More Canadians are using stimulants such as cocaine, new federal data suggests, and experts warn the trend is contributing to a high percentage of drug-related deaths.
In most municipalities studied, cocaine levels rose from January to May 2022 compared with the same period in 2020, and early data for 2023 suggests that overall rise is continuing, according to a Statistics Canada report released on Wednesday.
And, as drug overdoses increased overall by more than 30 per cent from 2020 to 2021, roughly half of the apparent accidental opioid deaths “also involved a stimulant,” said Statistics Canada, citing another report by the Public Health Agency of Canada.
The data “shows that in the last few years, things have worsened,” said Tara Gomes, a research scientist based out of Unity Health Toronto and a principal investigator with the Ontario Drug Policy Research Network (ODPRN), who wasn’t involved in the federal analysis.
“This is really complex,” she said. “People are using multiple substances, and need multiple types of programs and services.”
Cocaine deaths rising in Nova Scotia
The Statistics Canada report was based on data from the Canadian Wastewater Survey, which has been regularly collecting wastewater samples from several municipalities across the country since 2019 to test for various types of drugs.
The report also compared Canadian cities with more than 100,000 people to those in Europe, where wastewater monitoring is conducted by the European Monitoring Center for Drugs and Drug Addiction.
That breakdown puts five Canadian cities among the top ten places with the highest levels of cocaine in wastewater, including Montreal, Edmonton, Vancouver, and Toronto. The top Canadian city, ranked third, was Halifax.
CBC News recently reported that cocaine was linked to a rise in drug-related deaths and overdoses throughout Nova Scotia. Nearly half of the close to 80 accidental overdose deaths last year there involved cocaine, triple the number from a decade ago.
Nova Scotia’s health authority says cocaine and the opioid hydromorphone were among the drugs reported to have been used in one recent “cluster” of suspected overdoses, which included a death.
Ontario is also experiencing a rise in people dying from multiple toxic substances, including stimulants, based on the latest available data.
A report by Gomes, released in September by the ODPRN and Public Health Ontario, showed nearly 2,900 Ontarians died from consuming a toxic substance in 2021 — nearly double the number from just three years prior.
After the COVID-19 pandemic was declared in March 2020, more deaths occurred as a result of at least two types of substances, Gomes’ team found, with most of those people having a mixture of opioids and stimulants in their systems.
Gomes notes the illicit opioid supply has been contaminated with other substances, including benzodiazepines, a class of drugs that slow brain activity, and may be used to treat conditions such as anxiety. Some individuals may use stimulants to counter those sedating effects.
“We’re focusing so much on the opioid crisis, which is so important, but people don’t understand there’s poly-substance use,” said Linda Wonitoway-Raw, a nurse practitioner who works at a primary care clinic in a First Nations community northwest of Edmonton.
She says her patients “use opioids, which are a downer, and alcohol, which is a downer, then they turn to an upper.”
Opioids are a class of drugs which include heroin, fentanyl and a variety of legal pain relievers. Stimulants include cocaine, the highly addictive methamphetamine or “crystal meth,” MDMA/ecstasy and amphetamines — the last of which can include both illicit drugs and prescription medications used to treat conditions such as attention deficit/hyperactivity disorder (ADHD).
Cheap and easy to produce
Canadian cities also displayed very large levels of methamphetamine compared with cities in other countries worldwide, the StatsCan report noted, though usage has not changed significantly in recent years.
Among countries with available wastewater data that use comparable methodology, cities in the U.S., the Czech Republic, Australia, Canada and New Zealand had the highest levels of methamphetamine use in 2022.
Wonitoway-Raw says tackling crystal meth is a challenge because it’s cheap, easy to produce and readily available.
It’s also often laced with other toxic substances, leading to potentially deadly overdoses, she says, and even on its own can produce either feelings of extreme euphoria or drug-induced psychosis.
“My patients say it’s much more addictive than any opioids they’ve ever used,” she added.
The report also noted the average wastewater levels of amphetamine were much higher in the first half of 2022 compared with the same time period in 2020 in several major cities, including Montreal, Toronto and the Vancouver area.
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However, the authors say that could be due to increased use of amphetamine medications legally prescribed to treat ADHD. (New research out of British Columbia, for instance, has shown rising rates of ADHD medication usage among adults, and experts say it’s a broader trend elsewhere.)
“Further research is needed to better understand whether this is primarily from increased prescription or illicit amphetamine drug use,” said Statistics Canada.
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‘Very unpredictable’
On average, both methamphetamine and amphetamine levels have been consistently higher in cities in Western provinces — such as Edmonton, Prince Albert and Saskatoon — compared with the others participating in federal wastewater surveillance efforts.
Prince Albert, the third-largest city in Saskatchewan, had the highest average levels for January to May in 2022 and 2023.
But experts stress this is a trend that goes beyond any one city or country. American research, for example, also shows that the number of overdose deaths from fentanyl plus a stimulant increased more than 50-fold from 2010 to 2021.
Gomes says tackling this issue is complicated, since the usage and harms linked to various drugs are now so widespread, impacting both long-term, regular drug users and those taking illicit drugs on a more casual basis.
Even intermittent use, she said, comes with risks, given the tainted supply.
“The reality of the situation is, we are seeing use and associated harms across all populations… these drugs are very unpredictable.”