Canada’s other epidemic: As overdose deaths escalate, majority favour decriminalization of drugs

Canada’s other epidemic: As overdose deaths escalate, majority favour decriminalization of drugs

Public opinion reflects empirical data: half say opioid crisis worsening in their own communities


February 24, 2021 – It is unlikely that Canadians were ever as galvanized by public health data as they have been over the last twelve months. The past year has offered an endless avalanche of trackable statistics about COVID-19 infections, hospitalizations, deaths, recoveries, and vaccinations.

Perhaps lost in this information overload is the ongoing and deepening tragedy of Canada’s other epidemic: one that is bearing witness to more death, misery, and suffering as a result of drug addiction – propelled in particular by opioid dependence.

Against the backdrop of record deaths and calls from top cops to decriminalize the possession of hard drugs, a comprehensive new study of 5,003 Canadian adults from the Angus Reid Institute finds two trends defining the opioid epidemic in the public discourse.

Seven-in-ten Canadians say that they feel the problem of opioid addiction has worsened over the past year in Canada. For half (48%), it is a worsening in their own community.

While a majority recognize this broad trend, far fewer Canadians have had the energy or time to focus on the issue. In February 2019, fully two-in-five (42%) said they were following it closely and having discussions about it with their friends and family. Now, as COVID-19 consumes their personal bandwidth, just 16 per cent say the same.

Most, however, are calling for action. A majority in every province canvassed support the decriminalization of all illegal drugs (with the exception of those in Saskatchewan and New Brunswick, where nearly half do). It is a move advocates say would reduce the risk to users by improving the quality of supply whilst encouraging people who use drugs to seek treatment without stigma. Further, two-thirds support increasing access to supervised injection sites. Opponents suggest that liberalizing Canada’s drug laws is not the answer and support a tougher approach. Nearly half (45%) say it would be better to “get tough” on users by increasing arrests and charges for possession of illicit substances.

More Key Findings:

  • Canadians from coast-to-coast are critical of their provincial governments’ handling of this issue. A majority in each province, with the exception of Quebec, say their province is doing a poor job on this file
  • The issue is perceived as more serious in urban areas, where 68 per cent say it is a problem to be dealt with. That said, fully half (53%) of rural residents feel the same about their community
  • Majorities of past Conservative (63%) and Bloc Quebecois (57%) voters say that increasing punitive measures against people who use drugs is the right policy to pursue
  • Among those who report knowing someone who became dependent on these substances, two-in-three (63%) say that person either did not seek help or sought help but had a difficult time finding it
  • One-in-ten British Columbians (11%) say they know someone who has died due to an overdose from opioids, compared to 5 per cent who say this overall

 

About ARI

The Angus Reid Institute (ARI) was founded in October 2014 by pollster and sociologist, Dr. Angus Reid. ARI is a national, not-for-profit, non-partisan public opinion research foundation established to advance education by commissioning, conducting and disseminating to the public accessible and impartial statistical data, research and policy analysis on economics, political science, philanthropy, public administration, domestic and international affairs and other socio-economic issues of importance to Canada and its world.

 

INDEX:

Introduction

Part One: Awareness and concern

  • Spotlight on opioid crisis dims amid pandemic

  • Half say situation is deteriorating in their own communities

  • Anxiety highest in Vancouver, Regina, Saskatoon

Part Two: Personal Impact

  • Proximity to opioid use drives perceptions of gravity

  • Opioids and personal proximity: the national picture

  • Many who struggle with dependency have trouble finding help

Part Three: What to do?

  • Canadians deeply unsatisfied with provinces on crisis response

  • Policy options

  • Canadians tilt slightly away from “getting tough”

  • Personal proximity to the issue drives support for less punitive measures

  • Quebecers open to injection sites, British Columbians back decriminalization

Additional Data and Information

  • Appendix 1 – Provincial data on drug toxicity deaths

  • Appendix 2 – Support for policy options by provincial party support

Introduction

Canada’s public policy discourse over the last year has – for obvious reasons – centred on the COVID-19 pandemic. Other priorities have dissipated in the wake of more than 21,000 Canadian deaths and hundreds of thousands more infections from the coronavirus. Issues that were once top of mind are today more distant priorities. For example, climate change dropped from a top issue in the last year to a distant fourth behind pressing economic and health concerns.

