Follow-up Survey and Qualitative Research on Controlled Substances Awareness, Knowledge, and Behaviours for Public Education (2024)

Final report

Prepared for Health Canada

Supplier name: Earnscliffe Strategy Group
Contract number: CW2238166
Contract value: $214,725.99
Award date: November 20, 2023
Delivery date: April 26, 2024

Registration number: POR 088-23
For more information on this report, please contact Health Canada at:
hc.cpab.por-rop.dgcap.sc@canada.ca

Ce rapport est aussi disponible en français.

This public opinion research report presents the results of an online survey and focus groups conducted by Earnscliffe Strategy Group on behalf of Health Canada. The quantitative research was conducted from February 27 to March 16, 2024, and the qualitative research was conducted from January 24 to January 25, 2024.

Cette publication est aussi disponible en français sous le titre : Enquête de suivi et recherche qualitative sur la sensibilisation, les connaissances, et les comportements liés aux opioïdes aux fins de l'éducation du public (2024)

This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact the Public Health Agency of Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca or at:

Health Canada, CPAB
200 Eglantine Driveway, Tunney's Pasture
Jeanne Mance Building, AL 1915C
Ottawa, Ontario K1A 0K9

Catalogue Number: H14-629/2024E-PDF

International Standard Book Number (ISBN): 978-0-660-72545-1

Related publications (registration number):

Enquête de suivi et recherche qualitative sur la sensibilisation, les connaissances, et les comportements liés aux opioïdes aux fins de l'éducation du public (2024) (Final Report, French) ISBN 978-0-660-72546-8

© His Majesty the King in Right of Canada, as represented by the Minister of Health, 2024

Table of contents

• Executive summary
• Introduction
• Detailed findings
  • Section A: Opioids and illegal drug use
  • Section B: Opioid awareness, impressions, and basic understanding
  • Section C: Attitudes relating to behaviours, risk, and harms
  • Section D: Attitudes regarding stigma
  • Section E: Risk behaviour profiling
  • Section F: Opioid information
  • Section G: Views on chronic pain and chronic pain management
  • Section H: The role of stigma
  • Section I: Views regarding alcohol consumption and substance use
• Conclusions
• Appendix A: Quantitative methodology report
• Appendix B: Qualitative methodology report
• Appendix C: Discussion guide
• Appendix D: Recruitment screener
• Appendix E: Survey questionnaire

Executive summary

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of the follow-up survey and qualitative research on opioid awareness, knowledge, and behaviours for public education.

Canada has seen substantially elevated numbers of opioid-related deaths and other harms since surveillance began in 2016. The overdose crisis is complex and affects all communities, age groups, and socioeconomic strata. In 2018, Health Canada launched a multi-year marketing campaign to address the growing overdose crisis to raise awareness and educate Canadians on: the risks associated with substance use, including but not limited to opioids (legal and illegal); and the role of stigma as a barrier to seek help.

In 2017, to help inform the ensuing public education campaign, Health Canada contracted Earnscliffe to conduct a baseline survey on opioid awareness, knowledge, and behaviours. In 2019 and 2022, we conducted follow-up research to determine whether results had changed since the baseline survey. More recently, further research was required to determine if awareness of and attitudes towards opioid use have changed over the past few years, and if stigma has been reduced. This research provides evidence-based data and insights to guide Health Canada's marketing campaigns and policy development. The contract value for this project was $214,725.99 including HST.

To meet these objectives, Earnscliffe conducted two-phased approach involving both qualitative and quantitative research.

The initial phase involved qualitative research, which included a series of ten focus groups over January 24-25 with specific target audiences that face higher rates of drug overdoses: males 20-59 who work in physically demanding jobs outside of construction and Indigenous respondents aged 18-59. Two groups (one with each target audience) were conducted in each of the following regions: British Columbia (BC), the Prairies and Northern Canada, Ontario, Quebec, and Atlantic Canada.

Up to 10 participants were recruited for each group, with the goal that at least 8 be able to participate. In total, 76 people participated in the focus group discussions. The groups in Quebec were conducted in French, while the groups in all other locations were conducted in English. The sessions were approximately 90 minutes in length. Appendix B provides greater detail on how the groups were recruited, while Appendix C provides the discussion guide used to facilitate the focus groups and Appendix D provide the screeners used for recruiting the focus groups.

For the purposes of this report, it is important to note that qualitative research is a form of scientific, social policy, and public opinion research. Focus group research is not designed to help a group reach a consensus or to make decisions, but rather to elicit the full range of ideas, attitudes, experiences, and opinions of a selected sample of participants on a defined topic at a particular point in time. Because of the small numbers involved, the participants cannot be expected to be thoroughly representative in a statistical sense of the larger population from which they are drawn, and findings cannot reliably be generalized beyond their number.

The initial qualitative phase was followed by a quantitative phase involving an online survey, to update and compare results against baseline measures from the 2017, 2019, and 2021. We conducted a base survey of 1666 Canadians aged 13 and older, plus oversamples of at least 300 additional interviews among each of the following nine specific audiences identified by Health Canada:

• Youth 13-15;
• Parents of youth 13-15;
• Young adults 16-24;
• Males 20-59;
• Indigenous respondents;
• Racialized respondents;
• Male labourers (shortened from men in physically demanding jobs, including construction);
• People who use opioids legally, including prescriptions; and,
• People who use opioids illegally, including counterfeit prescriptions and/or other drugs that could be laced with opioids.

A total of 3,740 Canadians were surveyed using Leger's opt-in panel. Because respondents could qualify for more than one key target audience, the source of respondents was a combination of those found in the general population sample, those found specifically when sampling for that target audience, and those found when specifically targeting a different audience. The 3,740 interviews were comprised of the following:

• A base national sample of n=1666 Canadian residents aged 13 and older;
• An additional sample of n=373 youth aged 13-15;
• An additional sample of n=477 parents of youth 13-15;
• An additional sample of n=522 young adults 16-24;
• An additional sample of n=999 men aged 20-59;
• An additional sample of n=422 Indigenous respondents;
• An additional sample of n=338 racialized respondents;
• An additional sample of n=389 male labourers;
• An additional sample of n=567 people who use opioids legally; and,
• An additional sample of n=342 people who use opioids illegally.

The field work was conducted from February 27 to March 16, 2024, in English and French. It took an average of 17 minutes to complete.

Respondents for the online survey were selected from among those who have volunteered to participate in online surveys. The data for the general population sample was weighted to reflect the demographic composition of the Canadian population aged 13 and older. Because the online sample is based on those who initially self-selected for participation in the panel, no estimates of sampling error can be calculated, and the results cannot be described as statistically projectable to the target population. The treatment here of the non-probability sample is aligned with the Standards for the Conduct of Government of Canada Public Opinion Research - Online Surveys.

The final data for the general population and the youth 13-15, young adults 16-24, men 20-59, Indigenous, and racialized respondents' oversamples, were weighted to replicate actual population distribution by region, age and gender according to the 2021 census data available. The data for the parent, men who work in physically demanding jobs, people who use opioids legally, and people who use opioids illegally oversamples, were weighted based on the profile found in the general population, by age, gender, and region. Appendix A provides full details on the survey methodology and Appendix E provides the survey instrument used.

The key findings from the research are presented below. To ensure comparability, the survey largely remained consistent with questions asked in the 2021 and 2019 surveys. This includes some terminology that Health Canada no longer uses as it is considered stigmatising. Readers are encouraged to use non-stigmatising language when talking about substance use. For more information on changing how we talk about substance use, please see Communicating about Substance Use in Compassionate, Safe and Non-Stigmatizing Ways.

For statistical information on prevalence, refer to the Canadian Alcohol and Drugs Survey (CADS) or the Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS).

Section A: Opioid and illegal drug use

• The number of respondents who say that they have taken one of the listed drugs this year (23%), while up slightly from 2021, nonetheless represents a decline from the recorded peak of 29% who said the same in 2019.
• When it comes to whether respondents have prescriptions, Indigenous respondents (67%) are the most likely to say they always have one whereas men in physically demanding jobs (46%) and young adults aged 16-24 (42%) are the least likely to say the same.
• When asked if a doctor had ever refused to prescribe an opioid when it was needed for pain, those most likely to say yes are people who use opioids illegally with one quarter (24%) saying so. This suggests that there is a portion of people who use opioids illegally who are classified as such due to the refusal of a doctor to provide a prescription.
• As with past waves of this research, participants in focus groups were able to easily provide definitions for both "substance use" and "addiction" – the latter of which was frequently understood negatively and conflated with the term "substance abuse."
• As for "addiction," it was understood by participants as the inability to easily stop doing something.

