Reported drug toxicity deaths dropped in parts of Canada in 2024 – But what’s behind the numbers?

Prevention in Focus PiF 2025 Fall

Want to receive publications straight to your inbox?

CATIE
PiF 32 - Drug toxicity deaths image

Emerging evidence from Canada and the United States suggests that the number of drug toxicity deaths decreased in 2024. However, this decline was not seen in all regions or for all populations. In some regions, data suggest the opposite — that drug toxicity deaths increased. The reasons behind these shifts are unclear, and it is important to avoid drawing premature conclusions. The number of deaths remains staggering and unacceptable, even with the decline last year, and there is no cause for celebration. Far too many lives have been lost in this decade-long public health emergency, and far too many people continue to die. 

Receive Prevention in Focus in your inbox:

This article highlights data on the number of drug toxicity deaths in Canada and explores several theories for the changes observed in 2024.

What do the data tell us about changes in the number of drug toxicity deaths?

National-level data suggest that drug toxicity deaths decreased in Canada in 2024. Available data indicate that there were 17.1% fewer opioid toxicity deaths in 2024 than in 2023.1 This means that 1477 fewer people died in 2024 than in 2023.1 

The decrease in deaths did not occur in all regions in Canada. In 2024, the following provinces and territories reported declines in opioid toxicity deaths: 1

  • British Columbia (B.C.): 12.1% decrease – from 2616 deaths in 2023 to 2229 in 2024
  • Alberta: 36.8% decrease – from 1870 to 1181 deaths 
  • Saskatchewan: 41.9% decrease – from 346 to 201 deaths
  • Manitoba: 2.9% decrease – from 382 to 371 deaths
  • Ontario: 15.4% decrease – from 2638 to 2231 deaths 
  • New Brunswick: 20.4% decrease – from 98 to 78 deaths 
  • Nova Scotia: 6.8% decrease – from 73 to 68 deaths
  • Yukon: 17.7% decrease – from 17 to 14 deaths

Increases in opioid toxicity deaths were reported in the following regions over the same time period: 1

  • Quebec: 20.3% increase – from 536 to 645 deaths
  • Newfoundland and Labrador: 21.6% increase – from 37 to 45 deaths
  • Northwest Territories: 100% increase – from 3 to 6 deaths 

The number of deaths remained the same for Prince Edward Island in 2023 and 2024 (seven). Data are not available for Nunavut in 2024, making a comparison impossible.1

It is important to note that there are differences in how coroners and medical examiners in each province and territory investigate and classify drug toxicity deaths. This includes how long it takes them to report results and whether they report presumed cases (based on evidence found at the scene) or only closed cases after toxicology testing. As a result, the data are preliminary and may change as investigations are conducted.1 These data should be interpreted with caution. 

The numbers of drug toxicity deaths do not tell the whole story. It is essential not to lose sight of the human toll. Behind each number is a person whose life was lost and a community left grieving. The drug toxicity crisis remains a public health emergency that demands urgent and sustained action. 

What are some potential reasons for the observed decrease?

The underlying causes for this change remain unclear. At this time, there is no definitive evidence to explain why drug toxicity deaths declined in 2024. Attributing population-level trends to specific causes or interventions is challenging. Without rigorous research that controls for multiple variables, there is a risk of drawing inaccurate conclusions (e.g., conflating correlation with causation). This kind of research has not been conducted in relation to the changes observed in 2024. A range of potential theories have been suggested by researchers, medical professionals, reporters, politicians, people who use drugs and others about what might be behind this decrease, but none of them have been proven. 

One theory is that the unregulated drug supply has changed in ways that reduce the risk of drug toxicity death.2–8 Some suggest this may be due to a decrease in drug potency (e.g., lower fentanyl concentration) or increased predictability of the supply in some regions.2,4,6,9 Some suggest that the increased presence of sedatives, such as benzodiazepines and xylazine, is leading to lower concentrations of fentanyl and to less frequent use, which means that people are exposed to unregulated drugs less often.4,5,8 

Another theory is that people are using drugs in ways that reduce their risk of drug toxicity death.5–8,10 In some regions, smoking has become more common than injecting.11 While smoking still carries a risk of overdose, some people who use drugs report it can help increase individuals’ control over the amount of drug they are using, 12 which may reduce the risk of drug toxicity. There are also suggestions that implementation of safer substance use practices (e.g., using with others around) and increased access to harm reduction services (e.g., supervised consumption services) are reducing risks.5–8,10 

Another theory is that fewer people are using unregulated drugs. This includes suggestions that fewer people may be starting to use drugs and/or more people may be stopping (e.g., because of access to treatment or because of social recovery after pandemic-related lockdowns).4,9,10 Another possibility is that, after nearly a decade of extraordinarily high drug toxicity deaths, the number of people who remain at high risk of death has decreased because many have already died. In this view, recent declines in drug toxicity deaths may reflect, in part, the devastating toll the crisis has already taken. 5,7,8,10

In some cases, theories about changes in the number of drug toxicity deaths have been influenced by people’s politics and priorities, with some seeking to leverage the data on lower deaths to validate their work or approach. For example, some politicians have attributed the declines to a focus on abstinence-driven treatment. 9,13 There is no evidence that this approach is any more likely to have contributed to reducing the number of deaths than the above theories. 

