Submission ID 130550
| Issue/Objective | Canada's toxic drug crisis remains a major public health emergency, with over 55,000 opioid toxicity deaths since 2016 and more than 4,100 deaths reported in 2025 alone (January-September). The burden extends to over 51,000 hospitalizations and 214,000 emergency department visits and is increasingly driven by polysubstance use, with 70% of deaths involving stimulants. Impacts are disproportionately borne by Indigenous and structurally marginalized populations, while access to harm reduction services remains uneven, particularly in rural areas. This study examines inequities in access to harm reduction interventions and their association with overdose outcomes, addressing gaps between evidence and equitable implementation in Canada. |
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| Methodology/Approach | A systematic review was conducted of peer-reviewed and grey literature published between 2016 and 2025. Databases including MEDLINE, Embase, CINAHL, and Scopus were searched. Studies examining access to harm reduction interventions (e.g., supervised consumption services, naloxone distribution, opioid agonist therapy) and associated health outcomes in Canada were included. Screening followed PRISMA guidelines with dual independent review. Data were extracted and synthesized using a narrative approach, with thematic analysis applied to qualitative findings. |
| Results | A total of 68 studies were included. Consistent evidence showed that increased availability of supervised consumption services and naloxone distribution was associated with significant reductions in overdose mortality (ranging from 20-35%) and emergency department visits in urban centers. However, over 60% of rural and remote regions lacked access to these services, corresponding with disproportionately higher overdose death rates. Studies also identified lower initiation and retention in opioid agonist therapy among marginalized populations, driven by structural barriers. Qualitative findings revealed that stigma, criminalization, and lack of culturally safe care reduced service utilization, even where services existed. Interventions integrating peer-led models and mobile outreach demonstrated improved engagement and access among underserved populations. |
| Discussion/Conclusion | While harm reduction interventions are effective, inequitable access and systemic barriers constrain population-level impact in Canada. Addressing these gaps requires coordinated policy action to scale evidence-based interventions, reduce structural barriers, and prioritize community-led, culturally safe approaches. Aligning with Sub-theme 3 (From evidence to impact), this study highlights the urgent need to strengthen accountability and implementation to advance health equity in a fragmented policy landscape. |
| Presenters and Affiliations | FREDRICK AKINYOSOYE Delaware Department of Health and Social Services Wuraola Awosan Liberty University Tawakalt Bashir Ladoke Akintola University of Technology |