Perhaps no issue, however, has suffered from a deficit of attention more than the ongoing opioid crisis. Side effects of the COVID-19 pandemic have included deteriorating mental health for many – and for some – increasing issues with addition. In the last year, across the country, deaths due to opioid use have skyrocketed. While advocates plead for help, huge portions of a formerly attuned Canadian public have, at least temporarily, changed the channel. Unchanged and growing, however, is the impact both of opioid usage, both direct and indirect, on millions of Canadians.

Part One: Awareness and concern

Spotlight on opioid crisis dims amid pandemic

Provinces across the country have seen record overdose deaths involving opioids (see Appendix 1 for definition). Yet despite these troubling statistics, recent data indicate that the number of Canadians who say they are following this issue closely has plummeted, down 26 percentage points from early 2019. While research from the Canadian Centre on Substance Use and Addiction has shown the negative impacts of both health emergencies to be intimately connected, one problem is drawing considerably more attention that the other.

Despite their lessened attention to the issue, Canadians still perceive it as serious. Seven-in-ten say opioid addictions and deaths are a “serious problem” or “a crisis” in Canada, while about the same number gauge the issue as seriously in the province where they live. By contrast, just two-in-five (38%) perceive a serious problem or crisis with opioid addiction in their own communities:

There appears to be a significant correlation between awareness of the issue and perceived gravity of it. More attention to news surrounding opioid addiction mirrors the number of residents who say the problem is serious in their own province. In British Columbia, where the Coroner’s Service recently reported that more than 1,700 people died due to illicit drug use in 2020, three-quarters of residents say that the opioid issue is serious. This proportion drops to half in Quebec and Nova Scotia:

Half say problem has worsened in their own community over the past year

As the crisis has intensified, Canadians have seen the impacts closer to home. At a broad level, seven-in-ten say the problem of addictions and death have worsened in the country overall in the past year. In the community where they live, half (48%) note the same trend, and only four per cent say they have seen conditions in their community improve:

In the areas where residents are already expressing the most alarm about the situation, they are also most likely to perceive a deterioration. In Regina and Saskatoon, nearly three-quarters of residents say the problem is worsening where they live:

Anxiety highest in Vancouver, Regina, Saskatoon

This comprehensive study enables the Angus Reid Institute to analyze how people in many of Canada’s larger cities are perceiving the existence and impacts of opioid addiction in their own communities. Three urban areas stand out for their worry and unease. Roughly half of the residents of Vancouver, Regina, and Saskatoon say that opioids are a crisis or a serious problem in their community.

For years, Vancouver has held the reputation as ground zero for Canada’s opioid crisis. In 2016, the provincial government declared a provincial health emergency due to the opioid epidemic, with Vancouver enduring the vast majority of the deaths and overdoses. Advocates have also led the way in helping to create the first supervised injection site in North America – Insite – which was founded in 2003.

The reality, however, is that opiate dependence exists in almost every corner of the country and is taking on epidemic proportions in places far from the west coast. An apparent increase in the presence of fentanyl (an opioid 100 times the potency of morphine) in the illicit drug supply in Regina and Saskatoon is contributing to the spike in overdose deaths in the province of Saskatchewan (see Appendix 1). People living in these respective cities are unsurprisingly alarmed:

Please note that data from other cities are not included due to small sample sizes.

While urban areas are home to many of the most devastating impacts of the opioid epidemic, Canadians living in rural communities are also concerned, given research indicating overdose and dependence widely occur in suburbs and rural areas. In many cases, the impacts can be even worse in such places, which often lack existing systems and resources with which to respond. Fully half (53%) of rural Canadians say opioid addiction is a problem in their community, with three-in-ten saying it is serious or a crisis:

Part Two: Personal Impact

Opioid use in general is fairly familiar to many Canadians: two-in-five (38%) say they personally know someone who receives a prescription for opioids, commonly prescribed to manage acute or chronic pain. Troublingly, a significant number of Canadians say that they have also seen the effects and devastation of opioid addiction in their own social circles.

Related: Cost, access to treatment pose significant barriers for those suffering from chronic pain

While a small number of Canadians say that they, themselves, have dealt with opioid dependency (see detailed tables), one-in-seven (14%) know someone else who has endured these same challenges, speaking to the breadth of this issue and the permeation it has into Canadians’ lives. While unquestionably a valuable medicine for those dealing with chronic pain, one estimate finds that roughly 10 per cent of those who are prescribed opioids for chronic pain go on to develop an opioid use disorder.