It is extremely challenging to determine which, if any, of these proposed theories account for the reported decrease in drug toxicity deaths in 2024. It is likely that a combination of factors contributed to this change. 

What don’t the data tell us?

These numbers do not reflect the full extent of the drug toxicity crisis, from the impacts of other drug-related harms to the impacts on individuals and communities.

First, the data reported above focus on fatal overdoses; they do not capture non-fatal overdoses reversed in community by friends, family and healthcare providers. Estimates suggest that for every drug toxicity death, around 15 non-fatal overdoses occur,14 all of which could result in long-term health impacts such as brain injury and its related complications.15 

Second, current national surveillance data about how different populations are impacted by drug toxicity deaths are limited, which means that disparities are underexamined. Available data from B.C. indicate that First Nations people remain disproportionately impacted by the drug toxicity crisis.16 Deaths among First Nations people declined less than in B.C. overall, and First Nations people died at 6.7 times the rate of other B.C. residents, marking the largest disparity since B.C. declared a public health emergency.16,17 This highlights the ongoing impacts of colonialism and other structural inequities that put Indigenous people at disproportionate risk of harms related to substance use.18–20 Available data from B.C. and Ontario also indicate that deaths among males appear to have declined more than deaths among females.21,22 Reasons for this change are not known. Improved national reporting of demographic data would allow for better analysis of these trends across regions. 

Finally, the surveillance data do not capture the value of the lives lost or the trauma, pain and grief of their families and friends.23–25 They also do not capture the impacts of these deaths on service providers and first responders, who are witnessing a devastation of the communities that they serve. More than 50,000 people in Canada have died of drug toxicity in the past nine years.1 The long-term impacts of these continuing and compounding losses are unknown. 

A bigger perspective

It is important to look at the decrease in drug toxicity deaths within a broader context. What makes this trend noteworthy is that it is not limited to one area — it has occurred at around the same time across multiple regions in Canada and the United States. Researchers and public health professionals need to investigate this phenomenon to understand why this decrease happened and why there are differences between regions and populations. This information could help to inform how to prevent future deaths. 

The continuing toll of this public health crisis remains staggering and unacceptable. The reduction in the number of deaths in 2024 amounts to an average of just three fewer opioid toxicity deaths per day across Canada.1 An average of 20 people still died each day in Canada in 2024 — a devastating number. This is 2.5 times the eight deaths per day in 2016 1 — the year that public health authorities first declared that drug toxicity deaths were a public health emergency.26 

Decreases in drug toxicity deaths have happened before but they have not been sustained. In 2019, the number of deaths fell by 12% compared with the year before.1 At the time, there was a similar push to try to understand and investigate why drug toxicity deaths had decreased.27 But in 2020, they surged by 72% as the COVID-19 pandemic disrupted the unregulated drug supply, services were reduced or shut down, and people who used drugs were isolated from services and support.1,28 This shows that short-term trends can change quickly, reinforcing the need for ongoing monitoring to detect emerging patterns and inform community and public health responses. People who use drugs can often recognize and respond to new trends before they are reflected in surveillance data, so it’s essential to listen to their perspectives and feedback alongside traditional surveillance efforts. 

While the strength and unpredictability of the unregulated drug supply continues to drive the majority of drug toxicity deaths, a range of individual, social and structural factors interact to create and exacerbate drug-related harms.29 Whether the decrease in 2024 is sustained over the longer term depends on whether effective public health interventions remain available and whether they are scaled up to mitigate drug-related harms.30,31

Already there are signs that the decrease in the number of deaths may not be sustained. Some cities and regions that experienced a decrease in 2024 have seen high monthly rates of drug toxicity death in early 2025.32–35 The ongoing reduction in the availability and accessibility of harm reduction services in some provinces has the potential to increase the risk of drug toxicity death in many communities. Investing in harm reduction, treatment and prevention programs can prevent deaths and save lives.31,36–38 

Resources

What makes Canada’s illegal drug supply dangerous? 

