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We acknowledge our office is located on Treaty 1 Territory and that Manitoba is located on the Treaty Territories and ancestral lands of the Anishinaabeg, Anishininewuk, Dakota Oyate, Denesuline and Nehethowuk Nations.
We acknowledge Manitoba is located on the Homeland of the Red River Métis.
We acknowledge northern Manitoba includes lands that were and are the ancestral lands of the Inuit.
We respect the spirit and intent of Treaties and Treaty Making and remain committed to working in partnership with First Nations, Inuit and Métis people in the spirit of truth, reconciliation and collaboration.
Office of the Chief Medical Examiner (OCME).
Hospital Data - Two Sources.
Emergency Medical Services (EMS) - Winnipeg Fire and Paramedic Service (WFPS) Data
Take-Home Naloxone (THN) Kit distribution data
Substance related harm has tragic effects on many people in Manitoba, from the person experiencing the harm, to their family and friends, to community members and health care teams. These harms often befall society’s most marginalized populations.
Tracking substance use data helps the government and service delivery organizations to better understand substance use challenges in Manitoba. Evidence provides a foundation upon which to make informed and strategic decisions about how best to support the system and the individuals affected.
This summary provides up to date information on substance use and related harms in Manitoba. It will be updated on a quarterly basis with the information that is available from four key data sources and corresponds to each quarter’s data refresh on the Substance Related Harms Surveillance Report. The objective is to provide epidemiological interpretation of the data from the Surveillance Report, and a more in-depth look at the current data.
Leading up to the pandemic in March 2020, many of the surveillance indicators for substance harms held steady at lower levels. However, due to many factors, this changed starting in Q2 of 2020 with the onset of the pandemic.
The figure below displays surveillance indicators in four plots, with the red rectangles indicating the time span of the pandemic (March 15, 2020 to January 1, 2022). In summary, there was an increase in all four measures of substance related harms occurring in Q2 and Q3 2020, including:
Naloxone became unscheduled in Manitoba at the end of 2020, which means it no longer requires administration by a health professional. This may explain some of the increase in distribution of kits, though extreme increase in the demand for Naloxone points to a shift in substance use and drug supply patterns during the pandemic. This, along with increased public awareness and the increased efforts of community organizations and government to get Naloxone into the hands that need it, has increased the distribution of these life-saving kits.
For more information on national-level studies and findings around increasing drug toxicities across Canada, please visit https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/.
When looking to understand the reasons for increased rates in substance related harms in the province, there are two potential causes:
In this report, the toxicity of the drug supply is explored in more detail.
For some perspective, though the ratios fluctuate as a result of other biological and chemical factors, fentanyl is 10-50 times more potent than heroin, and a fatal dose of fentanyl can require 100 times less drug than a fatal dose of methamphetamine. Please see Health Canada`s website for more details on these and other chemical toxicities: https://www.canada.ca/en/health-canada/services/substance-use/controlled-illegal-drugs.html.
Historically, Manitoba has seen a large burden of methamphetamine use. However, through the pandemic, the data suggest that this burden is now shared with opioid use (including but not limited to fentanyl). The figure below illustrates that this change in substances attributed to fatalities, hospitalizations, emergency department visits, and WFPS events, are most often linked to both opioids and/or stimulants (or more specifically, where available, methamphetamine).
These plots overlaid with other substances are available in the Substance Harms Report. The changing trends in drug use and overdose source were likely exacerbated by pandemic-related border closures and subsequent supply chain disruptions and changes to drug supply. This was noted by the WHO as a particular concern for North America, as shortages in drug supply likely drove the increase in the uptake of synthetic drugs, such as fentanyl, over heroin (https://www.unodc.org/documents/data-and-analysis/covid/Covid-19-and-drug-supply-chain-Mai2020.pdf (accessed 2022-11-08)).
The use of more than one substance at a time (polysubstance) is common and a key aspect of the current challenges faced with an unregulated drug supply. As a result, an overdose event may be counted in more than one category for each indicator. As to the hospitalization data, “stimulants” indicates any stimulant related visit, excluding cocaine. The grouping of stimulants into a single category represents a limitation of the diagnosis codes, however, evidence from the province’s fatalities data would suggest that a high proportion of these visits are methamphetamine related.
From the above figure, a clear shift occurred around Q2 of 2020, with opioids becoming more prevalent in causing harm relative to methamphetamine/stimulant harms. This may be due to the stronger effects of opioids leading to a higher probability for causing acute toxicity (overdose) events. Additionally, new and emerging powerfully dangerous synthetic opioids are frequently being introduced to the drug supply.
Any drugs that are seized by law enforcement are subjected to analysis of drug contents. The drug analysis service data: https://health-infobase.canada.ca/drug-analysis-service/analyzed-drug-report.html, provides lab-analyzed, police seized substance chemical breakdowns. The graph below shows the number of seized samples that contain fentanyl and heroin in Manitoba. The data demonstrate that fentanyl is more prevalent in the drug supply in recent years (2020 and 2021 especially).
The simultaneous use of multiple substances is a concern in Manitoba, as with the rest of Canada. Polysubstance use is not practiced the same way by all people – one person may intentionally take more than one substance, while another person may not know that they are taking multiple substances because additional substances may have been introduced prior to the drug being sold to the user. Whether or not the individual was aware that they were using multiple substances cannot be known, as this information comes from toxicology reports after death. Below shows the fatalities in 2021 divided into opioid related, stimulant related, opioid and stimulant related, and other. Evidently, stimulants and opioids being taken together is the major source of fatalities in Manitoba. Polysubstance use is having the biggest impact on the numbers of substance related fatalities in Manitoba.