Issue #30 December 2023

[This issue includes a modified and updated excerpt from “Buzz Kill: The Corporatization of Cannabis”.  NOW AVAILABLE at or at your local independent bookstore. They could really use the support.

In the previous issue, I discussed ways in which we identify and define a drug problem – sometimes it’s obvious; sometimes it’s not. The grey area poses challenges – not only for clinicians but also for epidemiologists who attempt to assess the prevalence of drug problems in a defined population – for example, among Canadians adults. Knowing this information helps us to make a case for giving more attention to drug problems in social/health policy, making a case for specific policy interventions, or for monitoring the impact of the implementation of a specific policy initiative. So, let’s look at how we estimate the amount, and describe the types, of drug-related harm within a population.

Harm arising from drug use is usually captured by measures of injuries, illness, social disruption, or other harmful consequences, sometimes referred to as morbidity. It is also captured by counting the number of drug-related deaths, sometimes referred to as mortality.

We can gain an appreciation for the extent and types of harm from drug use, whether as morbidity or mortality, from two types of information gathered. One consists of routinely kept statistical records such as admissions to health services and to drug treatment programs, disruption of the workforce, and crime statistics, and deaths. The other is general population surveys of randomly selected individuals who are anonymously questioned on their use of drugs and any harms arising. 

Statistical Records

There are databases of routinely collected statistics on health information, including drug problems. These statistical records can be accessed at chosen intervals by researchers to provide ongoing reports. Such reports can give a comprehensive picture of the extent and types of harm from drug use.

The Canadian Substance Use Costs and Harms (CSUCH) Scientific Working Group is a collaborative project of the Canadian Institute for Substance Use Research (CISUR) at the University of Victoria and the Canadian Centre for Substance Use and Addiction (CCSA) in Ottawa. The CSUCH Working Group has issued three reports that provide statistical estimates of drug-related harms and costs for:

  • Healthcare: inpatient hospitalizations, day surgeries, emergency department visits, specialized treatment for substance use disorders, physician time and prescription drugs.
  • Lost productivity: substance use-attributable premature deaths, long-term disability, and short-term disability (absenteeism and impaired performance on the job).
  • Criminal justice: policing, courts, and correctional services (admissions to sentenced custody) attributable to substance use, including costs associated with the enforcement of current drug and impaired-driving laws, as well as the impact of violent and non-violent crimes that would not have occurred without some substance use; and,
  • A variety of other costs: research and prevention, fire damage, damage to motor vehicles and workplace costs not already covered in lost productivity, which would include employee assistance programs, drug testing programs and administrative costs associated with workers’ compensation.

Much of the data in the CSUCH reports and in its online interactive database also show the economic costs of drug problems to the Canadian economy.

There are two major limitations to using these statistical records for describing drug problems. One is that people who go to hospitals, enter drug treatment programs, or become involved in the criminal justice system are not necessarily representative of the general population. Given the more serious health and social problems of these groups, they make up a biased sample, so to speak. The other limitation is that with aggregate statistics such as hospital admissions, we cannot be certain if we are dealing with a large group of people admitted to hospital only once or twice, or a much smaller number of people, each with many admissions.

General Population Surveys

Statistical records are therefore well complemented by the second type of information – general population surveys. These surveys provide us with an estimate of the number of distinct individuals in the general population who are using drugs and experiencing harm.

In previous issues, I used the results from such a survey – The Canadian Alcohol and Drugs Survey (CADS) to create an understanding of the prevalence of drug use, use patterns, and high-risk behaviour. CTADS also provides information on harmful consequences of drug use including on physical health, friendships and social life, financial position, home life or marriage, work, studies, employment opportunities, legal problems, difficulty learning, and housing problems. Surveys are limited in the amount of information they collect because questionnaires are best kept short to maximize participation.

In the next issue, I will explore the extent and some of the types of harm identified at the population level. Spoiler alert: it’s not a pretty picture. 

Mike DeVillaer
Hamilton Ontario Canada
December 16 2023