Follow-up survey and qualitative research on opioid awareness, knowledge and behaviours for public education - Final Report

Prepared for Health Canada

Supplier name:  Earnscliffe Strategy Group
Contract number:  HT372-184591/001/CY
Contract value: $198,115.86
Award date:  March 19, 2019
Delivery date:  July 19, 2019

Registration number:  POR 137-18
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.

Prepared for Health Canada
Supplier name:  Earnscliffe Strategy Group
July 2019

This public opinion research report presents the results of focus groups and an online survey conducted by Earnscliffe Strategy Group on behalf of Health Canada.  The research was conducted from June 2019 to July 2019.

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

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 Health 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: H21-313/2019E-PDF

International Standard Book Number (ISBN): 978-0-660-31568-3

Related publications (registration number:  POR 137-18):

H21-313/2019F-PDF (Final Report, French)
978-0-660-31569-0

© Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2019

Table of Contents

Executive summary

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

Canada is facing a national opioid crisis, evidenced by the growing number of overdoses and opioid related deaths.   In 2018, Health Canada launched a multi-year public education campaign to address the growing opioid crisis and to educate Canadians on the risks associated with opioids as well as the role of stigma as a barrier to treatment.  The current research project was undertaken to help Health Canada gain insights Canadians' attitudes and perceptions toward opioids.  Feedback from the research will provide Health Canada with evidence-based data and insights to guide their public education campaigns.

The objective of the research was to follow-up on the 2017 baseline survey regarding the current state of awareness, knowledge, attitudes, beliefs and behaviours regarding opioids. This phase also included research into impressions of alcohol use, knowledge of Canada's Low-Risk Alcohol Drinking Guidelines, and views on chronic pain and pain management.  This project included both quantitative and qualitative methodologies. The contract value for this project was $198,115.86 including HST.

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

To meet these objectives, Earnscliffe conducted a two-phased research program.

We began with qualitative research, which included a series of ten focus groups with two segments of the Canadian population: men ages 30-39 and members of the general population 18 or older.  For each group, a maximum of ten (10) individuals were recruited as participants.  In total, 85 people participated in the focus group discussions.  Two sessions were conducted in each of the following five cities:  Toronto (June 10, 2019); Halifax (June 11, 2019); Montreal (June 11, 2019); Calgary (June 12, 2019); and Vancouver (June 13, 2019). The groups in Montreal were conducted in French, while the groups in all other locations were conducted in English. Please refer to the Recruitment Screener in the Appendix of this report for all relevant screening and qualifications criteria.

In each city, the groups with men aged 30-39 began at 5:30 pm and were followed by the groups with members of the general population (18+) at 7:30 pm. The sessions were approximately 2 hours in length. Focus group participants were given an honorarium of $100 as a token of appreciation for their time.  Appendix B provides greater detail on how the groups were recruited, while Appendix C provides the discussion guide used for the focus groups and Appendix D provides the screener used for recruiting the focus groups.

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.  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 phase of qualitative research was followed by a quantitative phase involving an online survey, to provide current information and to compare results against baseline measures from the 2017 survey.  Health Canada required the conduct of a base survey of 1,000 Canadians aged 13 and older, plus oversamples of at least 300 additional interviews conducted among each of the following six specific target audiences identified by Health Canada:

The online survey was conducted using Leger's opt-in panel and upon completion, consisted of a final aggregate sample of 2,833 respondents.  The 2,833 interviews were comprised of the following:

The profile of each oversample group is presented in the tables 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 six target audiences.

Youth 13-15 Oversample
Sample source Number of respondents
Gen pop sample 23
Teen oversample 308
Other oversamples 0
Total 331
Men 30-39 Oversample
Sample source Number of respondents
Gen pop sample 84
Men oversample 300
Other oversamples 11
Total 395
Parent of Youth 13-15 Oversample
Sample source Number of respondents
Gen pop sample 60
Parent oversample 310
Other oversamples 27
Total 397
Illegal User Oversample
Sample source Number of respondents
Gen pop sample 138
Illegal user oversample 300
Other oversamples 232
Total 670
Young Adults 16-24 Oversample
Sample source Number of respondents
Gen pop sample 119
Young adult oversample 310
Other oversamples 4
Total 433
Legal User Oversample
Sample source Number of respondents
Gen pop sample 194
Legal user oversample 302
Other oversamples 230
Total 726

Surveys were conducted between June 10 and July 3, 2019 in English and French. The online survey took an average of 16 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, and men 30-39 oversamples were weighted to replicate actual population distribution by region, age and gender according to the most recent Census (2016) data available. The data for the parent, legal and illegal user oversamples was 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 provide the survey instrument used.

The key findings from the research are presented below. Bolded results indicate that the result of the demographic group mentioned is significantly higher (at the 95% confidence interval) than the result found in other subgroups discussed in same analysis. To ensure comparability, the survey remained consistent with questions asked in the 2017 survey. 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: https://www.canada.ca/en/health-canada/services/substance-use/problematic-prescription-drug-use/opioids/stigma/stigmatips-talk-substance-use.html. Due to the use of non-probability online opt-in panels for data collection, statistical significance testing differences in results between years (2017 vs. 2019) is not appropriate and therefore, not provided.

For statistical information on prevalence, refer to the Canadian Tobacco and Alcohol Survey (CTADS), available at https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey.html or the Canadian Student Tobacco and Alcohol Survey (CSTADS), available at https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey.html.

Opioid and illicit drug use

Opioid awareness, impressions and basic understanding

Attitudes relating to behaviours, risk and harms

Attitudes regarding stigma

Risk behaviour profiling

Opioid information

The role of stigma

As was undertaken in the 2017 study, the sample was segmented into three groups based on their answers to three statements relating to either withholding sympathy or assigning blame to those who use opioids - Unsympathetic, Ambivalent, and Allies.  The evidence demonstrates that stigmatizing views about opioid use disorder continue to be held by a significant portion of the population and the incidence of each segment has remained fairly static.

Views on chronic pain and chronic pain management (qualitative only)

Alcohol consumption

Research Firm:

Earnscliffe Strategy Group Inc. (Earnscliffe)
Contract Number:  HT372-184591/001/CY
Contract award date:  March 19, 2019

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.

Signed:

Date:  July 19, 2019

Doug Anderson
Principal, Earnscliffe

Introduction

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

Canada is facing a national opioid crisis, evidenced by the growing number of overdoses and opioid related deaths.   In 2018, Health Canada launched a multi-year public education campaign to address the growing opioid crisis and to educate Canadians on the risks associated with opioids as well as the role of stigma as a barrier to treatment.  The current research project was undertaken to help Health Canada gain insights Canadians' attitudes and perceptions toward opioids.  Feedback from the research will provide Health Canada with evidence-based data and insights to guide their public education campaigns.

The objective of the research was to follow-up on the 2017 baseline survey regarding the current state of awareness, knowledge, attitudes, beliefs and behaviours regarding opioids. This phase also included research into impressions of alcohol use, knowledge of Canada's Low-Risk Alcohol Drinking Guidelines, and views on chronic pain and pain management.  This project included both quantitative and qualitative methodologies.

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

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

To meet these objectives, Earnscliffe conducted a two-phased research program.

The first phase was qualitative and included a series of ten focus groups with two segments each of the Canadian population: men (30-39) and members of the general population (18+).  For each group, a maximum of ten (10) individuals were recruited as participants.  In total, 85 people participated in this phase of focus group discussions.  Two sessions were conducted in each of the following five cities:  Toronto (June 10, 2019); Halifax (June 11, 2019); Montreal (June 11, 2019); Calgary (June 12, 2019); and Vancouver (June 13, 2019). The groups in Montreal were conducted in French whereas all other locations were conducted in English. Please refer to the Recruitment Screener in the Appendix of this report for all relevant screening and qualifications criteria.

In each city, the groups with men aged 30-39 began at 5:30 pm and the groups with members of the general population (18+) began at 7:30 pm. The sessions were approximately 2 hours in length. Focus group participants were given an honorarium of $100 as a token of appreciation for their time.  Appendix D provides greater detail on how the groups were recruited, while Appendix C provides the discussion guide used for the focus groups.

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.  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 phase of qualitative research was followed by a quantitative phase involving an online survey, conducted in collaboration with the quantitative sub-contractor, Leger Marketing. The online survey was conducted using Leger's opt-in panel and consisted of a sample of 2,833 Canadian residents aged 13 and older.  A total of 1,003 cases were collected as the sample of the general population. In addition to the base sample of 1,003, oversamples were also collected, achieving the following sample sizes in each of the six audiences below:

The profile of each oversample group is presented in the tables 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 six target audiences.

Youth 13-15 Oversample
Sample source Number of respondents
Gen pop sample 23
Teen oversample 308
Other oversamples 0
Total 331
Men 30-39 Oversample
Sample source Number of respondents
Gen pop sample 84
Men oversample 300
Other oversamples 11
Total 395
Parent of Youth 13-15 Oversample
Sample source Number of respondents
Gen pop sample 60
Parent oversample 310
Other oversamples 27
Total 397
Illegal User Oversample
Sample source Number of respondents
Gen pop sample 138
Illegal user oversample 300
Other oversamples 232
Total 670
Young Adults 16-24 Oversample
Sample source Number of respondents
Gen pop sample 119
Young adult oversample 310
Other oversamples 4
Total 433
Legal User Oversample
Sample source Number of respondents
Gen pop sample 194
Legal user oversample 302
Other oversamples 230
Total 726

Surveys were conducted between June 10 and July 3, 2019 in English and French. The online survey took an average of 16 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, youth, and young adult oversamples were weighted to replicate actual population distribution by region, age and gender according to the most recent Census (2016) data available. The data for the parents, men aged 30-39, legal and illegal user oversamples was weighted based on the profile found in the general population sample, by age, gender and region.

Bolded results presented in this report indicate that the difference between the demographic groups analysed are significantly higher than results found in other columns in the same demographic analysis.  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 reporting as well as the nature of the vast differences the oversample groups bring to the results.

The detailed findings from this research are presented in subsequent sections of this report. Appended to this report are the survey instruments and data tables (presented under a separate cover).

Detailed findings

The following report is divided into nine sections: opioids and illicit drug use; opioids awareness, impressions and basic knowledge; attitudes relating to behaviours, risk and harm; attitudes regarding stigma; risk behaviour profiling; opioid information; views on chronic pain; the role of stigma; and, alcohol. Each section presents the findings informed by the initial qualitative research and the follow-up 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 seven target segments:  the six 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.

Details about the survey design, methodology, sampling approach, and weighting of the results may be found in the Survey Methodology Report in Appendix A. 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 illicit 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.

For statistical information on prevalence, refer to the Canadian Tobacco and Alcohol Survey (CTADS), available at https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey.html or the Canadian Student Tobacco and Alcohol Survey (CSTADS), available at https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey.html.

Exhibit A1 - Opioid table
Generic name Trade name (examples) Street names
Buprenorphine BuTrans® Bupe, bute, subs, tems
Buprenorphine-naloxone Suboxone® Subby, bupe, sobos
Codeine Tylenol® 2,3, 4 (codeine _ acetaminophen) Cody, captain cody, T1, T2, T3, T4
Fentanyl Abstral®, Duragesic®, Onsolis® Patch, sticky, sticker, Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, Tango and Cash
Heroin Diaphin Smack, H, brown sugar, junk, skag, horse
Hydrocodone Tussionex®, Vicoprofen® Hydro, Vike
Hydromorphone Dilaudid® Juice, dillies, dust
Meperidine Demerol® Demmies
Methadone Methadose®, Metadol® drink done, metho, jungle juice, dolls, wafers
Morphine Doloral®, Statex®, M.O.S.® M, morph, red rockets
Oxycodone OxyNEO®, Percocet®, Oxycocet®, Percodan® Oxy, hillbilly heroin, percs
Pentazocine Talwin© Ts, Ts & Cs
Tapentadol Nycynta® Unknown
Tramadol Ultram®, Tramacet®, Tridural®, Durela® Chill pills, ultras

As respondents for the online survey were selected from among those who have volunteered/registered to participate in online surveys and thus constitute a non-probability sample, the results of this survey cannot be described as statistically projectable to the full population.  For statistical information on prevalence, refer to the Canadian Tobacco and Alcohol Survey (CTADS), available at https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey.html or the Canadian Student Tobacco and Alcohol Survey (CSTADS), available at https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey.html.

