{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,10]],"date-time":"2026-06-10T07:22:53Z","timestamp":1781076173553,"version":"3.54.1"},"reference-count":39,"publisher":"Springer Science and Business Media LLC","issue":"3","license":[{"start":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T00:00:00Z","timestamp":1665360000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T00:00:00Z","timestamp":1665360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001774","name":"University of Sydney","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100001774","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Int J Ment Health Addiction"],"published-print":{"date-parts":[[2024,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Escalating drug overdose death rates in Canada are of ever-increasing concern. To better understand the extent of this health threat, we obtained mortality statistics and population figures for the years 2000 to 2020, and examined rates of overdose deaths, coded (using ICD-10) as accidental, suicide or \u201cundetermined intent.\u201d The drug deemed as primarily responsible for the death was categorized as opioid, non-opioid, or unspecified. Age patterns of drug deaths were graphed. Joinpoint analysis was used to test the significance of changes in death rates. Accidental opioid and stimulant overdose death rates in Canada have climbed faster since 2011, though not as high as corresponding US rates. Unknown cause death rates have increased. However, opioid and non-opioid suicide rates have decreased significantly since 2011, and there have been fewer drug deaths of undetermined intent. Increased attention to the possibility that some suicides are being misclassified is warranted.<\/jats:p>","DOI":"10.1007\/s11469-022-00932-9","type":"journal-article","created":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T17:02:46Z","timestamp":1665421366000},"page":"1394-1412","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["Unanticipated Changes in Drug Overdose Death Rates in Canada During the Opioid Crisis"],"prefix":"10.1007","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9554-3187","authenticated-orcid":false,"given":"John","family":"Snowdon","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8382-1191","authenticated-orcid":false,"given":"Namkee","family":"Choi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"issue":"1","key":"932_CR1","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1007\/s00127-015-1119-x","volume":"51","author":"SS Bakst","year":"2016","unstructured":"Bakst, S. S., Braun, T., Zucker, I., Amitai, Z., & Shohat, T. (2016). The accuracy of suicide statistics: Are true suicide deaths misclassified? Social Psychiatry and Psychiatric Epidemiology, 51(1), 115\u2013123. https:\/\/doi.org\/10.1007\/s00127-015-1119-x","journal-title":"Social Psychiatry and Psychiatric Epidemiology"},{"key":"932_CR2","doi-asserted-by":"publisher","unstructured":"Belzak, L., & Halverson, J. (2018). The opioid crisis in Canada: A national perspective. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice, 38(6), 224\u2013233. https:\/\/doi.org\/10.24095\/hpcdp.38.6.02","DOI":"10.24095\/hpcdp.38.6.02"},{"issue":"7","key":"932_CR3","doi-asserted-by":"publisher","first-page":"1193","DOI":"10.1111\/add.13774","volume":"112","author":"KM Bohnert","year":"2017","unstructured":"Bohnert, K. M., Ilgen, M. A., Louzon, S., McCarthy, J. F., & Katz, I. (2017). Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration. Addiction, 112(7), 1193\u20131201. https:\/\/doi.org\/10.1111\/add.13774","journal-title":"Addiction"},{"key":"932_CR4","unstructured":"Centers for Disease Control and Prevention (2019). Annual surveillance report of drug-related risks and outcomes \u2013 United States, 2017. Surveillance Report 1. https:\/\/www.cdc.gov\/drugoverdose\/pdf\/pubs\/2017-cdc-drug-surveillance-report.pdf Accessed August 10, 2022."