Section B: Opioid awareness, impressions, and basic understanding

• The survey findings suggest that awareness of opioids is unchanged since 2019. At two-in-five, people who use opioids legally (40%) and Indigenous respondents (39%) were the most likely to say they are certain they know what an opioid is.
• Youth remain the least familiar with what opioids are with 29% saying they have never heard of them or do not really know what they are – this number jumps to 39% when prompted with a reference chart listing specific types of opioids.
• There is a broad sense that most (37%) or all (44%) of opioids in the chart provided to respondents are dangerous among the general population with no one saying that none are dangerous (0%). This trend is echoed in most of the other target audiences examined with the exception of people who use opioids illegally, who are the least likely to say that all of the drugs listed are dangerous.
• Levels of familiarity with fentanyl remain consistent with previous waves (with 45% saying they are at least somewhat, if not very familiar) as does its perceived danger (82% saying it is very dangerous).
• As with previous waves of this study, the vast majority believe that the term "illegal opioids" refers to those obtained on the street (89%) – similar to 2021 (89%), 2019 (87%), and 2017 (88%).
• Despite the lower numbers of respondents saying that they are very familiar with the opioid crisis, majorities across all target audiences say that it is at least somewhat, if not very, serious. Indigenous respondents (71%) and people who use opioids legally (67%) being the most likely to say it is very serious.
• There is a marked difference between the number of respondents in the general population sample who say that the opioid crisis in Canada is very serious (61%) versus those who say it is very serious in their community (28%).
• When asked to choose a term to best describe the current situation with overdose deaths in Canada, no clear consensus emerged with roughly equal numbers choosing the "opioid overdose crisis" and the "opioid crisis" with minor variations among the target audiences.
• Majorities across all audiences say that they believe there to be a high risk that an illegal non-opioid drug might be laced with an opioid like fentanyl.
• In the focus groups, a majority were aware of the term opioids, often from media reports. That being said, at least one in each group had some form of personal experience.
• When asked for signs of an overdose, at least some participants in each group offered: altered consciousness; changes to the eyes, pallor, lip colour, or breathing; or the presence of vomit.
• The most common response to a drug overdose for almost all participants would be to call 911, though some mentioned the use of naloxone with a few mentioning that they had a "Narcan" kit.
• While awareness of the Good Samaritan Drug Overdose Act was minimal (and at times confused with the Good Samaritan Act), once read a description of the Act, reactions were very positive.

Section C: Attitudes relating to behaviours, risk, and harms

• Reversing the trend noted in the last report, there has been a significant increase in the number of respondents agreeing that they understand why opioids are dangerous – from 60% in 2021 to 80% in 2024.
• In line with trends noted above, Indigenous respondents appear to be the most aware of the dangers of opioids, with 86% agreeing that they understand why opioids are dangerous – a number only matched by people who use opioids illegally.
• While male labourers are less likely to say they understand why opioids are dangerous than the general population, they are more likely to agree with all other metrics surrounding accessing resources or identifying overdoses or addiction.
• Majorities across all audiences say that they feel that the terms "opioid use disorder" and "addiction" refer to basically the same thing, if not exactly the same thing.
• These views were nuanced in the focus groups where different substances entailed varying level of acceptance, with alcohol and cannabis seen to be the most acceptable. Participants did appear to be preoccupied with the normalization of alcohol and concerned about the health implications.
• Participants highlighted how substance use seemed to most often be tied to the act of socializing or as a coping mechanism.
• Among male labourers, pain management was more often linked to substance use, including the use of cannabis, but especially the use of prescribed and/or illegal opioids. Illegal stimulants like cocaine appeared more prevalent among men working in physically demanding job so that they could stay up through long hours.

Section D: Attitudes regarding stigma

• It is clear that there is still stigma surrounding opioid use disorder. Even if on most metrics the tracking data suggests that this stigma has remained fairly stable, there are a few where there has been a slight degradation of opinion – for example, those saying that those who overdose get what they deserve has notched up to 14%.
• If most respondents are cognizant that this stigma exists, with three quarters (73%) of the general population sample agreeing that society is not very friendly toward people living with a drug addiction, there are important differences in the way in which the target audiences examined in this report understand and interact with this stigma.
• In the focus groups participants easily grasped the concept of stigma, with it often coming up unprompted and being tied to negative perceptions of shame, judgment, stereotypes, and barriers.
• There was near consensus that those who have a substance use addiction are stigmatized, however, most recognized that the amount of stigma or the way it is applied depends on the person being stigmatized and the substance in question. As we have seen in previous waves, there was definitely a sense that ethnic minorities and Indigenous people are stigmatized more than other communities.
• Most participants agreed that stigma negatively impacts those with substance use addiction and makes them less likely to reach out for help. This was particularly true of groups with Indigenous people, who pointed to stigma but also cost, limited access to healthcare, and issues of trust.
• Asked whether men in physically demanding jobs would reach out for help if they were worried about their substance use, most participants did not think they would due to the stigma and the fear of reprisal at work. There was also a link drawn by some participants to perceptions of masculinity, and the idea that men are expected to be tough or disciplined enough to handle the situation.

Section E: Risk behaviour profiling

• Unlike 2021 when proximity to those with opioid dependencies had fallen, this wave marks a reversal in this trend with half (48%) of respondents in the general population sample saying that known at least one friend or family member who has been prescribed an opioid – this up from 42% who said the same in 2021.
• Tragically, one-in-five (20%) respondents in the general population sample say they know someone who died of an overdose of one of these drugs or suffered a non-fatal overdose (19%). These represent new peaks since tracking began in 2017.
• Indigenous respondents report very high levels of personal proximity to opioid use and are the most likely to say they know someone who has become addicted (59%), to know someone who has done them illegally (52%), who has died from an overdose on one of these drugs (46%), or who has experienced a non-fatal overdose (40%).
• Consistent with previous waves of the study, just over half (55%) of the respondents in the general population sample say they store their opioids in a location where only they can access them.
• With regards to leftover opioids respondents who had them were equally split between those who returned them (29%) and those who say they saved them in case they needed them again (28%).
• Half (52%) of respondents who have used unprescribed opioids say they either took them a few times or once or twice with few reporting more frequent usage.
• Among those who have used opioids not prescribed to them, a plurality (35%) say that they got them from a friend or a relative who had a prescription.
• Prompted with the question of whether they would take a non-prescribed opioid they knew contained fentanyl, a majority across all audiences say they either probably, or definitely, would not take it. Despite this, important minorities of young adults (24%) and male labourers (25%) say they probably would regardless.
• Two thirds (67%) of the general population sample who have used opioids at some point say they never mix other drugs or alcohol with opioids. Among those who use multiple substances at once, alcohol (63%) and cannabis (40%) are the top two listed.
• When it comes to the risks of polysubstance use, seven-in-ten in the general population sample (70%) say that they are very familiar (26%) or somewhat familiar (44%) with the risks.
• While only a small number say they have sought treatment for an opioid use disorder (6%), this is up slightly from 2021 (4%).

Section F: Opioid information

• Consistent with previous waves of this study, a vast majority of respondents can identify a trusted source of information on opioids and their impacts. For most the primary sources of trusted information concerning the effects of opioid use are doctors (83%) and pharmacists (83%).
• Two thirds (67%) of parents of youth aged 13-15 say that they are discussing drug use in general with their children, while a little over half (55%) say they are having discussions on the subject of the use of illegal drugs. Interestingly, the same number (68%) of youth aged 13-15 report discussing drug use in general while half (50%) say they have talked about the use of illegal drugs with their parents.
• A quarter (26%) of respondents have seen, read, or heard information from the Government of Canada on the opioid crisis or resources for what to do if someone you know is developing an addiction to opioids.
• In focus groups with Indigenous participants, trusted sources mentioned included turning to their family doctor, a mutual aid fellowship, or community centre for information or support. Although the Government of Canada was seen to potentially play a role, there was more skepticism around their credibility and motivation for doing so – a concern which some suggested could be assuaged by providing resources to community healing centres.
• In focus groups with male labourers, there was a preference for anonymous support, family doctors, therapy programs, and online information. Here the Government of Canada was seen as a more positive and trusted source of information with a larger role to play in public awareness.

