National Report: Apparent Opioid-Related Deaths in Canada (December 2017)

This report provides information on the opioid crisis in Canada, including the number of apparent opioid-related deaths, national and regional trends, sex and age trends, and substances involved in these deaths. The report emphasizes the need for accurate information to reduce opioid-related harms and deaths.

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National report: Apparent opioid-related deaths in
Canada (December 2017)

Suggested citation
Canada is experiencing a serious and growing opioid crisis. Across the country, it is having devastating effects on
families and communities.
Accurate information about the crisis will help the efforts to reduce opioid-related harms and deaths.
The Government of Canada is working closely with the provinces and territories to collect and share data on
apparent opioid-related deaths. The data will be updated four times a year and may change based on review and
refinement.
The data in this report should be interpreted with caution due to provincial and territorial differences in the
processing and reporting of apparent opioid-related deaths. In addition, please refer to the Considerations and
Limitations for more information.
Key Findings
According to data reported as of December 11, 2017:
in 2016, there were 2,861 apparent opioid-related deaths in Canada
from January to June 2017, there were at least 1,460 apparent opioid-related deaths and it is expected that
this count will rise as additional data become available
overall, most apparent opioid-related deaths occurred among males (74%) and among individuals between
the ages of 30 and 39 (28%)
from January to June 2017, 74% of apparent opioid-related deaths involved fentanyl or fentanyl analogues,
compared to 53% in 2016.
The data in this report:
are updated on a quarterly basis
may change based on review and refinement
have been collected by the provinces and territories from their respective offices of Chief Coroners/Medical
Examiners
have been shared through the Special Advisory Committee on the Epidemic of Opioid Overdoses (SAC)
Changes from last report include:
the addition of available preliminary data from April to June 2017 (except for Manitoba, Quebec and
Newfoundland and Labrador)
updates to preliminary data from 2016 and January to March 2017
National and regional trends of apparent opioid-related deaths
The opioid crisis has affected every part of the country, but some provinces and territories have been impacted
more than others. According to data reported as of December 11, 2017:
there were 2,861Footnote a apparent opioid-related deaths in Canada in 2016, corresponding to a death rate of
7.9Footnote a per 100,000 population (Table 1)
there were at least 1,460 apparent opioid-related deaths from January to June 2017 (Table 1)
Figure 1. Number and rate (per 100,000 population) of apparent opioid-related deaths by
province or territory, 2016.
Text equivalent

Figure 1. Number and rate (per 100,000 population) of apparent opioid-related deaths by province or territory,
2016.
Province or territory 2016 2017 (January to June)
Number Death rate per 100,000 population Number
British ColumbiaFootnote 1 985 20.7 798
Alberta 611 14.4 350
SaskatchewanFootnote 2 71 6.2 10
Manitoba 69 5.2 30Footnote 3
Ontario 867 6.2 214Footnote 4
QuebecFootnote 2 140 1.7 Suppressed
New Brunswick 32 4.2 17
Nova Scotia 53 5.6 37
Prince Edward IslandFootnote 2 5 3.3 Suppressed
Newfoundland and Labrador 16 3.0 Suppressed
Yukon 7 18.4 4
Northwest Territories 5 11.2 0
Nunavut Suppressed Suppressed Suppressed
Total 2861 7.9 1460
Footnotes
N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the
Considerations and Limitations for more information.
Footnote 1
British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to,
opioids.
Return to footnote 1 referrer
Footnote 2
Saskatchewan, Quebec and Prince Edward Island report closed cases only. Updates to historical data will
be provided in future reports.
Return to footnote 2 referrer
Footnote 3
Manitoba data from April to June 2017 were not available at the time of this publication.
Return to footnote 3 referrer
Footnote 4
Only data from May to June 2017 were available for Ontario; data from January to April 2017 were not
available at the time of this publication. Updates to historical data will be provided in future reports.
Return to footnote 4 referrer

