Canadian Centre on Substance Use and Addiction

Canada is experiencing a drug toxicity crisis that is being fuelled by synthetic opioids like fentanyl. Between January 2016 and September 2022, there were more than 34,400 apparent opioid toxicity deaths, many of which also involved stimulants or other substances. The vast number of lost lives makes the drug toxicity crisis a major public health and safety concern.

To reduce the risks and harms associated with opioid use, it is crucial to understand its health and social impacts. To this end, CCSA collaborates with partners to gain a better understanding of the risks and harms of opioid use and supports evidence-based decisions about opioid policy and practice. CCSA also recognizes that interventions for opioid-related harms must address the broader context of polysubstance use and meet the specific needs of different groups and communities.  

What Are Opioids?

Opioids are available in both pharmaceutical and non-pharmaceutical forms. Common opioid pharmaceutical medications, such as codeine, fentanyl, morphine, oxycodone and diacetylmorphine, are primarily used to treat pain. However, people may also use these products for non-medical purposes. Fentanyl and fentanyl analogues of non-pharmaceutical origin are illegally manufactured and are the most widely available opioids in Canada's unregulated drug supply.

Most harms associated with opioids are caused by synthetic opioids, such as fentanyl and to a lesser extent nitazenes, which can be consumed unknowingly through the unregulated drug supply. The presence of these opioids in other substances significantly increases the risk of drug toxicity deaths, as they are extremely potent and can be fatal, even in small amounts.  

About the Opioid Toxicity Crisis

The opioid toxicity crisis in Canada has evolved, and the factors that contribute to it are complex and multifaceted. Factors that once played a central role, such as high levels of prescription opioid use and diversion, no longer have as significant an impact. The current crisis is influenced by several factors, including:

  • Psychological, social and biological risk factors, such as genetics, adverse childhood experiences, trauma, mental health, poverty, lack of secure housing and other social determinants of health;
  • The lack of a comprehensive spectrum of care, including harm reduction and treatment services, that can respond to an individual's physical, mental health and social needs in a timely manner;
  • The unpredictable dose and contents of fentanyl from the unregulated drug supply, which can lead to increased risk of drug poisoning and other harms from contaminants like synthetic opioids and non-medical benzodiazepines;
  • Disruptions to the drug supply during the COVID-19 pandemic, which led to increased toxicity combined with reduced access to supports and services;
  • Unintentional polysubstance exposure from the unregulated drug supply and intentional polysubstance use that includes use of opioids with stimulants;
  • Stigma toward those who use substances or are living with substance use disorders;
  • Lack of access to prescription opioids, leading individuals to use opioids from the unregulated drug supply;
  • Lack of awareness or access to alternative treatments for pain; and
  • Use of opioids diverted from friends’ and family members’ prescriptions.

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About the Opioid Crisis

The current opioid crisis is a result of multiple, complex factors that include:

  • A misunderstanding of the addictive risk of prescription opioids;
  • Psychological, social and biological risk factors like genetics, mental health, early life experiences, trauma, poverty, lack of secure housing and other social determinants of health;
  • Stigma towards substance use disorders;
  • Frequent opioid prescribing and high amounts being prescribed for pain relief;
  • Lack of awareness or access to alternative treatments for pain;
  • Use of prescription opioids by individuals to whom they are not prescribed, such as friends and family members;
  • Lack of access to prescription opioids leading to illicit opioid use;
  • Illegal drugs that are laced with fentanyl and its analogues; and
  • A lack of comprehensive care to respond to all the mental and physical health needs of an individual.

National numbers

To illustrate further the scope of the opioid crisis, view the interactive map from Health Canada’s National Report: Apparent Opioid-related Deaths in Canada. 

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