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Prev Med. 2018 Feb;107:109-113. doi: 10.1016/j.ypmed.2017.11.001. Epub 2017 Nov 7.

The 'fentanyl epidemic' in Canada - Some cautionary observations focusing on opioid-related mortality.

Author information

1
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science (IMS), University of Toronto, Toronto, Canada; Centre for Criminology & Sociolegal Studies, University of Toronto, Toronto, Canada; Department of Psychiatry, Federal University of São Paulo, São Paulo, Brazil. Electronic address: benedikt.fischer@utoronto.ca.
2
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
3
Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (CAMH), Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science (IMS), University of Toronto, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Institut für Klinische Psychologie und Psychotherapie, Technische Universität Dresden, Dresden, Germany.

Abstract

In Canada, opioid-related overdose mortality has steeply increased in recent years; as a substantial number of opioid-related deaths are related to fentanyl products, this phenomenon has widely been described as the 'fentanyl epidemic', also implying that these deaths are largely caused by clandestinely produced illicit fentanyl products. We examined numbers and rates of opioid- and fentanyl-related deaths in six pan-Canadian provinces with respective (coroner-based) data available from 2010 to 2016. While fentanyl-related deaths are clearly increasing from relatively low levels in all provinces, those increases are strongest in the two Western provinces (e.g., British Columbia, where fentanyl accounts for the majority of opioid deaths in 2016 and Alberta), and, to some extent, Ontario. However, fentanyl-related deaths remain a minority of deaths in Ontario (40%) and the remaining provinces (<25%). Furthermore, it is uncertain what proportion of fentanyl-related deaths is actually related to illicit fentanyl products. We conclude that fentanyl-related overdose deaths have risen - most strongly in the West - due to both a high availability of medical fentanyl products, as well as an influx of illegal fentanyl products. In most provinces, the majority of opioid deaths remain associated with other (non-fentanyl) products. Appropriate (prevention, treatment and policy) interventions need to be targeted at the full range of opioid deaths from different sources. Overall, a realistic framing of the social (e.g., media) discourse about the nature of the 'opioid overdose death crisis' is required, which is not exclusively an 'illicit fentanyl death crisis' even though this may be a socio-politically appealing image.

KEYWORDS:

Canada; Fentanyl; Mortality; Opioids; Public health

PMID:
29126920
DOI:
10.1016/j.ypmed.2017.11.001
[Indexed for MEDLINE]

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