Trends in Fentanyl Containing Drug Seizures and Fentanyl Related Deaths across Canada between 2020 and 2023

Background: Canada’s drug toxicity crisis has been largely attributed to a fentanyl dominated unregulated drug supply. In recent years, several potent fentanyl analogues have emerged, however impacts on the volatility of the unregulated drug supply and opioid related deaths remains unknown.

Objectives: To examine trends in fentanyl analogue containing drug seizures and fentanyl related deaths across Canada.

Methods: We conducted a repeated cross-sectional analysis of fentanyl containing (fentanyl or its analogue) drug seizures between January, 2020 and September, 2023 across 12 Canadian provinces/territories. We used anonymized data from Health Canada’s Drug Analysis Service and Cannabis Laboratories, which provides information on all drug seizures submitted for analysis. We also used publicly available data from the Public Health Agency of Canada including annual counts of all fentanyl related deaths, stratified by fentanyl versus its analogues. Our primary measure was the proportion of fentanyl containing drug seizures where at least one fentanyl analogue was detected per quarter. We used the Cochrane Armitage Test for Trend to look for significant changes in fentanyl analogue containing drug seizures. Our secondary measure was the proportion of fentanyl related deaths where an analogue directly contributed to death. All analyses were conducted overall and stratified by province/territory.

Results: We identified 60,678 fentanyl containing drug seizures over the study period. Overall, the proportion of fentanyl analogue containing drug seizures increased by 872.9% (5.1% to 49.9%; N=120 to 1616). This ranged substantially across the provinces/territories, with the largest number of fentanyl analogue containing drug seizures identified in Ontario (N=743; 45.3%) and Alberta (N=432; 65.1%) at the end of the study period. A significant trend in fentanyl analogue containing drug seizures was observed in several provinces/territories, and was most notable in Ontario (2550.9% increase, p<.001) and Alberta (905.2% increase, p<.001). In parallel, the proportion of fentanyl analogue related deaths increased 128.6% (14% to 32%; N=855 to 1,248) across Canada. Generally, provinces with significant increases in fentanyl analogue containing drug seizures experienced the largest increase in fentanyl analogue related deaths including Ontario (2% to 22%; N = 47 to 282) and Alberta (10% to 39%; N = 10 to 39).

Conclusions: Fentanyl analogue containing drug seizures and fentanyl analogue related deaths have dramatically increased across Canada. There is an urgent need for the expansion of harm reduction based responses including improved access to drug checking services and supervised consumption sites in regions with a highly volatile unregulated drug supply.