Over one-quarter (29%) report having taken opioids in the past year, up 7% from 2017's benchmark study. A near identical proportion (21%) compared to 2017 (20%) claim they have taken them, but not in the past year. Among opioid users, almost identical proportions in 2019 and 2017 (69% and 66%) say they always have a prescription for the opioids they take. A slightly larger proportion of Quebecers (58%) and residents of Manitoba and Saskatchewan (56%) say they have never taken opioids, compared to other regions. Respondents 55+ (80%) are most likely to have always had a prescription in their name.

The percentage of youth who have taken opioids in the past year has risen from 10% in 2017 to 19% in 2019. A greater proportion of youth also report having taken them, though not in the past year (8% vs 3%). Young adults have the highest incidence of opioid use (29%) compared to youth (19%) and adults 25+ (27%). Parents (33%) are more likely than youth and adults 25+ to have taken opioids in the past year.

A higher proportion of youth say they have always had a prescription in their name when they have taken opioids, compared to 2017 (54% vs 37%). While the proportion of young adults (52%) is similar, the incidence of adults who have always had a prescription is much higher (70%). Almost two-thirds of men 30-39 (63%) say they always have a prescription in their name.

Exhibit A2 - Q8. Have you taken any of the following?
Opioid use in the past year
Gen Pop 2019
(n=1003)
A
Gen Pop 2017
(n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users
(n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Have taken in the past year 29% 22% 19% 29% 27% 100% 79% 1% 33% 30%
BG - G BG BG ABCDFGHI ABCDGHI - BDG BG
Have taken, but not in the past year 21% 20% 8% 16% 24% - 10% 30% 26% 19%
BCF - - BF ABCFI - - ABCDFI BCFI BF
Have never taken 47% 55% 71% 49% 46% - 10% 66% 38% 46%
FH - ACDFGHI FH FH - - ACDFHI F FH
DK/NR 3% 3% 2% 5% 2% - 1% 3% 3% 5%


Exhibit A3 - Q9. [If opioid user in the past year, in reference to the opioid reference table] When you took any of these drugs or medicines in the past year, did you…
Prescribed opioid use in the past year
Gen Pop 2019
(n=282)
A
Gen Pop 2017
(n=290)
Youth 13-15
(n=66*)
B
Young adults
16-24 (n=129)
C
Adults 25+
(n=415)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=532)
F
Neither
(n=16)
G
Parents
13-15 (n=129)
H
Men
30-39
(n=118)
I
Always have prescription in your name 69% 66% 54% 52% 70% 100% 22% - 64% 63%
BCF - F F BCF - - - F F
Usually have prescription in your name 10% 11% 15% 15% 10% - 24% - 14% 17%
- - - - - - ABCDHI - - D
Sometimes have a prescription in your name 5% 5% 8% 8% 6% - 16% - 13% 5%
- - - - - - ABCDI - ADI -
Rarely have prescription in your name 4% 3% 5% 2% 4% - 8% - 2% 4%
- - - - - - ACDHI - - -
Never have prescription in your name 9% 12% 14% 17% 9% - 30% - 7% 9%
- - - ADH - - ABCDHI - - -
DK/NR 3% 3% 4% 7% 1% - - 100% - 2%

*Bear in mind the small sample sizes for this question, results should be regarded with caution.

Overall, few (6%) have ever been refused a prescription for opioids when they needed it for pain. Among those who use drugs illegally, this number rises to 20%.

Exhibit A4 -Q10. Has your doctor ever refused to prescribe you an opioid when you needed it for pain?
Doctor refusal of prescription
Gen Pop 2019
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Yes 6% 7% 11% 6% 12% 20% 3% 10% 12%
G - ADG G ABDG ABCDEGHI - ADG ABDG
No 50% 43% 44% 52% 70% 53% 46% 56% 50%
BCG - - ABCG ABCDFGHI BCG - ABCG -
Not Applicable / Never asked for this 42% 46% 43% 40% 17% 26% 49% 33% 35%
EFHI EFHI EFHI EFHI - E ACDEFHI EF EF
DK/NR 3% 4% 2% 2% 1% 2% 2% 1% 3%

Respondents take cocaine (18%) and ecstasy (18%) more often than methamphetamine (11%) and heroin (4%). Illicit drug use has increased slightly since 2017, from 5% to 8% having taken at least one illicit drug in the past year. Each drug is slightly more popular among young adults 16-24. Men are more likely to have tried any of the drugs listed than women. For example, 22% of men have taken cocaine, compared to 13% of women.

Q11. Have you taken any of the following?
Exhibit A5 -Q11A. Heroin (such as smack, H, skag, junk)
Opioid use in the past year
Gen Pop
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Have taken in the past year 1% 3% 4% 2% 5% 14% - 10% 3%
- - AD - ABDI ABCDEHI - ABCDEI -
Have taken, but not in the past year 3% 4% 4% 3% 4% 11% 1% 11% 8%
G - G G G ABCDEGI - ABCDEGI ABDEG
Have never taken 94% 92% 89% 94% 89% 72% 97% 79% 87%
CEFHI FHI FH CEFHI FH - ACDEFHI F FH
DK/NR 2% 1% 2% 1% 1% 2% 1% 1% 3%

Exhibit A6 -Q11B. Cocaine (such as coke, snow, powder) or crack cocaine (such as rock, freebase, angie)
Opioid use in the past year
Gen Pop
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Have taken in the past year 5% 2% 9% 4% 8% 29% - 9% 6%
- - ABD - ABD ABCDEHI - ABD BD
Have taken, but not in the past year 13% 6% 8% 13% 14% 19% 10% 20% 19%
BCG - - BCG BCG ABCDEG - ABCDEG ABCDEG
Have never taken 81% 90% 79% 82% 76% 49% 88% 68% 72%
EFHI ACDEFHI FHI EFHI FH - ACDEFHI F F
DK/NR 2% 2% 4% 1% 2% 3% 1% 3% 3%

Exhibit A7 -Q11C. Ecstasy (such as E, X, Molly), or hallucinogens (such as Psilocybin, also known as magic mushrooms/shrooms, LSD, also known as Acid, blotters, etc.)
Gen Pop
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Have taken in the past year 4% 4% 10% 3% 8% 25% - 9% 6%
D - ABDI - ABD ABCDEHI - ABD D
Have taken, but not in the past year 14% 4% 13% 14% 14% 26% 11% 19% 24%
BG - B BG B ABCDEGH B ABCDEG ABCDEG
Have never taken 80% 90% 74% 82% 76% 46% 87% 69% 67%
CEFHI ACDEFHI FI CEFHI FHI - ACDEFHI F F
DK/NR 2% 2% 4% 2% 2% 3% 1% 3% 3%

Exhibit A8 -Q11D. Methamphetamine (such as meth, crystal meth, crank, speed)
Gen Pop
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Have taken in the past year 3% 3% 6% 2% 7% 20% - 11% 4%
- - AD - ABDI ABCDEHI - ABCDEI D
Have taken, but not in the past year 8% 2% 7% 8% 8% 17% 5% 13% 13%
BG - B BG BG ABCDEGHI - ABCDEG ABCDEG
Have never taken 88% 93% 84% 89% 83% 60% 94% 75% 80%
CEFHI ACDEFHI FH CEFHI FH - ACDEFHI F F
DK/NR 2% 2 % 3% 1% 1% 3% 1% 1% 3%

Exhibit A3 - Q9. [If opioid user in the past year, in reference to the opioid reference table] When you took any of these drugs or medicines in the past year, did you…
Prescribed opioid use in the past year
Gen Pop 2019
(n=282)
A
Gen Pop 2017
(n=290)
Youth 13-15
(n=66*)
B
Young adults
16-24 (n=129)
C
Adults 25+
(n=415)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=532)
F
Neither
(n=16*)
G
Parents
13-15 (n=129)
H
Men
30-39
(n=118)
I
Always have prescription in your name 69% 66% 54% 52% 70% 100% 22% - 64% 63%
BCF - F F BCF - - - F F
Usually have prescription in your name 10% 11% 15% 15% 10% - 24% - 14% 17%
- - - - - - ABCDHI - - D
Sometimes have a prescription in your name 5% 5% 8% 8% 6% - 16% - 13% 5%
- - - - - - ABCDI - ADI -
Rarely have prescription in your name 4% 3% 5% 2% 4% - 8% - 2% 4%
- - - - - - ACDHI - - -
Never have prescription in your name 9% 12% 14% 17% 9% - 30% - 7% 9%
- - - ADH - - ABCDHI - - -
DK/NR 3% 3% 4% 7% 1% - - 100% - 2%

*Bear in mind the small sample sizes for this question, results should be regarded with caution.

Overall, few (6%) have ever been refused a prescription for opioids when they needed it for pain. Among those who use drugs illegally, this number rises to 20%.

Exhibit A4 -Q10. Has your doctor ever refused to prescribe you an opioid when you needed it for pain?
Doctor refusal of prescription
Gen Pop 2019
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Yes 6% 7% 11% 6% 12% 20% 3% 10% 12%
G - ADG G ABDG ABCDEGHI - ADG ABDG
No 50% 43% 44% 52% 70% 53% 46% 56% 50%
BCG - - ABCG ABCDFGHI BCG - ABCG -
Not Applicable / Never asked for this 42% 46% 43% 40% 17% 26% 49% 33% 35%
EFHI EFHI EFHI EFHI - E ACDEFHI EF EF
DK/NR 3% 4% 2% 2% 1% 2% 2% 1% 3%

Respondents take cocaine (18%) and ecstasy (18%) more often than methamphetamine (11%) and heroin (4%). Illicit drug use has increased slightly since 2017, from 5% to 8% having taken at least one illicit drug in the past year. Each drug is slightly more popular among young adults 16-24. Men are more likely to have tried any of the drugs listed than women. For example, 22% of men have taken cocaine, compared to 13% of women.