*Question fielded separately January 7 – 11

Proximity to opioid use drives perceptions of gravity

These experiences and relationships affect assessments of the problem. Those who have struggled with a dependency themselves, or know someone who has endured challenges or worse, lost their lives, are much more likely to say the problem is more acute in their community now than it was last year:

Opioids and personal proximity: the national picture

In recent years, Canada’s westernmost provinces have endured the worst rates of opioid dependency in the country. This may be changing as the grip of the epidemic intensifies in both Ontario and Quebec. A recent study conducted by Ontario Public Health found that opioid deaths rose 38 per cent in the province in the first 15 weeks of pandemic. Meanwhile, Quebec first saw a surge in overdose deaths in 2019, and then again 2020 (see Appendix 1).

B.C. residents continue to have the most personal proximity to opioid dependence within their social circles. One-in-ten British Columbians (11%) say they personally know of someone who has died from opioid dependence, although personal connection to someone who has dealt with addiction or dependency is significant across the country:

*Question fielded separately January 7 – 11

Many who struggle with dependency have trouble finding help

Among those who report knowing someone who became dependent on opioids, two-in-three (63%) say that person either did not seek help or sought help but had a difficult time finding any.

Part Three: What to do?

Canadians deeply unsatisfied with provinces on crisis response

Amid the ongoing epidemic, Canadians have been looking to both the federal and their provincial governments for action. While provincial governments are responsible for handling the ongoing response to the crisis, such as access to treatment and dealing with street crime, many possible policy responses (for example decriminalization of drug possession) are handled at the federal level. In 2019, the Angus Reid Institute asked if their governments had invested appropriate resources in this area and the desire for more action was clear.

Today, a mere three per cent of Canadians say their provincial government is doing a ‘very good’ job in dealing with drug use and addictions, while one-quarter (23%) say they’re handling it well. Half say their province is doing either a poor job (30%) or very poor job (22%).

While Premier John Horgan has been consistently praised for his work on COVID-19 and overall governance, his government performs worst on this issue, with two-thirds of British Columbians critical of the BC NDP’s response.

Policy Options

As the toll of overdoses rises, a wide variety of treatments are being undertaken and debated among advocates and policymakers. The Angus Reid Institute asked Canadians about four of these most discussed strategies:

  • a criminal justice-oriented approach or “getting tough” on people who use drugs
  • supervised-injection sites
  • decriminalization of all illicit substances
  • compulsory treatment programs

In a criminal justice-oriented approach, law enforcement would get tougher on people who use drugs, a policy where people found with illegal opioids are prosecuted and either fined or serve jail sentences. Typically, the goal of this strategy is to make drug dependence a riskier, scarier prospect, in hopes of warning off potential addicts.

Public health-oriented solutions, such as supervised-injection sites where people can go to take illegal drugs in a clean and safe environment under medical supervision, focus on reducing harm (such as the transmission of infections through reused needles) rather than emphasizing face jail time or other punishments.

Decriminalization of the possession and use of illegal drugs is meant to encourage users to be open about their behaviour and seek help addressing it. Producing and selling illegal drugs, however, would still be a criminal offence.

Canadians tilt slightly away from “getting tough”

Canadians are least enthusiastic about increasing punitive actions against users. Just under half (45%) Canadians say that cracking down or ‘getting tough’ is a good way to alleviate the problem.

More support is found for other alternatives: three-in-five (59%) favour the decriminalization of all illegal drugs, an idea which represents a more dramatic shift from current policy, but is beginning to gain wider traction: the national chiefs of police association has advocated for decriminalizing simple possession of all illegal drugs.

Two-thirds (66%) say they would be in favour of supervised injections sites, which have become more common in Canada over the past decade (more information on this in forthcoming paragraphs).

The most supported approach is compulsory treatment for people who use drugs. While 88 per cent of Canadians say they support this strategy, there is a current absence of evidence as to its effectiveness in this country. Nonetheless, Canadians appear enthusiastic about the idea of forcing people who are having challenges to seek treatment in some form:

For full descriptions of each policy approach, please refer to the questionnaire

Personal proximity to the issue drives support for less punitive measures

Support for supervised-injection sites and compulsory treatment does not appear to be affected by personal proximity to opioid dependence. It does, however, play a role in support for two other policies. Those who have dealt with dependence themselves, or know someone who has dealt with opioid dependence, or have lost someone, are more likely to support decriminalization and far less likely to support a ‘get tough’ strategy:

As noted previously, the concept of compulsory treatment is broadly popular among Canadians, with uniformly high levels of support across different age groups. Conversely, the less-favoured “get tough” approach is least popular among younger people (35% support), while being supported by half (51%) of those who are 55 or older.

