Estimating substance use costs and harms in Canada

BACKGROUND

It has been almost two decades since economic costs of substance use in Canada were estimated. Substance use (SU) in Canada has changed dramatically since 2002 with increased availability and consumption of alcohol and the opioid overdose crisis, and will continue to change given the regulation of non-medical cannabis, use of electronic cigarettes, and the ongoing introduction of new psychoactive substances into the illicit marketplace.

METHODS

The Canadian Centre on Substance Use and Addiction and the Canadian Institute for Substance Use Research have recently estimated the economic costs and harms associated with a broad range of substances, including alcohol, tobacco, cannabis, opioids, other central nervous system (CNS) depressants, cocaine and other CNS stimulants, and other substances (e.g., hallucinogens, inhalants). Costs and harms were assessed from 2007 to 2014 across three main categories: (1) the healthcare system including costs associated with SU-attributable inpatient hospitalizations, day surgery treatment episodes, emergency department presentations, specialist treatment for SU disorders, the costs of physician time and prescription drug costs; (2) the workplace including costs associated with SU-related lost productivity due to premature mortality, long-term disability, absenteeism and impaired performance; and (3) the criminal justice system including costs associated with SU-related policing, courts and corrections.

The methods used draw from an international literature that has generated economic costs of SU for many countries and includes international guidelines for the conduct of such studies. Nonetheless, in order to derive our estimates we updated health-related attributable fractions for all our drug categories. In addition we were able to access a survey of Canadian men and women offenders (n = 29, 138) who were incarcerated in federal prisons in Canada between 2006 and 2016. These surveys were used to develop new attributable fractions (AF) to estimate the proportions of criminal offences partially attributable to substance use (e.g., violent offences such as homicide or assault, non-violent offences such as theft).

RESULTS

The study found that the overall economic cost of SU in Canada in 2014 was estimated to be $38.4 billion. This estimate represents a cost of approximately $1,100 for every Canadian regardless of age. In 2014, the legally available and most widely used psychoactive substances, alcohol and tobacco, contributed almost 70% of these costs. Alcohol accounted for about $14.6 billion (38.1%), tobacco accounted for about $12.0 billion (31.2%) and other substances accounted for about $11.8 billion (30.7%) of these costs. Updated criminal justice AFs revealed that 20% of all violent crimes in Canada between 2006 and 2016 would not have occurred if the perpetrator had not been intoxicated or seeking alcohol. In contrast, all other substances combined accounted for approximately 26% of all violent crime in Canada during the same timeframe.

CONCLUSIONS

This presentation will review key findings, consider implications of the results, discuss updates to the methods used to estimate the costs and harms, and will include a short demonstration of an accompanying suite of tools for data visualization.