More than one in four deaths among young Canadians between 2019 and 2021 were opioid-related, with the COVID-19 pandemic and the increased use of fentanyl potentially playing significant roles, according to new research.
A study published Monday in the Canadian Medical Association Journal (CMAJ) found that during the same years, premature deaths related to opioids doubled across Canada, with the highest spike among young adults aged 20 to 39.
“While we know that these rates of death have unfortunately been growing over the past decade, we’ve also seen that there’s more of a concentration and clustering of these deaths in younger people,” said Dr. Tara Gomes, senior author of the study and scientist at Unity Health Toronto.
“So we wanted to better understand the broad impacts of this early loss of life that we are seeing across our communities all across Canada.”
To do this, the researchers looked at data on accidental deaths from opioid toxicity from provinces and territories in Canada: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia and the Northwest Territories.
They found that in three years (between 2019 and 2021) the annual number of opioid-related deaths rose from 3,007 to 6,222. And the number of years of life lost due to opioids increased from 126,115 to 256,336.
In 2021, the highest number of years of life lost was among males (70 per cent) and people aged 30 to 39 years (30 per cent).
“If you imagine someone in their 30s, their life expectancy might be into their 80s. They are losing 40 years of their life because of this early loss of life, and early death,” Gomes told Global News.
“If you add up all of those years of life lost across every opioid-related death that occurred across Canada, we found that there were a quarter of a million years of life lost in 2021 from opioid toxicity deaths.”
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While the prevalence of harm among younger people remained consistent across nine Canadian provinces and territories examined in this study, certain regions experienced disproportionate impacts. In Alberta, for example, almost half of all deaths among people aged 20 to 39 were attributed to opioids.
Manitoba saw the sharpest rise in overdose deaths for those aged 30 to 39 — reaching 500 deaths per million population, more than five times the 89 deaths per million population recorded at the beginning of the study period.
In Saskatchewan, the death toll for that age group nearly tripled to 424 per million, up from 146 per million.
What's behind the rise?
Before the emergence of COVID-19, the number of accidental opioid-related deaths across Canada rose from 2,470 in 2016 to 3,447 in 2019, the study said.
Both prescription and unregulated opioids contribute to toxicity deaths, but the proportion of these substances has shifted significantly over time, the researchers argue. For example, from 2020 to early 2023, fentanyl from the unregulated drug supply was linked to over 80 per cent of opioid-related deaths, the study said.
The study suggested that the surge in fentanyl combined with the COVID-19 pandemic may have contributed to a “significant increase” in the number of opioid-related deaths.
This includes reduced access to harm reduction programs and border restrictions that may have increased the toxicity of the drug supply, the researchers suggested.
“The pandemic exacerbated feelings of anxiety, uncertainty, and loneliness, contributing to increased substance use globally,” the study said. “The intersection of the COVID-19 pandemic with the drug toxicity crisis in Canada has created an urgent need to better understand the patterns of opioid-related deaths across the country to inform targeted public health responses.”
The researchers also argued that amid the pandemic, people who used drugs not only faced significant decreases in access to social support and health-care services but also reported changes in patterns of drug use. This included frequently using drugs alone and a shift toward increased inhalation of drugs, which are both risk factors for opioid toxicities.
“Right around the time of the pandemic, there was a significant increase in opioid-related deaths across the country,” Gomes said. “And that isn’t completely surprising to many of us working in this space. We expected that people would be pushed into using drugs alone more often because of a lot of the social distancing requirements and a lot of the community-based programs that had to reduce their hours or close for short periods of time. ”
While death rates were expected to rise, she said they were not expecting the numbers would stay as high as they have been.
“We are still, even into late 2023 and early 2024, seeing death rates across Canada that are much higher than the rates that we were seeing in 2019 before the pandemic arrived,” she said.
These high numbers highlight the need to expand harm-reduction-based policies and treatment programs across Canada, Gomes said.
“These are preventable and accidental deaths, and these are people who have their whole lives ahead of them, who have so many contributions that they could have — and I’m sure wanted to make — to their families, to their communities and societies as a whole,” she said.
“And those lives have been cut short, and we are not able to see all of the wonderful things that these people could have done.”
— with files from the Canadian Press and Global News’ Katherine Ward
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