Exhibit A5 -Q11A. Heroin (such as smack, H, skag, junk)
Opioid use in the past year
Gen Pop
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Have taken in the past year 1% 3% 4% 2% 5% 14% - 10% 3%
- - AD - ABDI ABCDEHI - ABCDEI -
Have taken, but not in the past year 3% 4% 4% 3% 4% 11% 1% 11% 8%
G - G G G ABCDEGI - ABCDEGI ABDEG
Have never taken 94% 92% 89% 94% 89% 72% 97% 79% 87%
CEFHI FHI FH CEFHI FH - ACDEFHI F FH
DK/NR 2% 1% 2% 1% 1% 2% 1% 1% 3%

Exhibit A6 -Q11B. Cocaine (such as coke, snow, powder) or crack cocaine (such as rock, freebase, angie)
Gen Pop
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Have taken in the past year 5% 2% 9% 4% 8% 29% - 9% 6%
- - ABD - ABD ABCDEHI - ABD BD
Have taken, but not in the past year 13% 6% 8% 13% 14% 19% 10% 20% 19%
BCG - - BCG BCG ABCDEG - ABCDEG ABCDEG
Have never taken 81% 90% 79% 82% 76% 49% 88% 68% 72%
EFHI ACDEFHI FHI EFHI FH - ACDEFHI F F
DK/NR 2% 2% 4% 1% 2% 3% 1% 3% 3%

Exhibit A7 -Q11C. Ecstasy (such as E, X, Molly), or hallucinogens (such as Psilocybin, also known as magic mushrooms/shrooms, LSD, also known as Acid, blotters, etc.)
Gen Pop
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Have taken in the past year 4% 4% 10% 3% 8% 25% - 9% 6%
D - ABDI - ABD ABCDEHI - ABD D
Have taken, but not in the past year 14% 4% 13% 14% 14% 26% 11% 19% 24%
BG - B BG B ABCDEGH B ABCDEG ABCDEG
Have never taken 80% 90% 74% 82% 76% 46% 87% 69% 67%
CEFHI ACDEFHI FI CEFHI FHI - ACDEFHI F F
DK/NR 2% 2% 4% 2% 2% 3% 1% 3% 3%

Exhibit A8 -Q11D. Methamphetamine (such as meth, crystal meth, crank, speed)
Gen Pop
(n=1003)
A
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Have taken in the past year 3% 3% 6% 2% 7% 20% - 11% 4%
- - AD - ABDI ABCDEHI - ABCDEI D
Have taken, but not in the past year 8% 2% 7% 8% 8% 17% 5% 13% 13%
BG - B BG BG ABCDEGHI - ABCDEG ABCDEG
Have never taken 88% 93% 84% 89% 83% 60% 94% 75% 80%
CEFHI ACDEFHI FH CEFHI FH - ACDEFHI F F
DK/NR 2% 2 % 3% 1% 1% 3% 1% 1% 3%

Key takeaways: Opioids and illicit drug use

Section B: Opioid awareness, impressions and basic understanding

Awareness of opioids is fairly broad and has increased slightly since 2017. Roughly two-thirds (69%) are certain or pretty sure they know what an opioid is, up 6% since 2017. Over one-quarter of adults 25 and older are certain they know what an opioid is (28%), higher than among young adults (23%) and youth (14%). Over a quarter of youth (28%) say they have never heard the term opioid or do not really know what it is, less than in 2017 (36%). A greater percentage of Quebecers (17%) have never heard of/don't really know what an opioid is compared to respondents in Atlantic Canada (6%), Ontario (9%), Manitoba/Saskatchewan (7%) and Alberta (9%).

Over half of men 30-39 (60%) are pretty sure or certain they know what an opioid is. A very similar proportion of illegal drug users (62%) say the same. The group most certain of their knowledge is legal users - 75% are pretty sure or certain.

Exhibit B1 - Q12. Which of these best describes your level of understanding about what an opioid is?
Knowledge of opioids
Gen Pop
(n=1003)
A
Gen Pop

2017 (n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
I am certain I know what an opioid is 27% 26% 14% 23% 28% 39% 27% 24% 28% 27%
BG - - B BCG ABCDFGHI B B B B
I am pretty sure I know what an opioid is 42% 37% 30% 36% 42% 36% 35% 42% 37% 33%
BCEFI - - - BCEFHI - - BCEFHI - -
I might know what an opioid is, but I'm unsure 19% 20% 26% 22% 20% 16% 21% 21% 25% 24%
- - ADE E E - E ADE ADE ADE
I don't really know what an opioid is 7% 9% 20% 10% 6% 4% 9% 8% 4% 10%
E - ACDEFGHI ADEH EH - DEH DEH - DEH
I had never heard the term "opioid" before this survey 4% 7% 8% 7% 4% 5% 7% 3% 6% 5%
- - ADEG ADG - - DG - - -
DK/NR 1% 2% 1% 2% 1% - 1% 1% - 1%
E - - EH E - EH DEH - E

Familiarity with opioids has remained the same since 2017, with 26% of people reporting they are very familiar with at least one of the referenced opioids. Almost two-thirds (65%) are at least somewhat familiar with one, and just 16% are not familiar with any. More men are not at all or just a little familiar with at least one (36%) than women (30%).

Youth are less familiar with opioids than the other age groups. One quarter (27%) say they are not at all familiar with any opioids, compared to 15% of young adults and 16% of adults 25 and older. However, fewer youth now are not at all familiar with opioids than was the case in 2017 (39%).

Legal and illegal users of drugs are more familiar with opioids - 48% and 39% respectively are very familiar. These proportions are similar to the 2017 results (51% and 43%). Parents' and men's (30-39) familiarity resemble that of the general population.

Exhibit B2 - Q13. How familiar are you with these types of opioids?
Familiarity with opioids
Gen Pop
(n=1003)
A
Gen Pop

2017 (n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Very familiar with at least one 26% 26% 12% 23% 26% 48% 39% 18% 27% 24%
BG - - BG BG ABCDFGHI ABCDGHI - BG BG
Somewhat familiar with at least one 39% 36% 33% 45% 39% 35% 38% 40% 41% 37%
- - - ABDEFGI B - - B B -
No more than a little familiar with at least one 17% 17% 26% 14% 18% 11% 15% 19% 19% 19%
E - ACDEFGHI - E - - ACDEF E EF
Not at all familiar with any 16% 18% 27% 15% 16% 5% 8% 22% 13% 19%
EF - ACDEFGHI EF EF - E ACDEFH EF EFH
DK/NR 2% 3% 2% 3% 1% 1% - 2% - 1%
DEFH - - EFH - - - DEFH - -

Qualitative insights:  Awareness of and familiarity with opioids among focus groups participants?

Consistent with the survey findings, awareness of the term opioids was generally high, although, familiarity and knowledge varied widely across the country and the two focus group segments.  Members of the general population (across all regions) and those in Eastern Canada (including Toronto, Halifax and Montreal) were less knowledgeable than men 30-39 and participants in Western Canada (both Calgary and Vancouver).  Some, usually at least one or two participants in each group (other than those in Montreal), either had personal experience with opioid use or knew someone who had developed a substance use disorder.

When asked what drugs participants considered to be opioids, top-of-mind mentions, especially among members of the general population and those in Eastern Canada, were more often than not prescription medications.  Those volunteered most often included:  oxycodone, codeine, morphine, Percocet, and Dilaudid.  There seemed to be a little more confusion and uncertainty around drugs like cocaine, meth, and heroin.  Some participants, usually men 30-39, thought these drugs and others such as ecstasy, MDMA, and cannabis could be laced with fentanyl, but this was not commonly understood.  Those less knowledgeable often confused opioids with illicit drugs (i.e., cocaine, heroin, etc.), generally; ignorant of the fact that these drugs are not dangerous because they are opioids but rather because they could be laced with opioids such as fentanyl.

Two in five respondents (39%) believe that all opioids referenced on the chart are dangerous, compared to 45% in 2017. However, the number of respondents who think most are dangerous (42%) has increased since 2017 (35%), so the combined proportion of those who think all or most are dangerous has barely shifted (81% in 2019 and 80% in 2017). Respondents from Quebec are less likely to believe all are dangerous (30%) than those from Atlantic Canada (46%), Ontario (42%), Manitoba/Saskatchewan (47%) and Alberta (44%).

Young adults are less wary of opioids than youth and adults 25+. A quarter (25%) believe all opioids are dangerous, compared to 43% of youth and 42% of adults 25+. Illegal drug users are perhaps unsurprisingly less inclined to believe all are dangerous (25%), a decline since the 2017 survey (30%).

Exhibit B3 - Q14. In thinking about the types of opioids included in this list, is it your impression that…
Perceived danger of opioids
Gen Pop
(n=1003)
A
Gen Pop

2017 (n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
All are dangerous 39% 45% 43% 25% 42% 39% 25% 43% 34% 31%
CFI - CFHI - ACFHI CFI - ACFHI CF CF
Most are dangerous 42% 35% 40% 48% 41% 43% 41% 41% 42% 34%
I - - ABDFGI I I I I I -
About half are dangerous 6% 7% 6% 10% 6% 6% 16% 5% 9% 12%
- - - ABDEG - - ABCDEGH - ADG ABDEG
A few are dangerous 7% 7% 7% 11% 7% 9% 14% 5% 12% 13%
G - - ADG G G ABDEG - ABDG ABDEG
None of these are dangerous 2% 1% 1% 2% 1% 1% 3% 1% - 2%
DGH - - DGH - H DEGH - - DGH
DK/NR 5% 5% 3% 4% 4% 1% 2% 5% 3% 7%
EF - - EF EF - - DEF - ABCDEFH

There is almost universal agreement across the general population and oversamples that opioids obtained on the street are very/somewhat dangerous to those who use them (88% very dangerous, 6% somewhat dangerous). Agreement is similarly high when it comes to the danger faced by people who use illegal drugs (82% very dangerous, 12% somewhat dangerous). Youth 13-15 are more concerned (82%) about the danger of opioids to them personally than young adults (69%) and those 25+ (70%). Legal drug users are less concerned about the danger opioids pose to them personally (60%), compared to the general population (69%).

Exhibit B4 - Q15. Based on your impressions, how dangerous would you say opioids are for each of the following? [% very dangerous or somewhat dangerous]
Perceived danger of opioids to various groups
Gen Pop
(n=1003)
A
Gen Pop

2017 (n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
People who use illegal drugs such as cocaine, ecstasy 95% 95% 96% 94% 95% 97% 92% 95% 96% 89%
FI - FI I FI ACDFI - FI FI -
People who use opioids obtained on the street 94% 95% 96% 95% 96% 98% 92% 96% 95% 91%
FI - FI FI AFI ACFI - AFI FI -
People who use opioids prescribed for someone else 94% 94% 94% 90% 95% 95% 89% 95% 93% 86%
CFI - CFI - CFI CFI - CFI FI -
Teens 94% 93% 93% 92% 95% 94% 89% 95% 95% 89%
FI - F - ACFI FI - ACFI FI -
Young adults 90% 91% 90% 87% 92% 91% 87% 92% 91% 83%
CFI - I - ACFI CFI - ACFI CFI -
Seniors 87% 86% 85% 84% 87% 88% 83% 88% 90% 81%
FI - - - FI FI - FI CFI -
You, personally 69% 70% 82% 69% 70% 60% 68% 74% 76% 70%
E - ACDEFGI E E - E ACDEF ACDEFI E
People who use opioids prescribed for them (follow Rx) 53% 52% 58% 47% 55% 46% 48% 56% 56% 55%
CEF - CEF - CEF - - ACEF CEF CEF

The vast majority (87%) believe the term "illegal opioids" means opioids obtained on the street, a similar proportion to 2017 (88%).  Just under two-thirds (61%) also believe the term can include prescription opioids that are taken without a prescription, slightly lower than in 2017 (66%).

Men 30-39 (78%) and illegal drug users (76%) are the least likely of all the oversamples to equate illegal opioids with opioids obtained on the street, though large majorities still do. Non-users (59%), men 30-39 (58%) and youth (47%) are least likely to relate the term to prescription opioids taken without a prescription.

In terms of other demographic differences, women (90%) are more likely to say the term means opioids obtained on the street than men (84%). A greater percentage of Ontarians (63%), as well as those in Alberta (71%) and BC (66%) believe illegal opioids could include prescription opioids taken without a prescription. While virtually all respondents picked one of these two responses, a small number (2%) said that "illegal opioids" means something else to them.  Asked to explain these responses, the more common answers were that illegal opioids means both those purchased on the street and those used without a prescription, or means those that are homemade or purchased online.

Exhibit B5 - Q16. When you hear the term "illegal opioids" which, if any, of the following do you think it means? [check all that apply]
Understanding of illegal opioids
Gen Pop
(n=1003)
A
Gen Pop

2017 (n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Opioids obtained on the street 87% 88% 86% 84% 89% 86% 76% 90% 82% 78%
FHI - FI FI ACFHI FHI - ACDEFHI F -
Prescription opioids not prescribed to you 61% 66% 47% 65% 61% 67% 62% 59% 64% 58%
B - - BGI BG ABDFGI B B BGI B
Other 2% 3% - 2% 2% 2% 2% 2% 1% 2%
B - - B B B B B - B
DK/NR 4% - 6% 5% 3% 1% 2% 4% 3% 8%
DEF - EF EF E - - DEF - ADEFGH

Overall awareness of Canada's opioid crisis remains virtually unchanged since 2017 (73% vs. 74% in 2019 very or somewhat aware). The number of respondents who state they are 'very aware' has fallen slightly from 28% to 25%. More youth (58%) say they are aware of the opioid crisis than in 2017 (50%). However, they, along with young adults (69%), are less aware than adults 25 and older (77%). A greater proportion of Quebecers (42%) are not aware of the opioid crisis, compared to all other regions. Those with a household income of less than $40,000 are also less familiar (30% not aware) compared to those with incomes between $40,000-$80,000 (21%) and $80,000 or more (22%).