Table 2. Number of apparent opioid-related deaths, quarterly, by province or territory, January 2016 to June 2017.
Province or territory 2016 2017 (January to June)
Jan to Mar Apr to Jun Jul to Sep Oct to Dec Jan to Mar Apr to Jun
British ColumbiaFootnote 1 221 191 195 378 389 409
Alberta 138 146 159 168 161 189
SaskatchewanFootnote 2 N/A N/A N/A N/A N/A N/A
Manitoba 16 13 15 25 30 N/A
Ontario 214 218 195 240 N/A 214Footnote 4
QuebecFootnote 3 50 43 35 12 N/A N/A
New Brunswick 12 4 9 7 9 8
Nova Scotia 17 14 17 5 19 18
Prince Edward IslandFootnote 3 Suppressed Suppressed Suppressed Suppressed Suppressed Suppressed
Newfoundland and Labrador Suppressed Suppressed Suppressed Suppressed N/A N/A
Yukon 0 2 2 3 4 0
Northwest Territories 2 0 1 2 0 0
Nunavut Suppressed Suppressed Suppressed Suppressed Suppressed Suppressed
Footnotes
N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the
Considerations and Limitations for more information.
Footnote 1
British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to,
opioids.
Return to footnote 1 referrer
Footnote 2
Only annual totals were available for Saskatchewan; quarterly data were not available at the time of this
publication.
Return to footnote 2 referrer
Footnote 3
Quebec and Prince Edward Island report closed cases only. Updates to historical data will be provided in
future reports.
Return to footnote 3 referrer
Footnote 4
Only data from May to June 2017 were available for Ontario; data from January to April 2017 were not
available at the time of this publication. Updates to historical data will be provided in future reports.
Return to footnote 4 referrer
Sex and age trends of apparent opioid-related deaths

This crisis has affected Canadians from all walks of life. However, available data from January 2016 to June 2017,
reported as of December 11, 2017, indicate there are differences by sex and age.
Although these trends vary by province or territory, overall:
most (74%) apparent opioid-related deaths occurred among males (Figure 2)
the highest percent (28%) of apparent opioid-related deaths occurred among individuals between the ages of
30 and 39 (Table 3)
Figure 2. Sex distribution of apparent opioid-related deaths by province or territory, January
2016 to June 2017Figure 2 Footnote 1.
Text equivalent
Table 3. Percent of apparent opioid-related deaths by age group and province or territory, January 2016 to June
2017Footnote 1.
Province or territory Age group
≤ 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 ≥ 70
British ColumbiaFootnote 2 2.5% 18.4% 28.1% 23.2% 21.6% 5.8% 0.4%
Alberta 2.5% 20.2% 33.8% 17.6% 18.5% 6.5% 0.9%
Saskatchewan 0.0% 16.0% 35.8% 14.8% 22.2% 9.9% 1.2%
Manitoba 2.0% 23.2% 32.3% 14.1% 10.1% 13.1% 5.1%
Ontario 1.8% 18.9% 22.8% 21.4% 23.9% 8.6% 2.7%
Quebec N/A N/A N/A N/A N/A N/A N/A
New Brunswick 2.0% 16.3% 18.4% 20.4% 24.5% 16.3% 2.0%
Nova Scotia 2.2% 15.6% 26.7% 16.7% 20.0% 14.4% 4.4%
Prince Edward Island Suppressed
Newfoundland and Labrador Suppressed
Yukon 0.0% 9.1% 36.4% 27.3% 9.1% 0.0% 18.2%
Northwest Territories 0.0% 60.0% 0.0% 0.0% 20.0% 20.0% 0.0%
Nunavut Suppressed
Total 2.2% 19.0% 28.1% 20.8% 21.2% 7.3% 1.4%
Footnotes
N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the
Considerations and Limitations for more information.
Footnote 1
Not all provinces and territories were able to report data for the full time period (January 2016 to June
2017). Table 3 includes only 2016 data for Quebec, 2016 data and 2017 data limited to May to June only
for Ontario, and data from January 2016 to March 2017 only for Manitoba and Newfoundland and
Labrador. Saskatchewan and Prince Edward Island report closed cases only. Updates to historical data will
be provided in future reports. Refer to Table 6 for more details.
Return to footnote 1 referrer
Footnote 2
British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to,

