Abstract
BackgroundOver the past decade, rates of drug poisoning deaths have increased dramatically in Canada. Current evidence suggests that the non-medical use of synthetic opioids, stimulants and patterns of polysubstance use are major factors contributing to this increase.MethodsCounts of substance poisoning deaths involving alcohol, opioids, other central nervous system (CNS) depressants, cocaine, and CNS stimulants excluding cocaine, were acquired from the Canadian Vital Statistics Death Database (CVSD) for the years 2014 to 2017. We used joinpoint regression analysis and the Cochrane-Armitage trend test for proportions to examine changes over time in crude mortality rates and proportions of poisoning deaths involving more than one substance.ResultsBetween 2014 and 2017, the rate of substance poisoning deaths in Canada almost doubled from 6.4 to 11.5 deaths per 100,000 population (Average Annual Percent Change, AAPC: 23%, p < 0.05). Our analysis shows this was due to increased unintentional poisoning deaths (AAPC: 26.6%, p < 0.05) and polysubstance deaths (AAPC: 23.0%, p < 0.05). The proportion of unintentional poisoning deaths involving polysubstance use increased significantly from 38% to 58% among males (p < 0.0001) and 40% to 55% among females (p < 0.0001). Polysubstance use poisonings involving opioids and CNS stimulants (excluding cocaine) increased substantially during the study period (males AAPC: 133.1%, p < 0.01; females AAPC: 118.1%, p < 0.05).ConclusionsIncreases in substance-related poisoning deaths between 2014 and 2017 were associated with polysubstance use. Increased co-use of stimulants with opioids is a key factor contributing to the epidemic of opioid deaths in Canada.
Highlights
Over the past decade, rates of drug poisoning deaths have increased dramatically in Canada
This study presents counts, rates and proportions of polysubstance-related poisoning deaths involving alcohol, opioids, other central nervous system (CNS) depressants, cocaine, and other CNS stimulants excluding cocaine using data acquired from the Canadian Vital Statistics Death Database for the years 2014 to 2017
The Multiple Cause of Death files (MCOD) database provides information on a single underlying cause of death (UCD), up to 20 additional causes and demographic data from all provincial and territorial vital statistics registries on all deaths occurring in Canada
Summary
Data sources and cause of death variables All methods were performed in accordance with the relevant guidelines and regulations. The multiple cause of death data using the ICD-10 “T” codes is used to identify poisoning deaths resulting from combinations of substances across the selected substance categories. Among deaths with substance poisoning as the underlying cause, the type of substance or substance category is indicated by the following ICD-10 multiple cause-of-death codes: alcohol (T51.91, T51.92, T51.94), opioids (T40.0, T40.1, T40.2, T40.3, T40.4, or T40.6); other CNS depressants (T42.3, T42.2, T42.6, T42.7), cocaine (T40.5); and CNS stimulants excluding cocaine (T43.6). A substance poisoning death is Statistical analyses Crude mortality rates were calculated by sex and intent for the years 2014 to 2017 and were expressed as the number of deaths reported each calendar year divided by.
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