Awareness is highest among legal opioid users. The vast majority (80%) are aware, a similar figure to 2017 (79%). Three-quarters of illegal users are aware (75%), slightly higher than 2017 (70%). Awareness among parents has not changed - 75% are aware in the most recent data, similar to the 73% aware in 2017. Two-thirds (64%) of men 30-39 are aware of the opioid crisis in Canada.

Exhibit B6 - Q17. How aware would you say you are of Canada's opioid crisis?
Awareness of Canada's opioid crisis
Gen Pop
(n=1003)
A
Gen Pop

2017 (n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Very awaret 25% 28% 15% 20% 25% 36% 27% 22% 21% 22%
BCG - - - BCG ABCDFGHI BCGH B B B
Somewhat aware 49% 45% 43% 49% 52% 44% 48% 52% 54% 42%
EI - - - ABEI - - BEI BEFI -
Not very aware 17% 15% 26% 22% 16% 15% 17% 17% 18% 24%
- - ADEFGH ADEFG - - - D - ADEFG
Not at all aware 7% 8% 14% 7% 6% 4% 7% 7% 5% 9%
E - ACDEFGHI - E - - E - E
DK/NR 2% 4% 2% 2% 1% 1% 1% 2% 1% 3%
E - - - - - - D - DEF

Across the general population and oversamples, a majority or more, sense that the opioid crisis is serious in their community. In fact, over two-thirds (70%) view the opioid crisis as very or somewhat serious in their community, up slightly from 2017 (65%). Respondents in BC are particularly sensitive to the severity of the crisis - 43% agree it is very serious, significantly more than in Atlantic Canada (22%) and Quebec (19%). Respondents with a university degree are also more likely to view the crisis as serious in their community (74%) than those with only a high school diploma (67%).

Youth are less likely to view the crisis as serious (61%) compared to young adults (64%) and adults 25 and over (72%). Men 30-39 are less likely than the general population to rate the crisis as serious (61%). Parents are more concerned about the severity of the crisis than they were in 2017 (73% vs 68%). Those who use neither legal or illegal opioids feel the crisis is less serious (68%) than those who use legal (76%) or illegal (73%) opioids.

Exhibit B7 - Q18. Based on your impressions, how serious would you say the opioid crisis is in your community?
Awareness of opioid crisis in your community
Gen Pop
(n=1003)
A
Gen Pop

2017 (n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Very serious 31% 29% 24% 27% 31% 38% 28% 29% 25% 21%
BGHI - - I BGHI ABCDFGHI I I - -
Somewhat serious 39% 36% 37% 37% 41% 38% 45% 39% 48% 40%
- - - - - - ABCEG - ABCDEGI -
Not very serious 14% 16% 21% 24% 13% 15% 18% 15% 17% 21%
- - ADEG ADEFGH - - AD D - ADEG
Not at all serious 3% 4% 3% 4% 3% 2% 4% 3% 2% 4%
- - - - - - E - - DE
DK/NR 12% 15% 15% 8% 12% 8% 5% 14% 9% 14%
CEFH - CEFH F CEFH F - CDEFH F CEFH

Qualitative insights:  scale and cause of the opioid crisis

Based on what they had heard, seen or read in the media, participants felt that there currently was an opioid crisis in Canada although the crisis in the United States was felt to be much more acute.  Most, including those in Eastern Canada, had the sense that the crisis was more serious in Western Canada, although the majority acknowledged that their communities were not immune, and some felt it was only a matter of time before it spread to their communities.

Despite the broad awareness of the term and the general tendency to describe the situation as a crisis, a lack of knowledge and/or inconsistency of knowledge was demonstrated as participants discussed the cause(s) of the opioid crisis. Most reasoned that it is the highly addictive nature of opioids that creates substance use disorder challenges that leads to black market activity.

When asked, the overwhelming majority of participants blamed the health care system for the crisis.  The following were cited as causes:

As mentioned previously, very few - outside the groups with men 30-39 in Calgary and Vancouver - instinctively linked the crisis to fentanyl (specifically recreational drugs being laced with fentanyl).  Worth noting, however, some men 30-39 in Calgary and Vancouver did attribute fentanyl to the opioid crisis describing it as highly addictive, easily accessible (some mentioned having heard of frequent large shipments of fentanyl from China), and inexpensive especially in the context of their feeling that a very small amount can produce a fairly significant feeling/impact.

Familiarity with fentanyl has not changed since 2017, with half (49%) of respondents claiming they are very or somewhat familiar. There was a slight (5%) decrease in the percentage of people who are not at all familiar with fentanyl. There is some regional variation in familiarity - significantly more Quebecers are not familiar (66%) compared to all other regions. Those with a household income of less than $40,000 are also less familiar (57% not familiar) compared to those with a household income of $80,000 or more (40%).

The percentage of youth who are not at all familiar has fallen by nine percentage points from 35% in 2017 to 26%, and they remain less familiar than older cohorts. Parents' familiarity with fentanyl is slightly higher (56%) than the general population (49%). Men's (30-39) familiarity largely reflects the general population results. Familiarity among legal (59%) and illegal (57%) drug users has increased slightly since 2017, when it was 52% and 56%, respectively.

Exhibit B8 - Q19. How familiar would you say you are with fentanyl?
Familiarity with fentanyl
Gen Pop
(n=1003)
A
Gen Pop

2017 (n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Very familiar 12% 12% 10% 15% 12% 19% 20% 11% 10% 14%
- - - BGH G ABDGHI ABCDGHI - - -
Somewhat familiar 37% 36% 30% 38% 38% 40% 37% 36% 46% 39%
B - - B BG B B - ABCDEFGI B
Not very familiar 31% 25% 31% 27% 31% 22% 28% 32% 29% 28%
E - E - E - E CE E E
Not at all familiar 18% 23% 26% 17% 18% 18% 13% 19% 13% 15%
FH - ACDEFGHI - FH FH - DFH - -
DK/NR 2% 3% 3% 3% 2% 1% 1% 2% 1% 4%
E - E E - - - DE - DEFH

Qualitative insights:  Awareness of and familiarity with fentanyl

As with the term opioids, participants seemed to be aware of the term fentanyl, but familiarity and knowledge varied significantly across region and segment.  In several groups, one or two participants described fentanyl as a particularly strong painkiller (i.e., specifically a horse tranquilizer) and/or that it could cause an overdose with even the most minute exposure.  A few participants referenced news stories about first responders having to wear special equipment to avoid the effects of coming into physical contact with fentanyl on the job.

Among those familiar with fentanyl, well over three-quarters (81%) describe it as very dangerous, comparable to the 83% who felt the same way in 2017. Respondents in Atlantic Canada (91%) and BC (90%) are more likely to believe fentanyl is very dangerous, particularly compared to Quebecers (76%), Ontarians (79%), and those in Manitoba/Saskatchewan (77%). While most across all oversamples agree it is dangerous, fewer youth (77%), young adults (74%), parents (72%), illegal drug users (65%) and men 30-39 (69%) believe fentanyl is very dangerous.

Exhibit B9 - Q20. [If some familiarity with fentanyl] To the best of your knowledge, how dangerous is fentanyl?
Familiarity with fentanyl
Gen Pop 2019
(n=809)
A
Gen Pop 2017
(n=975)
Youth 13-15
(n=239)
B
Young adults
16-24 (n=348)
C
Adults 25+
(n=1198)
D
Legal Opioid
users (n=595)
E
Illegal Drug users (n=578)
F
Neither
(n=1205)
G
Parents
13-15 (n=335)
H
Men
30-39
(n=320)
I
Very dangerous 81% 83% 77% 74% 82% 82% 65% 85% 72% 69%
CFHI - FI F CFHI CFHI - ABCDFHI F -
Somewhat dangerous 15% 13% 19% 19% 15% 15% 27% 12% 24% 23%
G - - G G - ABCDEG - ADEG ADEG
Not very/ Not at all dangerous 3% 1% 3% 5% 2% 2% 5% 1% 3% 5%
DG - - DEG - - ADEG - - ADEG
DK/NR 2% 2% 2% 2% 1% 1% 3% 1% 1% 3%
H - - - - - DH - - DH

Almost three-quarters (71%) think there is a high risk that illegal non-opioid drugs could be laced with fentanyl.  Fewer youth (62%), young adults (63%), parents (61%), men 30-39 (51%) and illegal users (53%) agree.  Very few (3%) believe there is not much or no risk.  Respondents in BC perceive greater risk (79%) than those in Quebec or Ontario (68%).

Exhibit B10 - Q21. [If some familiarity with fentanyl] To the best of your knowledge, for those who use an illegal non-opioid drug like methamphetamine or cocaine, how much of a risk is there that the drug might be laced with an opioid like fentanyl?
Familiarity with fentanyl
Gen Pop 2019
(n=809)
A
Youth 13-15
(n=239)
B
Young adults
16-24 (n=348)
C
Adults 25+
(n=1198)
D
Legal Opioid
users (n=595)
E
Illegal Drug users (n=578)
F
Neither
(n=1205)
G
Parents
13-15 (n=335)
H
Men
30-39
(n=320)
I
Very dangerous 71% 62% 63% 72% 73% 53% 72% 61% 51%
BCFHI FI FI BCFHI BCFHI - BCFHI FI -
Some risk 23% 29% 30% 21% 23% 35% 23% 31% 36%
- D ADEG - - ADEG - ADEG ADEG
Not very much/No risk at all 3% 4% 3% 2% 3% 9% 1% 4% 6%
G - - G - ABCDEGHI - G ADEG
DK/NR 4% 5% 4% 5% 2% 3% 5% 4% 6%
E E - E - - E - EF

Key takeaways: Opioid awareness, impressions and basic understanding

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

Since 2017, there has been a slight increase in concern about opioids in a number of ways. For example, concern that opioids might harm someone respondents care about has risen by 6% to 56%. Though over half are concerned that opioids might harm the people close to them, fewer believe friends and family members could be at risk of developing opioid use disorder (37%) or overdosing (27%).

Respondents seem slightly more comfortable identifying and reacting to opioid use disorder and overdoses. More than in 2017, though still less than the majority, feel they would be able to identify signs of an opioid use disorder (39% vs 33%) or overdose (33% vs 29%), or would know what to do if they saw someone experiencing an overdose (30% vs 26%). As was the case in 2017, respondents are more confident in their ability to handle their own interactions with opioids. For example, 45% are confident they could easily find help for dealing with problematic opioid use, and almost all (80%) would ask their doctors for more information about side effects, risks or alternatives if they were prescribed an opioid.

In some respects, respondents' sense that opioids can be dangerous. Two-thirds (67%) agree they know what makes them so dangerous, and only one in five (22%) agree it is difficult to develop an opioid use disorder if following a prescription. However, just under half (47%) worry they could become addicted (develop an opioid use disorder) if prescribed an opioid. Few (10%) believe there are any circumstances under which it is acceptable to share a prescription for opioids.

Youth's attitudes towards opioids vary somewhat from those of young adults and adults 25+. Youth are less confident that they understand what makes opioids so dangerous (53% vs 66% of young adults and 66% of adults 25+) and more agree it is difficult to become addicted (develop an opioid use disorder) to opioids if using a prescription (31% vs 22% of adults 25+).

