Non-medical opioid use, harms, and interventions in Canada – a 10-year update on an unprecedented substance use-related public health crisis

Abstract

This commentary follows up on previous examinations on the state and evolution of opioid use, related harms, and interventions since the early 2000s in Canada. Since the most recent commentary, there have been distinct yet heterogeneous developments on these fronts. Policy and intervention systems have become notably more active in regards to what is now popularly dubbed ‘the opioid crisis,’ including a widely expanded array of prevention and treatment interventions; however, these have been limited in overall reach and impact. While population-level opioid dispensing and exposure have overall plateaued, or selectively decreased by province, in recent years, key indicators of opioid morbidity, but especially mortality and its related population health burden have continued to substantially increase across Canada. The latter developments have been associated with the devastating impact of recent increases in the availability of potent illicit opioid products following increasingly restricted medical opioid supplies for which direct intervention measures have been largely amiss. Key surveillance indicators are improved yet continue to include major gaps. More than a decade into this unprecedented public health problem, Canada continues to search for a comprehensively effective and integrated strategy combining prevention and treatment measures towards effectively reducing the burden of opioid-related population health harms.