Intended for healthcare professionals


Opioid deaths in Ontario, Canada

BMJ 2018; 362 doi: (Published 29 August 2018) Cite this as: BMJ 2018;362:k3537
  1. Scott E Hadland, assistant professor1 2,
  2. Stefan G Kertesz, professor3 4
  1. 1Grayken Center for Addiction/Department of Pediatrics, Boston Medical Center, Boston, MA 02118, USA,
  2. 2Boston University School of Medicine, Division of General Pediatrics, Department of Pediatrics, Boston, MA 02118, USA
  3. 3Birmingham VA Medical Center and Department of Medicine, Birmingham, AL 35233, USA
  4. 4University of Alabama at Birmingham School of Medicine, Birmingham, AL 35205, USA
  1. Correspondence to: S E Hadland scott.hadland{at}

Curbs to prescribing must be part of a broader package of measures

Practitioners, researchers, and policy makers face a shifting landscape of opioid related morbidity and mortality. In North America, an overdose crisis initially fuelled by prescription opioids now features an unabating surge in deaths from heroin and illicitly manufactured fentanyl.1 An overdue recalibration of opioid prescribing seems to be only one part of what is needed at this time.

In the BMJ this week (doi:10.1136/bmj.k3207), Gomes and colleagues describe trends in opioid related deaths in Ontario, Canada.2 In roughly one third of opioid related overdoses between 2013 and 2016, decedents had an active opioid prescription when they died. Whereas this proportion declined slightly over the study period, the number of deaths involving fentanyl nearly quadrupled from 2013 to 2016, reflecting a North American trend. In people with active opioid prescriptions, benzodiazepines were found in 60% of toxicology reports, with most such people having active benzodiazepine prescriptions.

These findings highlight that in Ontario, as elsewhere, fatalities involving drugs that are prescribed—and often diverted—remain a critical component of the broader overdose crisis. Canada is second only to the US …

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