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The cost of substance use in Canada reached an estimated $46-billion and contributed to almost 75,900 deaths in 2017, with drinking and smoking principally responsible, according to a new report.

The report, to be published Tuesday by the Canadian Centre on Substance Use and Addiction (CCSA), found alcohol and tobacco to be by far the deadliest drugs. Together they led to 66,027, or almost 87 per cent, of substance use-related deaths that year and accounted for almost two-thirds of the associated costs of all substance use, including health care, lost productivity and criminal justice.

Opioids, meanwhile, caused 5,084 deaths and accounted for $5.9-billion, or almost 13 per cent, of the total costs for that year.

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Matthew Young, one of the authors and a senior research and policy analyst at the non-governmental CCSA, which reports to Parliament, said the report offers a comparison of the toll various substances have on Canadians.

“We’re in the middle of an opioid crisis and it’s really important and it’s destroyed a lot of people’s lives,” Dr. Young said. “But sometimes because of that, we also forget the toll that other substances like alcohol have on our population as well.”

The report provides estimates for 2015 to 2017, the most recent year for which complete data is available, and found a significant increase in the costs associated with the use of opioids and central nervous system stimulants such as amphetamines and methamphetamine. Meanwhile, even though tobacco use (not including vaping) was responsible for the greatest number of deaths, the costs associated with it had fallen – a trend the authors said was a reflection of strong public-health policies designed to curb its use.

This was not the case with alcohol, however. Costs associated with alcohol use were on the rise, largely owing to lost productivity as a result of injuries and deaths occurring at a young age, the authors said.

“We haven’t really invested a large amount in our public-health response to alcohol-related harms,” Dr. Young said, noting that some provinces and territories have, in fact, eased restrictions on the sale and availability of alcohol.

The report says regulations for advertising alcohol are also outdated and do not apply to modern digital media.

Moreover, Dr. Young added, alcohol remains more socially accepted than other substances. “We, as a culture, kind of see alcohol a little bit differently. We associate it with joy and celebration,” he said, but “it does have this darker side, and we see that appear in our study.”

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The cost of all substance use amounted to an average of $1,258 per Canadian in 2017, the report says. The costs were far higher in the Northwest Territories and Nunavut, partly owing to their sparse populations and the higher cost of providing health care there, Dr. Young said. Substance use cost $4,045 a person in the Northwest Territories and $5,608 in Nunavut.; by way of comparison, it cost $1,344 a person in B.C. and $1,235 in Ontario.

The authors used multiple data sets, including hospitalization data and crime records from the provinces and territories, to estimate how much money Canadians would have saved and the number of deaths and illnesses that would have been avoided in the absence of the various substances. For health conditions that were not 100-per-cent attributable to substance use – for example, colorectal cancer – they based their calculations on the risk of developing such conditions with a particular substance involved.

The authors said their findings provide a baseline against which they can gauge how the costs and harms of substance use will change as a result of the pandemic and the legalization of non-medical cannabis in 2019. (The report says cannabis accounted for $3.2-billion, or 7 per cent, of the total costs of substance use in 2017.)

Dave Martell, an addiction medicine physician in Lunenburg, N.S., who was not involved in the CCSA report, said he was not surprised to see that alcohol and tobacco continue to cause the most harm and account for a high percentage of health care costs. Even though the opioid crisis tends to get more media attention, policy makers should not lose sight of the harms and costs associated with those common substances, he said.

He noted that while the report provides a snapshot through 2017, we need more current data, as the substance use landscape in Canada keeps changing.

“Things are moving so quickly that data is becoming critical to collect and reflect on,” Dr. Martell said, noting that more reports like this one would “allow us to do these kinds of reflections and to drive policy on an ongoing basis.”

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