},{"key":"932_CR5","unstructured":"Centers for Disease Control and Prevention (2022). Death Rate Maps & Graphs. www.cdc.gov\/drugoverdose\/deaths Accessed August 10, 2022."},{"key":"932_CR6","doi-asserted-by":"publisher","unstructured":"Chan, E. Y. L., McDonald, B. M., Brooks-Lim, E., Jones, G. R., Klein, K. B., & Svenson, L. W. (2018). The role of opioid toxicity in suicide deaths in Alberta, 2000 to 2016. Health Promotion and Chronic Disease Prevention: Research, Policy and Practice, 38(9), 343\u2013346. https:\/\/doi.org\/10.24095\/hpcdp.38.9.07","DOI":"10.24095\/hpcdp.38.9.07"},{"issue":"8","key":"932_CR7","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1017\/S1041610218001540","volume":"31","author":"NG Choi","year":"2019","unstructured":"Choi, N. G., DiNitto, D. M., Marti, C. N., & Choi, B. Y. (2019). Poisoning deaths among late-middle aged and older adults: Comparison between suicides and deaths of undetermined intent. International Psychogeriatrics, 31(8), 1159\u20131169. https:\/\/doi.org\/10.1017\/S1041610218001540","journal-title":"International Psychogeriatrics"},{"issue":"4","key":"932_CR8","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1097\/YCO0000000000000717","volume":"34","author":"D Ciccarone","year":"2021","unstructured":"Ciccarone, D. (2021). The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Current Opinion in Psychiatry, 34(4), 344\u2013350. https:\/\/doi.org\/10.1097\/YCO0000000000000717","journal-title":"Current Opinion in Psychiatry"},{"key":"932_CR9","doi-asserted-by":"publisher","unstructured":"DeWeerdt, S. (2019). The natural history of an epidemic. Nature,\u00a0573(7773), S10S12. https:\/\/doi.org\/10.1038\/d41586-019-02686-2","DOI":"10.1038\/d41586-019-02686-2"},{"issue":"1","key":"932_CR10","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1186\/s13011-021-00350-5","volume":"16","author":"B Fischer","year":"2021","unstructured":"Fischer, B., O\u2019Keefe-Markman, C., Lee, A., & Daldegan-Bueno, D. (2021). \u2018Resurgent\u2019, \u2018twin\u2019 or \u2018silent\u2019 epidemic? A select data overview and observations on increasing psycho-stimulant use and harms in North America. Substance Abuse Treatment, Prevention, and Policy, 16(1), 17. https:\/\/doi.org\/10.1186\/s13011-021-00350-5","journal-title":"Substance Abuse Treatment, Prevention, and Policy"},{"key":"932_CR11","doi-asserted-by":"publisher","first-page":"553","DOI":"10.2307\/2096076","volume":"58","author":"C Girard","year":"1993","unstructured":"Girard, C. (1993). Age, gender, and suicide: A cross-national analysis. American Sociology Review, 58, 553\u2013574.","journal-title":"American Sociology Review"},{"key":"932_CR12","unstructured":"Government of Canada (2018). National report: Apparent opioid-related deaths in Canada (March 2018). Ottawa (ON): Public Health Agency of Canada.\u00a0https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/healthy-living\/national-report-apparent-opioid-related-deaths-released-march-2018.html. Accessed 10 Aug 2022."},{"key":"932_CR13","unstructured":"Government of Canada (2021). Special Advisory Committee on the Epidemic of Opioid Overdoses. Opioid- and stimulant-related harms in Canada. Ottawa: Public Health Agency of Canada.\u00a0https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants. Accessed 10 Aug 2022."},{"key":"932_CR14","unstructured":"Government of Canada (2022). Opioid and stimulant-related harms in Canada.\u00a0https:\/\/health-infobase.canada.ca\/substance-related-harms\/opioids-stimulants\/. Accessed\u00a0June prior to 2022."