opioids.
Return to footnote 2 referrer
Province or territory Age group
≤ 19 20 to 29 30 to 39 40 to 49 50 to 59 60 to 69 ≥ 70
Fentanyl, fentanyl analogues, and other substances involved in
apparent opioid-related deaths
Apparent opioid-related deaths often involveFootnote b multiple substances including one or more opioids as well
as non-opioid substances. Knowing the type(s) of opioid and non-opioid substances involved in these deaths can
help public health officials and other government agencies communicate risks and target harm reduction efforts.
Similar to previous updates, we are seeing more fentanyl or fentanyl analogues involved in apparent opioid-related
deaths (Table 4, Table 5). According to available data reported as of December 11, 2017:
the percent of deaths involving fentanyl or fentanyl analogues was 53% in 2016 and 74% from January to
June 2017Footnote c
the number of apparent opioid-related deaths involving fentanyl or fentanyl analogues more than doubled in
January to June of 2017 compared to the same time period in 2016
Non-opioid substances
We can also highlight the involvement of non-opioid substances in apparent opioid-related deaths.
According to available data, approximately 82% of apparent opioid-related deaths from January 2016 to June
2017Footnote d also involved one or more types of non-opioid substances.
Table 4. Number and percent of apparent opioid-related deaths involving fentanyl or fentanyl analogues by
province or territory, 2016 and January to June 2017.
Province or territory 2016 2017 (January to June)
Number Percent Number Percent
British ColumbiaFootnote 1 668 68% 662 83%
AlbertaFootnote 2 357 63% 257 76%
SaskatchewanFootnote 3 8 11% 2 20%
ManitobaFootnote 4 33 48% 14 47%
Ontario 353 41% 122Footnote 5 65%
QuebecFootnote 3 27 19% N/A N/A
New Brunswick 4 13% 4 24%
Nova Scotia 8 15% 4 11%
Prince Edward IslandFootnote 3 1 20% Suppressed
Newfoundland and Labrador Suppressed Suppressed
Yukon 5 71% 2 50%
Northwest Territories 1 20% 0 Not applicable
Nunavut Suppressed Suppressed
Footnotes
N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the
Considerations and Limitations for more information.
Please note: Higher percentages in 2017 compared to 2016 of apparent opioid-related deaths involving fentanyl

or fentanyl analogues should be interpreted with caution. The observed differences between the two time periods
may reflect relative increases in the numbers of deaths involving fentanyl or fentanyl analogues, or may reflect a
delay in the reporting of deaths involving non-fentanyl-related opioids in some jurisdictions. Furthermore, these
data are preliminary and are subject to change.
Footnote 1
British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to,
opioids. British Columbia data on deaths related to illicit drugs where fentanyl was detected is used here to
approximate apparent opioid-related deaths involving fentanyl.
Return to footnote 1 referrer
Footnote 2
This table reflects data for unintentional/accidental deaths only from Alberta.
Return to footnote 2 referrer
Footnote 3
Saskatchewan, Quebec and Prince Edward Island report closed cases only. Updates to historical data will
be provided in future reports.
Return to footnote 3 referrer
Footnote 4
Manitoba data from April to June 2017 were not available at the time of this publication.
Return to footnote 4 referrer
Footnote 5
This table reflects Ontario data from May to June 2017 for closed cases only; data from January to April
2017 were not available at the time of this publication. Updates to historical data will be provided in future
reports.
Return to footnote 5 referrer
Province or territory 2016 2017 (January to June)
Number Percent Number Percent
Table 5. Number of apparent opioid-related deaths involving fentanyl or fentanyl analogues, quarterly, by
province or territory, January 2016 to June 2017.
Province or territory 2016 2017 (January to June)
Jan to Mar Apr to Jun Jul to Sep Oct to Dec Jan to Mar Apr to Jun
British ColumbiaFootnote 1 123 127 120 298 327 335
AlbertaFootnote 2 69 81 87 120 126 131
SaskatchewanFootnote 3 N/A N/A N/A N/A N/A N/A
Manitoba 8 2 8 15 14 N/A
Ontario 76 94 72 111 N/A 122Footnote 4
Quebec 10 9 6 2 N/A N/A
New Brunswick 2 0 1 1 3 1
Nova Scotia 4 2 2 0 1 3
Prince Edward Island Suppressed Suppressed Suppressed Suppressed Suppressed Suppressed
Newfoundland and Labrador Suppressed Suppressed Suppressed Suppressed N/A N/A
Yukon 0 1 1 3 2 0
Northwest Territories 0 0 0 1 0 0

