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07 Jun 2017

Canadian opioid overdose data provide only a partial picture of death toll

by Kelly Grant and Karen Howlett

 

Nearly seven people a day died of opioid-related overdoses in Canada last year, according to the first official attempt to measure the toll that the powerful drugs, including illicit fentanyl, have taken from coast to coast.

In a slim report released on Tuesday, a national advisory committee on the opioid epidemic said there were at least 2,458 apparent opioid-related deaths in Canada in 2016, representing an average of almost seven a day or 8.8 fatalities for every 100,000 people in the country.

However, the national snapshot is far from complete: The committee declined to release preliminary figures by province, the total does not include Quebec, and the data from Ontario and Newfoundland and Labrador are from 2015, making them more than a year out of date.

The lack of detail in the new report underscores the long-standing challenge of tracking the opioid epidemic in a country where 13 provincial and territorial health-care systems collect and publish data on drug fatalities in different ways. Until April, there was not even a consistent national definition of what constitutes an opioid-related death.

Federal Health Minister Jane Philpott pledged last November to address the “huge gaps” in Canada’s ability to monitor the crisis by creating a central clearing house that will track emergency-department visits and overdose deaths. Dr. Philpott has expressed frustration with the jurisdictions that have not provided timely data, a concern echoed by those on the front lines of the opioid crisis.

“The absence of surveillance is a major problem,” said Hakique Virani, a public-health and addiction doctor in Edmonton. “Without characterizing a problem in real time, you can’t identify an epidemic, and you certainly can’t execute sensible action.”

The preliminary national death toll for 2016 was released by the co-chairs of a federal-provincial-territorial special advisory committee set up last December to tackle the epidemic of overdoses linked to opioids, a class of potent painkillers that includes oxycodone, hydromorphone and fentanyl, the illicit powdered version of which is behind a spike in overdoses.

Robert Strang, Nova Scotia’s chief medical officer of health and a co-chair of the special advisory committee, said the group did not release opioid deaths by province because several provinces, including his own, are still in the midst of tabulating their official figures.

“We didn’t want to hold up the release of the national number,” Dr. Strang said. “Certainly our objective is ultimately to have provincial numbers that are behind this.”

Several provinces already make opioid-related deaths public. In British Columbia, for example, the Coroners Service releases monthly reports on overdose deaths. In April, 136 people in B.C. died from illicit opioids, the second-highest recorded number in a single month, and almost double the 69 deaths in April, 2016.

In Ontario, an online surveillance system unveiled last month shows that at least 412 people died of opioid overdoses in the first six months of 2016, compared with 371 in the same period of 2015.

The special advisory committee and the Canadian Institute for Health Information (CIHI) which publishes the country’s official health-care statistics, gathered coroners and chief medical examiners from across Canada for a meeting on March 1 in Ottawa, where they developed a standard definition of an opioid-related death.

Tuesday’s report said the new national definition, which was formally settled on in April, includes deaths caused by poisoning as a result of drug use where one or more of the drugs is an opioid. The definition includes deaths stemming from accidental and intentional overdoses, and among those with and without a personal prescription for an opioid.

Eventually, the totals will include both preliminary and confirmed cases of fatal opioid poisoning, something Theresa Tam, Canada’s interim chief public health officer, hopes will speed up the release of data in the future.

“It would normally take many, many months for [coroners] to close a case and certify a death,” Dr. Tam said. “We’ve managed to move further up in the timing scale in having consensus that they would allow preliminary data to be counted.”

But Dr. Virani lamented the fact that it took the special advisory committee four months just to reach formal consensus on a definition.

“This pace would never be acceptable in a communicable diseases emergency,” he said. “It’s tragic that this test of our public health infrastructure's ability to monitor and respond to a non-communicable threat is happening in the face of an extremely toxic hazard.”

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