Time for national registry tracking opioid deaths

Ottawa is not well-placed to act directly in healthcare delivery, but could better support provinces. It could make funding conditional on them meeting minimum access standards for opioid agonist therapy (OAT), the most well-established treatment for people with opioid use disorder.

Vincent Lam, The Hill Times
July 6, 2026

ORONTO—On June 15, the Public Health Agency of Canada reported a 23 per cent decrease in opioid-related deaths in 2025 compared to 2024. The report was quick to point out the number of deaths, still higher than pre-COVID-19 pandemic levels, is “unacceptably high.” For context, that is a level of 145 deaths per million people for opioids alone, which is multiples of the rate in many peer countries. In 2024, deaths from all drugs per million were 25 in the European Union, 28 in New Zealand, and 71 in Australia. Along with the United States, which saw 161 deaths per million for opioids alone in 2024, we are the outliers in the developed world. The decrease in opioid-related deaths in Canada does not represent a great healthcare victory, and it turns out not to be clearly explained.

A seemingly banal statement in the commentary accompanying the data release speaks volumes through its implications. It is conjectured that one of the possible reasons we saw a decrease in deaths in 2025—alongside harm reduction measures such as naloxone access and changes in the illicit drug supply—was “a smaller population at risk of overdose.” To spell it out, it suggests that so many people have already died, that there may simply have been fewer Canadians with opioid use disorder (OUD) who remained alive, or who could have died, in 2025. Therefore, fewer died. The other alarming thing about

The other alarming thing about this phrase is its vagueness, which is necessitated by a glaring gap: we don’t even know the number of people we are trying to help. We can only speculate that there are fewer people still alive. It’s impossible to answer the core question: are we doing a better job of preventing overdose deaths? A worse job? To do so, we would need a denominator—the number of Canadians who contend with OUD and are in need of treatment—to make sense of the numerator, in this case the death toll. We only have the latter. Remarkably, two decades after Purdue Pharma released Oxy-Contin in 1996 and launched our country into a devastating opioid crisis, we have no national registry for OUD, and no systematic prevalence surveillance system for OUD or other addictions. That reporting gap exists within the broader context of Canada having no unified health-data system.

What about medical treatment? In December 2025, the Public Health Agency of Canada examined whether opioid agonist therapy (OAT), the most well-established treatment for OUD, was driving population-level declines in opioid related deaths. (Note that OAT uses long-acting opioids to treat withdrawal, and should be distinguished from “safe supply,” which provides short-acting opioids to substitute for illicit opioids, and has less evidence for benefit than OAT). Ironically, this report both re-iterated one of the most clear pieces of medical knowledge around this problem, that OAT is a “proven treatment for people with an OUD,” and concluded that it is unlikely to be driving recent declines in deaths because not enough people are receiving it. A study was cited in which only 10 per cent of patients who survived an opioid overdose in Ontario hospitals initiated OAT treatment. We have a proven treatment for a devastating medical condition, yet only 10 per cent of people who have nearly died from that condition are starting that treatment. This tells me that as a system, we are failing these Canadians. In comparison, France achieved population-level reductions in opioid related deaths of 79 per cent when they increased the number of patients treated with OAT by tenfold.

In my addiction medicine clinic, the past decade has brought many changes. The protocols we use to administer and adjust medications have become more flexible and patient-centered. New forms of this treatment are now available including a monthly injectable form of buprenorphine (previous treatment options are daily dosing). A welcome change has been the removal in 2018 of the Sec. 56 exemption, under which physicians previously needed a federal exemption from Health Canada to prescribe methadone.

The landscape of illicit drugs has become more unpredictable, such that a recent report from Toronto’s Drug Checking Services showed that only five per cent of drug samples thought to be fentanyl were only fentanyl. The rest often contained fentanyl as well as a mix of other substances. This makes medical treatment more complex and difficult.

Some broad themes in my clinic endure. Regardless of which medication is used—although receiving some kind of OAT treatment consistently at a therapeutic dose is almost always an essential support—people who are housed and meaningfully connected to others in society through work, school, family, or a sober partner are more likely to stabilize with treatment. People who are unhoused, out of school or work, cut off from meaningful relationships, and unable to participate in society are more likely to be stuck, to suffer, and to die.

The federal government should lead our national response to the opioid crisis with the idea that people who use drugs are valued members of Canadian society, who have societal and economic contributions to make. The federal government must also find ways to support this idea concretely. Ottawa is not well placed to act directly in health-care delivery, but it should robustly support the provinces in doing so. It could make targeted OUD-specific funding conditional on provinces meeting minimum OAT access standards. It should lead a national registry and public health surveillance system for opioid and other substance use issues, co-ordinating with provinces and municipal public health units.

Bill C-64, the last Parliament’s pharmacare legislation, should be expanded to include OAT. Currently, some patients are ‘stuck’ receiving welfare or disability payments because the coverage for their essential medication would be lost if they return to entry-level employment without medication benefits. Removing this barrier to work would benefit both the patient and our GDP. We have successful programs in Canada to support doctors and nurses with addictions in returning to work, and should offer the same for all Canadian workers.

The federal government could lead by creating similar programs for a broad range of workers, particularly those in the skilled trades, within the Major Projects Office and Build Canada Homes. Both of these present major opportunities to bring people whose lives and careers have been derailed by drugs back into the workforce. Three out of four opioid related deaths since 2016 were in men, and of those who were employed at the time of their death, between 30 and 50 per cent worked in the skilled trades. It would be comical were it not so tragic, that we face a housing crisis while people sit in my waiting room, some of them unhoused, who have the skills to build the housing we need. Meanwhile, Build Canada Homes should make a clear commitment to a Housing First approach, which would provide low barrier access to housing without a precondition of either treatment or employment.

The duty we have to care for our fellow Canadians is the prime imperative, but an estimated $8.8-billion in productivity loss between 2016 and 2021 from opioid overdoses reminds us that sound economic arguments can stand alongside humanistic ones. The message to people who use drugs should be ‘We want you to receive the medical treatment you need, and have the opportunity to fully participate fully in your community.’ Both of these goals are good for our fellow neighbours and our economy.

The Hill Times