Characteristics of substance-related toxicity deaths in Ontario

Stimulant, opioid, benzodiazepine, and alcohol-related deaths

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Citation

Gomes T, Leece P, Iacono A, Yang J, Kolla G, Cheng C, Ledlie S, Bouck Z, Boyd R, Bozinoff N, Campbell T, Doucette T, Franklyn M, Newcombe P, Pinkerton S, Schneider E, Shearer D, Singh S, Smoke A, Wu F on behalf of the Ontario Drug Policy Research Network and Ontario Agency for Health Protection and Promotion (Public Health Ontario). Characteristics of substance-related toxicity deaths in Ontario: Stimulant, opioid, benzodiazepine, and alcohol-related deaths. Toronto, ON: Ontario Drug Policy Research Network. September 14, 2023. Available at: https://odprn.ca/research/publications/characteristics-of-substance-related-toxicity-deaths-in-ontario/.

Background

Coinciding with the COVID-19 pandemic emergency starting in March 2020, deaths due to accidental alcohol and drug toxicities increased 37% from 2020 to 2021 in Canada. In Ontario, detailed data on fatal substance-related toxicities have largely been restricted to opioid toxicity deaths, with limited data available on the relative frequency of toxicity deaths attributable to alcohol, benzodiazepines, and stimulants, and the frequency of polysubstance use among these deaths.

This is the first report of our joint three-report series by the ODPRN and Public Health Ontario. This report provides an overview on the trends and patterns of single and polysubstance (more than one substance) deaths from alcohol, benzodiazepines, opioids, and stimulants in Ontario (January 2018 to December 2021).

Objective

Given signals of increasing death rates due to alcohol and other drugs in Canada, there is a need for reporting of trends in toxicity deaths due to alcohol, stimulants, and benzodiazepines, either alone or in combination with other substances, including opioids. Therefore, this report describes trends and circumstances surrounding fatal substance-related toxicities broadly in Ontario, combining data on deaths due to alcohol, stimulants, benzodiazepines, and opioids.

Methods

We conducted a descriptive cross-sectional study to describe trends and characteristics among people who died from an alcohol, stimulant, benzodiazepine, or opioid toxicity in Ontario, Canada. To capture data on alcohol, stimulant, and benzodiazepine toxicity deaths, we used a newly derived database which includes information on deaths that occurred between January 1st, 2018 and December 31st 2021 in Ontario.

Results

There were 8,767 accidental substance-related toxicity deaths from 2018 to 2021 in Ontario that involved alcohol, stimulants, benzodiazepines, and/or opioids. Overall, substance toxicity deaths nearly doubled from 1,586 in 2018 to 2,886 in 2021 in Ontario. From January 2018 to December 2021, the monthly number of deaths involving one substance doubled, and the number of deaths involving two substances tripled. Overall, the highest proportion of individuals who died from a substance-related toxicity death were between the ages of 25 to 44 (52.7%), males (75.0%), and resided in neighbourhoods with the lowest income quintile.

Conclusion

The number of substance toxicity deaths is alarmingly high in Ontario – 5 times higher than deaths due to motor vehicle collisions in the province – and has grown at an unprecedented rate during the pandemic. These findings stress the continued relevance and need for the adaption and expansion of harm reduction programs, including supervised consumption services across Ontario, with a pressing need to consider programs and services in Northern Ontario.