Opioid poisoning deaths down in Canada, but not in Quebec

Several provinces in Canada have seen a decline in apparent opioid-related deaths, according to new data from the Canadian Centre on Substance Use and Addiction (CCSA). This is not the case, however, in Quebec, where an upward trend is observed.

The data indicate that there was a 17 per cent decrease in apparent opioid-related deaths in 2024 in Canada compared to 2023. Despite this decline, the CCSA notes in a report that the number of deaths remains high across the country, with regional variations. Overall, they counted close to nearly 7,150 deaths in 2024, representing an average of 20 deaths per day.

The majority (80 per cent) of apparent opioid-related deaths occurred in British Columbia (2,299 deaths), Ontario (2,231 deaths), and Alberta (1,181 deaths).

Quebec ranks fourth with 645 deaths in 2024. This is more than double the number reported in 2022. In 2023, a total of 536 deaths were reported.

“In terms of absolute numbers, Quebec has historically had lower rates than other provinces and territories, although it appears to have seen a steady increase in recent years,” says Samantha King, Research and Policy Analyst at CCSA.

There is a movement of substances, such as fentanyl, to the east of the country, adds the expert. “We know that this has been a problem in British Columbia, Alberta and Ontario. Until recent years, Quebec has been somewhat more spared, and stimulants have always been the main concern in Quebec. But in recent years, fentanyl derivatives, such as para-fluorofentanyl or carfentanil, have become more common in Quebec, which could contribute to the increase observed in this province in particular.”

King says opioids and stimulants are often combined. So, when looking at opioid-related deaths, many of them overlap and also involve stimulants.

An increase in deaths between 2023 and 2024 is also observed in Newfoundland and Labrador and the Northwest Territories. Trends in Nova Scotia and Prince Edward Island remain virtually unchanged.

In its report, the Canadian Centre on Substance Use and Addiction notes that there has been a recent shift in the mode of consumption, moving from injection to inhalation in many regions. It specifies that the role of this shift in the decline in opioid-related deaths is uncertain.

In Thunder Bay, Ontario, the number of deaths related solely to substances consumed by inhalation has increased. In Quebec, there has also been an increase in the use of drugs through smoking/inhalation compared to injection.

King says this trend is happening across the country, with a shift from injecting opioids to inhaling them. She explains that this pattern of use has some protective effect, because by stopping injecting drugs, people can use more slowly and have a better idea of the dose.

“But if someone chooses to inhale opioids or stimulants, or both, right now, across the country, including in Quebec, we don’t have adequate support,” King said. If people are looking for harm reduction services, there aren’t many that are specifically for inhaled drug use.”

No more contamination

The report puts forward some hypotheses that may explain apparent opioid-related deaths, but more in-depth investigations are needed to confirm them, King said.

For example, there have been frequent changes in the drug supply, especially with the presence of new substances, such as xylazine or other central nervous system depressants. These new substances contaminate the unregulated supply and are associated with additional risks.

“There are more or less potent substances that can be put on the market. Different substances end up being mixed with other new substances that we have not yet seen. People are therefore exposed to several substances at the same time. And in the absence of drug control services, they can’t predict what’s in the product. This puts people at risk, including opioid-related mortality,” King said.

“It’s a very complex situation,” she continues. No single factor can explain the declines we are seeing at the national level.” She said that the objective of the report was to present in a preliminary manner the trends observed in the different regions.

—The Canadian Press’s health coverage is supported by a partnership with the Canadian Medical Association. The Canadian Press is solely responsible for this journalistic content.

–This report by La Presse Canadienne was translated by CityNews