},{"key":"932_CR15","unstructured":"Join Point Regression Program (2020). Version 4.8.0.1, April 2020. Available from Statistical methodology and applications branch, surveillance research program, National Cancer Institute.\u00a0https:\/\/en.freedownloadmanager.org\/Windows-PC\/Joinpoint-FREE.html"},{"key":"932_CR16","doi-asserted-by":"publisher","unstructured":"Kariisa, M., Scholl, L., Wilson, N., Seth, P., & Hoots, B. (2019). Drug overdose deaths involving cocaine and psychostimulants with abuse potential \u2013 United States, 2003\u20132017. Morbidity and Mortality Weekly Report, 68(17), 388\u2013395. https:\/\/doi.org\/10.15585\/mmwr.mm6817a3","DOI":"10.15585\/mmwr.mm6817a3"},{"issue":"5","key":"932_CR17","doi-asserted-by":"publisher","first-page":"377","DOI":"10.1136\/jech-2018-210599","volume":"73","author":"T Kerr","year":"2019","unstructured":"Kerr, T. (2019). Public health responses to the opioid crisis in North America. Journal of Epidemiology and Community Health, 73(5), 377\u2013378. https:\/\/doi.org\/10.1136\/jech-2018-210599","journal-title":"Journal of Epidemiology and Community Health"},{"issue":"6","key":"932_CR18","doi-asserted-by":"publisher","first-page":"424","DOI":"10.1136\/injuryprev-2017-042376","volume":"24","author":"J Lachaud","year":"2018","unstructured":"Lachaud, J., Donnelly, P., Henry, D., Kornas, K., Fitzpatrick, T., Calzavera, A., Bornbaum, C., & Rosella, L. (2018). Characterising violent deaths of undetermined intent: A population-based study, 1999\u20132012. Injury Prevention, 24(6), 424\u2013430. https:\/\/doi.org\/10.1136\/injuryprev-2017-042376","journal-title":"Injury Prevention"},{"key":"932_CR19","doi-asserted-by":"publisher","unstructured":"Mattson, C. L., Tanz, L. J., Quinn, K., Kariisa, M., Patel, P., & Davis, N. L. (2021). Trends and geographic patterns in drug and synthetic opioid overdose deaths - United States, 2013\u20132019.\u00a0MMWR. Morbidity and Mortality Weekly Report,\u00a070(6), 202\u2013207. https:\/\/doi.org\/10.15585\/mmwr.mm7006a4","DOI":"10.15585\/mmwr.mm7006a4"},{"key":"932_CR20","doi-asserted-by":"publisher","unstructured":"Mikkelsen, L., Phillips, D. E., AbouZahr, C., Setel, P. W., de Savigny, D., Lozano, R., & Lopez, A. D. (2015). A global assessment of civil registration and vital statistics systems: Monitoring data quality and progress. Lancet (london, England), 386(10001), 1395\u20131406. https:\/\/doi.org\/10.1016\/S0140-6736(15)60171-4","DOI":"10.1016\/S0140-6736(15)60171-4"},{"issue":"23","key":"932_CR21","doi-asserted-by":"publisher","first-page":"2340","DOI":"10.1001\/jama.2019.16566","volume":"322","author":"M Olfson","year":"2019","unstructured":"Olfson, M., Rossen, L. M., Wall, M. M., Houry, D., & Blanco, C. (2019). Trends in intentional and unintentional opioid overdose deaths in the United States, 2000\u20132017. JAMA, 322(23), 2340\u20132342. https:\/\/doi.org\/10.1001\/jama.2019.16566","journal-title":"JAMA"},{"issue":"17","key":"932_CR22","doi-asserted-by":"publisher","first-page":"1567","DOI":"10.1056\/NEJMp1801417","volume":"378","author":"MA Oquendo","year":"2018","unstructured":"Oquendo, M. A., & Volkow, N. D. (2018). Suicide: A silent contributor to opioid-overdose deaths. The New England Journal of Medicine, 378(17), 1567\u20131569. https:\/\/doi.org\/10.1056\/NEJMp1801417","journal-title":"The New England Journal of Medicine"},{"key":"932_CR23","unstructured":"Population Pyramid (2021). Population of WORLD 2021. https:www.populationpyramid.net\/Canada. Accessed 30 May 2021."