Nunavut Suppressed Suppressed Suppressed Suppressed Suppressed Suppressed
Footnotes
N/A - Data were not available at the time of this publication.
Suppressed - Data may be suppressed in provinces or territories with low numbers of cases. Please refer to the
Considerations and Limitations for more information.
Footnote 1
British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to,
opioids. British Columbia data on deaths related to illicit drugs where fentanyl was detected is used here to
approximate apparent opioid-related deaths involving fentanyl.
Return to footnote 1 referrer
Footnote 2
This table reflects data for unintentional/accidental deaths only from Alberta.
Return to footnote 2 referrer
Footnote 3
Only annual totals were available for Saskatchewan, quarterly data were not available at the time of this
publication. Saskatchewan reports closed cases only. Updates to historical data will be provided in future
reports.
Return to footnote 3 referrer
Footnote 4
This table reflects Ontario data from May to June 2017 for closed cases only; data from January to April
2017 were not available at the time of this publication. Updates to historical data will be provided in future
reports.
Return to footnote 4 referrer
Province or territory 2016 2017 (January to June)
Jan to Mar Apr to Jun Jul to Sep Oct to Dec Jan to Mar Apr to Jun
Considerations and Limitations
Definition of apparent opioid-related death
An apparent opioid-related death is a death caused by intoxication/toxicity (poisoning) as a result of drug use,
where one or more of the drugs is an opioid.
How apparent opioid-related deaths are counted
The data can include:
open (preliminary) and closed (certified) cases
non-natural manners of death (both intentional and unintentional)
individuals with or without personal prescriptions
These data do not include deaths due to:
chronic substance use (for example, the medical consequences of long term use or overuse of an exogenous
[external] substance(s), such as alcoholic cirrhosis)

medical assistance in dying
trauma where an exogenous (external) substance contributed to the circumstances of the injury
However, some jurisdictional differences remain in the type of data reported and in the time periods for which
data are available (refer to Table 6).
Table 6. Reporting periods and manners of death included in data used for this report by province or territory.
BCFootnote
1 AB SK MB ONFootnote
2
QCFootnote
3 NB NS PE NL YK NT NU
Reporting period (as of December 11, 2017)
January to December 2016 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
January to March 2017 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
April to June 2017 ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Deaths included in the reported data
Closed
(certified)
cases
with
completed
death
investigation
Unintentional/accidental ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Intentional/suicide ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Undetermined manner
of death ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Open cases with ongoing death
investigation ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Footnotes
✓ - These data have been reported by the province or territory and are reflected in this report, unless otherwise
specified.
Footnote 1
British Columbia reports unintentional deaths related to all illicit drugs including, but not limited to, opioids.
Return to footnote 1 referrer
Footnote 2
As of May 1, 2017, apparent opioid-related death data in Ontario were captured using an enhanced data
collection tool by the Office of the Chief Coroner. Only 2016 data and 2017 data limited to May to June
were available; data from January to April 2017 were not available at the time of this publication. Updates
to historical data will be provided in future reports.
Return to footnote 2 referrer
Footnote 3
Quebec data for individuals 19 years and younger were not available at the time of this publication. Quebec
data were available for closed/certified cases only; 44% of the cases for 2016 were still under investigation.
Updates to historical data will be provided in future reports.
Return to footnote 3 referrer
Data suppression
The suppression of data in this report is based on the preferences of individual provinces or territories to address

