Opioid deaths in Canada have fallen. Five factors that may explain why
Recent data show opioid mortality has dropped by at least a third. Experts point to changes in the drug supply, naloxone access, consumption patterns and demographic shifts, but caution remains.
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By Torontoer Staff
After a decade marked by record overdose deaths, Canada has seen a notable decline in opioid mortality. National figures for the first half of 2025 put the rate at about 13.5 deaths per 100,000, down from a peak near 20 per 100,000 in previous years, and overall deaths since 2016 exceed 53,300.
Public-health officials and researchers say the drop is real but uneven. Some provinces and demographic groups have seen substantial falls, while others, including parts of the east and many Indigenous and northern communities, continue to face rising or persistently high death rates.
What the numbers show and why caution remains
Ontario’s chief coroner, Dirk Huyer, described the trend as cautiously optimistic and stressed uncertainty. "It’s tough to know what it’s from," he said. "It’s tough to know if it’s going to be sustained." Federal and provincial data point to a meaningful decline in several hard-hit provinces, but the full-year data for 2024 and regional breakdowns are still being finalised.
Experts emphasise that a lower national average can mask sharp local disparities. Recent coroner reports show opioid death rates in parts of northern Ontario that are two to four times the national figure, and a Chiefs of Ontario report found Indigenous people dying from opioids at nearly ten times the national rate.
Five factors that researchers and public-health officials point to
- A possible international supply shock that reduced fentanyl availability
- Shifts in the chemical composition and lethality of street drugs
- Wider distribution and use of naloxone
- A rise in smoking rather than injecting opioids
- A demographic effect after many of the most vulnerable people have already died
1. An international supply shock
Researchers link part of the decline to a clampdown originating in China after a high-level meeting in late 2023, when Beijing pledged to restrict exports of fentanyl precursors. The change appears to have affected North American supply chains, and analyses published in Science and other journals found synchronous drops in fentanyl purity and overdose deaths.
There are instances in which the supply shock kind of breaks the momentum of an epidemic.
Jonathan Caulkins, Carnegie Mellon University
2. A less lethal, but still dangerous, drug supply
Drug-checking services report lower fentanyl concentrations in tested samples: a Toronto lab found average fentanyl content fall from about 5 per cent in 2024 to 2 per cent in 2025. Benzodiazepine contamination has also declined in some analyses, which can reduce the risk of fatal respiratory depression when combined with opioids.
At the same time, new adulterants are complicating the picture. The veterinary sedative medetomidine has emerged rapidly, present in a growing share of samples and linked to prolonged sedation and severe overdoses. In one recent sample set, medetomidine appeared in 83 per cent of fentanyl checks for January.
We’re finding ‘new’ drugs all the time, drugs that weren’t approved for human use, so we don’t know a lot about what their strengths or effects may be.
Karen McDonald, executive director, Toronto Drug Checking Service
3. Expanded naloxone access
Naloxone became available without a prescription in 2016, and distribution has accelerated since. National kits and training are now widely provided by pharmacies, harm-reduction centres, hospitals and some workplaces. Between 2020 and 2024 naloxone distribution tripled, and provinces with substantial distribution saw notable mortality declines, according to the Public Health Agency of Canada.
I think we have the highest rates of naloxone distribution across the province. I think that’s hopefully a reason why there’s a little bit of a plateau.
Kit Young Hoon, medical officer of health, Northwestern Health Unit, Ontario
4. Fewer people injecting opioids
Over the past decade smoking has become the more common mode of consumption for many people who use illicit opioids. Peer-reviewed research published in Addiction in January 2025 found those who primarily smoke opioids die at roughly two-thirds the rate of people who primarily inject. Smoking can allow for smaller, test doses and reduced risk of injection-related infections.
Researchers caution that smoking remains dangerous and that the population-level effect is hard to quantify. "People need to remain very vigilant against overdose no matter how they use drugs," said George Karandinos, lead author of the study.
5. A grim demographic effect
Some public-health experts say the decline may partly reflect a tragic reality: many of the most vulnerable people who used illicit opioids have already died. Ontario’s chief coroner called the idea difficult to prove, but noted that provinces with the largest cumulative death tolls have seen some of the steepest recent declines.
The Public Health Agency of Canada describes this as a "likely" contributor, while noting regions where the crisis began later have seen smaller declines or increases.
What remains unchanged
Advocates warn that a modest decline in deaths does not signal a solved crisis. The unregulated drug market, criminalisation of people who use drugs, and disproportionate harm to marginalised communities persist. "Though a slight decline in deaths may bring some sense of relief, this is not a moment for celebration," said DJ Larkin of the Canadian Drug Policy Coalition.
Public-health officials call for continued monitoring of the drug supply, expanded harm reduction and easier access to treatment. The recent fall in national mortality offers cautious hope, but experts stress that ongoing, targeted action is required to reduce regional disparities and prevent further loss of life.
opioidspublic healthnaloxonedrug supplyharm reduction
