation of chronic pain
patients’ health care experiences during the opioid overdose epidemic in Canada. Canadian
Journal of Pain, 5(1), 66–80. https://doi.org/10.1080/24740527.2021.18818865
5 Els, C., Jackson, T. D., Kunyk, D., Lappi, V. G., Sonnenberg, B., Hagtvedt, R., … Straube, S. (2017).
Adverse events associated with medium- and long-term use of opioids for chronic non-cancer
pain: An overview of Cochrane Reviews. The Cochrane Database of Systematic Reviews, 10,
Article CD012509. https://doi.org/10.1002/14651858.CD012509.pub2
6 Controlled Drugs and Substances Act, S.C. 1996, c. 19.
https://laws-lois.justice.gc.ca/eng/acts/c-38.8/FullText.html
7 Bill C-224, An Act to amend the Controlled Drugs and Substances Act (assistance – drug
overdose), 42nd Parliament, 1st Session. (2017). https://www.parl.ca/DocumentViewer/en/42-
1/bill/C-224/royal-assent
8 Health Canada (2022). Exemption from Controlled Drugs and Substances Act: Personal
possession of small amounts of certain illegal drugs in British Columbia (January 31, 2023 to
January 31, 2026). https://www.canada.ca/en/health-canada/services/health-
concerns/controlled-substances-precursor-chemicals/policy-regulations/policy-
documents/exemption-personal-possession-small-amounts-certain-illegal-drugs-british-
columbia.html
9 Statistics Canada. (2021). Canadian Alcohol and Drugs Survey (CADS): Summary of results for
2019. Ottawa, Ont.: Health Canada. https://www.canada.ca/en/health-
canada/services/canadian-alcohol-drugs-survey/2019-summary.html
10 Statistics Canada. (2019). Canadian Tobacco, Alcohol and Drugs Survey: Summary of results for
2017. Ottawa, Ont.: Health Canada. https://www.canada.ca/en/health-
canada/services/canadian-alcohol-drugs-survey/2017-summary.html
11 Health Canada. (2021). Canadian Postsecondary Education Alcohol and Drug Use Survey,
019/2020. Ottawa, Ont.: Author. https://health-infobase.canada.ca/alcohol/cpads/
12 Statistics Canada. (2017). Canadian Tobacco, Alcohol and Drugs Survey: 2015 summary.
Ottawa, Ont.: Health Canada. https://www.canada.ca/en/health-canada/services/canadian-
alcohol-drugs-survey/2015-summary.html
13 Statistics Canada. (2015). Canadian Tobacco, Alcohol and Drugs Survey: 2013 summary.
Ottawa, Ont.: Health Canada. https://www.canada.ca/en/health-canada/services/canadian-
alcohol-drugs-survey/2013-summary.html

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 14
 Canadian Drug Summary: Opioids