},{"issue":"1","key":"932_CR24","doi-asserted-by":"publisher","first-page":"73","DOI":"10.2105\/AJPH.2019.305422","volume":"110","author":"IRH Rockett","year":"2020","unstructured":"Rockett, I. R. H., & Caine, E. D. (2020). Reconciling suicides with \u201caccidental\u201d drug-intoxication deaths: A behaviorally based definition of self-injury mortality. American Journal of Public Health, 110(1), 73\u201374. https:\/\/doi.org\/10.2105\/AJPH.2019.305422","journal-title":"American Journal of Public Health"},{"key":"932_CR25","first-page":"48","volume":"2","author":"IRH Rockett","year":"2011","unstructured":"Rockett, I. R. H., Kapusta, N. D., & Bhandari, R. (2011). Suicide misclassification in an international context: Revisitation and update. Suicidology Online, 2, 48\u201361.","journal-title":"Suicidology Online"},{"issue":"8","key":"932_CR26","doi-asserted-by":"publisher","first-page":"e0135296","DOI":"10.1371\/journal.pone.0135296","volume":"10","author":"IRH Rockett","year":"2015","unstructured":"Rockett, I. R. H., Hobbs, G. R., Wu, D., Jia, H., Nolte, K. B., Smith, G. S., et al. (2015). Variable classification of drug-intoxication suicides across US States: A partial artifact of forensics? PLoS One, 10(8), e0135296. https:\/\/doi.org\/10.1371\/journal.pone.0135296","journal-title":"PLoS One"},{"key":"932_CR27","doi-asserted-by":"publisher","first-page":"100741","DOI":"10.1016\/j.eclinm.2021.100741","volume":"32","author":"IRH Rockett","year":"2021","unstructured":"Rockett, I. R. H., Caine, E. D., Banerjee, A., Ali, B., Miller, T., Connery, H. S., et al. (2021). Fatal self-injury in the United States, 1999\u20132018: Unmasking a national mental health crisis. EClinicalMedicine, 32, 100741. https:\/\/doi.org\/10.1016\/j.eclinm.2021.100741","journal-title":"EClinicalMedicine"},{"key":"932_CR28","doi-asserted-by":"crossref","unstructured":"Rockett, I.R.H., Hobbs, G., De Leo, D., Stack, S., Frost, J.L., Ducatman, A.M. et al. (2010). Suicide and unintentional poisoning mortality trends in the United States, 1987\u20132006: Two unrelated phenomena? BMC Public Health, 10, 705.\u00a0http:\/\/www.biomedcentral.com\/1471-2458\/10\/705","DOI":"10.1186\/1471-2458-10-705"},{"key":"932_CR29","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1007\/s11469-018-9994-5","volume":"17","author":"H Rontziokos","year":"2019","unstructured":"Rontziokos, H., & Deane, F. (2019). Systematic review of suicidal behaviour in individuals who have attended substance abuse treatment. International Journal of Mental Health and Addiction, 17, 1580\u20131598.","journal-title":"International Journal of Mental Health and Addiction"},{"issue":"3","key":"932_CR30","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1007\/s11606-013-2648-1","volume":"29","author":"JF Scherrer","year":"2014","unstructured":"Scherrer, J. F., Sravik, D. M., Freedland, K. E., Chrusciel, T., Balasubamanian, S., Bucholz, K. K., et al. (2014). Prescription opioid analgesics increase the risk of depression. Journal of General Internal Medicine, 29(3), 491\u2013499. https:\/\/doi.org\/10.1007\/s11606-013-2648-1","journal-title":"Journal of General Internal Medicine"},{"issue":"7","key":"932_CR31","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1177\/0706743716639918","volume":"61","author":"R Skinner","year":"2016","unstructured":"Skinner, R., McFaull, S., Rhodes, A. E., Bowes, M., & Rockett, I. R. H. (2016). Suicide in Canada: Is poisoning misclassification an issue? Canadian Journal of Psychiatry, 61(7), 405\u2013412. https:\/\/doi.org\/10.1177\/0706743716639918","journal-title":"Canadian Journal of Psychiatry"},{"key":"932_CR32","doi-asserted-by":"publisher","first-page":"143","DOI":"10.1146\/annurev-pharmtox-010617-052534","volume":"58","author":"P Skolnick","year":"2018","unstructured":"Skolnick, P. (2018). The opioid epidemic: Crisis and solutions. Annual Review of Pharmacology and Toxicology, 58, 143\u2013159. https:\/\/doi.org\/10.1146\/annurev-pharmtox-010617-052534","journal-title":"Annual Review of Pharmacology and Toxicology"},{"issue":"5","key":"932_CR33","doi-asserted-by":"publisher","first-page":"721","DOI":"10.1007\/s00127-020-01948-z","volume":"56","author":"J