Legal opioid users claim to be more cognizant of the dangers of these drugs (75%) than illegal users (69%) and the general population (67%). Both legal and illegal drug users are more concerned about their ability to obtain a prescription - 30% of legal users and 34% of illegal users agree. They also claim to be better equipped than the general population when it comes to recognizing opioid use disorder (50% of legal and 50% of illegal users), an overdose (both 48%) and treating an overdose (42% and 43%, respectively). The percentage of both groups of users who are confident they could identify opioid use disorder (addiction) and overdose, as well as treat an overdose, has risen since 2017. For instance, notably fewer legal (29%) and illegal (31%) drug users in 2017 felt they would know what to do if they observed someone experiencing an overdose.

Parents are the most likely of all oversamples to think their family or friends could develop an opioid use disorder (addiction) (48%). Aside from illegal drug users, they are also most likely to agree their family/friends might experience an overdose (38%).

In contrast, men aged 30-39 are less concerned that opioids may harm people they care about (51%) and that family or friends might become develop an opioid use disorder (addiction) (32%). Similar to the findings among parents, men aged 30-39 are relatively more confident in their ability to identify signs of addiction (46%) or an overdose (39%) than the general population. They are also more likely to agree it is difficult to become addicted (develop an opioid use disorder) if you are following a prescription (34%).

Other notable demographic differences in attitudes about behaviour, risk and harms include that Quebecers (60%), Albertans (60%) and residents of BC (59%) are more concerned opioids might harm the people they care about. At the same time, Quebecers are least likely to think their friends/family might develop an opioid use disorder (28%, compared to 44% of those in BC and 40% of Albertans). Respondents in BC claim to be most capable to deal with an overdose - 40% say they would know what to do, compared to just 24% in Quebec and Manitoba/Saskatchewan. Indigenous respondents are more comfortable sharing opioid prescriptions - 32% say there are times when it is acceptable, compared to 9% of non-Indigenous respondents.

Respondents with higher levels of education claim to be more knowledgeable about opioids. For example, 77% of those with a post-grad degree and 71% of those with an undergrad degree say they know what it is about opioids that makes them so dangerous, compared to 61% of those with a high school education only.

Respondents with a household income between $40,000 and $80,000 appear more comfortable dealing with overdoses and opioid use disorder. A third (34%) would know what to do if they saw someone experiencing an overdose, compared to 24% of those with an income lower than $40,000 and 30% of those with an income greater than $80,000. Those with higher incomes are more confident they could get help with an opioid use disorder. Almost half (49%) of respondents with an income of $80,000 or more agree, compared to 40% of those with incomes lower than $40,000.

Exhibit C1 - Q22. Please indicate how strongly you agree or disagree with each of the following statements. [% strongly agree or agree]
Behaviours, risk & harm
Gen Pop 2019
(n=1003)
A
Gen Pop 2017
(n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
*OUDA = Opioid Use Disorder (Addiction)
If prescribed, I would ask my doctor for more info about the risks, the side effects or alternatives to using an opioid 80% 77% 73% 75% 81%
BCEFI -  - BCEFI
I understand what it is about opioids that is so dangerous 67% 64% 53% 66% 66%
BGI - - B BGI
I'm worried that opioids might harm people I care about 56% 50% 61% 56% 56%
- - I - GI
I worry that if I am prescribed an opioid, I could become addicted 47% 42% 52% 46% 47%
- - I - -
If I needed to, I am confident I could easily find help for dealing with problematic opioid use (or an opioid addiction) 45% 44% 41% 49% 44%
G - - BDG G
I think I'd be able to identify signs of an OUDA* 39% 33% 32% 44% 36%
BDG - - BDG G
I think people in my family and/or friends could develop OUDA* 37% 37% 29% 34% 38%
BG - - - BGI
I think I'd be able to identify signs of an opioid overdose if faced with them 33% 29% 30% 39% 31%
DG - - ABDG G
I would know what to do if I saw a person experiencing an overdose 30% 26% 24% 35% 30%
G - - ABDG G
I think people in my family and/or friends could experience an opioid-related overdose or poisoning 27% 24% 27% 27% 27%
G -  - G
If you are following a prescription, it is difficult to develop OUDA* 22% 19% 31% 30% 22%
- - ADG ADG G
I'm worried I won't be able to obtain a prescription for opioids when I need it 15% - 19% 19% 16%
G - G G G
There are certain times when it is acceptable to share an opioid prescription with someone else 10% 10% 18% 17% 9%
G - ADG ADG G

Exhibit C2 - Q22. Please indicate how strongly you agree or disagree with each of the following statements. [% strongly agree or agree]
Behaviours, risk & harm
Gen Pop 2019
(n=1003)
A
Gen Pop 2017
(n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
*OUDA = Opioid Use Disorder (Addiction)
If prescribed, I would ask my doctor for more info about the risks, the side effects or alternatives to using an opioid 76% 73% 81% 78% 70%
I BCEFI FI  -
I understand what it is about opioids that is so dangerous 75% 69% 64% 71% 60%
ABCDFGI BGI B BDGI  -
I'm worried that opioids might harm people I care about 58% 62% 54% 60% 51%
I ACDGI  - GI
I worry that if I am prescribed an opioid, I could become addicted 45% 52% 47% 52% 44%
 - ACDEGI  - EI
If I needed to, I am confident I could easily find help for dealing with problematic opioid use (or an opioid addiction) 56% 54% 40% 53% 48%
ABCDGI ABDGI ABDG BDG
I think I'd be able to identify signs of an OUDA* 50% 50% 33% 45% 46%
ABDG ABCDG ABDG ABDG
I think people in my family and/or friends could develop OUDA* 42% 44% 33% 48% 32%
ABCDGI ABCDGI  - ABCDEGI
I think I'd be able to identify signs of an opioid overdose if faced with them 48% 48% 26% 45% 39%
ABCDGI ABCDGI  - ABDG ABDG
I would know what to do if I saw a person experiencing an overdose 42% 43% 25% 41% 38%
ABCDG ABCDG  - ABDG ABDG
I think people in my family and/or friends could experience an opioid-related overdose or poisoning 35% 41% 22% 38% 27%
ABCDGI ABCDEGI  - ABCDGI
If you are following a prescription, it is difficult to develop OUDA* 29% 38% 20% 34% 34%
ADG ACDEG ADG ADEG
I'm worried I won't be able to obtain a prescription for opioids when I need it 30% 34% 10% 27% 25%
ABCDGI ABCDGHI  - ABCDG ACDG
There are certain times when it is acceptable to share an opioid prescription with someone else 17% 28% 7% 24% 20%
ADG ABCDEGI  - ABCDEG ADG

Concern about teens using opioids as prescribed has risen only slightly since 2017, from 76% to 81%. Parents are also slightly more concerned - 87% compared to 82%. However, the percentage of youth who say they are very concerned has risen substantially, from 19% in 2017 to 32%. Another 41% are somewhat concerned, for a total of 73%, compared to 61% in 2017.

Exhibit C3 – Q23. How concerned are you about the risk to teens who are using opioid medication as prescribed?
Concern about teen opioid use
Gen Pop 2019
(n=1003)
A
Gen Pop 2017
(n=1330)
Youth 13-15
(n=331)
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Very concerned 39% 35% 32% 25% 43% 42% 36% 41% 42% 30%
BCI - C - ABCFGI BCFI CI BCI BCI -
Somewhat concerned 42% 41% 41% 46% 40% 39% 42% 41% 45% 40%
- - DEG - - - - D -
Not very concerned 12% 15% 17% 21% 11% 13% 17% 12% 10% 18%
 - - ADH ADEFGH - - ADEGH - - ADEGH
Not at all concerned 2% 3% 4% 3% 2% 4% 4% 2% 1% 5%
H - H - - ADGH H - - ADGH
DK/NR 5% 5% 7% 5% 4% 2% 2% 5% 2% 6%
DEFH - EFH EF EFH - - DEFH - DEFH

Concern among the general population about teens using opioids without a prescription is roughly equal to 2017. Just over three-quarters (76%) are very concerned, compared to 75% in 2017. Less youth are very concerned about their peers using opioids without a prescription (62%) compared to young adults (70%), and adults (79%).

Exhibit C4 - Q24. How concerned are you about the risk to teens who are using prescription opioids without a prescription?
Concern about teen prescription opioid use
Gen Pop 2019
(n=1003)
A
Gen Pop 2017
(n=1330)
Youth 13-15
(n=331)
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
Very concerned 76% 75% 62% 70% 79% 80% 65% 78% 69% 61%
BCFHI - - BI ABCFHI ABCFHI - BCFHI BI -
Somewhat concerned 17% 18% 28% 21% 16% 16% 26% 15% 27% 26%
- - ACDEG ADEG - - ADEG - ADEG ADEG
Not very / Not at all concerned 4% 4% 6% 5% 3% 2% 8% 3% 3% 8%
- - DEH E - - ACDEGH - - ACDEGH
DK/NR 3% 4% 4% 4% 2% 2% 1% 3% 1% 4%
DEFH - EFH EFH F - - DFH - DEFH

Qualitative insights:  Understanding of opioid overdoses and naloxone

When asked to describe signs related to an opioid overdose, symptoms were offered that seemed to be more related to overdoses of other drugs than specifically opioids (e.g., foaming at the mouth), but generally people assumed they would witness disorientation, blackouts or unconsciousness, slurred speech, and perhaps perspiring or "clamminess."

In terms of aiding in the event of a drug overdose, most participants described having an immediate instinctive reaction to call 911.  Many said they would do the "right thing" but beyond calling 911, few knew what more they could or should do and opinions varied widely.  Participants in Montreal felt that they would be inclined to more readily take an active role in helping with things like CPR, ensuring airways were not blocked, trying to keep people awake/conscious until help arrived, etc.  Elsewhere, participants were a little less inclined to do anything beyond calling 911.  They questioned whether they felt prepared or educated enough to know how to help someone experiencing an overdose, whether they might make things worse, or expose themselves to harmful substances.

Awareness and knowledge of naloxone was limited.  Some participants in each group had heard the term but knowledge varied considerably from group to group and by location.  In some groups, there were those who knew what naloxone was, including those who referred to it by the brand name "Narcan", and mentioned that naloxone kits could be easily acquired for free in any pharmacy.  In some groups, few were certain of what it was; often guessing it was an overdose kit.  Typically, about one or two participants per city had obtained a naloxone kit simply in the event they were out with friends and something went wrong.

Initial discussions suggested that most participants were in favour of supervised consumption sites, although there seemed to be some polarization of opinion.  Whether in support or opposed to them, most participants agreed that the main benefit to the community was the provision of clean equipment and keeping people safe from discarded syringes and the spread of disease.  Among those who were supportive, they praised the availability of medical assistance if necessary, the ability to help people who wanted to deal with a substance use disorder, and the benefit of having people do the drugs under supervision rather than alone. Conversely, those uncomfortable with or opposed to supervised consumption sites tended to feel that the existence of such sites may encourage drug use, that they tended to create a location that attracted undesirable people to a community, and some wrongly assumed that drugs were provided.  Correcting this misconception typically helped the person feel less opposed, but rarely made the individual supportive.

On an unaided basis, generally one or two participants in each group were familiar with laws that protected witnesses and bystanders, sometimes mentioning the "Good Samaritan Law" on an unprompted basis.  Those familiar tended to be able to recall the main points that someone who helps a person in overdose is not going to get in trouble themselves.  These individuals tended to feel positively about the law, based on what they had heard.

Participants were then read the following description:

"The Good Samaritan Drug Overdose Act became law in 2017 and provides some legal protection for individuals who seek emergency help (call 911 or your local emergency number) during an overdose.  More specifically, the Act protects individuals from being charged with simple possession of a controlled substance (drugs).  It covers by-standers who call for help or people experiencing overdose who call for help.  It will protect you if you choose to stay with the victim or leave the scene.  Instances where you are not protected: outstanding warrants, possessing with intent to distribute, production or trafficking of drugs, other crimes, etc."

