The Costs and Harms of Substance Use in Canada: Key Trends from 2007 to 2022

Background

The substance use (SU) landscape in Canada has changed dramatically in the past two decades with increasing alcohol use and availability, nicotine vaping, cannabis legalization and the toxic supply of other drugs. The Canadian Substance Use Costs and Harms (CSUCH) project, a collaboration between the Canadian Centre on Substance Use and Addiction (CCSA) and the Canadian Institute for Substance Use Research (CISUR), uses internationally agreed upon methods to estimate costs and harms caused by SU for a 14-year time series ending in 2020. New estimates to 2022 are currently being developed.

Methods

The costs and harms for alcohol, tobacco, cannabis, opioids, other CNS depressants, cocaine, other CNS stimulants and "other" substances were estimated in the domains of health healthcare, mortality, lost production, crime and miscellaneous other domains. The extent of exposure to each type of substance by age, gender, jurisdiction, and year was modelled based on available survey data augmented by relevant sales and hospitalisation data using empirical best linear unbiased prediction (EBLUP). Attributable fraction methodology was applied for estimating healthcare and crime costs, including the use of the International Model for Alcohol Harms and Policies. A hybrid human capital and prevalence-based approach was used to estimate lost productivity.

Results

In 2020, SU was responsible for $49 billion in social costs. Over 40% of these costs were related to lost productivity . While alcohol and tobacco accounted for over 60% of costs since 2007, per-person costs of SU increased the most for stimulants (excluding cocaine) (72%) and opioids (66%). Nearly 74,000 SU attributable deaths occurred in 2020 with about 1/3 of the total deaths occuring in people under the age of 65; opioid- and stimulant-attributable deaths doubled over the study period due to rising poisoning deaths. Alcohol accounted for 40% of criminal justice costs, while cannabis-attributable costs declined following its legalization. Results are being finalized for years 2021 and 2022.

Conclusions

These estimates will help inform decision making across the spectrum of SU prevention, harm reduction and treatment. Estimates can also help to monitor the impact of the changing SU policy environment in Canada.