concerns around releasing small numbers for their jurisdiction.
Prince Edward Island suppressed counts less than five for total and quarterly data, and for any data
regarding sex and age distribution. However, if the total annual count of apparent opioid-related deaths is
greater than four, annual counts less than five may be reported when presenting type of substance(s).
Newfoundland and Labrador suppressed all counts less than five.
Nunavut suppressed all counts less than five.
While Yukon has typically suppressed counts of less than five, the decision was made between the Chief
Medical Officer of Health and the Chief Coroner, to release smaller counts, due to the urgency of the
current opioid crisis, the value of detailed ongoing surveillance, and the importance of being as transparent
as possible while still maintaining confidentiality with respect to case details.
Opioids and other involved substances
Fentanyl and fentanyl analogues include, but are not limited to:
3-methylfentanyl
acetylfentanyl
butyrylfentanyl
carfentanil
despropionyl-fentanyl
fentanyl
furanyl-fentanyl
norfentanyl
Non-fentanyl-related opioids include, but are not limited to:
buprenorphine metabolites
codeine
dihydrocodeine
heroin
hydrocodone
hydromorphone
loperamide
meperidine
methadone
monoacetylmorphine
morphine
normeperidine
oxycodone
tapentadol
tramadol
U-47700
Non-opioid substances include, but are not limited to:
alcohol
benzodiazepines
cocaine
W-18
Limitations of these apparent opioid-related deaths data
Data presented in this report should be interpreted with caution:
This report is based on data submitted to the Public Health Agency of Canada on or before December 11,
2017. New or revised data submitted after this date will be reflected in future updates.
Data released by provinces and territories may differ from the data provided in this report due to the

availability of updated data, differences in the type of data reported (e.g. manners of death), alternate age
groupings, differences in time periods presented, etc.
As some data are based on ongoing investigations by coroners and medical examiners, they are considered
preliminary and subject to change. Data are considered closed (certified) after completion of the death
investigation by the coroner/medical examiner. The time required to complete an investigation and related
administrative processes is case-dependent and can range from approximately 3 to 24 months.
This report does not distinguish between pharmaceutical and non-pharmaceutical opioids, or prescription
and non-prescription drugs, which may have differing levels of potency.
Jurisdictional differences in the death investigation process, death classification method, toxicology testing
and type of data reported (e.g. intentional/suicide deaths included or excluded) may impact the
interpretation and comparability of the reported data.
Information related to changes over time at the national level is based only on jurisdictions where data were
available for all time periods of interest.
Rates reported here have not been age-standardized and therefore have not been adjusted for existing
differences in provincial and territorial age distributions.
Rates for jurisdictions with smaller populations may change substantially with even slight changes in the
number of deaths; comparisons over time and between jurisdictions should be interpreted with caution.
Footnotes
Footnote a
The revised number and rate of apparent opioid-related deaths in 2016 reflects updates to provincial or
territorial data.
Return to footnotea Referrer
Footnote b
Given jurisdictional differences in death classification methods, the term “involved” includes deaths where
the substance was either detected and/or directly contributed to the death.
Return to footnoteb Referrer
Footnote c
These percentages are based only on jurisdictions where data were available for both time periods. Higher
percentages in 2017 compared to 2016 of apparent opioid-related deaths involving fentanyl or fentanyl
analogues should be interpreted with caution. The observed differences between the two time periods may
reflect relative increases in the numbers of deaths involving fentanyl or fentanyl analogues, or may reflect a
delay in the reporting of deaths involving non-fentanyl-related opioids in some jurisdictions. Furthermore,
these data are preliminary and are subject to change.
Return to footnotec Referrer
Footnote d
Data were not available from British Columbia, Saskatchewan, and Quebec. Not all provinces and
territories were able to report data for the full time period (January 2016 to June 2017). This percentage
includes only 2016 data for Ontario, data from January 2016 to March 2017 only for Manitoba and
Newfoundland and Labrador, and data from Alberta for closed cases only. Ontario data do not include
alcohol as one of the non-opioid substances.
Return to footnoted Referrer
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Date modified:
2018-04-06
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