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Canadians who live in small cities face substantially higher risks of opioid overdoses than those who live in larger centres, according to new national data that expose how poverty, unemployment and other factors are exacerbating the continuing crisis.

More than 2,000 people died as a result of opioids from January to June, a slight increase over the same period in 2017, and 17 people are hospitalized across the country every day as a result of opioid overdoses, according to data released on Wednesday by the Public Health Agency of Canada and the Canadian Institute for Health Information (CIHI). The vast majority of the deaths were accidental and more than 70 per cent were linked to fentanyl, a powerful opioid.

The rate of hospitalizations for opioid overdoses was two and a half times higher in smaller cities with populations of 50,000 to 99,999 than in large urban centres, according to the CIHI data. Prince George, Nanaimo and Kamloops in British Columbia, Medicine Hat in Alberta and Belleville and Sault Ste. Marie in Ontario are among the communities with the highest hospitalization rate for opioid poisonings, according to CIHI.

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The top 10 communities in the 50,000 to

99,999 population size with the highest rates

of hospitalizations due to opioid poisoning by

community size, Canada, 2017

Hudson

Bay

B.C.

ALTA.

SASK.

0

650

MAN.

KM

Prince George

QUE.

ONT.

Red Deer

Kamloops

Medicine Hat

Belleville

Lethbridge

Nanaimo

Sault Ste. Marie

Chilliwack

Saint-Jean-sur-Richelieu

U.S.

THE GLOBE AND MAIL, SOURCES: HOSPITAL MORBIDITY

DATABASE, CANADIAN INSTITUTE FOR HEALTH

INFORMATION; TILEZEN; OPENSTREET CONTRIBUTORS; HIU.

NOTE: QUEBEC DATA AND POPULATION DATA ARE

FROM 2016 (THE MOST RECENT YEAR OF DATA AVAILABLE)

The top 10 communities in the 50,000 to 99,999

population size with the highest rates

of hospitalizations due to opioid poisoning by

community size, Canada, 2017

CANADA

Hudson

Bay

B.C.

ALTA.

SASK.

MAN.

0

650

KM

Prince George

ONT.

QUE.

Red Deer

Kamloops

Medicine Hat

Belleville

U.S.

Nanaimo

Lethbridge

Sault Ste. Marie

Chilliwack

Saint-Jean-sur-Richelieu

THE GLOBE AND MAIL, SOURCES: HOSPITAL MORBIDITY DATABASE,

CANADIAN INSTITUTE FOR HEALTH INFORMATION; TILEZEN; OPENSTREET

CONTRIBUTORS; HIU. NOTE: QUEBEC DATA AND POPULATION DATA ARE

FROM 2016 (THE MOST RECENT YEAR OF DATA AVAILABLE)

The top 10 communities in the 50,000 to 99,999 population size with

the highest rates of hospitalizations due to opioid poisoning

by community size, Canada, 2017

Hudson

Bay

B.C.

ALTA.

SASK.

MAN.

0

650

Prince George

KM

CANADA

ONT.

QUE.

Red Deer

Kamloops

Saint-Jean-sur-Richelieu

Sault Ste. Marie

Medicine Hat

Lethbridge

Nanaimo

Belleville

U.S.

Chilliwack

THE GLOBE AND MAIL, SOURCES: HOSPITAL MORBIDITY DATABASE, CANADIAN INSTITUTE FOR HEALTH

INFORMATION; TILEZEN; OPENSTREET CONTRIBUTORS; HIU. NOTE: QUEBEC DATA AND POPULATION DATA

ARE FROM 2016 (THE MOST RECENT YEAR OF DATA AVAILABLE)

“People are really suffering here,” Andrew Gray, medical health officer for the northern interior region of B.C.’s Northern Health, said from Prince George. “There are a lot of people who are grieving, who are burning out from the stress.”

While the opioid crisis affects every part of Canada, Dr. Gray and other experts say there are a few factors that make smaller communities more susceptible. Access to methadone or suboxone, which are opioids used to treat addiction, and other health-care resources may be better in larger cities. But small communities also tend to have lower employment rates, higher poverty and other factors known as the social determinants of health that are often linked to a higher risk of opioid use and related problems.

“The social determinants of health have a very strong impact on addiction,” Dr. Gray said. “People continue to use opioids … because they’re still in pain.”

Jeffrey Eppler, an emergency physician at Kelowna General Hospital, said he’s seen more overdoses in the past two years than in the previous 20.

“I’ve lost people I know,” he said. “It’s close to home. So many people have been touched by this.”

Claire Dineen, health promotion educator at the AIDS Vancouver Island Health Centre in Nanaimo, attributed the high overdose rates in part to the city’s geography; Nanaimo is a seaside community with a milder climate that can draw homeless and drug-using populations from elsewhere.

More than 150 homeless people who once inhabited a sprawling tent city by the waterfront just moved into newly opened modular housing, but Ms. Dineen said the city still needs to significantly increase treatment services.