Supervised-injection sites, which already exist in some Canadian cities, and the concept of decriminalization have majority support in all age groups, though they are especially favoured among 18- to 34-year-old’s:

Looking through a political lens, the “get tough” tactic is backed with majority support among those who voted for the Conservatives or the Bloc Quebecois in the previous federal election:

Quebecers open to injection sites, British Columbians back decriminalization

Approaches to addiction issues, including the opioid crisis, vary across the country. In Vancouver, for instance, North America’s first legal supervised injection site opened in 2003. Meanwhile, in other provinces, safe injection sites are a newer phenomenon. The first supervised injection site in Atlantic Canada, for instance, opened in Halifax in 2019. As for Quebec – where residents are most likely to support this approach – supervised injection sites began operating in 2017 in Montreal.

Some public officials, however, have raised concerns with these sites. In Alberta, Premier Jason Kenney has criticized the policy, and his government has instead opted for investments in addictions treatment and recovery to help combat the opioid crisis. The Saskatchewan government has also invested in treatment facilities, while not committing to funding the province’s first safe-injection site.

Just half of residents in Alberta and Saskatchewan are in favour of safe injection sites:

When it comes to other policies, Vancouver continues to break new ground. In November, Vancouver’s city council unanimously supported a motion to decriminalize the possession of small amounts of illicit drugs. The city now awaits approval from the federal government on its plan, having requested an exemption from the Controlled Drugs and Substances Act within its boundaries. Two-in-three B.C. residents (66%) are in favour of this policy, the highest level of support in the country:

As mentioned, partisan differences are also a key factor in varying attitudes towards drug policies. This holds true when it comes to provincial party affiliations as well, illustrating deeper divisions within provinces. See Appendix 2 for a summary of provincial party supporters’ opinions on these policies.

Additional Data and Information

Appendix 1 – Provincial data on drug toxicity deaths

For the purposes of this survey, opioids are defined as natural or synthetic substances that reduce feelings of pain, including both prescribed pain medications such as fentanyl, oxycodone, and codeine, as well as illegal substances like heroin.

The collection of public health data, including those related to drug use, is administered by provincial governments. Due to differences between data collection methods and reporting requirements across provincial jurisdictions, comparisons over time and between provinces should be interpreted with caution.

Unless otherwise specified, the number of reported deaths includes deaths which are:

Unintentional (accidental and undetermined)

  • Data marked with a superscript one (¹) include both unintentional and intentional deaths

Confirmed (coroner’s investigation complete) and suspected (coroner’s investigation pending)

  • Data marked with a superscript two (²) include only confirmed deaths

Please also note that categories of drugs involved in drugs toxicity deaths are not mutually exclusive. A drug may have been used alone or in combination with other drugs.

These data are subject to change as coroner’s investigations are concluded.

British Columbia

*Data for drug toxicity deaths involving opioids was not separately reported

**2020 data for illicit drug toxicity deaths for which illicit fentanyl was detected is preliminary and therefore approximate

Alberta

Saskatchewan

Up-to-date data for Manitoba unavailable, only until end of 2018

Ontario

*Projection based on rate of increase in weekly opioid-related deaths during the first 15 weeks of the COVID-19 pandemic (See full report)

Quebec

*2019–2020 data reports “Deaths related to suspected opioid or other drug poisoning”.

Data for drug toxicity deaths involving opioids was not separately reported.

New Brunswick

Nova Scotia

Newfoundland and Labrador

Appendix 2 – Support for policy options by provincial party support

Note that due to small sample sizes, support for policies by last provincial vote in New Brunswick, Prince Edward Island, Nova Scotia, and Newfoundland and Labrador is not published

For detailed results by age, gender, region, education, and other demographics, click here.

For detailed results by proximity to opioid use, click here.

For detailed results by ethnicity, click here.

To read the full report, including detailed tables and methodologyclick here.

To read the questionnaire, click here.

Image – PATRICK SISON/ASSOCIATED PRESS

MEDIA CONTACTS:

Shachi Kurl, President: 604.908.1693 shachi.kurl@angusreid.org @shachikurl

Dave Korzinski, Research Director: 250.899.0821 dave.korzinski@angusreid.org


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