Section G: Views on chronic pain and chronic pain management

• Pain management remains the primary reason for starting opioid use, including pain resulting from a medical procedure (59%), to manage pain resulting from an injury (31%), or to manage chronic pain (22%). If pain management was the primary reason for most respondents starting their use of opioids, it is also true that it is the dominant reason they continue to use opioids today. This remains consistent with the findings in 2021.
• Among those that have used opioids to manage pain, and consistent with the findings in 2021, the vast majority (84%) have not felt that they have been treated differently by health care providers or first responders due to their opioid use. Just over half (56%) of respondents who felt that they had been treated differently due to their opioid usage for pain management say that they felt worse about how they were treated.
• In the focus groups, men in physically demanding jobs mentioned that in addition to helping to manage stress and the easy availability of these substances, pain management was a primary contributing factor to opioid and drug usage. Nearly everyone had experienced chronic pain, or knew someone who had, with many mentioning they turn to substances to get through the day.
• To manage chronic pain some participants spoke of alternative therapies, like physiotherapy, chiropractic care, and acupuncture, whereas others mentioned the use of medications or cannabis to manage the pain. The barriers for treating chronic pain included long wait times, poor access to treatment, the cost of treatment, inflexible work hours/lack of time off and inconvenient provider hours of operation, and rural job locations.

Section H: The role of stigma

• The overall size of the segments has not shifted dramatically since the last wave, although the unsympathetic segment has decreased slightly since tracking began in 2017. A quarter (25%) are Allies, with an equal number (24%) falling into the Unsympathetic segment. The remaining half (50%) of respondents are considered Ambivalent.
• When it comes to the demographic makeup of each segment, males appear to continue to hold more stigmatizing views and constitute a larger proportion of the Unsympathetic segment with their share rising to 67% (up from 56%) in 2021. The inverse trend is witnessed among Allies, of which 64% identify as female (this up from 59% in 2021).
• There is also variation in the personal exposure to opioids across the different segments. Compared with 2021, exposure to almost every single metric tracked has increased across all segments. This has not translated into increased familiarity with the opioids tested or an increased sense of danger, however.
• What has increased is the number of respondents across all segments who believe they would know what to do if they saw someone experiencing an overdose, being able to identify the signs of an opioid overdose or being able to identify signs of an opioid use disorder.

Section I: Views regarding alcohol consumption and substance use

• In line with the previous waves of this study, a majority of respondents are supportive of alcoholic beverage labels containing health risks and warnings (69%) and ingredients (59%).
• While all are majority supportive of this, racialized respondents (76%), people who use opioids legally (70%), and Indigenous respondents (69%) are all the most likely to say health risks and warnings should feature on alcoholic beverages.
• There is a high degree of awareness and concern with the health risks of alcohol. Three quarters (77%) say that it increases a person's risk of developing serious health conditions whereas three-in-five (62%) say that any amount of alcohol consumption can have risks to your health.
• There is a greater sense among the general population sample at least that people who have an alcohol use disorder could stop if they wanted to (31%) than those who are taking opioids (20%).

Research firm: Earnscliffe Strategy Group (Earnscliffe)
Contract number: CW2238166
Contract value: $214,725.99
Award date: November 20,2023

I hereby certify as a representative of Earnscliffe Strategy Group that the final deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate or ratings of the performance of a political party or its leaders.

Date: April 26, 2024

Stephanie Constable
Principal, Earnscliffe

Introduction

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of the follow-up survey and qualitative research on opioid awareness, knowledge, and behaviours for public education.

Canada has seen substantially elevated numbers of opioid-related deaths and other harms since surveillance began in 2016. The overdose crisis is complex and affects all communities, age groups, and socioeconomic groups.

In 2017, to help inform the ensuing public education campaign, Health Canada contracted Earnscliffe Strategy Group to conduct a Baseline Survey on Opioid Awareness, Knowledge, and Behaviours for Public Education. In 2019 and 2022, Earnscliffe Strategy Group completed follow-up studies to assess if the results had changed since the initial baseline survey. More recently, further research was required to determine if awareness of and attitudes towards opioid use have changed over the past few years, and if stigma has been reduced.

In 2018, Health Canada launched a multi-year public education campaign to address the growing overdose crisis to raise awareness and to educate Canadians on the risks associated with substance use, including the use of opioids (legal and illegal) as well as the role of stigma as a barrier to seek help.

The overall objective of this study was to track changes since the Follow-up Survey and Qualitative Research on Opioid Awareness, Knowledge and Behaviours for Public Education conducted in 2022, regarding the current state of awareness, knowledge, attitudes, beliefs (including assessing opinions around varying harm reduction measures), and behaviours with respect to opioids and other controlled substances. This research provides evidence-based data and insights to guide Health Canada's marketing campaigns and policy development. The contract value for this project was $214,725.99 including HST.

The specific objectives of the quantitative phase included, but were not limited to:

• Re-assess and compare levels of awareness and knowledge on the issue of controlled substances including opioids, in comparison to pre-campaign levels cited in the 2022 survey;
• Understand current views on this issue (including stigma);
• Identify barriers, knowledge gaps and misperceptions related to controlled substances including opioids (both legal and illegal), substance use disorder, opioid overdose, and related deaths to develop messaging that is meaningful and will resonate with target audiences; and
• Understand what types of information Canadians need and are looking for as it relates to controlled substances including opioids.

The specific objectives of the qualitative phase included, but were not limited to:

• Gain insight into awareness, perceptions, and attitudes among target audiences on issues related to controlled substances, including:
  • Opioid use in their communities.
  • Government actions; and
  • Opinions on actions to respond to the overdose crisis.

To meet these objectives, Earnscliffe conducted a two-phased approach involving both qualitative and quantitative research to follow-up the survey and qualitative research on controlled substances awareness, knowledge, and behaviours, for public education.

The initial phase involved qualitative research, which included a series of ten focus groups over January 24-25 with specific target audiences that face higher rates of drug overdoses: males 20-59 who work in physically demanding jobs outside of construction and Indigenous respondents aged 18-59. Two groups (one with each target audience) were conducted in each of the following regions: British Columbia (BC), the Prairies and Northern Canada, Ontario, Quebec, and Atlantic Canada.

Up to 10 participants were recruited for each group, with the goal that at least 8 be able to participate. In total, 76 people participated in the focus group discussions. The groups in Quebec were conducted in French, while the groups in all other locations were conducted in English. The sessions were approximately 90 minutes in length. Appendix B provides greater detail on how the groups were recruited, while Appendix C provides the discussion guide used to facilitate the focus groups and Appendix D provide the screeners used for recruiting the focus groups.

For the purposes of this report, it is important to note that qualitative research is a form of scientific, social policy, and public opinion research. Focus group research is not designed to help a group reach a consensus or to make decisions, but rather to elicit the full range of ideas, attitudes, experiences, and opinions of a selected sample of participants on a defined topic at a particular point in time. Because of the small numbers involved, the participants cannot be expected to be thoroughly representative in a statistical sense of the larger population from which they are drawn, and findings cannot reliably be generalized beyond their number.

The initial qualitative phase was followed by a quantitative phase involving an online survey, to update and compare results against baseline measures from the 2017, 2019, and 2021. We conducted a base survey of 1666 Canadians aged 13 and older, plus oversamples of at least 300 additional interviews among each of the following nine specific audiences identified by Health Canada:

• Youth 13-15;
• Parents of youth 13-15;
• Young adults 16-24;
• Males 20-59;
• Indigenous respondents;
• Racialized respondents;
• Male labourers;
• People who use opioids legally, including prescriptions; and,
• People who use opioids illegally, including counterfeit prescriptions and/or other drugs that could be laced with opioids.

A total of 3,740 Canadians were surveyed using Leger's opt-in panel. Because respondents could qualify for more than one key target audience, the source of respondents was a combination of those found in the general population sample, those found specifically when sampling for that target audience, and those found when specifically targeting a different audience. The 3,740 interviews were comprised of the following:

• A base national sample of n=1666 Canadian residents aged 13 and older;
• An additional sample of n=373 youth aged 13-15;
• An additional sample of n=477 parents of youth 13-15;
• An additional sample of n=522 young adults 16-24;
• An additional sample of n=999 men aged 20-59;
• An additional sample of n=422 Indigenous respondents;
• An additional sample of n=421 racialized respondents;
• An additional sample of n=389 men who work in physically demanding jobs, including construction;
• An additional sample of n=567 people who use opioids legally; and,
• An additional sample of n=342 people who use opioids illegally.

