High, increasing costs of substance use in Canada can’t be ignored

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MANITOULIN – Substance use cost Canadians almost $46 billion in 2017, led to over 275,000 hospitalizations and contributed to the loss of nearly 75,000 lives, according to a report prepared by the Canadian Centre on Substance Use and Addiction (CCSA) and the Canadian Institute for Substance Use Research at the University of Victoria. Alcohol and tobacco use accounted for almost two-thirds of the total costs, followed by opioid and cocaine use.

This represents a 3.3 percent increase in per-person cost between 2015 and 2017, from $1,218 in 2015 to approximately $1,258 in 2017 according to the report, Canadian Substance Use Costs and Harms 2015-2017. 

The high cost related to alcohol and tobacco use was not surprising, said study co-author Bridget Maloney Hall (with CCSA). That finding was the same in an earlier iteration of the study, but it is one of the most important. 

“When it comes to public health and the Canadian economy we really can’t ignore the impacts of alcohol and tobacco use,” she said, “but we saw the biggest increases in costs in stimulants and in opioids.” 

The stimulants category is broken down into cocaine and central nervous system stimulants, mostly methamphetamines and amphetamines. Overall, costs associated with opioid use increased 20.9 percent; costs associated with cocaine use increased 10.5 percent and with other stimulants, 22.1 percent. The overall alcohol use increased 1.6 percent and the per-person cost of tobacco use decreased overall by 5.1 percent. The costs associated with alcohol ($5.4 billion) and tobacco ($6.1 billion) use accounted for 62.9 percent of the total per person cost.

The study goes up to 2017, which is the beginning of the opioid crisis, so that increase was also not surprising but is a trend to watch in the future. “If you look at our numbers for opioid deaths as well as more recent numbers posted by the Government of Canada, we saw national opioid deaths decrease from 2018 to 2019 but it looks like there’s been an increase again during COVID-19.”

There is a relationship between different substances and different types of crime and that really drives the cost, said Ms. Maloney-Hall. “For example, there’s a strong relationship between alcohol use and crime in general but particularly violent crimes. About 20 percent of all violent crimes wouldn’t occur without alcohol, compared to other substances that don’t have a strong association with violent crime. With cocaine, it’s the same thing; there’s a very strong association between cocaine use and crime.”

There continues to be costs associated with impaired driving; 95 percent of costs related to impaired driving were due to alcohol. 

Lost productivity costs are calculated by looking at long- or short-term disability as well as at premature deaths (prior to 65 years which is counted as the year of retirement). “Someone who passed away from opioid use at the age of 40 would count 25 years of lost productivity because that’s where they would have been in the workforce contributing to the economy. While tobacco by far had the most deaths associated with it, a lot of those deaths occur at a much older age, past the age of retirement, whereas with opioids a lot of those deaths are at a much younger age so that partly accounts for why they make up a large amount of lost productivity costs,” she said.

Tobacco was by far the deadliest substance, according to the report, with its use leading to 47,707 deaths in 2017. This was followed by alcohol at 18,320 deaths and all other drugs combined for 8,872 deaths. Although more deaths can be attributed to tobacco use, alcohol use led the way in total costs because it can be attributed to injuries and deaths of people at a younger age and was therefore responsible for more lost years of productive life. 

“We suspect this is the curve because fewer people are using tobacco following decades of public health campaigns showing the risks associated with tobacco use. Those costs are still quite high but they are going down,” Ms. Maloney-Hall continued. “One message that we hope comes out of our study is that not only are alcohol costs the highest but they’re also still increasing and while we’ve had those really strong public messages with tobacco we haven’t seen that to the same extent with alcohol. It’s still promoted quite widely across the country and it seems that people don’t really see the same risk with alcohol that they do with tobacco so I think one of the things that we hope will come out of this study is raising awareness and maybe leading to some policy change around how alcohol is promoted and made accessible in Canada.”

The report noted that at the same time, some provincial and territorial governments have loosened restrictions on the sale and availability of alcohol, national advertising codes have not been updated in a quarter of a century and do not apply to digital media, used by many young people to communicate. A 2020 NANOS Research poll pointed to increasing alcohol consumption during COVID-19 due to lack of regular schedules, stress and boredom, which suggests there will likely be more harms attributable to alcohol in future estimates. 

There are additional questions that will be addressed in future updates. It is likely that the crime-related costs associated with cannabis will decrease when we update our data to include 2019, the first full year that non-medical cannabis was legalized. Will health care and other costs increase? Will the costs of alcohol use continue to rise as some provinces move to privatize its sale and distribution? Will tobacco and nicotine-related harms and costs increase or decrease as people who smoke switch to vapour devices for delivering nicotine? What will be the short- and long-term impact of the COVID-19 pandemic on substance use and related harms in Canada?

The report concluded with the need for evidence-based decision-making in efforts to reduce the costs and harms from substance use in Canada, particularly at a time when researchers and lawmakers are assessing the impacts of legal, non-medical cannabis, the country remains in the midst of an opioid crisis and many regions are seeing increases in harms related to methamphetamine use, all during a pandemic that is changing our social landscape.

“What we’re most interested in is seeing how the trends change over time so we plan on continuing new years of data to this study,” noted Ms. Maloney-Hall. “This study ends in 2017 which is right when the use of cannabis was legalized so we’re very curious to see how the costs associated with cannabis use change with that. We anticipate that maybe the criminal justice costs might go down but health care costs might increase so exactly how that looks will be really interesting to see. With the opioid crisis continuing it will be important to see how those trends continue or change. The COVID-19 pandemic has kind of thrown a curveball. A lot of substance use trends seem to be coming out of COVID-19 so it will be important to capture that in our study. It’s important for people to see that substance use does lead to significant costs in Canada and we really need to ensure that our policies create appropriate access to substances while also limiting harms and that’s the tricky balancing act.”