Are we really in an “addictions crisis”?

More than 44,592 people in Canada have died due to opioid toxicity since 2016, surpassing the number of Canadian fatalities in the Second World War. This alarming number underscores the severity of the public health crisis, which has only worsened over the past decade. The average number of daily deaths has almost tripled, from 8 in 2016 to 22 in 2023.

The terminology used to describe this crisis has changed over the past decade, reflecting our attempts to understand what is causing the loss of so many lives. Terms like “opioid crisis” and “overdose crisis” have largely been replaced because they do not accurately capture the nature of the problem and, in some cases, led to unintended and harmful responses. The term “addictions crisis” has recently been gaining popularity in media and political discourse. However, if this term were accurate, two conditions would need to be met:

1) addiction must be rising alongside drug-related deaths
2) addiction must be driving drug-related deaths 

Is addiction rising in Canada?

Evidence indicates that rates of addiction among the Canadian population have not risen over the past decade. The 2022 Mental Health and Access to Care Survey reported that addiction to substances other than alcohol and cannabis in the Canadian population is relatively stable, at 0.7% in 2012 and 0.5% in 2022. This stability in addiction rates contrasts sharply with the dramatic increase in drug-related deaths, indicating that factors other than addiction are at play.

The first condition, that addiction is rising alongside drug-related deaths, does not hold true, which draws into question the legitimacy of the term “addictions crisis.”  

Are drug-related deaths only occurring in people with addictions?

Drug-related deaths are occurring among people with and without diagnosed addictions. This means that people trying drugs for the first time, people who use drugs occasionally, people who use drugs regularly and people who have addictions are all at risk of death. For example, in Ontario, between 2018 and 2021, about a third of people who died due to drug-related toxicity had not been diagnosed with an addiction and half did not have a diagnosed opioid addiction. Similarly, 29% of people in Alberta who died after using opioids in 2017 had not been diagnosed with an opioid addiction.   

Anyone using unregulated drugs is at risk of death. Addiction is not a prerequisite for drug toxicity death, and the absence of addiction does not shield individuals from the dangers of toxic, unregulated drugs.

The second condition, that addiction is driving drug-related deaths, does not hold true, which also draws into question the legitimacy of the term “addictions crisis.”

What is driving drug-related deaths?

Changes in the unregulated drug supply are the primary driver of the continued surge in drug-related deaths. Over the past decade, fentanyl and other synthetic drugs have become more dominant, making the drug supply more toxic and unpredictable. This increase is mirrored by a significant increase in the proportion of opioid-related deaths that involve unregulated fentanyl, from 44% in 2016 to 82% in 2023. The illegal and unregulated nature of the drug supply means people are often unaware of the potency and contents of their drugs, which can change unpredictably, leading to fatal overdoses.

Data from drug checking indicates that fluctuations in fentanyl concentration correlate with changes in rates of drug-related death. The lack of regulation allows for unknown and potentially lethal substances to be mixed into the drug supply, heightening the risk of harmful outcomes.

Social and structural factors also shape the risk of drug-related deaths. These include prohibition, criminalization, colonialism, racism, stigma, gender inequalities and socioeconomic inequality. These factors disproportionately impact certain communities, including Indigenous communities, racialized communities, and people who are unstably housed, increasing their vulnerability to drug-related harms and death.

What is the problem with the term “addictions crisis”?

The term “addictions crisis” is not an accurate description of what is happening. It oversimplifies this complex public health emergency. The current crisis is driven by a toxic drug supply, compounded by a range of individual, social and structural factors. Addressing these multifaceted drivers will require significant political will and resources. Labeling the issue solely as an “addictions crisis” neglects these complexities and promotes a one-size-fits all approach focused primarily on treatment for substance use disorders.

While individuals with substance use disorders deserve a range of low-barrier, voluntary and evidence-based treatment options, not all people who use drugs need or want treatment. First and foremost, we need to ensure that people who have an addiction are alive to access treatment if and when they are ready.

Truly addressing this public health emergency of toxic drug deaths requires a multi-faceted approach involving harm reduction, treatment and prevention policies, programs and services. Only through holistic, evidence-informed efforts can we hope to mitigate the devastating impact of this crisis.

Magnus Nowell is CATIE’s knowledge specialist in harm reduction. Magnus has previously worked in harm reduction research, community organizing and housing. He has a master’s degree in health promotion.