The profile of each oversample group is presented in the table below. Because respondents could qualify for more than one key target audience, the source of respondents was a combination of those found in the general population sample, those found specifically when sampling for that target audience, and those found when specifically targeting a different audience.

The tables below show the sample sources for each of the nine target audiences.

The field work was conducted from February 27 to March 16, 2024, in English and French. It took an average of 17 minutes to complete.

Respondents for the online survey were selected from among those who have volunteered to participate in online surveys. The data for the general population sample was weighted to reflect the demographic composition of the Canadian population aged 13 and older. Because the online sample is based on those who initially self-selected for participation in the panel, no estimates of sampling error can be calculated, and the results cannot be described as statistically projectable to the target population. The treatment here of the non-probability sample is aligned with the Standards for the Conduct of Government of Canada Public Opinion Research - Online Surveys.

The final data for the general population and the youth 13-15, young adults 16-24, men 20-59, Indigenous, and racialized respondents' oversamples, were weighted to replicate actual population distribution by region, age and gender according to the 2021 census data available. The data for the parent, men who work in physically demanding jobs, people who use opioids legally, and people who use opioids illegally oversamples, were weighted based on the profile found in the general population, by age, gender and region.

Appendix A provides full details on the survey methodology and Appendix E provides the survey instrument used.

Within the tables included in the body of the report, letters beside percentages indicate results that are significantly different than those found in the specific comparison columns indicated by the letter. Unless otherwise noted, differences highlighted are statistically significant at the 95% confidence level. The statistical test used to determine the significance of the results was the Z-test. Due to rounding, results may not add to 100%. We have chosen not to include a total column to remain consistent with the 2017, 2019, and 2021 reporting as well as the nature of the vast differences the oversample groups bring to the results.

The key findings from the research are presented below. To ensure comparability, the survey largely remained consistent with questions asked in the 2021 and 2019 surveys. This includes some terminology that Health Canada no longer uses as it is considered stigmatising. Readers are encouraged to use non-stigmatising language when talking about substance use. For more information on changing how we talk about substance use, please see Communicating about Substance Use in Compassionate, Safe and Non-Stigmatizing Ways.

For statistical information on prevalence, refer to the Canadian Alcohol and Drugs Survey (CADS) or the Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS).

Detailed findings

The following report presents the analysis of both the quantitative and qualitative research. It is divided into nine main sections:

• Section A: Opioids and illegal drug use;
• Section B: Opioids awareness, impressions and basic understanding;
• Section C: Attitudes relating to behaviours, risk and harms;
• Section D: Attitudes regarding stigma;
• Section E: Risk behaviour profiling;
• Section F: Opioid information;
• Section G: Views on chronic pain;
• Section H: The role of stigma; and,
• Section I: Views regarding alcohol consumption and substance use.

Each section presents the findings of the qualitative research and the quantitative survey. Except where specifically identified, the qualitative findings represent the combined results across the various audiences and for both English and French.

The quantitative findings focus primarily on the differences across the ten target segments: the nine oversamples and the general population as a whole. Appended data tables provide results of findings across a much broader range of characteristics, behaviours, and attitudes. It is also worth noting that in the tracking tables provided in the body of the report below, the statistical testing is only done relatively to the most recent results – i.e., the 2024 results are tested against 2021, 2019, 2017 for significance but 2021 is not tested against 2019.

Details about the survey design, methodology, sampling approach, and weighting of the results may be found in the Quantitative methodology report in Appendix A. Appended data tables provide results of findings across a much broader range of demographics and attitudes.

Details about the focus group design, methodology, and analysis may be found in the Qualitative methodology report in Appendix B. Except where specifically identified, the qualitative findings represent the combined results across the various audiences and for both English and French. Quotations used throughout the report were selected to bring the analysis to life and provide unique verbatim commentary from participants across the various audiences. Percentages may not add up to 100% due to rounding. "Don't know" and "no response" are denoted by DK and NR respectively.

Section A: Opioids and illegal drug use

In order to determine whether respondents had taken any sort of opioid in the past year, they were shown the following table and asked if they had taken any of the drugs listed in the past year or at any point in their lives.

Just over one-in-five (23%) respondents say that they have taken one of the drugs listed in the above table in the past year with a similar proportion (20%) saying that they have taken one of the drugs listed, but not in the past year.

Among the target audiences examined, the lowest rates reported of respondents having taken one of the tested drugs in the previous year are among youth aged 13-15 years old. The highest rates observed are among male labourers (31%) – i.e., those in physically demanding jobs – and Indigenous respondents (29%).

At three-in-five (62%) saying so, respondents from Quebec are the most likely to say that they have never used any of the listed opioids.

The number of respondents who say that they have taken one of the listed drugs this year (23%) represents a decline from the recorded peak of 29% who said the same in 2019.

An important dynamic emerges when looking at patterns surrounding whether respondents are using the drugs listed with a prescription in their name or not – in particular when it comes to the two target audiences with the highest reported rates of having used of these substances in the previous year.

At two thirds (67%), Indigenous respondents are the most likely to say that they always have a prescription in their name when they take one of the drugs or medicines listed. This compared with male labourers where just under half (46%) say the same.

There is also a unique dimension surrounding age, where younger respondents are the most likely to say that they never have a prescription in their name. One-in-five (21%) young adults aged 16-24 report never having a prescription, for example, whereas 18% of youth aged 13-15 say the same.

To note, any respondents who used one of the substances without a prescription in their name are reported as "people who use opioids illegally" in the tables presented throughout this report. Those who exclusively use these drugs and medicines with a prescription in their name are reported as "people who use opioids legally."

At 83%, those in Atlantic Canada are the most likely to say that they always take an opioid with a prescription in their name. This compared with 45% of respondents from British Columbia who say the same. The regions with the highest rates of self-identified people who use opioids illegally are in Ontario (46%) and British Columbia (44%).

Notable in this year's findings are the much higher rates of those saying that they never have a prescription in their name (11%) compared with previous years (3-5%). Given the distribution of the results, it is possible that this does not actually represent an actual increase in absolute numbers but instead a higher proportion of respondents selecting this option instead of "DK/NR" as in previous years.

The following table collapses the above questions and illustrates what percentage of each target audience qualifies as a current opioid user, a past opioid user, or a non-user. Of note, these segments are not reported on in the body of this report but can be found in the appended data tables.

When asked if a doctor had ever refused to prescribe an opioid when it was needed for pain, those most likely to say yes are people who use opioids illegally with one quarter (24%) saying so. This suggests that there is a portion of people who use opioids illegally who are classified as such due to the refusal by a doctor to prescribe them.

Following people who use opioids illegally, the highest rates of those saying they have experienced a doctor refusing them an opioid for pain relief are: male labourers (14%), Indigenous respondents (14%), and young adults aged 16-24 (11%).

Broken down by region, those in Atlantic Canada are the least likely to be told "no" by their physicians at 59%.

Respondents were also asked if they had taken any of the following drugs: cocaine, ecstasy, methamphetamine, or heroin. While rates for the drugs in question ranged from 1-4% in the general population sample, rates were significantly higher among Indigenous populations, men in physically demanding jobs, and people who use opioids illegally across all drugs tested.

At the level of the general population, those who say they have taken cocaine, ecstasy or hallucinogens, and methamphetamines in the past year generally edged up slightly when compared to the data from 2021 and 2019.

Qualitative insights: Awareness and understanding of substance use and addiction

As with past waves of this research, participants were able to easily provide definitions for both "substance use" and "addiction."

Understanding of the term, substance use, continues to be more negative than positive and is often confused with the term, substance abuse. Unaided, participants often refer to substance use as the use of different drugs and/or alcohol. Other mentions included the use of cigarettes and medication. A few participants also volunteered reasons for using substances as part of this discussion which included recreationally, as a stimulant, for pain management, and, to cope with trauma. The other dimension that was raised spontaneously here was addiction.

