The number of opioid deaths is accelerating in the hardest-hit provinces of British Columbia and Alberta, with Canada’s top doctor describing the growing crisis across the country as “devastating.”
Nearly 4,000 Canadians died as a result of opioids in 2017, a 34-per-cent jump from the previous year, according to data from a new federal task force.
In B.C., for example, there were 523 deaths attributed to illegal-drug overdoses (primarily opioids) in 2015. A year later, the number of such deaths rose to 974 and increased further to 1,399 in 2017. In Alberta, there were 443 opioid deaths in 2015. That number rose to 548 in 2016 and 714 in 2017. And in Ontario, more than 1,100 people died from opioid overdoses last year, up from 726 a year earlier.
The increasing number of opioid-related deaths shows “how this crisis is devastating for Canadians from all walks of life,” Theresa Tam, Canada’s Chief Public Health Officer, said in a conference call with reporters Tuesday. “We know we need to reverse the trend of this crisis.”
More than 90 per cent of the deaths were unintentional. And 72 per cent involved prescription and illicit fentanyl, an increase from 55 per cent in 2016. The majority of deaths involved men and nearly 30 per cent of all opioid-related deaths occurred in people aged 30 to 39.
“They eradicated a small town of Canadians in just one year,” said Benedikt Fischer, senior scientist at the Institute for Mental Health Policy Research at Toronto’s Centre for Addiction and Mental Health. “I don’t even think we have the vocabulary any more to describe [how] it’s getting worse.”
After the United States, Canada is the world’s second highest per capita consumer of painkilling opioids such as oxycodone, hydromorphone and fentanyl. Under pressure to curb the death toll, Health Canada has announced a number of measures, such as dedicating $100-million over five years to the national drug strategy, which includes urgent funding to the hard-hit provinces of B.C., Alberta and Manitoba.
This week, Health Canada also moved to reclassify the opioid tramadol as a controlled narcotic. And on Tuesday, it said it is moving to clamp down on advertising of opioids to doctors, and is asking drug makers to voluntarily cease marketing activities related to opioid drugs until new rules are created. Industry members said they would co-operate with Health Canada.
As part of the proposal, Health Canada said it will provide $5-million over five years to create a dedicated marketing compliance and enforcement team to monitor opioid marketing and enforce any new rules. The force will recommend criminal charges, where appropriate, Health Canada said. The proposal will be open to public consultation until July 18.
Ms. Tam said these steps are necessary to combat opioid misuse, dependence and addiction.
In addition to deaths, 17 people are taken to hospital every day across Canada as a result of opioid poisonings, according to figures also published Tuesday by the Canadian Institute for Health Information. That’s up from an average of 16 a day in 2016.
New CIHI data also show a dip in opioid prescriptions in Canada, from 6,269 daily doses per 1,000 people in 2016 to 5,633 in 2017. And after years of increases, the total number of opioids prescribed in Canada dipped to 21.3 million in 2017, compared with 21.7 million in 2016. In 2012, the total number of opioid prescriptions was 20.3 million.
CIHI also found that the daily doses of benzodiazepines and related drugs dispensed in Canada dropped nearly 6 per cent from 2016 to 2017. The drugs are often prescribed to treat anxiety or sleep disorders.
Tara Gomes, a scientist at the Li Ka Shing Knowledge Institute at Toronto’s St. Michael’s Hospital, said the trend of rising opioid-related death rates and lower prescription rates is troubling. Too much attention has been focused on overprescribing of opioids at the expense of ensuring existing users have easy access to treatment and other resources, she said. In many parts of Canada, for instance, it can be difficult for opioid users or their loved ones to access naloxone, a drug that counteracts the effects of opioids and can save the life of a person who overdoses.
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Lower opioid prescribing rates could also signal a problem, said David Juurlink, an opioid expert and head of clinical pharmacology and toxicology at Toronto’s Sunnybrook Health Sciences Centre. Some doctors, worried about the opioid crisis, may be cutting off patients who are taking high doses. Doing so could push those patients to illicit drugs and could make the situation “far, far worse,” he said.
“It’s true we need to prescribe more carefully, but we must also help people with addiction by providing them with the sort of care that we know works and saves lives,” Dr. Juurlink said, adding that Health Canada’s plan to restrict opioid advertising is a good idea, but one that should have been done years ago.
“Had they been more cautious 20 years ago ... we might be in a different place today,” he said. Innovative Medicines Canada, an industry association representing drug companies, said it will comply with any policies related to marketing.
The organization’s members understand that “non-medical use, misuse, abuse and diversion of prescription medicines, including prescription opioids, is a major public health crisis in this country,” the organization said in a statement.
Purdue Pharma Canada, which brought OxyContin onto the market and has been a major manufacturer of opioids, said in a statement it has always marketed products in accordance with Health Canada’s rules and that it looks forward to participating in the government’s consultation process.
With a report from Andrea Woo in Vancouver