Background: The impact of Canada’s overdose crisis has not been as extreme in Québec compared to other provinces, but recent data suggest the situation may be deteriorating.
Methods: We estimated annual age-standardised rates of fatal opioid or stimulant poisoning per 100,000 of population, 2012-2021, and the proportions of deaths in which specific drugs were detected.
Results: Opioid mortality rates increased sharply in 2020, from 1.9 to 2.7 per 100,000, and 2.5 per 100,000 in 2021. Pharmaceutical opioids were detected in ≈80% of opioid deaths until 2019, declining to 55% in 2021. The proportion of deaths involving fentanyl varied; 2020 and 2021 were the only consecutive years where the proportion of deaths with fentanyl increased (38% to 52%). There was an increasing trend of methamphetamine in opioid deaths, from 6% to 41% and a rapid increase in illicitly manufactured benzodiazepines from <5% of deaths in 2019 to 41% in 2021. Stimulant mortality rates steadily increased from 0.7 to 2.0 per 100,000. Cocaine detection declined from 80% to 58% of stimulant deaths, while methamphetamine detection increased from 29% to 62%.
Conclusion: Québec is experiencing significant drug market disruption and may be in the early stages of a sustained period of escalating overdose mortality. Throughout Canada, overdose mortality rates have remained high even in the presence of multiple interventions. Radical policy reform is essential to address root causes of overdose including an unpredictable drug supply, strained health systems, and socioeconomic precarity.