"The use of any substance used as a 'boost'." – man in physically demanding job, Prairies

"Ways people cope with unhealed trauma." – Indigenous person, Prairies

Addiction was understood by participants as the inability to easily stop doing something whether it be with respect to the use of a wide range of substances, or even activities. Often the descriptions provided conveyed a sense of dependence, a loss of control, and in others, feelings of sadness and despair. The dimension of stigma also came up unaided by a few participants as part of this discussion.

"Loss of control over a substance." – man in physically demanding job, Atlantic Canada

"A heavy weight to bare." – man in physically demanding job, Atlantic Canada

"Something you are labelled with." – man in physically demanding job, Prairies

"Addiction means to me a struggle. It's not always a choice. It can be hard to ask for help." – Indigenous person, Atlantic Canada

Key takeaways: Opioids and illegal drug use

• The number of respondents who say that they have taken one of the listed drugs this year (23%), while up slightly from 2021, nonetheless represents a decline from the recorded peak of 29% who said the same in 2019.
• When it comes to whether respondents have prescriptions, Indigenous respondents (67%) are the most likely to say they always have one whereas men in physically demanding jobs (46%) and young adults aged 16-24 (42%) are the least likely to say the same.
• When asked if a doctor had ever refused to prescribe an opioid when it was needed for pain, those most likely to say yes are people who use opioids illegally with one quarter (24%) saying so. This suggests that there is a portion of people who use opioids illegally who are classified as such due to the refusal by a doctor to prescribe them.
• As with past waves of this research, participants were able to easily provide definitions for both "substance use" and "addiction" – the latter of which was frequently understood negatively and conflated with the term "substance abuse."
• As for "addiction," it was understood by participants as the inability to easily stop doing something.

Section B: Opioid awareness, impressions, and basic understanding

Awareness of opioids is fairly broad and remains relatively unchanged from levels noted in 2021 and 2019. Two thirds (66%) say they are at least pretty sure, if not certain, they know what an opioid is. At two-in-five, people who use opioids legally (40%) (i.e., those with a prescription in their name) and Indigenous respondents (39%) were the most likely to say they are certain they know what an opioid is.

Echoing trends noted in previous years, parents of youth aged 13-15 (29%) are more likely to say they are certain they know what an opioid is than young adults (20%) or youth (15%). Youth are the most likely to say they do not really know what an opioid is (19%) or that they have never heard the term before (10%).

At 6%, respondents from Quebec are the most likely to say that they have never heard the term "opioid" before.

Upon being shown the reference chart, the level of assessed familiarity drops to 61% (down from 66%) among the general population sample. Parents of youth aged 13-15, young adults aged 16-24, and males aged 20-59 track with this trend.

Among the target audiences, it is worth noting that the rates of those saying they are very familiar actually increased for both people who use opioids legally (40% to 47%) and people who use opioids illegally (31% to 40%).

As noted above, youth remain the least familiar with any of the opioids listed, with two-in-five (39%) saying they are not at all familiar with any.

When it comes to the perceived danger of the opioids provided in the reference chart, there is a broad sense among the general population that most (37%) or all (44%) of them are dangerous, with no one saying that none are dangerous (0%).

For the most part, this same pattern tracks across the target audiences examined. There are slight variations in degree with Indigenous respondents, for example, being the most likely to say that all of the opioids listed are dangerous at half (49%) saying so.

Against this broad consensus, people who use opioids illegally stand out in being the least likely to say that all of the drugs listed are dangerous (24%) and being the most likely to say that only a few (14%) are dangerous.

There is certainly an acknowledgement that danger exists, but the perception appears to be that it is not universal, i.e., there are opioids which are safe or safer. It is unclear from this data whether people who use opioids illegally are identifying the substances they use as safe – perhaps as a mental coping mechanism – or if they acknowledge that their practices with these substances entail a level of danger.

From a regional perspective, respondents from Manitoba and Saskatchewan are the most likely to say that all or most opioids are dangerous (at 88%), this followed closely by Quebec (at 85%).

While the overall levels of respondents saying that most or all of the opioids included in the list provided are dangerous remain relatively stable, the distribution continues to shift slightly with 44% saying that all are dangerous – this up from 39% who said the same in 2019.

A plurality of respondents in each target audience say they are somewhat familiar with fentanyl, with the exception of youth where more say they are either not very or not at all familiar. When it comes to those who say they are very familiar, in line with general awareness noted above, Indigenous respondents (22%), people who use opioids illegally (18%), and male labourers (17%) are the most likely to say so.

When asked about the dangers of fentanyl, there is a broad consensus that it is somewhat, if not very, dangerous (96%) with no one (0%) saying it is not at all dangerous. This combined proportion has shifted very little over time. Of note, there is a sense that the danger is acute, with strong majorities across all audiences saying that it is very dangerous.

The relationships between awareness and the perceived danger appears to be uneven among the groups that self-assessed as most familiar with fentanyl. Indigenous respondents, for example, are the most likely to say it is very dangerous (at 85%), whereas male labourers (72%) and people who use opioids illegally (69%) are less likely than the general population sample to say the same.

A majority of respondents across all target audiences say that opioids are at least somewhat, if not very, dangerous for all the populations tested. The one outlier is people who use prescribed opioids and take them as per the instructions on their prescription. While over half of most samples still say that opioids are at least somewhat dangerous for these people, this is substantially lower than any of the other scenarios tested.

It is also worth noting that most respondents say that opioids are less dangerous for themselves than for others. The one target audience that represents an exception in this regard is youth aged 13-15, who at 81% saying that opioids are at least somewhat dangerous for them, are significantly more likely to say so than other target audiences.

Overall levels of perceived danger remain consistent across waves of this study, with four-in-five saying that opioids are at least somewhat dangerous for people who use illegal drugs (95%), those who use them on the street (94%), people who use opioids prescribed to someone else (93%), youth aged 13-15 (93%), young adults 16-24 (92%), and seniors (88%). Personal risks and the risks to those who have them prescribed continue to be perceived as the lowest.

As with previous waves of this study, the vast majority believe that the term "illegal opioids" refers to those obtained on the street (89%) – similar to 2021 (89%), 2019 (87%), and 2017 (88%). Although still over half, far fewer respondents (59%) perceive opioids not prescribed to them as falling under the umbrella of illegal opioids – although this rate is notably highest among people who use opioids illegally where two thirds (66%) say so.

Those from Manitoba and Saskatchewan are the most likely to say that a prescription opioid not prescribed to you is an illegal opioid, with seven-in-ten (69%) saying so.

On the subject of Canada's opioid crisis, three quarters (73%) say they are at least somewhat aware if not very aware. Those audiences most likely to say they are very aware are Indigenous respondents where two-in-five (39%) say so and legal (33%) and illegal (30%) opioid users.

As with the overall familiarity data discussed above, younger respondents are less familiar with the opioid crisis with 18% of youth saying they are not at all aware while 13% of young adults say the same. Respondents from ethnic and racialized communities are also less likely than the general population sample to say that they are at least somewhat aware of the crisis.

Following a decline in 2021, the number saying they are very aware of Canada's opioid crisis has notched back up to one quarter (24%).

Despite the lower numbers of respondents saying that they are very familiar with the opioid crisis, majorities across all target audiences say that it is at least somewhat, if not very, serious. If there is broad directional alignment, there are differences in degree with Indigenous respondents (71%) and people who use opioids legally (67%) being the most likely to say it is very serious.

Perhaps related to lower levels of familiarity, youth (54%) and young adults (49%) are the least likely to say that is very serious. Despite higher levels of familiarity, people who use opioids illegally also rank lower than other target audiences in terms of the number of respondents who say that it is very serious (54%).

Across all audiences, no one (0%) says it is not at all serious.

There is a marked difference between the number of respondents in the general population sample who say that the opioid crisis in Canada is very serious (61%) versus those who say it is very serious in their community (28%). By contrast, there are more respondents opting instead to say that it is not very serious (16%) or even not at all serious (3%).

Though still perceived to be less severe than the opioid crisis in Canada, at half (50%) saying so, Indigenous respondents remain the most likely to say that the crisis in their community is very serious. This followed by people who use opioids legally (37%).

When asked to choose a term to best describe the approximately 20 opioid-related overdose deaths in Canada every day, no clear consensus emerged among the general population or any of the target audiences. Instead, roughly equal numbers choose the "opioid overdose crisis" and the "opioid crisis" with minor variations among the target audiences.