14 Health Quality Ontario. (2017). 9 million prescriptions: What we know about the growing use of
prescription opioids in Ontario. Toronto, Ont.: Queen’s Printer for Ontario.
https://www.hqontario.ca/portals/0/Documents/system-performance/9-million-prescriptions-
en.pdf
15 Canadian Institute for Health Information. (2019). Opioid prescribing in Canada: How are
practices changing? Ottawa, Ont.: Author.
https://www.cihi.ca/sites/default/files/document/opioid-prescribing-canada-trends-en-web.pdf
16 Jones, W., Kaoser, R. & Fischer, B. (2021). Patterns, trends and determinants of medical opioid
utilization in Canada 2005-2020: Characterizing an era of intensive rise and fall. Substance
Abuse Treatment, Prevention and Policy, 16, Article 65. https://doi.org/10.1186/s13011-021-
00396-5
17 Canadian Institute for Health Information. (2018). Pan-Canadian trends in the prescribing of
opioids and benzodiazepines, 2012 to 2017. Ottawa, Ont.: Author.
https://www.cihi.ca/sites/default/files/document/opioid-prescribing-june2018-en-web.pdf
18 Antoniou, T., Ala-Leppilampi, K, Shearer, D., Parsons, J. A., Tadrous, M., & Gomes, T. (2019).
“Like being put on an ice floe and shoved away”: A qualitative study of the impacts of opioid-
related policy changes on people who take opioids. International Journal of Drug Policy, 66, 15-
22. https://doi.org/10.1016/j.drugpo.2019.01.015
19 IQVIA. (2022). Prescription opioid trends in Canada: An independent IQVIA report on measuring
and understanding the use of prescription opioids dispensed in 2015 and 2020.
https://www.iqvia.com/-/media/iqvia/pdfs/canada/white-
paper/prescriptionopioidtrendsincanada_report_en.pdf?_=1660670833220
20 Canadian Agency for Drugs and Technologies in Health. (2017). Sustained release oral
morphine, injectable hydromorphone, and prescription diacetylmorphine for opioid use disorder:
Clinical and cost-effectiveness, and guidelines. Ottawa, Ont.: Author.
https://www.cadth.ca/sustained-release-oral-morphine-injectable-hydromorphone-and-
prescription-diacetylmorphine-opioid
21 Bruneau, J., Ahamad, K., Goyer, M.-È, Poulin, G., Selby, P., Fischer, B., Wood, T. C., & Wood, E.
(2018). Management of opioid use disorders: A national clinical practice guideline. CMAJ,
190(9), E247–E257. https://doi.org/10.1503/cmaj.170958
22 Taha, S. (2018). Best practices across the continuum of care for the treatment of opioid use
disorder. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.
https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Best-Practices-Treatment-Opioid-Use-
Disorder-2018-en.pdf
23 Propel Centre for Population Health Impact. (2020). Summary of results of the Canadian Student
Tobacco, Alcohol and Drugs Survey 2018–19. Ottawa, Ont.: Health Canada.
https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-
survey/2018-2019-summary.html
24 Propel Centre for Population Health Impact. (2018). Summary of results for the Canadian
Student Tobacco, Alcohol and Drugs Survey 2016–17. Ottawa, Ont.: Health Canada.
25 Substance Abuse and Mental Health Services Administration. (2021). Key substance use and
mental health indicators in the United States: Results from the 2020 National Survey on Drug
Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville,
Maryland.: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental
Health Services Administration.

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 15
 Canadian Drug Summary: Opioids