On an aided basis, reactions continued to be quite positive.  The assumed context tended to fall into two categories: those who assumed this meant coming across someone on a street who had overdosed; and, those who imagined friends being together as one or more used recreational drugs.  Those who imagined the latter context tended to more immediately be able to describe the net effect as positive as friends would otherwise be scared to call if they themselves possessed or had taken drugs.  Those who assumed this was about coming across a stranger in crisis appeared less in need of the protection.

Regardless of the assumed context, there was no observed opposition to the concept although some participants still had concerns about whether they could really count on the Act being executed as written and, more importantly, whether the exceptions were problematic.  Some participants, particularly men 30-39, felt that the exceptions may be counter-productive and questioned whether they were ill-advised in some circumstances such as where a dealer or someone with an outstanding warrant for a petty crime or parking ticket could help save someone who is overdosing.  Inevitably, some reasoned that unshackling the dealers would be problematic as it may encourage use.

Key takeaways: Attitudes relating to behaviours, risk and harms

Section D: Attitudes regarding stigma

While people with an opioid use disorder still encounter stigma, the tracking data shows it has not worsened since 2017. For example, 64% of respondents disagree with the statement, "People who overdose on opioids get what they deserve." which is a 9% increase since 2017. Furthermore, over three-quarters (82%) agree that, "People who have an opioid use disorder deserve the help they need to lead a healthy lifestyle." This is a 5% increase since 2017. Support for addressing the crisis has also risen, with almost two-thirds (64%) agreeing we should be using more of our health care resources to deal with opioid use disorder, compared to 55% in 2017.

Despite the improvement, stigma is still prevalent throughout Canada. Over a third of respondents (37%) agree that, "People with an opioid use disorder are dangerous and/or untrustworthy." Furthermore, there has not been much change in the proportion who say that, "People who are dependent upon or addicted to opioids could stop taking them if they really wanted to." (19% in 2019 vs 17% in 2017), "I don't have much sympathy for people who misuse opioids." (26% in 2019 and 27% in 2017) and, "A lack of self-control is usually what causes a dependence upon or an addiction to opioids." (33% in both 2019 and 2017).

Respondents appear cognizant that stigma exists and acknowledge that there are attitudes prevalent in society that might stop those who have an opioid use disorder, or even themselves, from discussing it with others. For example, two-thirds (69%) acknowledge that, "Society is not very friendly toward people with an opioid use disorder." Further, 66% agree that, "Society's attitudes about people with an opioid use disorder affect whether they seek help or treatment." Over two-thirds (69%) also agree that people who have an opioid use disorder may be embarrassed to seek help, and a quarter (74%) agree it may also be uncomfortable to share this information with family and friends. Fewer, though still a majority (60%), say that if they ever developed an opioid use disorder, they would find it difficult to tell friends and family.

As was noted in 2017, youth ages 13-15 are more likely to hold various stigmatizing views than those older than them. Very similar proportions in 2017 (45%) and 2019 (43%) agree that a lack of self-control is usually how people become addicted to opioids (develop an opioid use disorder). In contrast, 42% of young adults and 32% of those 25 and older agree. One in five (19%) youth agree that people who overdose on opioids get what they deserve, identical to the 2017 results (19%) and higher than the percentage of young adults 16-24 (18%) and adults 25+ who feel the same way (12%). Two in five (42%) youth also feel individuals with an opioid use disorder are untrustworthy and two-thirds (67%) would be disappointed if they found out a friend or family member had an opioid use disorder.

Adults 25+, in contrast, appear to have a broader understanding of the causes of opioid use disorder and its consequences. Almost three-quarters (73%) agree one can become addicted to opioids (develop and opioid use disorder), even if they are following a doctor's prescription, and slightly more agree the opioid crisis is a public health issue (77%). They are also more comfortable seeking help for an opioid use disorder (56%) compared to youth (45%) and young adults (41%). One topic all respondents agree on, regardless of age, is that addiction to opioids (opioid use disorder) is a disease - 64% of youth, 61% of young adults and 62% of adults 25+ agree.

Although legal and illegal drug users' attitudes about opioids and stigma are similar in some respects, there are notable distinctions. They have similar understandings of some of the causes and impacts of the crisis. A little over half of legal (56%) and illegal (59%) drug users agree people are overdosing because they did not realize the drugs they were consuming contained opioids and just under two-thirds (67% and 63% respectively) agree addiction to opioids is a disease. Over half of legal opioid users (54%), and illegal drug users (56%) believe opioids are over-prescribed. However, illegal drug users seem more likely to stigmatize. Among illegal users, 49%, compared to 40% of legal users, believe a lack of self-control is what causes addiction to opioids. A quarter of illegal users (26%) agree that people who overdose get what they deserve, compared to 18% of legal users, and a third of illegal users (34%) agree it is mostly people who are either homeless or already addicted (living with substance use disorder) to another drug who become addicted to opioids (develop an opioid use disorder), compared to 22% of legal users. A third (33%) of illegal users think people who are addicted to opioids (living with opioid use disorder) could stop if they really wanted to, compared to 25% of legal users. The results from 2017 reinforce the difference in stigmatizing attitudes when it comes to legal vs illegal users. For example, 41% of illegal drug users agreed that a lack of self-control causes addiction (opioid use disorder), compared to 32% of legal users.

Men 30-39 are notably more likely to hold stigmatizing views about opioids or those who use opioids than the general population. More believe people who are addicted (living with opioid use disorder) could stop taking opioids if they really wanted to (30% vs 19% in the general population), do not have sympathy for people who are addicted (33% vs 26%) and believe a lack of self-control is generally what causes one to become addicted (50% vs 33%).

Respondents in Alberta and BC (61% agree) are more likely to connect overdoses to people taking drugs they didn't realize had opioids or had higher doses than they expected, compared to respondents in Atlantic Canada (43%), Quebec (47%), Ontario (51%) and Manitoba/Saskatchewan (44%). Ontarians (24%) and respondents in BC (28%) are most likely to agree that it is people who are down on their luck, homeless or already addicted to drugs who develop an opioid use disorder. However, at least when it comes to BC respondents, they do not necessarily feel these people are dangerous - just 29% agree, significantly lower than the 50% in Manitoba/Saskatchewan who feel the same way. Fewer respondents in BC (66%) agree that even when following a prescription, one can become addicted to opioids (develop an opioid use disorder) than in any other region. In Ontario, 77% agree.

Those with a higher level of education claim to be more aware of stigma in society but are also more likely to hide their own opioid use. Three-quarters of those with an undergrad or postgrad degree (74%) agree society is not friendly toward people with an opioid use disorder, compared to 62% of those with a high school education and 57% of those who have not completed high school. At the same time, 65% of those with a postgrad and 63% of those with an undergrad degree say if they developed an opioid use disorder, they would find it difficult to tell friends and family, compared to 58% of those who have a high school diploma and 46% of those who have not completed high school.

Indigenous respondents hold some stigmatizing attitudes (38% agree people who overdose get what they deserve, compared to 12% of non-Indigenous respondents) and are also less likely to disclose prescribed opioid use (42% vs 19% among those who are not Indigenous).

Exhibit D1 - Q25. Please indicate how strongly you agree or disagree with each of the following statements. [% strongly agree or agree]
Attitudes towards stigma
Gen Pop 2019
(n=1003)
A
Gen Pop 2017
(n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
*OUDA = Opioid Use Disorder (Addiction)
People who have an OUDA* deserve the help they need to lead a healthy lifestyle 82% 77% 75% 79% 83%
I - - I BGI
The opioid crisis in Canada is a public health issue 76% 74% 71% 75% 77%
I - - - BI
I expect that people who have an OUDA* find it embarrassing or uncomfortable to tell friends/family they have an OUDA* 74% - 73% 73% 74%
I - I I GI
When following your doctor's instructions for taking an opioid painkiller, you can still become addicted 73% - 66% 67% 73%
BCGI - - - BCGI
Society is not very friendly toward people with an OUDA* 69% - 71% 70% 69%
- - - - G
I expect that people who have an OUDA* must find it embarrassing/uncomfortable to seek help with their OUDA* 69% - 71% 68% 69%
I - I - GI
Society's attitudes about people with an OUDA* affect whether people with an opioid use disorder seek help 66% - 62% 71% 66%
 - - - ABDGI G
We should be using more of our health care resources for dealing with OUDA* 64% 55% 64% 65% 63%
GI - - I GI
Addiction to opioids is a disease 63% 61% 64% 61% 62%
I - I - GI
If I ever developed an OUDA*, I would find it embarrassing or uncomfortable to tell friends or family 60% - 62% 64% 59%
- - - - -
I'd feel disappointed or upset if I found out one of my family or friends developed an OUDA* 59% - 67% 61% 56%
DI - ADEFGHI FI I
If I were to use an opioid obtained on the street, I would not want my friends or family to know that 56% 49% 56% 57% 56%
- - - - G
If I ever developed an OUDA*, I would feel completely comfortable seeking help 55% 59% 45% 41% 56%
BCG - - - BCG
I think opioids are overprescribed in Canada 54% 55% 46% 44% 57%
BC - - - ABCGI
People are overdosing on opioids b/c they used drugs that they didn't realize had opioids/higher doses than they expected 52% 49% 51% 51% 51%
G - - - G
If I were to use a prescription opioid not prescribed to me, I would not want my friends or family to know that 48% 42% 53% 56% 46%
G - DGI ADGI -
People with an OUDA* are dangerous and/or untrustworthy 37% - 42% 33% 34%
DG - CDG - G
I think my friends or family would feel comfortable telling me they had an OUDA* 34% - 37% 35% 32%
G - G G G
A lack of self-control is usually what causes a dependence upon or an addiction to opioids 33% 33% 43% 42% 32%
G - ADG ADG G
I don't have much sympathy for people who misuse opioids 26% 27% 31% 26% 25%
- - DG - G
It's mostly people who are homeless/down on their luck/ already have drug use problems who develop an OUDA* 21% - 28% 32% 18%
DG - ADEG ADEG -
If I were prescribed an opioid, I would not want my friends or family to know that 20% 16% 31% 29% 19%
G - ADG ADG G
People who are dependent upon or addicted to opioids could stop taking them if they really wanted to 19% 17% 28% 27% 17%
G - ADG ADG G
Canada's opioid crisis is not as serious a public health crisis as SARS or H1N1 were 17% 17% 22% 25% 15%
G - ADG ADG G
People who overdose on opioids get what they deserve 14% 16% 19% 18% 12%
DG - ADG DG G