Majorities across all audiences say that they believe there to be a high risk that an illegal non-opioid drug might be laced with an opioid like fentanyl. Echoing variation on other questions, people who use opioids legally are the most likely to believe this is a high risk (78% saying so) whereas people who use opioids illegally are the least likely (with the exception of young adults) to say the same at 63%.

In line with the lower self-assessed levels of awareness noted above, youth are the most likely to say they do not know or prefer not to respond to this question (18%).

When compared with previous waves, at 10% the of respondents who report saying they do not know or prefer not to respond continues to grow whereas those saying that there is some risk has dropped from 23% in 2021 to 15% this year.

On the subject of Naloxone, there are diverse levels of awareness among the different samples surveyed. Reflecting their lower levels of awareness across a range of opioid related questions and metrics, youth (31%) and young adults (39%) are the least likely to agree that they know what it is or what it is used for. On the other end of the spectrum, people who use opioids legally (63%) and Indigenous respondents (62%) are the most likely to agree that they are aware of what Naloxone is and what it does.

Another target audience with higher reported rates of opioid use, male labourers, interestingly report lower levels of awareness (47%) than even the general population sample.

The knowledge of where one could get Naloxone is lower than the awareness of what it is used for across all audiences surveyed. There does appear to be a correlation between knowledge of what it is and where to get it, however, with people who use opioids legally (44%) and Indigenous respondents (47%) being the most likely to know where to find it.

A quarter (25%) of respondents among the general population sample say that they would know how to administer Naloxone if they needed to – a number which rises to 40% among Indigenous respondents and 34% among people who use opioids legally. Across all audiences, the number who say they could administer it is even lower than those who would know where to get it.

Qualitative insights

Most participants across both audiences were aware of the term, opioids, which may be slighter higher than in years past. Awareness was often tied to media coverage of the opioid crisis, or having viewed one of the many documentaries and shows available for viewing on the topic. Moreover, usually at least one participant in a given group knew someone who was either addicted to opioids, struggled with addiction at some point, or had passed as a result of an overdose. The term 'fentanyl' was used conversationally in most groups as part of this conversation; and, at times, this part of the group conversations veered towards the perceived problems around over-prescription of opioids as well as stigma.

"It's a common term. I seem to hear about it every day." – man in physically demanding job, Quebec

However, despite having heard the term, many participants did not feel they were all that knowledgeable about opioids.

"I don't know a lot. I don't take any drugs. I have heard of opioids on tv or word of mouth." – man in physically demanding job, Quebec

With respect to the quantitative findings among Indigenous peoples noted above with respect to the higher proportion who say that opioid use is a very serious issue in their communities, the qualitative findings shed some light on this dimension. Indigenous peoples spoke of the pervasive use of opioids in their communities which they spoke of in the context of over-prescription and dependence; stigma and not being able to discuss opioid use or seek help; use, as are other substances, as a way of coping with trauma; and, a personal safety risk around opioid use.

"I have a family member addicted to opioids. She has been for a number of years. She is so desperate to get her hands on these drugs." – Indigenous person, Atlantic Canada

"It's a crisis now because they were over-prescribed in the 90s." – Indigenous person, Quebec

"I take opioids for pain. It's upsetting because we weren't given an option in the beginning." – Indigenous person, Atlantic Canada

"I'm diabetic. I take it for nerve damage. I take it as prescribed, but I keep it very hush-hush. I don't want people to know." – Indigenous person, Atlantic Canada

"On First Nations reserves, if they know you have it, it's not safe. They will follow you when you pick up your prescription and break into your home. You don't advertise it." – Indigenous person, Atlantic Canada

In every group, some participants indicated they would recognize the signs and symptoms of an opioid overdose if they saw it. These included altered consciousness or the appearance of lifelessness; changes to the eyes, pallor, lip colour, or breathing; or the presence of vomit or vomiting.

The most common response to a drug overdose for almost all participants would be to call 911, though some mentioned the use of naloxone. A few participants specifically mentioned that they were in possession of a "Narcan" kit, though most did not seem to carry it with them at all times.

"I keep a naloxone kit in my vehicle and at the house." – Indigenous person, Atlantic Canada

While awareness of the Good Samaritan Drug Overdose Act was minimal (usually one or two participants per group), once read a description of the Act, reactions were very positive. Prior to being read a description, many confused it for the Good Samaritan Act and offered a description of it as relating to being free from liability for causing injury or death if they attempt to give medical attention to someone ill or unconscious.

"This is hugely important. I know someone who passed away [of an overdose] because no one called because they were scared to get in trouble. This would save lives and protect people." – Indigenous person, Prairies

Key takeaways: Opioid awareness, impressions and basic understanding

• The survey findings suggest that awareness of opioids is unchanged since 2019. At two-in-five, people who use opioids legally (40%) and Indigenous respondents (39%) were the most likely to say they are certain they know what an opioid is.
• Youth remain the least familiar with what opioids are with 29% saying they have never heard of them or do not really know what they are – this number jumps to 39% when prompted with a reference chart listing opioids.
• There is a broad sense that most (37%) or all (44%) of opioids in the chart provided are dangerous among the general population with no one saying that none are dangerous (0%). This trend is echoed in most of the other target audiences examined with the exception of people who use opioids illegally, who are the least likely to say that all of the drugs listed are dangerous.
• Levels of familiarity with fentanyl remain consistent with previous waves (with 45% saying they are at least somewhat, if not very familiar) as does its perceived danger (82% saying it is very dangerous).
• As with previous waves of this study, the vast majority believe that the term "illegal opioids" refers to those obtained on the street (89%) – similar to 2021 (89%), 2019 (87%), and 2017 (88%).
• Despite the lower numbers of respondents saying that they are very familiar with the opioid crisis, majorities across all target audiences say that it is at least somewhat, if not very, serious. Indigenous respondents (71%) and people who use opioids legally (67%) being the most likely to say it is very serious.
• There is a marked difference between the number of respondents in the general population sample who say that the opioid crisis in Canada is very serious (61%) versus those who say it is very serious in their community (28%).
• When asked to choose a term to best describe the current situation with overdose deaths in Canada, no clear consensus emerged with roughly equal numbers choosing the "opioid overdose crisis" and the "opioid crisis" with minor variations among the target audiences.
• Majorities across all audiences say that they believe there to be a high risk that an illegal non-opioid drug might be laced with an opioid like fentanyl.
• In the focus groups, a majority were aware of the term opioids, often from media reports. That being said, at least one in each group had some form of personal experience.
• When asked for signs of an overdose, at least some participants in each group offered: altered consciousness; changes to the eyes, pallor, lip colour, or breathing; or the presence of vomit.
• The most common response to a drug overdose for almost all participants would be to call 911, though some mentioned the use of naloxone with a few mentioning that they had a "Narcan" kit.
• While awareness of the Good Samaritan Drug Overdose Act was minimal (and at times confused with the Good Samaritan Act), once read a description of the Act, reactions were very positive.

Section C: Attitudes relating to behaviours, risk, and harms

Reversing the trend noted in the last report, since 2021 there has been an increase in concern and awareness of opioids in a few ways. For example, the number of respondents in the general population sample (80%) who agree or strongly agree that they understand why opioids are dangerous is at the highest level recorded since tracking began in 2017. Of note, this represents a significant jump from 2021, when only 60% said the same.

In line with trends noted above, Indigenous respondents appear to be the most alive to the dangers of opioids, with 86% agreeing that they understand why opioids are dangerous – a number only matched by people who use opioids legally. Unlike in other questions noted above, people who use opioids illegally are here much closer to the benchmark set by the general population with 79% agreeing that they understand why opioids are dangerous.

There is an interesting dynamic with youth in that they self-assessed as the least knowledgeable of opioids (19% saying they do not know what an opioid is) but also saw very high personal risks to themselves (81%). Here they are the least likely to agree that they understand why opioids are dangerous (72%). This suggests that even in the absence of concrete knowledge of why opioids are dangerous, there is still a strong sense that they do, in fact, pose a danger.

If there appears to be a broad understanding of the dangers – and one that has expanded significantly from previous years – there does not appear to be an equivalent growth on any of the other measures tested. When it comes to being confident in being able to find help for dealing with problematic opioid use or addiction, at 36% agreeing it is consistent with 2021 but still lower than 2019 (45%) and 2017 (44%).