CATIE statement on the need for a spectrum of substance use services 

Seeking safety in a dangerous drug supply 

References

  1. Substance-related Overdose and Mortality Surveillance Task Group on behalf of the Council of Chief Medical Officers of Health. Opioid- and stimulant-related harms in Canada. 2025 Mar. Available from: https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/
  2. Bilhete B. Number of non-fatal overdoses Toronto paramedics respond to is declining, city data shows. CBC News. 2025 Apr 4. Available from: https://www.cbc.ca/news/canada/toronto/overdose-data-tph-paramedics-1.7500104
  3. Hoffman J, Weiland N. What’s behind the remarkable drop in U.S. overdose deaths. The New York Times. 2024 Nov 21. Available from: https://www.nytimes.com/2024/11/21/health/overdose-deaths-decline-drug-supply.html
  4. Luymes G. Drug deaths in B.C. are dropping. Here are some of the theories why. Vancouver Sun. 2024 Dec 24. Available from: https://vancouversun.com/news/drug-deaths-in-bc-are-dropping-theories-why
  5. Picard A. Overdose deaths are falling across North America. But why? The Globe and Mail. 2025 Apr 1. Available from: https://www.theglobeandmail.com/opinion/article-overdose-deaths-are-falling-across-north-america-but-why/
  6. Smith A. Deaths from drug overdoses are falling, but it’s too soon to tell if this will last. The Globe and Mail. 2025 Jan 2. Available from: https://www.theglobeandmail.com/canada/article-deaths-from-drug-overdoses-are-falling-but-its-too-soon-to-tell-if/
  7. Shah H. Drug overdose deaths have declined. No one knows why. Vox. 2024 Dec 12. Available from: https://www.vox.com/health/390840/drug-overdose-deaths-decline-fentanyl-opioids
  8. Fischer B, Hall W, Jutras-Aswad D et al. Considering possible drivers of the recent decrease in drug overdose deaths in Canada. The Lancet Regional Health Americas. 2025 Jul;47(101141). 
  9. Lee J. Alberta opioid deaths continue to decline from record high last year. CBC News. 2024 Dec 14. Available from: https://www.cbc.ca/news/canada/calgary/alberta-opioid-deaths-decline-from-record-high-last-year-1.7410594
  10. Szalavitz M. Not Everyone is benefiting from drops in overdose deaths. The New York Times. 2024 Dec 2. Available from: https://www.nytimes.com/2024/12/02/opinion/drug-overdose-deaths-decline.html
  11. Parent S, Papamihali K, Graham B et al. Examining prevalence and correlates of smoking opioids in British Columbia: opioids are more often smoked than injected. Substance Abuse Treatment, Prevention, and Policy. 2021;6:1-9. 
  12. Ivsins A, Bonn M, McNeil R et al. A qualitative study on perceptions and experiences of overdose among people who smoke drugs in Vancouver, British Columbia. Drug and Alcohol Dependence. 2024 May;258:111275. 
  13. Opinko D. Province credits recovery model for falling drug overdose deaths in Lethbridge. Lethbridge News Now. 2025 Mar 17. Available from: https://lethbridgenewsnow.com/2025/03/17/province-credits-recovery-model-for-falling-drug-overdose-deaths-in-lethbridge/
  14. Casillas SM, Pickens CM, Tanz LJ et al. Estimating the ratio of fatal to non-fatal overdoses involving all drugs, all opioids, synthetic opioids, heroin or stimulants, USA, 2010-2020. Injury Prevention. 2024 Jan 30;30(2):114-24. 
  15. Xavier CG, Kuo M, Desai R et al. Association between toxic drug events and encephalopathy in British Columbia, Canada: a cross-sectional analysis. Substance Abuse Treatment, Prevention, and Policy. 2023 Jul 7;18(1):42. 
  16. First Nations Health Authority. First Nations and the toxic drug poisoning crisis in BC January - December 2024. 2025. Available from: https://www.fnha.ca/Documents/FNHA-First-Nations-and-the-Toxic-Drug-Poisoning-Crisis-in-BC-Jan-Dec-2024.pdf
  17. The Canadian Press. First Nations Health Authority backs harm reduction on B.C. overdose anniversary. CTV News. 2025 Apr 14. Available from: https://www.ctvnews.ca/vancouver/article/first-nations-health-authority-backs-harm-reduction-on-bc-overdose-anniversary/
  18. Byrne CJ, Sani F, Thain D et al. Psychosocial factors associated with overdose subsequent to illicit drug use: a systematic review and narrative synthesis. Harm Reduction Journal. 2024 Dec 1;21(1). 
  19. Dasgupta N, Beletsky L, Ciccarone D. Opioid crisis: no easy fix to its social and economic determinants. American Journal of Public Health. 2018;108(2):182-6. 