Exhibit D2 - Q25. Please indicate how strongly you agree or disagree with each of the following statements. [% strongly agree or agree]
Attitudes towards stigma
Legal Opioid
users
(n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
*OUDA = Opioid Use Disorder (Addiction)
People who have an OUDA* deserve the help they need to lead a healthy lifestyle 86% 80% 81% 80% 71%
ABCFGHI I I I  -
The opioid crisis in Canada is a public health issue 80% 76% 75% 76% 70%
ABCDGI I I  -  -
I expect that people who have an OUDA* find it embarrassing or uncomfortable to tell friends/family they have an OUDA* 78% 72% 72% 73% 64%
ADFGI I I I  -
When following your doctor's instructions for taking an opioid painkiller, you can still become addicted 77% 73% 71% 75% 64%
ABCDGI BCI I BCI  -
Society is not very friendly toward people with an OUDA* 77% 70% 67% 69% 66%
ABCDFGHI  -  -  -
I expect that people who have an OUDA* must find it embarrassing/uncomfortable to seek help with their OUDA* 75% 69% 67% 71% 62%
ACDFGI I I I  -
Society's attitudes about people with an OUDA* affect whether people with an opioid use disorder seek help 72% 68% 64% 69% 62%
ABDGI  -  - BGI  -
We should be using more of our health care resources for dealing with OUDA* 70% 68% 60% 67% 58%
ADGI ADGI  - GI  -
Addiction to opioids is a disease 67% 63% 61% 65% 55%
DGI I I I  -
If I ever developed an OUDA*, I would find it embarrassing or uncomfortable to tell friends or family 60% 63% 60% 66% 58%
 -  - ADEGI  -
I'd feel disappointed or upset if I found out one of my family or friends developed an OUDA* 58% 55% 57% 60% 49%
I  - I I  -
If I were to use an opioid obtained on the street, I would not want my friends or family to know that 62% 62% 54% 60% 56%
ADGI ADGI G  -
If I ever developed an OUDA*, I would feel completely comfortable seeking help 62% 54% 51% 55% 53%
ABCDFGHI BC C BC C
I think opioids are overprescribed in Canada 54% 56% 54% 59% 49%
BC BCI BC BCGI  -
People are overdosing on opioids b/c they used drugs that they didn't realize had opioids/higher doses than they expected 56% 59% 48% 51% 48%
DGI ABCDGHI  -  -  -
If I were to use a prescription opioid not prescribed to me, I would not want my friends or family to know that 51% 55% 45% 51% 45%
DG ADGI  - G  -
People with an OUDA* are dangerous and/or untrustworthy 39% 41% 32% 41% 43%
CDG CDG CDG CDG
I think my friends or family would feel comfortable telling me they had an OUDA* 39% 42% 29% 40% 38%
ADG ACDG  - ADG DG
A lack of self-control is usually what causes a dependence upon or an addiction to opioids 40% 49% 29% 45% 50%
ADG ACDEG  - ADG ACDEG
I don't have much sympathy for people who misuse opioids 27% 33% 24% 32% 33%
 - ACDEG  - ADG ACDEG
It's mostly people who are homeless/down on their luck/already have drug use problems who develop an OUDA* 22% 34% 16% 30% 31%
DG ADEG  - ADEG ADEG
If I were prescribed an opioid, I would not want my friends or family to know that 25% 37% 17% 33% 33%
ADG ABCDEG  - ADEG ADEG
People who are dependent upon or addicted to opioids could stop taking them if they really wanted to 25% 33% 15% 28% 30%
ADG ACDEGH  - ADG ADEG
Canada's opioid crisis is not as serious a public health crisis as SARS or H1N1 were 23% 30% 13% 30% 29%
ADG ABDEG  - ABDEG ABDEG
People who overdose on opioids get what they deserve 18% 26% 10% 21% 25%
ADG ABCDEGH  - ADG ACDEG

Qualitative insights:  Views related to stigma

Virtually all participants agreed that people with a substance use disorder face stigma and that stigma is a problem.  The major contradiction that consistently showed up was that there was widespread sympathy for people with substance use disorder, agreement that the stigma has important negative effects (on mental health; on seeking help; on causing isolation and withdrawal from those who do not use drugs), and yet often a failure to recognize that their own descriptions of people with substance use disorder represent problematic stigma.  One impression common to all is that people with substance use disorder cannot be trusted because they are beholden to their disorder.  Several said people with substance use disorder will burn through their money and seem unhesitant to steal from loved ones, if necessary.  As one sympathetic participant put it, people with substance use disorder should not be feared, but they should not be trusted either.

Participants agreed that recovery from substance use disorder is possible but that it is typically a long, difficult, expensive process that is fraught with challenges.  Participants often offered that those with substance use disorder may have to restart treatment multiple times, having given into temptation - particularly, if they are still associating with those who enable use.  In most groups, two barriers consistently came up as significant and in need of removal: the limited accessibility of public programs and the cost of private options.  Public programs were typically seen as having waiting times that are months long, leading to a sense of futility.

Key takeaways: Attitudes regarding stigma

Section E: Risk behaviour profiling

The frequency of respondents' acquaintances use of opioids has increased slightly since 2017. Over half (54%) have at least one friend/family member that has been prescribed one of the referenced opioids, a 4% rise from 2017. A quarter say a friend or family member used one of the drugs listed without a prescription, compared to 17% in 2017. A third (33%) of respondents know someone who became addicted (developed an opioid use disorder) to one of these drugs, whereas only a quarter (24%) reported the same in 2017. Roughly one in five (17%) have known someone who has had a non-fatal overdose of one of these drugs and an equal number (17%) have known someone who has had a fatal overdose. In 2017 one in ten (10%) knew someone who had experienced a non-fatal overdose and 12% knew someone who had a fatal overdose.

Legal opioid users, as one might expect, are more likely than those who use drugs illegally or who do not use drugs at all to report that one of their friends/family members has been prescribed an opioid (71%). Illegal users are most likely to report a friend or family member has used an opioid not prescribed to them (46%), known someone who has an addiction to opioids (53%), and had a fatal or non-fatal overdose (30% and 33%, respectively).

In terms of demographic differences, significantly more women (57%) have a friend or family member who has been prescribed an opioid compared to men (50%). Further, those living in Alberta were most likely to know someone who has been prescribed an opioid (69%), which is more than twice the amount of Quebecers who knew someone (33%). Interestingly, those living in Alberta were the least likely (8%) to have known someone who has had a non-fatal opioid overdose, while those living in Atlantic Canada were the most likely (29%).

Respondents living in British Columbia were most likely to know someone who has died of an overdose of one of these drugs (27%) and they were the most likely to know an illegal drug user (31%). Indigenous respondents were roughly three times more likely (63%) than non-Indigenous respondents (23%) to have a friend or family member who has used an opioid without a prescription or obtained on the street. With regards to education, post graduates were twice as likely to know someone who became addicted (developed an opioid use disorder) to opioids (45%), compared to respondents that did not complete high school (20%).

Exhibit E1 - Q26. Please indicate whether any of the following are true, to the best of your knowledge or recollection. [% true]
Acquaintance opioid use
Gen Pop 2019
(n=1003)
A
Gen Pop 2017
(n=1330)
Youth 13-15
(n=331)
B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552)
G
Parents
13-15 (n=397)
H
Men
30-39
(n=395)
I
At least one friend or family member has been prescribed one of these drugs 54% 50% 40% 47% 54% 71% 61% 46% 53% 42%
BCGI - - B BCGI ABCDFGHI ABCDGHI - BGI -
I have known someone who became addicted to one of these drugs 33% 24% 26% 31% 33% 47% 53% 25% 32% 29%
BG - - G BG ABCDGHI ABCDEGHI - G -
At least one friend or family member has used one of these drugs without a prescription in their name or purchased on the street 25% 17% 19% 27% 24% 33% 46% 19% 29% 26%
BG - - BG G ABCDGI ABCDEGHI - BDG BG
I have known someone who has had a non-fatal overdose of one of these drugs 17% 10% 14% 17% 16% 24% 33% 11% 22% 20%
G - - G G ABCDG ABCDEGHI - BDG BDG
I have known someone who died of an overdose of one of these drugs 17% 12% 14% 18% 16% 24% 30% 12% 20% 19%
G - - G G ABCDG ABCDEGHI - BDG G
I have a teen child who has been prescribed one of these drugs in the past year* 11%
(n=60)
9%
(n=62)
- - 8%
(n=395)
20%
(n=101)
27%
(n=108)
3%
(n=245)
10%
(n=397)
23%
(n=40*)
G - - - G DGH ADGH - G DGH

*Bear in mind the small sample sizes for question 26F. Results should be regarded with caution. This question was only asked of parents of teens 13-15.

Three-quarters (75%) of current and past opioid indicate having taken opioids illegally (not always with a prescription) at some point in their life. In 2017, fewer had ever taken them illegally (64%). Of the 726 identified as ‘legal opioid users’ (have used an opioid in the past year and always had a prescription when using an opioid in the past year), when expanding the timeframe to their entire lifetime, only 33% now report having always had a prescription for all opioids they have ever taken.

Exhibit E2 – Q27. [Current and past opioid users] You previously indicated that you have taken at least one of the opioids on this list. Of the opioid(s) you have ever taken, how often were they prescribed for you personally?
Prescription opioid use
Gen Pop 2019
(n=497)
A
Gen Pop 2017
(n=562)
Youth 13-15
(n=93)
B
Young adults
16-24 (n=199)
C
Adults 25+
(n=751)
D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=598)
F
Neither
(n=404)
G
Parents
13-15 (n=225)
H
Men
30-39
(n=191)
I
Always 23% 34% 13% 17% 24% 33% 11% 18% 17% 17%
BFG - - - BCFGHI ABCDFGHI - F - F
Usually 4% 8% 5% 7% 5% 7% 9% 4% 9% 7%
- - - - - AG ADG - ADG -
Sometimes 17% 9% 26% 21% 16% 19% 27% 8% 25% 20%
G - DG G G DG ACDEGI - ADG G
Rarely 47% 38% 44% 38% 49% 38% 33% 63% 43% 43%
BCEF - - - CEF - - ABCDEFHI F F
Never 7% 9% 8% 12% 6% 3% 16% 6% 6% 11%
E - - ADEGH E - ABDEGH E - DEGH
DK/NR 2% 2% 4% 5% 1% 1% 3% 2% - 2%
H - - DEGH - - DEH - - -

Slightly more prescribed opioid users (56% vs 52%) are reportedly storing their prescribed opioids in a location that can only be accessed by them. Legal opioid users are the most likely to claim they store their opioids in a location only they can access (61%) compared to illegal users (59%) and those who do not use opioids (51%)

Exhibit E3 – Q28. [Among those who always, usually, sometimes, rarely had a prescription for opioids] When you had opioids prescribed to you, would you say you stored them…?
Opioid storage
Gen Pop 2019
(n=463)
A

Gen Pop 2017
(n=501)
Youth 13-15
(n=85)
B
Young adults
16-24 (n=173)
C
Adults 25+
(n=701)
D
Legal Opioid
users (n=706)
E
Illegal Drug users (n=501)
F
Neither
(n=373)
G
Parents
13-15 (n=213)
H
Men
30-39
(n=170)
I
In a location that could only be accessed by you 56% 52% 43% 56% 56% 61% 59% 51% 60% 62%
BG - - - BG ABDG BG - BG BG
In a location that could be accessed by others 39% 45% 50% 41% 40% 37% 37% 45% 38% 36%
- - EFI - - - - ADEF - -
DK/NR 5% 3% 7% 3% 3% 2% 4% 4% 2% 1%
DEI - - - - - - I - -

More prescribed opioid users are flushing/disposing of opioids in the garbage (13%) than in 2017 (8%). Slightly fewer did not have leftover patches/pills/liquids (29% vs 37%). Roughly a quarter in both waves returned their opioids to a doctor or pharmacy or saved them in case they need them again. Few (4%) gave them to others, though it is worth noting that more men 30-39 (11%) and illegal drug users (9%) gave their leftovers to someone who needed them.

Exhibit E4 – Q29. [Among those who always, usually, sometimes, rarely had a prescription for opioids] When you had opioids prescribed to you, what did you do with the leftover pills/patches/liquids? Check all that apply.
Disposal of prescription opioids
Gen Pop 2019
(n=463) A
Gen Pop 2017
(n=501)
Youth 13-15
(n=85) B
Young adults
16-24 (n=173)
C
Adults 25+
(n=701) D
Legal Opioid
users (n=706)
E
Illegal Drug users (n=501)
F
Neither
(n=373) G
Parents
13-15 (n=213) H
Men
30-39
(n=170) I
Does not apply, had no leftover pills/patches/
liquids
29% 37% 31% 34% 30% 35% 28% 27% 34% 25%
- - - - - ADFGI - - I -
Returned to pharmacy, hospital or doctor 27% 28% 15% 17% 29% 26% 21% 34% 22% 21%
BCF - - - BCFHI BCF - ABCDEFHI - -
Saved them in case I need them again 27% 27% 27% 30% 26% 27% 30% 21% 25% 35%
G - - G G G G - - DGH
Flushed them or disposed of them in garbage 13% 8% 16% 21% 12% 12% 15% 15% 17% 17%
- - - ADE - - - - - -
Gave them to someone who needed them 4% 3% 11% 6% 3% 2% 9% 2% 6% 11%
EG - DEG - - - ADEG - DEG ADEGH
Did something else with them 3% 2% 5% 4% 1% 2% 4% 1% 1% 2%
DGH - - D - - DEH - - -
DK/NR 3% - 3% 5% 3% 1% 4% 3% 2% 3%
E - - E - - E - - -

The proportion of respondents using opioids without a prescription almost daily or many times is roughly the same as found in 2017 (10% vs 9%). The proportion who have used them a few times has remained unchanged (23%). As could be expected, more illegal drug users say they have used unprescribed opioids almost daily or many times (20%). What may be more surprising is that parents are just as likely to describe the same usage (21% daily or many times).