Again, there are important variations by target groups with Indigenous respondents, people who use opioids legally, and people who use opioids illegally being above the general population benchmark in agreement across all measures tested.

Interestingly, while male labourers are less likely to say they understand why opioids are dangerous than the general population, they are more likely to say that they could find help with problematic opioid use, be able to identify signs of an overdose, or know what to do if they someone experiencing an overdose.

This in contrast with racialized respondents and youth who both consistently have lower levels of agreement than the general population.

When broken down by region, respondents from Quebec are the most likely to disagree that they would be able to identify the signs of an overdose (42%) – this compared with 29% of those in British Columbia who say the same.

To inform public messaging and education, respondents were asked what they think of the terms "opioid use disorder" and "addiction." Majorities across all audiences say that they feel that the terms "opioid use disorder" and "addiction" refer to basically the same thing, if not exactly the same thing. Minorities say they mean different things, with young adults (30%) being the most likely to say so. Respondents from Quebec are the most likely to say that these two terms represent different things, with one third (35%) saying so.

Qualitative insights

In terms of the public's level of acceptance of the use of different substances, most participants felt that it does depend on the substance in question. There seemed to be consensus around the view that the use of alcohol and cannabis was more acceptable as compared to other drugs obtained on the illegal market and, to a lesser extent, prescribed opioids. However, as has been noted in the past, use of harder drugs, particularly among male labourers seemed to be more common.

"There is definitely a difference in terms of acceptance. Alcohol and cannabis are totally fine. For illegal or prescribed drugs, illegal is worse, but you're vilified." – man in physically demanding job, Atlantic Canada

"Cannabis is more acceptable than harder drugs. Prescription drugs? Good question. There is some judgment." – man in physically demanding job, Quebec

"People are more accepting of alcohol because it's legal; not to say that alcoholism isn't a bad addiction. Now more people are doing cannabis and it's more accepted. Cocaine and meth users think they're better than opioid users." – Indigenous person, Atlantic Canada

Having said that, there appeared to be more preoccupation with alcohol use than we have noted in the past, especially in the context of the perceived normalization of alcohol use coupled with increased awareness of the associated health concerns (and adverse effects) of alcohol use. The qualitative findings certainly seemed to suggest that more participants were looking to reduce their alcohol consumption (which may have been linked to the timing of the groups at the beginning of the year, i.e., "dry January"). A few participants also suggested that alcohol use was more prevalent among older people and lower among younger people, who more readily turn to cannabis or do not use substances altogether.

"Alcohol is almost so normalized that if you don't drink, people are asking, why not?" – Indigenous person, Prairies

Substance use seemed to most often be tied to the act of socializing or as mentioned throughout, as a coping mechanism (i.e., to help deal with anxiety, stress, or some form of trauma; to relax; to help get through the day). Among male labourers, pain management was more often linked to substance use, including the use of cannabis, but especially the use of prescribed and/or illegal opioids. Drugs obtained on the illegal market, like cocaine, seemed to be more prevalent among men working in physically demanding jobs, especially as a stimulant so that they could stay up through long hours or deal with overtime (particularly effective for shift workers).

"I don't know very many young people who don't use coke." – man in physically demanding job, Prairies

"There is a lot of acceptance depending on industry. For example, if you work in the oil industry, cocaine is more readily accepted." – man in physically demanding job, Prairies

As mentioned, participants were well aware of a variety of health concerns related to alcohol consumption (i.e., those affecting the liver, kidneys, or heart; high blood pressure; mental health issues). When asked what would motivate people to consume less alcohol, participants tended to link messaging to health and physical well-being; cost; and strained relationships with loved ones.

In discussions among Indigenous peoples, several spoke of a reconnection with culture and Indigenous identity. They explained that traditionally alcohol did not have a place in their lives. They also explained that they were never taught how to do deal with trauma, including feelings of abandonment and/or not belonging, or to process their feelings.

Key takeaways: Attitudes relating to behaviours, risk, and harms

• Reversing the trend noted in the last report, there has been a significant increase in the number of respondents agreeing that they understand why opioids are dangerous – from 60% in 2021 to 80% in 2024.
• In line with trends noted above, Indigenous respondents appear to be the most aware of the dangers of opioids, with 86% agreeing that they understand why opioids are dangerous – a number only matched by people who use opioids legally.
• While male labourers are less likely to say they understand why opioids are dangerous than the general population, they are more likely to agree with all other metrics surrounding accessing resources or identifying overdoses or addiction.
• Majorities across all audiences say that they feel that the terms "opioid use disorder" and "addiction" refer to basically the same thing, if not exactly the same thing.
• These views were nuanced in the focus groups where different substances entailed varying level of acceptance, with alcohol and cannabis seen to be the most acceptable. Participants did appear to be preoccupied with the normalization of alcohol and concerned about the health implications.
• Participants highlighted how substance use seemed to most often be tied to the act of socializing or as a coping mechanism.
• Among male labourers, pain management was more often linked to substance use, including the use of cannabis, but especially the use of prescribed and/or illegal opioids. Illegal stimulants like cocaine appeared more prevalent among men working in physically demanding jobs, so that they could stay up through long hours.

Section D: Attitudes regarding stigma

From the data, it is clear that there is still stigma surrounding opioid use disorder even if the tracking data suggests that, on most metrics tested, it has remained fairly stable. That being said, there appears to be a slight reversal in some of the improvements noted in 2021.

For example, the number of respondents who say that people who overdose get what they deserve has notched up again (to 14% from 12%). Similar increases are noted in the number who agree that people living with a drug addiction should be cut off from services (to 24% from 22%) and who say they do not have much sympathy for those who misuse opioids (to 26% from 25%). At the same time, the percentage who agree that more of our health care resources should be used for dealing with addictions to drugs is at the lowest point recorded (55% agreement, down from a peak of 64% in 2019).

The contour of this stigma shifts in important ways depending on the target audience examined.

Racialized respondents, for example, track fairly closely to the general population sample along many metrics but with a few important distinctions that surround, notably, the intersection of self-discipline and opioid use. At 64%, racialized respondents are the least likely to agree that you can become addicted to opioids even if you follow your doctor's instructions. At the same time, at 44% they are the most likely (along with, interestingly, people who use opioids illegally) to agree with the idea that a lack of self-control is usually what causes a dependence on opioids.

Male labourers, for their part, are the least likely to agree that a stigma exists (65% saying that society is not friendly toward people with addictions) or that it might affect whether someone might seek help (47% saying that society's attitudes affect people seeking help). Perhaps reflective of seeing this as a personal issue, and not a societal one, men in physically demanding jobs are also the most likely to say (at 33%) those addicted to opioids could simply stop taking them if they really wanted to. Despite these counter-indications, there does appear to be some level of shame or stigma associated with this use, as this target audience is also the most likely to agree (at 32%) that if they were prescribed an opioid they would not want their friends or family to know.

In what appears to be a departure from previous years, parents of youth aged 13-15 now distinguish themselves for their punitive views of those living with opioid use or addiction. At a quarter (25%) agreeing, they are significantly more likely than the general population sample (14%) to say that those who overdose on opioids get what they deserve. At just over half (51%) they are, along with racialized respondents, the most likely to agree that those living with drug addictions cost the healthcare system too much money.

Young adults are fairly consistent with the general population across a number of metrics but are, of note, significantly more likely to see opioid use as stemming from external triggers such as homelessness or other drug use with 38% saying so – this compared with 23% from the general population sample.

Again, tracking with trends noted above, Indigenous respondents and people who use opioids legally appear to be the most empathetic towards those with opioid dependence or addictions of all the target audiences examined.

Qualitative insights

Participants were easily able to provide an interpretation of the term, stigma. Indeed, as mentioned earlier, the term often came up spontaneously as part of the initial discussion about substance use and addiction. Interpretations were often tied to negative perceptions of shame, judgment, stereotypes, and barriers.

There was near consensus that those who have a substance use addiction are stigmatized, however, most recognized that the amount of stigma or the way it is applied depends on the person being stigmatized and the substance in question. As we have seen in previous waves, there was definitely a sense that ethnic minorities and Indigenous people might receive more stigma than others.

Most participants agreed that stigma negatively impacts those with substance use addiction and makes them less likely to reach out for help.