https://www.samhsa.gov/data/sites/default/files/reports/rpt35325/NSDUHFFRPDFWHTMLFile
s2020/2020NSDUHFFR1PDFW102121.pdf
26 Australian Institute of Health and Welfare. (2020). National Drug Strategy Household Survey
2019. Drug Statistics series no. 32. PHE 270. Canberra AIHW.
https://www.aihw.gov.au/getmedia/77dbea6e-f071-495c-b71e-3a632237269d/aihw-phe-
270.pdf.aspx?inline=true
27 Statistics Canada. (2021, July 26). Wastewater analysis suggests that consumption of fentanyl,
cannabis and methamphetamine increased in the early pandemic period. The Daily.
https://www150.statcan.gc.ca/n1/daily-quotidien/210726/dq210726a-eng.htm
28 Konefal, S., Maloney-Hall, B., Urbanoski, K., & the National Treatment Indicators Working Group
(2020). National treatment indicators report: 2016-2018 Data. Ottawa, Ont.: Canadian Centre
on Substance Use and Addiction. https://www.ccsa.ca/sites/default/files/2021-01/CCSA-
National-Treatment-Indicators-2016-2018-Data-Report-2021-en.pdf
29 Canadian Centre on Substance Use and Addiction. (2022). Community Urinalysis and Self-Report
Project: Cross-Canada report on the use of drugs from the unregulated supply, 2019-2021 data.
Ottawa, Ont.: Author. https://www.ccsa.ca/sites/default/files/2022-04/CCSA-CUSP-Use-of-
Drugs-from-the-Unregulated-Supply-2019-2021-Data-Report-2022-en.pdf
30 Canadian Community Epidemiology Network on Drug Use. (2022a). CCENDU drug alert:
Nitazenes. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.
https://www.ccsa.ca/sites/default/files/2022-03/CCSA-CCENDU-Drug-Alert-Nitazenes-2022-
en_0.pdf
31 Canadian Community Epidemiology Network on Drug Use. (2020, April). CCENDU Bulletin:
Adulterants, contaminants and co-occurring substances in drugs on the illegal market in
Canada. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.
https://www.ccsa.ca/sites/default/files/2020-05/CCSA-CCENDU-Adulterants-Contaminants-Co-
occurring-Substances-in-Drugs-Canada-Bulletin-2020-en_0.pdf
32 Canadian Community Epidemiology Network on Drug Use. (2022. July). CCENDU drug alert:
Xylazine. Ottawa, Ont.: Canadian Centre on Substance Use and Addiction.
https://www.ccsa.ca/sites/default/files/2022-07/CCSA-CCENDU-Drug-Alert-Xylazine-2022-
en.pdf
33 United Nations Office on Drugs and Crime. (2021). World drug report. Vienna: Author.
https://www.unodc.org/unodc/en/data-and-analysis/wdr2021.html
34 Drug Analysis Service. (2022). Analyzed Drug Report January 2020–December 2021 (dataset).
Ottawa, Ont.: Health Canada. https://health-infobase.canada.ca/drug-analysis-service/analyzed-
drug-report.html
35 Health Canada Drug Analysis Service, Royal Canadian Mounted Police, Canada Border Services
Agency. (2022). At-a-glance: The emergence of nitazenes and brorphine in Canada since 2019.
Longueuil, Que.: Government of Canada. https://www.canada.ca/en/health-
canada/services/publications/healthy-living/emergence-nitazenes-brorphine-canada-2019.html
36 United Nations Office on Drugs and Crime. (2020). The growing complexity of the opioid crisis.
Global SMART Update, 24. https://www.unodc.org/documents/scientific/Global_SMART-2020-
Vol_24_web.pdf
37 Canadian Institute for Health Information. (2018). Opioid-related harms in Canada. Ottawa, Ont.:
Author. https://www.cihi.ca/sites/default/files/document/opioid-related-harms-report-2018-en-
web.pdf

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 16
 Canadian Drug Summary: Opioids

