Abstract

Background

Following the 2016 opioid overdose emergency declaration in British Columbia (B.C.), provincial stakeholders collaborated to link data that resulted in the B.C. Provincial Overdose Cohort. This database provides information about people who have experienced opioid overdoses to inform policy and intervention developments. Subsequently, Statistics Canada likewise constructed a cohort and integrated federal data to broaden the scope of the B.C. initiative. This provided federally sourced information about people’s circumstances that was not otherwise available.

Methods

The Statistics Canada British Columbia Opioid Overdose Analytical File further characterizes the socioeconomic circumstances of 13,318 people who experienced illicit drug toxicity deaths and non-fatal opioid overdoses in B.C. between January 1, 2014, and December 31, 2016. Statistics Canada linked federal data on immigration, employment, the justice system and social assistance receipt in the year of, and prior to, people’s first overdose.

Results

During the observation period, most people (78%) had one overdose episode, rather than several. Seven percent were immigrants or temporary residents, 41% of whom arrived in Canada more than 20 years before their index overdose. Half (49.6%) had not received social assistance, and one-third (33.8%) were employed—primarily within construction (21% of those employed)—in the year prior to their index overdose. Most employed people (65.5%) experienced periods of unemployment within five years prior to their index overdose. Employment was more prevalent among people who experienced illicit-drug toxicity death (36.1%). About 60% of people had not had any formal police contact within the two years prior to the index overdose.

Interpretation

This project demonstrated further added value to existing data by using this linkage approach and aligned with strategies underway by BC public health partners to provide cross-sectoral evidence to inform efforts to prevent and manage opioid overdoses.

Keywords

opioids, illicit drugs, linked data, administrative data

DOI: https://www.doi.org/10.25318/82-003-x202100200003-eng

Findings

In 2016, British Columbia’s (B.C.) Provincial Health Officer declared a public health emergency in response to increases in illicit-drug overdoses and related deaths. Between 2011 and 2016, the number of illicit-drug toxicity deaths in B.C. totalled 2,788, having increased from 295 in 2011, to 991 in 2016. These deaths were largely related to the use of illicit fentanyl and its analogues. In 2019, these substances were detected in 87% of illicit-drug toxicity deaths. In 2012, this proportion was 5%. Although the opioid crisis is national in scope, B.C. continues to experience a disproportionately higher rate of deaths attributed to illicit drug overdoses, at 20.7 per 100,000 population (age-adjusted), relative to 8.4 for the whole of Canada. [Full article]

Authors

Gisèle Carrière gisele.carriere@canada.ca and Rochelle Garner (rochelle.garner@canada.ca) are with the Health Analysis Division, Analytical Studies Branch, Statistics Canada and Claudia Sanmartin (claudia.sanmartin@canada.ca) is with the Strategic Analysis, Publications and Training Division, Analytical Studies Branch, Statistics Canada.

Acknowledgements

The authors wish to thank the Government of British Columbia (B.C.) data steward representatives, who were provided the opportunity to review the appropriateness of use of these data for this article, as well as the B.C. government partners who provided expert data advice to Statistics Canada: the British Columbia Ministry of Health, Elizabeth Vickery (B.C. Stats), Martin Monkman (B.C. Stats), Lisa Lapointe (B.C. Coroners Service), Tej Sidhu (B.C. Coroners Service). Consulted experts Michael Otterstatter, Amanda Slaunwhite and Margot Kuo, at the B.C. Centre for Disease Control, should also be acknowledged for providing guidance to Statistics Canada.
“All inferences, opinions, and conclusions drawn in this report are those of the authors, and do not reflect the opinions or policies of the data steward(s).”

 

What is already known on this subject?

  • Opioid overdoses are more common among males and younger adults (i.e., aged 20 to 39).
  • People who overdosed had high engagement with health services in the year prior to their overdose.
  • Substance use and mental health-related concerns were the primary diagnoses among people in B.C. who were hospitalized and, subsequently, overdosed.
  • Most people who overdosed in B.C. did not have a prescription for a pain-relieving opioid, and half had not had one in the five years prior to their overdose.

What does this study add?

  • Seven percent of people who overdosed in B.C. were immigrants or temporary residents, 41% of whom landed in Canada more than 20 years before their index overdose.
  • Among people who overdosed in B.C., half had not received social assistance.
  • One-third were employed, primarily in construction, in the year prior to their index overdose, yet 65.5% of these workers experienced unemployment within the five years prior to their index overdose.
  • Among people who overdosed in B.C., about 60% did not have any formal police contact within the two years prior to their index overdose and, among those who did, offences were primarily shoplifting-related.

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