Indigenous participants had the sense that Indigenous peoples reach out for help far less than most other populations. When asked what they thought was preventing them from doing so, most pointed to stigma, anticipated cost, limited access to health care/resources (especially difficult for those in remote communities) and issues of trust.

A few participants who live on reserve also mentioned that the fact of living in small communities can prevent people from reaching out for help as they do not want to share or disclose their stories (i.e., want them known in the community).

"Stigma is a barrier. Even in health care, when you go to the hospital, they just send you home. They assume you're looking for drugs." – Indigenous person, Prairies

"When I was putting in my application [for rehab], there was a stereotype. I didn't want to be another drunk native. Addiction doesn't discriminate." – Indigenous person, Atlantic Canada

Asked whether men in physically demanding jobs would reach out for help if they were worried about their substance use and most participants did not think they would. Participants spoke of the personal nature of this conversation, and the stigma around admitting one had a dependency. More importantly, they were concerned about the fear of reprisal (at work) and the fear of isolation (at home).

A few also noted that there is a linkage to one's sense of masculinity. These comments suggested there is a need to be tough or disciplined enough to handle one's own challenges.

"In my trade, I don't think they would [ask for help] unless a family member encouraged them to. I've seen people drink or do weed on the job." – man in physically demanding job, Atlantic Canada

"From my experience, no. I have worked with a wide range of people of different ages. I've worked with 55-year old alcoholics who don't seem to want to or feel they need to get help. It's a way for them to forget about everything. I also think cause of their masculinity, they don't want to look for help." – man in physically demanding job, Atlantic Canada

Key takeaways: Attitudes regarding stigma

• It is clear that there is still stigma surrounding opioid use disorder. Even if on most metrics the tracking data suggests that this stigma has remained fairly stable, there are a few where there has been a slight degradation of opinion – for example, those saying that those who overdose get what they deserve has notched up to 14%.
• If most respondents are cognizant that this stigma exists, with three quarters (73%) of the general population sample agreeing that society is not very friendly toward people living with a drug addiction, there are important differences in the way in which the target audiences examined here understand and interact with this stigma.
• In the focus groups participants easily grasped the concept of stigma, with it often coming up unprompted and being tied to negative perceptions of shame, judgment, stereotypes, and barriers.
• There was near consensus that those who have a substance use addiction are stigmatized, however, most recognized that the amount of stigma or the way it is applied depends on the person being stigmatized and the substance in question. As we have seen in previous waves, there was definitely a sense that ethnic minorities and Indigenous people are stigmatized more than other communities.
• Most participants agreed that stigma negatively impacts those with substance use addiction and makes them less likely to reach out for help. This was particularly true of groups with Indigenous people, who pointed to stigma but also cost, limited access to healthcare, and issues of trust.
• Asked whether men in physically demanding jobs would reach out for help if they were worried about their substance use, most participants did not think they would due to the stigma and the fear of reprisal at work. There was also a link drawn by some participants to perceptions of masculinity, and the idea that men are expected to be tough or disciplined enough to handle the situation.

Section E: Risk behaviour profiling

In 2021 it was noted that the proximity of respondents to those with dependencies on opioids, or who had experiences with addiction or overdoses, had declined across all metrics measured. This most recent wave of data marks a sharp reversal in this trend. Half (48%) of respondents in the general population sample say that they know at least one friend or family member who has been prescribed an opioid – this up from 42% who said the same in 2021.

At one third (33%), the number who say they have known someone who became addicted to one of these drugs has climbed back up to its peak from 2019 while those say they know someone who has used one of these drugs illegally has inched up slightly to 24%.

Tragically, one-in-five (20%) respondents in the general population sample – this reflective of the national Canadian population – say they know someone who died of an overdose of one of these drugs. Almost the same number (19%) say they know someone who has had a non-fatal overdose. In both cases, these represent new peaks since tracking began in 2017.

This high-level picture obscures very different stories when you break things down by target audiences. Racialized respondents who, as noted above, appeared to view these issues through the lens of individual self-discipline, are also the least likely of all target audiences to say know someone who has been in any of the situations tested (with the minor exception of having a child who was prescribed one of these drugs).

Among the other target audiences, parents of youth aged 13-15 and males between the age of 20-59 track fairly closely with the general population across most metrics. Male labourers, people who use opioids legally, and people who use opioids illegally, all report frequencies above the general population sample across all issues tested.

Although the data does not speak to the root causes driving this in Indigenous communities, the story it does tell is one in which Indigenous respondents are disproportionately exposed to the pernicious consequences of opioid misuse. They are the most likely to say they know someone who has become addicted (59%), to know someone who has done them illegally (52%), who has died from an overdose on one of these drugs (46%), or who has experienced a non-fatal overdose (40%).

Three-in-ten (29%) respondents indicate that, of the opioids they have ever taken, they have always been prescribed to them personally or provided in a healthcare setting such as a hospital – this a steep drop from 2021 when 41% said the same. This year a plurality (34%), however, say that this is rarely the case.

There is minor variation among the target audiences. Of note, young adults (16%) are the most likely to say that they never take these in the context of a healthcare setting or as prescribed to them personally by medical provider.

Consistent with previous waves of the study, just over half (55%) of the respondents in the general population sample say they store their opioids in a location where only they can access them. This peaks at three-in-five (62%) of people who use opioids legally who say the same and bottoms out with young adults, where only two-in-five (42%) are on the same page.

When asked what they did with leftover opioids, a plurality (31%) say that it does not apply in their circumstance as they went through the full course and had no leftovers. Among those who did, respondents were equally split between those who returned them (29%) and those who say they saved them in case they needed them again (28%). These are consistent with the numbers seen in previous waves.

At one-in-five (19%), young adults were the most likely to say that they gave them to someone who needed them whereas male labourers were the most likely to say that they flushed them (23%).

Half (52%) of respondents who have used unprescribed opioids say they either took them a few times or once or twice. People who use opioids illegally (8%) and youth (9%) are the most likely to say that they took them daily, although it is worth noting that the youth sample size is small and that these results must be interpreted with caution.

At two-in-five (41%) saying so, respondents from Alberta are the most likely to admit they have used opioids that were not prescribed to them.

Among those who have used opioids not prescribed to them, a plurality (35%) say that they got them from a friend or a relative who had a prescription. This jumps to three-in-five (58%) among youth and half (48%) of Indigenous respondents. All target audiences except racialized respondents and people who use opioids legally report higher incident rates of seeking unprescribed opioids on the streets than the general population sample. In terms of opioids procured over the internet, this is most prevalent among young adults, of which 16% say that's where they got their unprescribed opioids.

In line with what was mentioned above, respondents from Alberta are the most likely of any region to say that they have used a friend or family member's prescription (at 48% saying so).

In the sample of respondents who have used opioids that were not prescribed to them, echoing what was noted above with the primary reason for initially taking an opioid, pain management tops the list in the general population (49%) and in all target audiences (48-64%). This nonetheless represents a decline from the previous wave in 2021 and 2019 where 54% and 63% said the same respectively.

Among the target audiences, young adults aged 16-24 (26%), male labourers (18%), Indigenous respondents (16%), and males 20-59 (15%) were more likely to have used opioids that were not prescribed to them to try them and see what they felt like. Young adults aged 16-24 (18%), and male labourers (16%) were also more likely to have had opioids not prescribed for them for the feeling it causes.

Prompted with the question of whether they would take a non-prescribed opioid they knew contained fentanyl, a majority across all audiences say they either probably, or definitely, would not take it. At the level of the general population, the number who say they definitely would not jumped 5% from last year (65% to 70%).

That being said, there are important minorities within specific target audiences that exhibit more willingness to take risks when it comes to opioids laced with fentanyl. A quarter of young adults (24%) and male labourers (25%) say they probably would take the opioid regardless. While youth appear to be the most likely to definitely take a non-prescribed opioid containing fentanyl at 11%, this must be caveated with the low sample size and understood in the context of their lower awareness of opioids as a whole.

Two thirds (67%) of the general population sample who have used opioids at some point say they never mix other drugs or alcohol with opioids. In line with the propensity for higher risk tolerances noted above, young adults, male labourers, and people who use opioids illegally all report higher frequencies of polysubstance use.

The other substances most commonly used at the same time as opioids are alcohol (63%), cannabis (40%), and cocaine (26%). These are consistent with the results from 2021, although fewer options were provided so the data is not directly comparable.