38 Special Advisory Committee on the Epidemic of Opioid Overdoses. (2022). Opioid- and stimulant-
related harms in Canada. Ottawa, Ont.: Public Health Agency of Canada.
https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants
39 Canadian Institute for Health Information. (2021). Unintended consequences of COVID-19:
Impact on harms caused by substance use. Ottawa, Ont.: Author.
https://secure.cihi.ca/free_products/unintended-consequences-covid-19-substance-use-report-
en.pdf
40 Canadian Institute for Health Information. (2021). Unintended consequences of COVID-19:
Impact on harms caused by substance use, self-harm and accidental falls. Ottawa, Ont.: Author.
https://www.cihi.ca/en/covid-19-resources/impact-of-covid-19-on-canadas-health-care-
systems/unintended-consequences
41 Public Health Agency of Canada. (2021). Neonatal abstinence syndrome in Canada: A
descriptive analysis of hospitalization data. Ottawa, Ont.: Author.
https://www.canada.ca/en/health-canada/services/opioids/data-surveillance-
research/neonatal-abstinence-syndrome-descriptive-analysis-hospitalization.html
42 Canadian Centre on Substance Use and Addiction. (2022). Polysubstance use and poisoning
deaths in Canada [Report-at-a-Glance]. Ottawa, Ont.: Author.
https://www.ccsa.ca/sites/default/files/2022-06/CCSA-Polysubstance-Use-Poisoning-Deaths-
Canada-Report-at-a-Glance-2022-en.pdf
43 Ontario Drug Policy Research Network, Office of the Chief Coroner for Ontario/Ontario Forensic
Pathology Service, Public Health Ontario, Centre on Drug Policy Evaluation. (2020). Preliminary
patterns in circumstances surrounding opioid-related deaths in Ontario during the COVID-19
pandemic. Toronto, Ont.: Public Health Ontario. https://www.publichealthontario.ca/-
/media/documents/o/2020/opioid-mortality-covid-surveillance-report.pdf
44 Gomes, T., Murray, R., Kolla, G., Leece, P., Bansal, S., Besharah, J., … Walford, J. (2021).
Changing circumstances surrounding opioid-related deaths in Ontario during the COVID-19
pandemic. Toronto, Ont.: Public Health Ontario. https://www.publichealthontario.ca/-
/media/documents/c/2021/changing-circumstances-surrounding-opioid-related-deaths.pdf
45 Government of Alberta. (2022). Alberta substance use surveillance system.
https://healthanalytics.alberta.ca/SASVisualAnalytics/?reportUri=%2Freports%2Freports%2F1b
bb695d-14b1-4346-b66e-
d401a40f53e6&sectionIndex=0&sso_guest=true&reportViewOnly=true&reportContextBar=false
&sas-welcome=false
46 British Columbia Coroners Service. (2020). Illicit drug toxicity deaths in BC: January 1, 2010 –
January 31, 2020. Burnaby, B.C.: Ministry of Public Safety and Solicitor General.
47 British Columbia Coroners Service (2022). Illicit drug toxicity deaths in BC: January 1, 2012 -
April 20, 2022. Burnaby, B.C.: Ministry of Public Safety and Solicitor general.
48 Government of Nova Scotia. (2022). Numbers and rates of substance-related fatalities in Nova
Scotia [visualization]. https://data.novascotia.ca/d/iu6y-z4n3/visualization
49 Canadian Centre on Substance Use and Addiction. (2017). The effects of psychoactive
prescription drugs on driving [Report-at-a-Glance]. Ottawa, Ont.: Author.
https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Psychoactive-Prescription-Drugs-and-
Driving-Report-at-a-Glance-2017-en.pdf
50 Beasley, E. E., & Beirness, D. J. (2012). Alcohol and drug use among drivers following the
introduction of immediate roadside prohibitions in British Columbia: Findings from the 2012
Roadside Survey. Victoria, B.C.: British Columbia Ministry of Justice.
Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 17
 Canadian Drug Summary: Opioids

51 Canadian Centre on Substance Use and Addictions. (2015). Opioids, driving and implications for
youth [Topic Summary]. Ottawa, Ont.: Author. https://www.ccsa.ca/sites/default/files/2019-
04/CCSA-Opioids-Driving-Implications-for-Youth-Summary-2015-en.pdf
52 Brubacher, J. R., Chan, H., Masud, M., Yuan, Y., Erdelyi, S., Likhodi, S., & National Drug Driving
Research Group. (2021). The 2021 National Drug Driving Study. Vancouver, BC: Department of
Emergency Medicine, University of British Columbia. https://med-fom-
rsph.sites.olt.ubc.ca/files/2021/06/National-Drug-Driving-Study-June-2021-Final.pdf
53 Canadian Substance Use Costs and Harms Scientific Working Group (2020). Canadian
substance use costs and harms 2015–2017. (Prepared by the Canadian Institute for Substance
Use Research and the Canadian Centre on Substance Use and Addiction.) Ottawa, Ont.:
Canadian Centre on Substance Use and Addiction. https://csuch.ca/publications/CSUCH-
Canadian-Substance-Use-Costs-Harms-Report-2020-en.pdf

ISBN 978-1-77871-030-8 © Canadian Centre on Substance Use and Addiction 2022

CCSA was created by Parliament to provide national leadership to address
substance use in Canada. A trusted counsel, we provide national guidance to
decision makers by harnessing the power of research, curating knowledge and
bringing together diverse perspectives.
CCSA activities and products are made possible through a financial contribution from
Health Canada. The views of CCSA do not necessarily represent the views of the
Government of Canada.

Canadian Centre on Substance Use and Addiction • Centre canadien sur les dépendances et l’usage de substances Page 18