Growth of the North American Overdose Crisis

"Over the past two decades, a significant surge in worldwide drug overdose deaths has been observed, with North America experiencing a particularly alarming rise. This increase is largely attributed to the widespread presence of the synthetic opioid fentanyl (Penington Institute, 2022), which became an economically viable replacement for heroin after the deprescription of opiate pills (Ciccarone, 2019). Overdose deaths resulting from the toxic drug supply have also been exacerbated by structural factors, particularly the insufficient and unsustainable funding for harm reduction initiatives and limited access to care (Nguemeni Tiako et al., 2022). In 2023, in the United States, using the population midpoint for the year (US Census Bureau, 2024), the crude overdose death rate soared to 32.1 per 100,000 individuals (National Vital Statistic System, 2024), a staggering increase of over 5.4 times compared to its rate in 1999 (Centers for Disease Control and Prevention, 2019). In Canada, the 2023 crude death rate was 20.3 per 100,000 people, which, while lower than several of its international counterparts, was still three times higher than its 2016 rate of 7.8 per 100,000 (Government of Canada, 2023a). The province of British Columbia (BC) has been particularly hard-hit, with the provincial rate spiking to 46.4 per 100,000 individuals in 2023, almost six times higher than its rate of 7.9 per 100,000 individuals in 2014 (BC Coroners Service, 2023). The crisis is now emerging in other geographical areas as well, with Scotland being exemplary as the worst hit in Europe, reaching a per capita overdose death rate of 25.2 deaths per 100,000 people, 4.6 times as many deaths as in 2000, and more than 3.5 times higher than the rest of the United Kingdom (Penington Institute, 2022)."