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Opioid poisoning hospitalization rates,

census metropolitan areas,

Canada, 2017

4.6–10.0

10.1–20.0

Age-adjusted rate per

100,000 population

20.1–30.0

30.1–40.0

40.1–53.0

Thunder Bay

Ottawa–Gatineau

(Quebec part)

Vancouver

Quebec

Edmonton

St. John’s

Saskatoon

Moncton

Winnipeg

Halifax

Toronto

Saint John

Greater

Sudbury

Victoria

Montreal

Regina

Ottawa–

Gatineau

(Ontario part)

Calgary

Brantford

Kelowna

London

Abbotsford–Mission

St. Catharines–

Niagara

Hamilton

Notes: Quebec data is from 2016 (the most

recent year of data available). To be considered

a CMA, the area must have a total population

of at least 100,000, of which 50,000 or more

live in the urban core.

CARRIE COCKBURN/THE GLOBE AND MAIL,

SOURCE: HOSPITAL MORBIDITY DATABASE, CANADIAN

INSTITUTE FOR HEALTH INFORMATION.

Opioid poisoning hospitalization rates,

census metropolitan areas, Canada, 2017

Age-adjusted rate per 100,000 population

4.6–10.0

10.1–20.0

40.1–53.0

20.1–30.0

30.1–40.0

Thunder Bay

Ottawa–Gatineau

(Quebec part)

St. John’s

Edmonton

Quebec

Saskatoon

Moncton

Vancouver

Winnipeg

Halifax

Toronto

Saint John

Montreal

Calgary

Greater

Sudbury

Victoria

Regina

Ottawa–Gatineau

(Ontario part)

Kelowna

Brantford

Abbotsford–

Mission

St. Catharines–

Niagara

London

Hamilton

Notes: Quebec data is from 2016 (the most recent year

of data available). To be considered a CMA, the area must

have a total population of at least 100,000, of which

50,000 or more live in the urban core.

CARRIE COCKBURN/THE GLOBE AND MAIL,

SOURCE: HOSPITAL MORBIDITY DATABASE, CANADIAN INSTITUTE

FOR HEALTH INFORMATION.

Opioid poisoning hospitalization rates, census metropolitan areas, Canada, 2017

Age-adjusted rate per 100,000 population

4.6–10.0

10.1–20.0

40.1–53.0

20.1–30.0

30.1–40.0

Ottawa–Gatineau

(Quebec part)

St. John’s

Edmonton

Quebec

Thunder Bay

Saskatoon

Vancouver

Moncton

Winnipeg

Halifax

Toronto

Saint John

Montreal

Calgary

Greater

Sudbury

Victoria

Ottawa–Gatineau

(Ontario part)

Regina

Kelowna

Brantford

St. Catharines–

Niagara

Abbotsford–Mission

London

Hamilton

Notes: Quebec data is from 2016 (the most recent year of data available). To be considered

a CMA, the area must have a total population of at least 100,000, of which 50,000 or more

live in the urban core.

CARRIE COCKBURN/THE GLOBE AND MAIL, SOURCE: HOSPITAL MORBIDITY DATABASE, CANADIAN INSTITUTE

FOR HEALTH INFORMATION.

“They’re not in tents any more; that’s great, but we need to have a lot of other services,” she said.

Bob Hughes is the Kamloops-based executive director of the Ask Wellness Society, an organization that advocates for at-risk populations. He said he was not surprised to hear of the high hospitalization rate from a year or two ago, but noted there has been a “seismic change” in the availability of services and supports since.

“Some major inroads have been made around addressing homelessness in our community, and efforts by the health authority have been unprecedented, in my 20 years in the field,” he said, citing supervised consumption service, drug-checking technology and a housing-first initiative as examples.

Dr. Gray said part of the challenge is making people more aware of who is most at risk and how to reduce stigma and build strategies to help them. Many people think of Vancouver’s Downtown Eastside when they think of drug overdoses, but when it comes to opioids, a large proportion of those dying are using drugs at home alone, where help can’t reach them in time.

“A lot of the people that are dying are dying behind closed doors,” he said. “A lot of these cases don’t make the news.”

Opioids have long been a public health issue in Canada but has exploded in the past few years as a result of fentanyl. Illicit fentanyl, often shipped to Canada from China, is increasingly being added to cocaine, MDMA and other street drugs, and users have no idea they are ingesting a powerful, deadly opioid, said Bonnie Henry, B.C.'s provincial health officer.

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She said the new figures demonstrate much more needs to be done to address the crisis. Canada must consider decriminalizing opioids, expanding the number of safe consumption sites and stopping the flow of toxic fentanyl.

Without these and other measures, “it’s discouragingly hard to see how it’s going to get a lot better,” Dr. Henry said.

Evan Wood, executive director of the British Columbia Centre on Substance Use, said while political leaders and policy-makers recognize there is a crisis, they aren’t taking the bold steps required to address it, such as decriminalization or providing much greater access to safe consumption sites.

“I think there’s a failure to really look at the structural reasons that the situation is worsening,” he said. “There still seems to be a lot of hesitancy for bold action.”

Federal Health Minister Ginette Petitpas Taylor told reporters this issue “keeps me up at night” because of the damage it’s causing. She called the opioid crisis her “No. 1 priority."

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