Trends in accidental drug overdose mortality in Canada: An analysis from 1974 to 2023

Overdose deaths in Canada have been rising since 2016, but long-term trends remain poorly characterized. We examined national overdose mortality trends from 1974 to 2023 and explored differences by sex, age, and province.

We conducted a retrospective analysis of accidental and undetermined-intent poisoning deaths in the Canadian Vital Statistics Death Database, calculating crude mortality rates (CMR) using Statistics Canada population estimates. We used segmented regression to model temporal trends and calculated average annual percentage change (AAPC) for each resulting segment. Analyses were stratified by sex, age (<25, 25-44, 45-64, and ≥65), and province.

Between 1974 and 2023, 80,944 overdose deaths were recorded. Segmented regression of CMR revealed three phases: a period of relative stability (AAPC: -0.28 %; 1974-1991), followed by two accelerations (AAPC: 5.46 %; 1991-2013 and AAPC: 12 %; 2013-2023) CMRs were similar by sex until 2013-15, then surged in both males (AAPC: 13.81 %; 2012-2023) and females (AAPC: 9.32 %; 2015-2023). Rates in youth (<25) were stable until the early 2000s, then rose sharply (AAPC: 30.62 %; 2014-2017) before slowing, while rates among adults aged 25-44 (AAPC: 13.59 %; 2012-2023), 45-64 (AAPC: 11.56 %; 2014-2023), and ≥65 (AAPC: 18.48 %; 2020-2023) increased in recent years. Rates increased the most in Western provinces compared to Quebec and the Atlantic provinces.

Canada's overdose epidemic reflects a segmented trajectory, with marked accelerations in 1996 and 2013, driven by healthcare practices, evolving drug markets, and social vulnerabilities. Regional and demographic disparities underscore the need for targeted, historically informed public health strategies.