Research Spotlight:
Ledlie S, et al. (2025). The changing role of substances: trends, characteristics of individuals and prior healthcare utilization among individuals with accidental substance-related toxicity deaths in Ontario Canada. PLOS One.
The rate of substance-related toxicity deaths continues to dramatically increase across Canada, with the number of opioid-related deaths attributable to fentanyl in combination with cocaine and methamphetamine increasing 39.2% and 73.6%, respectively between 2018 and 2022.
Methods: a population-based cross-sectional study of all accidental substance-related toxicity deaths in Ontario, Canada from Jan 2018 to June 2022. We reported monthly rates of substance-related toxicity deaths and investigated the combination of substances most commonly involved in deaths. Demographic characteristics, location of incident, and prior healthcare encounters for non-fatal toxicities and substance use disorders were examined.
Results
Overall, 10,022 accidental substance-related toxicity deaths occurred, with the annual number of deaths nearly doubling between the first and last 12 months of the study period (N=1,570 to 2,702). Opioids were directly involved in the majority of deaths (84.1%; N=8,431), followed by stimulants (60.9%; N=6,108), alcohol (13.4%; N=1,346), and benzodiazepines (7.8%; N=782). In total, 56.9% (N=5,698) of deaths involved combinations of substances. Approximately one-fifth of individuals were treated in a hospital setting for a substance-related toxicity in the past year, with the majority being opioid-related (17.4%; N=1,748). Finally, 60.9% (N=6,098) of people had a substance use disorder diagnosis at time of death.
Conclusion
Our study shows not only the enormous loss of life from substance-related toxicities but also the growing importance of combinations of substances in these deaths. A large proportion of people had previously interacted within an hospital setting for prior substance-related toxicity events or related to a substance use disorder, representing important missed intervention points in providing appropriate care.
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