Snowdon","year":"2021","unstructured":"Snowdon, J. (2021). Spain\u2019s suicide statistics: Do we believe them? Social Psychiatry and Psychiatric Epidemiology, 56(5), 721\u2013729. https:\/\/doi.org\/10.1007\/s00127-020-01948-z","journal-title":"Social Psychiatry and Psychiatric Epidemiology"},{"issue":"12","key":"932_CR34","doi-asserted-by":"publisher","first-page":"1894","DOI":"10.1080\/17441692.2020.1801789","volume":"15","author":"J Snowdon","year":"2020","unstructured":"Snowdon, J., & Choi, N. (2020). Undercounting suicides: Where suicide data lie hidden. Global Public Health, 15(12), 1894\u20131901. https:\/\/doi.org\/10.1080\/17441692.2020.1801789","journal-title":"Global Public Health"},{"key":"932_CR35","doi-asserted-by":"publisher","unstructured":"Snowdon, J. (2021a). Comparing rates and patterns of male suicide and \u201chidden suicide\u201d between nations and over time. Journal of Men\u2019s Health. Online July 31, 2021a. https:\/\/doi.org\/10.31083\/jomh.2021.083","DOI":"10.31083\/jomh.2021.083"},{"key":"932_CR36","doi-asserted-by":"publisher","unstructured":"Statistics Canada (2022). Table 13\u201310\u20130156\u201301 Deaths, by cause, Chapter XX: External causes of morbidity and mortality (V01 to Y89) https:\/\/doi.org\/10.25318\/1310015601-eng","DOI":"10.25318\/1310015601-eng"},{"issue":"8","key":"932_CR37","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.2105\/AJPH.2017.303863","volume":"107","author":"DM Stone","year":"2017","unstructured":"Stone, D. M., Holland, K. M., Bartholow, B., Logan, J. E., McIntosh, W. L. K. W., Trudeau, A., & Rockett, I. R. H. (2017). Deciphering suicide and other manners of death associated with drug intoxication: A Centers for Disease Control and Prevention consultation meeting summary. American Journal of Public Health, 107(8), 1233\u20131239. https:\/\/doi.org\/10.2105\/AJPH.2017.303863","journal-title":"American Journal of Public Health"},{"issue":"2","key":"932_CR38","doi-asserted-by":"publisher","first-page":"231","DOI":"10.23907\/2013.029","volume":"3","author":"M Warner","year":"2013","unstructured":"Warner, M., Paulozzi, L. J., Nolte, K. B., Davis, G. G., & Nelson, L. S. (2013). State variation in certifying manner of death and drugs involved in drug intoxication deaths. Academic Forensic Pathology, 3(2), 231\u2013237.","journal-title":"Academic Forensic Pathology"},{"key":"932_CR39","volume-title":"The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines (CDDG)","author":"World Health Organization","year":"1992","unstructured":"World Health Organization. (1992). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines (CDDG). WHO."}],"container-title":["International Journal of Mental Health and Addiction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11469-022-00932-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11469-022-00932-9\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11469-022-00932-9.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,27]],"date-time":"2024-06-27T13:33:09Z","timestamp":1719495189000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11469-022-00932-9"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,10]]},"references-count":39,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,6]]}},"alternative-id":["932"],"URL":"https:\/\/doi.org\/10.1007\/s11469-022-00932-9","relation":{},"ISSN":["1557-1874","1557-1882"],"issn-type":[{"value":"1557-1874","type":"print"},{"value":"1557-1882","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,10]]},"assertion":[{"value":"29 September 2022","order":1,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 October 2022","order":2,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of Interest"}}]}}