Opioid-related deaths between 2019 and 2021 across 9 Canadian provinces and territories.

Background: The drug toxicity crisis continues to accelerate across Canada, with rapid increases in opioid-related harms following the onset of the COVID-19 pandemic. We sought to describe trends in the burden of opioid-related deaths across Canada throughout the pandemic, comparing these trends by province or territory, age, and sex.
Methods: We conducted a repeated cross-sectional analysis of accidental opioid-related deaths between Jan. 1, 2019, and Dec. 31, 2021, across 9 Canadian provinces and territories using aggregated national data. Our primary measure was the burden of premature opioid-related death, measured by potential years of life lost. Our secondary measure was the proportion of all deaths attributable to opioids; we used the Cochrane-Armitage test for trend to compare proportions.
Results: Between 2019 and 2021, the annual number of opioid-related deaths increased from 3007 to 6222 and years of life lost increased from 126 115 to 256 336 (from 3.5 to 7.0 yr of life lost per 1000 population). In 2021, the highest number of years of life lost was among males (181 525 yr) and people aged 30-39 years (87 045 yr). In 2019, we found that 1.7% of all deaths among those younger than 85 years were related to opioids, rising to 3.2% in 2021. Significant increases in the proportion of deaths related to opioids were observed across all age groups ( p < 0.001), representing 29.3% and 29.0% of deaths among people aged 20-29 and 30-39 years in 2021, respectively.
Interpretation: Across Canada, the burden of premature opioid-related deaths doubled between 2019 and 2021, representing more than one-quarter of deaths among younger adults. The disproportionate loss of life in this demographic group highlights the critical need for targeted prevention efforts.
Competing Interests: Competing interests:: David Juurlink is a member of Physicians for Responsible Opioid Prescribing and the American College of Medical Toxicology. Both groups have publicly available positions on this issue. He has also received payment from law firms for lectures and medicolegal opinions regarding the safety and effectiveness of analgesics, including opioids. Mina Tadrous reports consulting fees from Health Canada and the Canadian Agency for Drugs and Technologies in Health (CADTH). Tara Gomes reports funding from the Ontario College of Pharmacists and CADTH, consulting fees from the Province of British Columbia, honoraria from Indigenous Services Canada, and payment for expert testimony from the Office of the Chief Coroner of Ontario. No other competing interests were declared.
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