Stimulant Harms Snapshot: Technical Notes

TECHNICAL NOTES

Stimulant Harms Snapshot

This Snapshot captures stimulant-related mortality data provided by the Office of the Chief Coroner/Ontario Forensic Pathology Service (OCC/OFPS). Data is reported by both calendar quarter (2018 Q1 to 2021 Q3) and calendar year (2018 to 2020) of death for local Public Health Units (PHUs) and other geographic comparators in Ontario.

Specific Indicators Stimulant-toxicity deaths*

Mortality from any stimulant

Mortality from any stimulant (with opioid)

Mortality from any stimulant (without opioid)

Mortality from cocaine

Mortality from methamphetamines

Mortality from other stimulants**

Definitions *Stimulant toxicity death: A death caused by intoxication/toxicity (poisoning) resulting from

substance use, where one or more of the substances is a stimulant, regardless of how it was obtained (e.g. illegally or through personal prescription). Only confirmed cases of stimulant toxicity deaths are included in this Snapshot.

**Other stimulants: Amphetamine, methylenedioxyamphetamine (MDA), methylenedioxymethamphetamine (MDMA), mephedrone, methylphenidate, phentermine, pseudoephedrine, and methylenedioxypyrovalerone. Amphetamine is a known metabolite of methamphetamine but can also be consumed separately and directly contribute to a toxicity death. Deaths where amphetamine (without methamphetamine) directly contributed to the death are reported under ‘other stimulants’.

Stimulant Harms Snapshot: Technical Notes 2

Measures Included Age-standardized rates

Age-standardized rate (both sexes)

Age-standardized rate (males)

Age-standardized rate (females)

Crude rates

Crude rate (both sexes)

Crude rate (males)

Crude rate (females)

Age-specific rates (both sexes, males, females)

Age-specific rate (ages 15 to 24)

Age-specific rate (ages 25 to 44)

Age-specific rate (ages 45 to 64)

Age-specific rate (ages 65+)

Metrics Included Rates (Age-standardized, crude, age-specific)

95% confidence intervals (CIs for rates calculated using a Poisson approximation of the binomial distribution)

Statistical significance compared to Ontario (For rates, confidence interval around the difference between the health unit rate and the Ontario rate does not include zero)

Cases (Numerator)

Population (Denominator)

Geographic Comparisons Included Ontario

Snapshots peer groups (based on Statistics Canada peer groups). For more information on Statistics Canada peer group methodology, see: Health region peer groups – working paper, 2018 on the Statistics Canada website. Table 1 shows the mapping between the peer groupings used in Snapshots and the nationally defined 2018 Statistics Canada peer groups.

Stimulant Harms Snapshot: Technical Notes 3

Table 1. Mapping between Snapshots Peer Groups and Statistics Canada 2018 Peer Groups

Peer Groups Public Health Units

Mainly urban centres with moderate population density (Statistics Canada peer group B)

Durham Region Health Department Halton Region Public Health City of Hamilton Public Health Services Middlesex-London Health Unit Ottawa Public Health Region of Waterloo Public Health and Emergency Services Windsor-Essex County Health Unit

Sparsely populated urban-rural mix (Statistics Canada peer group C)

Algoma Public Health Brant County Health Unit Chatham-Kent Health Unit Eastern Ontario Health Unit Haliburton, Kawartha, Pine Ridge District Health Unit Hastings Prince Edward Public Health Kingston, Frontenac and Lennox & Addington Public Health Lambton Public Health Niagara Region Public Health North Bay Parry Sound District Health Unit Porcupine Health Unit Peterborough Public Health Public Health Sudbury & Districts Thunder Bay District Health Unit Timiskaming Health Unit

Mainly rural (Statistics Canada peer group D)

Grey Bruce Health Unit Haldimand-Norfolk Health Unit Huron Perth Public Health Leeds, Grenville & Lanark District Health Unit Northwestern Health Unit Renfrew County and District Health Unit Simcoe Muskoka District Health Unit Southwestern Public Health Wellington-Dufferin-Guelph Public Health

Largest population centres with high population density (Statistics Canada peer groups G & H)

Toronto Public Health Peel Public Health York Region Public Health

Stimulant Harms Snapshot: Technical Notes 4

Other Methodological Notes This update is based on data from the Office of the Chief Coroner effective February 10, 2022.

New or revised data reported after this date will be reflected in future updates.

As some data are based on ongoing investigations by coroners, they are considered preliminary and subject to change.

This update is based on data that do not specify how the opioids or stimulants were obtained (e.g. illegally or through personal prescription); the level of toxicity may differ depending on the opioid or stimulant (substance(s) involved, concentration, and dosage).

Data on apparent opioid toxicity deaths and stimulant toxicity deaths are not mutually exclusive. A high proportion of deaths involving a stimulant also involved an opioid. Adding up those numbers would result in an overestimation of the burden of opioids and stimulants.

Due to the small sample size, use caution when interpreting the statistics.

Data Sources Numerator:

Office of the Chief Coroner/Ontario Forensic Pathology Service (OCC/OFPS) 2018 to 2021 Q3, extracted February 10, 2022.

Denominator:

Population Estimates, 2018 – 2021, Statistics Canada, extracted November 15, 2020.

Suggested Citation Generic Citation Format:

Author. Content tool: Title of indicator. Place of publication: Publisher; copyright year [last updated date; date of access]. Available from: insert URL to page being referenced.

Example Citation:

Ontario Agency for Health Protection and Promotion (Public Health Ontario). Snapshots: Stimulant Harms Snapshot [Internet]. Toronto, ON: Queen’s Printer for Ontario; 2022 [updated 2022 Feb 24; cited 2022 Feb 24]. Available from: https://www.publichealthontario.ca/en/data-and-analysis/substance-use/stimulant-harms.