  20. Lavalley J, Steinhauer L, Bundy D (Boomer) et al. “They talk about it like it’s an overdose crisis when in fact it’s basically genocide”: the experiences of Indigenous peoples who use illicit drugs in Vancouver’s Downtown Eastside neighbourhood. International Journal of Drug Policy. 2024 Dec 1;134. 
  21. Office of the Chief Coroner for Ontario. OCC opioid mortality summary Q4 2024. 2025 May. Available from: https://odprn.ca/occ-opioid-and-suspect-drug-related-death-data/
  22. BC Coroner’s Service. Unregulated drug deaths - Sex. 2025. Available from: https://app.powerbi.com/view?r=eyJrIjoiM2JlNDY1MTItYjBiNS00NWNiLWJlZjAtNzAzNzQ3ZTYwMzg3IiwidCI6IjZmZGI1MjAwLTNkMGQtNGE4YS1iMDM2LWQzNjg1ZTM1OWFkYyJ9
  23. Dives J. Portrait of a crisis: living and dying through B.C.’s overdose emergency. The Globe and Mail. 2025 Mar 28. Available from: https://www.theglobeandmail.com/opinion/article-overdose-crisis-british-columbia-portraits-underexposed/
  24. Whitfield J. Meet the kokum who’s raising 14 grandchildren without batting an eye. CBC News. 2024 Jul 8. Available from: https://www.cbc.ca/news/canada/saskatchewan/matriarchs-kokums-14-grandchildren-1.7253059
  25. Athey A, Kilmer B, Cerel J. An overlooked emergency: more than one in eight US adults have had their lives disrupted by drug overdose deaths. American Journal of Public Health. 2024 Mar;114(3):276-9.
  26. BC Ministry of Health. Provincial health officer declares public health emergency. 2016 Apr 16. Available from: https://news.gov.bc.ca/releases/2016HLTH0026-000568
  27. Lupick T. Why overdose deaths have fallen here—despite more overdoses. Filter. 2020 Jan 14. Available from: https://filtermag.org/overdose-harm-reduction-vancouver/
  28. Rolle V, Bakewell N, Na Y et al. Patterns of opioid toxicity deaths after the implementation of COVID-19 emergency measures in Ontario, Canada: a weekly interrupted time series. International Journal of Drug Policy. 2025 May;139:104797. 
  29. Collins AB, Boyd J, Cooper HLF et al. The intersectional risk environment of people who use drugs. Social Science & Medicine. 2019;234:112384. https://doi.org/10.1016/j.socscimed.2019.112384
  30. Public Health Agency of Canada. Modelling apparent opioid toxicity deaths during the overdose crisis. Ottawa (ON): Government of Canada; 2024 Dec. Available from: https://www.canada.ca/en/health-canada/services/opioids/data-surveillance-research/modelling.html
  31. BC Centre for Disease Control. Harm reduction & medically supported treatment saves lives: drug poisoning death events prevented from 2019-2024. Available from: http://www.bccdc.ca/Health-Professionals-Site/Documents/Harm-Reduction-Reports/Drug_poisoning_death_events_prevented-2019-2024.pdf
  32. BC Coroner’s Service. Unregulated drug deaths - BC. 2025. Available from: https://app.powerbi.com/view?r=eyJrIjoiM2JlNDY1MTItYjBiNS00NWNiLWJlZjAtNzAzNzQ3ZTYwMzg3IiwidCI6IjZmZGI1MjAwLTNkMGQtNGE4YS1iMDM2LWQzNjg1ZTM1OWFkYyJ9
  33. CBC News. Edmonton region hits all-time monthly peak in opioid-related deaths. CBC News. 2025 Jul 3. Available from: https://www.cbc.ca/news/canada/edmonton/edmonton-drug-poisoning-opioid-1.7575814
  34. Woodward L. Saskatoon’s fentanyl overdose crisis: 9 deaths, more than 435 overdoses in March. CTV News. 2025 Mar 26. Available from: https://www.ctvnews.ca/saskatoon/article/saskatoons-fentanyl-overdose-crisis-9-deaths-more-than-435-overdoses-in-march/
  35. Mann B. New report: U.S. drug overdose deaths rise again after hopeful decline. NPR. 2025 Jun 18. Available from: https://www.npr.org/2025/06/18/nx-s1-5436711/overdose-drugs-cdc
  36. Slaunwhite A, Min JE, Palis H et al. Effect of Risk Mitigation Guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: retrospective cohort study. BMJ. 2024 Jan 10;e076336. 
  37. Canadian Public Health Association. Public health approaches to the toxic drug crisis. 2025 Jan. Available from: https://www.cpha.ca/toxic-drug-crisis
  38. Ledlie S, Garg R, Cheng C et al. Prescribed safer opioid supply: a scoping review of the evidence. International Journal of Drug Policy. 2024 Mar;125:104339. 

Externally reviewed by: Dr. Alexis Crabtree & Leandra Gilbert

Production of this article has been made possible through a financial contribution from Health Canada's Substance Use and Addictions Program. The views expressed herein do not necessarily represent the views of Health Canada.

About the author(s)

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.