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. 2024 Mar 13;2(1):e000480.
doi: 10.1136/bmjph-2023-000480. eCollection 2024 Jun.

Varying circumstances surrounding opioid toxicity deaths across ethno-racial groups in Ontario, Canada: a population-based descriptive cross-sectional study

Tonya J Campbell  1 , Sophie A Kitchen  2 , Mina Tadrous  2   3   4 , Cynthia Damba  5 , Colin H Johnson  6 , Ashley Smoke  7 , Frank Crichlow  8 , Tara Gomes  1   2   3   9
Affiliations

Varying circumstances surrounding opioid toxicity deaths across ethno-racial groups in Ontario, Canada: a population-based descriptive cross-sectional study

Tonya J Campbell et al. BMJ Public Health. .

Abstract

Introduction: The North American toxic drug crisis has been framed as an epidemic primarily affecting white people. However, evidence suggests that deaths are rising among racialised people. Accordingly, we sought to describe and compare characteristics and circumstances of opioid toxicity deaths across ethno-racial groups.

Methods: We conducted a population-based, descriptive cross-sectional study of all individuals who died of accidental opioid toxicity in Ontario, Canada between 1 July 2017 and 30 June 2021. Decedents were categorised as Asian, black, Latin American or white. We summarised decedents' sociodemographic characteristics, circumstances surrounding death and patterns of healthcare utilisation preceding death by ethno-racial group, and used standardised differences (SDs) to draw comparisons.

Results: Overall, 6687 Ontarians died of opioid toxicity, of whom 275 were Asian (4.1%), 238 were black (3.6%), 53 were Latin American (0.8%), 5222 were white (78.1%) and 899 (13.4%) had an unknown ethno-racial identity. Black people (median age: 35 years; SD: 0.40) and Asian people (median age: 37 years; SD: 0.30) generally died younger than white people (median age: 40 years), and there was greater male predominance in deaths among Asian people (86.2%; SD: 0.30), Latin American people (83.0%; SD: 0.21) and black people (80.3%; SD: 0.14) relative to white people (74.6%). Cocaine contributed to more deaths among black people (55.9%; SD: 0.37) and Asian people (45.1%; SD: 0.15) compared with white people (37.6%). Racialised people had a lower prevalence of opioid agonist treatment in the 5 years preceding death (black people: 27.9%, SD: 0.73; Asian people: 51.1%, SD: 0.22; white people: 61.9%).

Conclusions: There are marked differences in the risk factors, context and patterns of drug involvement in opioid toxicity deaths across ethno-racial groups, and substantial disparities exist in access to harm reduction and treatment services. Prevention and response strategies must be tailored and targeted to racialised people.

Keywords: epidemiology; public health; social medicine.

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Conflict of interest statement

All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare financial support for the submitted work from the Ontario Ministry of Health and the Canadian Institutes of Health Research. TG has received research grants and honorariums from the Government of Canada, the Canadian Agency for Drugs and Technologies in Health, the Public Health Agency of Canada and Indigenous Services Canada. MT has received research grants from the Canadian Institutes of Health Research, the Ontario Ministry of Health, and the Centre for Effective Practice, and has done paid consultancy for the Canadian Agency for Drugs and Technologies in Health, Health Canada and Green Shield Canada. AS has done paid consultancy for the Dr Peter Centre, Public Health Ontario, Health Canada, the Centre for Addiction and Mental Health and META:PHI. AS participates on advisory boards for Unity Health Toronto (the Ontario Drug Policy Research Network and the Centre on Drug Policy Evaluation), the Centre for Addiction and Mental Health, the Peel Drug User Network, and the National Safer Supply Community of Practice, and has received payment for lectures, presentations or manuscript writing from Unity Health Toronto (MAP Centre for Urban Health Solutions and the Ontario Drug Policy Research Network), Public Health Ontario, Health Canada, the Centre for Addiction and Mental Health, META:PHI, Addictions and Mental Health Ontario, the Canadian Liver Foundation, the National Safer Supply Community of Practice, the University of Toronto, and the Canadian Association of People who Use Drugs. AS has received support from the Dr Peter Centre, Health Canada, and the Canadian Aboriginal AIDS Network for travel/attending meetings. AS holds paid and unpaid leadership roles with the Canadian Association of People who Use Drugs, the Ontario Network of People Who Use Drugs, Northumberland Drug Users and Tweak Easy Cobourg, and is employed full time with the Ontario Aboriginal HIV/AIDS Strategy.

Figures

Figure 1
Figure 1. Trends in the distribution of opioid toxicity deaths in Ontario by ethno-racial group, July 2017 to June 2021. Note: data for black people and non-black people of colour are plotted on the secondary Y-axis. *ICES prohibits the reporting of small cells (counts <5), as well as any related values (eg, percentages, rates) that would result in residual disclosure of a small cell. therefore, in accordance with institutional policies, data for Asian people and Latin American people were combined for this figure. We refer to this combined group as ‘Non-Black People of Colour’. ICES, Institute for Clinical Evaluative Sciences
Figure 2
Figure 2. Prevalence of healthcare utilisation prior to death among Ontario residents who died of opioid toxicity, by ethno-racial group, July 2017 to June 2021. Note: data for Latin American people (n=53) were excluded from this figure in accordance with ICES’ privacy policy prohibiting the reporting of small cells (counts <5) and any related percentages or rates that would result in residual disclosure of small cells. *Indicates a standardised difference >0.10 when compared with white people. ICES, Institute for Clinical Evaluative Sciences.
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