 

Exhibit E5 – Q30. [Among those who never, rarely, sometimes, usually had a prescription] Thinking of the opioids you took that were not prescribed to you, how many times would you say you used them?
Frequency of use of non-prescribed opioids
Gen Pop 2019
(n=375) A
Gen Pop 2017
(n=356)
Youth 13-15
(n=78) B
Young adults
16-24 (n=158)
C
Adults 25+
(n=579) D
Legal Opioid
users (n=488)
E
Illegal Drug users (n=519)
F
Neither
(n=327) G
Parents
13-15 (n=181) H
Men
30-39
(n=152) I
Almost daily 3% 3% 6% 2% 3% 4% 4% 3% 5% 1%
I - - - I I I - I -
Many times 7% 6% 7% 8% 8% 7% 16% 6% 16% 13%
- - - - - ABCDEG - ABCDEG ADEG
A few times 23% 23% 31% 39% 22% 19% 37% 19% 26% 35%
 - - - ADEGH - - ADEGH - - ADEGH
Once or twice 32% 33% 43% 37% 35% 39% 34% 34% 36% 33%
 - - - - - A - - - -
DK/NR 34% 36% 13% 14% 32% 32% 9% 38% 17% 18%
BCFHI - - - BCFHI BCFHI - BCDFHI F F

Fewer overall are relying on a friend or relative’s prescribed opioid (35% vs 38% in 2017), but slightly more are getting them on the street (13% vs 11%) and the Internet (5% vs 1%). More youth (14%) and young adults (13%) say they obtained their illegal opioids on the Internet than adults 25+ (3%).  Youth (56%) also say they obtained them from a friend more often than young adults (31%) or adults (34%) have. Men 30-39 (23%), illegal drug users (23%), young adults (26%) and parents (20%) are all more likely than the general population sample to have taken opioids without a prescription from the street (13%). 

Exhibit E6 – Q31. [Among those who never, rarely, sometimes, usually had a prescription] Thinking of the opioids you took that were not prescribed to you, where did you get them? Check all that apply.
Sources of non-prescribed opioids
Gen Pop 2019
(n=375) A
Gen Pop 2017
(n=356)
Youth 13-15
(n=78) B
Young adults
16-24 (n=158)
C
Adults 25+
(n=579) D
Legal Opioid
users (n=488)
E
Illegal Drug users (n=519)
F
Neither
(n=327) G
Parents
13-15 (n=181) H
Men
30-39
(n=152) I
A friend’s or relative’s prescribed opioid 35% 38% 56% 31% 34% 37% 43% 30% 45% 43%
- - ACDEFG - G - ACDG - ACDG CDG
On the street 13% 11% 16% 26% 11% 9% 23% 10% 20% 23%
- - - ADEG - - ADEG - ADEG ADEG
The Internet 5% 1% 14% 13% 3% 4% 10% 1% 5% 8%
G - ADEG ADEGH - - ADEGH - G DEG
Other 22% 23% 7% 20% 25% 21% 16% 26% 17% 9%
BFI - - BI BFGHI BFI BI BFI BI -
DK/NR 32% 32% 13% 20% 31% 33% 16% 34% 21% 26%
BCFH - - - BCFH BCFH - BCFH - BF

As in 2017, a majority (54%) took the opioids that were not prescribed to them for pain relief. Fewer took them to see what it would feel like (11%), for the feeling it causes (8%) or to get high (8%). More young adults took the opioids to get high (17%) or for the feeling it causes (20%). A greater proportion of youth (23%) and men 30-39 (22%) took it to try it out our see what it felt like compared to the general population. Illegal drug users are more likely to have taken opioids without a prescription for all the reasons listed, compared to the general population sample.

Upon further investigation of the 2017 and 2019 ‘other’ responses, it was determined that the majority of these respondents misinterpreted the qualifier question (Q27) and had in fact always had a prescription for opioids or obtained them over the counter (Tylenol 3). This could also be the reason for the increase in DK/NR for Q30, 31, and 32. This speculation is a result of the majority of answers given for ‘other’ (Q31&32), including: prescription from doctor/hospital/dentist; it was over the counter; and, I did not take/have never taken opioids not prescribed to me.

Exhibit E7 – Q32. [Among those who never, rarely, sometimes, usually had a prescription] When you had opioids that were not prescribed for you, for what reason(s) did you take them? Select all that apply.
Reasons for taking non-prescribed opioids
Gen Pop 2019
(n=375) A
Gen Pop 2017
(n=356)
Youth 13-15
(n=78) B
Young adults
16-24 (n=158)
C
Adults 25+
(n=579) D
Legal Opioid
users (n=488)
E
Illegal Drug users (n=519)
F
Neither
(n=327) G
Parents
13-15 (n=181) H
Men
30-39
(n=152) I
Pain relief 54% 53% 61% 62% 55% 61% 61% 50% 54% 52%
 - - - G G AG ADGI - - -
To try it out/see what it felt like 11% 8% 23% 15% 8% 5% 20% 7% 15% 22%
E - ADEG DEG - - ADEG - DEG ADEG
For the feeling it causes 8% 6% 9% 20% 7% 5% 18% 5% 17% 13%
EG - - ABDEG - - ABDEGI - ADEG DEG
To get high 8% 9% 12% 17% 6% 4% 15% 6% 13% 13%
E - - ADEG - - ADEG - ADEG DEG
Other 13% 2% 4% 4% 14% 14% 3% 17% 9% 4%
 BCFI - - - BCFI BCFI - BCFHI B -
DK/NR 19% 22% 7% 10% 17% 16% 7% 23% 8% 18%
BCFH - - - BCFH BCFH - BCDEFH - BCFH

Half (52%) of illegal opioid users say they definitely would no longer take illegal opioids if they discovered they contained fentanyl. This number has dropped since 2017, when 58% said they would definitely no longer take them. While the general population is more likely to definitely avoid illegal opioids containing fentanyl, the percentage of youth 13-15 who definitely would not take them has remained fairly steady and lower than the general population – 49% this wave, aligned with the 46% in 2017. Similarly, fewer young adults would definitely not take non-prescribed opioids if they thought they also risked consuming fentanyl (53%).

A slightly lesser proportion of parents of 13-15 year-olds would definitely avoid non-prescription opioids that could contain fentanyl – 53%, down from 56% in 2017.

Men 30-39 are the least concerned about non-prescription opioids containing fentanyl, with under half (41%) saying they would definitely not take them.

Exhibit E8 – Q33. [Among those who never, rarely, sometimes, usually had a prescription] If you knew that the non-prescribed opioid you were taking contained fentanyl, would you still take any of it?
Presence of fentanyl in non-prescribed opioids
Gen Pop 2019
(n=375) A
Gen Pop 2017
(n=356)
Youth 13-15
(n=78) B
Young adults
16-24 (n=158)
C
Adults 25+
(n=579) D
Legal Opioid
users (n=488)
E
Illegal Drug users (n=519)
F
Neither
(n=327) G
Parents
13-15 (n=181) H
Men
30-39
(n=152) I
Definitely would 1 % 2% 2%  - 2% 2% 3% 1% 6% 4%
-  -  - A  - ADEG  -
Probably would 8% 5% 20% 16% 7% 6% 20% 4% 21% 20%
G - ADEG ADEG G  - ADEG  - ADEG ADEG
Probably would not 12% 17% 26% 26% 12% 12% 21% 11% 15% 25%
 - - ADEG ADEGH  -  - ADEGH ADEGH
Definitely would not 75% 64% 49% 53% 73% 74% 52% 76% 53% 41%
BCFHI -  - I BCFHI BCFHI I BCFHI I
DK/NR 4% 12% 4% 5% 7% 6% 5% 8% 6% 10%
-  - A  - A  - AF

In keeping with results from 2017, few (5%) who have used opioids have ever sought treatment for an opioid use disorder. Just over one in ten (12%) of youth who have used opioids say they have sought treatment, compared to 9% of young adults and 4% of those 25+. This result also represents an increase from 2017, when just 6% of youth said they had sought treatment.

The proportion of illegal drug users who have sought treatment is slightly higher than the general population (11%) and reflects 2017 results (8%). Men 30-39 are also more likely to report they have sought treatment (13%).

Exhibit E9 – Q34. [If opioid user or past opioid user] Have you ever sought treatment for an opioid use disorder (addiction)?
Opioids use disorder treatment
Gen Pop 2019
(n=497) A
Gen Pop 2017
(n=562)
Youth 13-15
(n=132) B
Young adults
16-24 (n=199)
C
Adults 25+
(n=793) D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=598)
F
Neither
(n=404) G
Parents
13-15 (n=225) H
Men
30-39
(n=191) I
Yes 5% 4% 12% 9% 4% 6% 11% 2% 9% 13%
G - DG DG G G ADEG - ADG ADEG
No 92% 94% 84% 89% 94% 92% 84% 96% 89% 84%
FI - - - BCFHI FI - ABCDEFHI F -
DK/NR 3% 2% 4% 2% 2% 1% 5% 1% 2% 3%
G - - - - - ADEGH - - -

Over half of parents (61%) whose teens have been prescribed opioids in the past year believe their teen is taking them as prescribed. While caution must be taken when interpreting these results due to small sample size, this represents a smaller proportion than in 2017 (81%). Few parents (6%) say their teen has taken an opioid that was not prescribed to them, however this proportion is significantly higher among parents who are illegal drug users (17%).  Among parents who say their teen has not been prescribed an opioid in the past year, roughly one in ten (9%) say their teen has been prescribed an opioid at some earlier time in their life.

Exhibit E10 – Q35. [Parents of children 13-15 prescribed opioids] You indicated that you have a teenager who has been prescribed an opioid in the past year. To the best of your knowledge, has your teen been taking his or her opioid medication as prescribed?
Parents on teen opioid use
Parents 13-15
2019
(n=35*)
A
Parents 13-15
2017
(n=29*)
Adults 25+
(n=35*)
B
Legal Opioid
Users
(n=20*)
C
Illegal Drug users (n=27*)
D
Neither
(n=7*) E
Men
30-39
(n=7*)
F
Yes 61% 81% 62% 80% 63% 73% 100%
No 37% 19% 35% 20% 32% 27% -
DK/NR 2% - 3% - 4% - -

*Bear in mind the small sample sizes for this question, results should be regarded with caution.

 

Exhibit E11 – Q36. [Parents of children 13-15 not prescribed opioids] To the best of your knowledge, has your teen ever been prescribed an opioid?
Parents on teen opioid use
Parent 13-15
2019
(n=362)
A
Parents 13-15
2017
(n=322)
Adults 25+
(n=360)
B
Legal Opioid
Users
(n=81*)
C
Illegal Drug users
(n=81)
D
Neither
(n=238*)
E
Men
30-39
(n=33*)
F
Yes 9% 6% 9% 12% 10% 7% 11%
No 90% 92% 90% 88% 85% 92% 89%
- -  - - B
DK/NR 1% 1% 1% - 5% 1% -

*Bear in mind the small sample sizes for this question, results should be regarded with caution.

 

Exhibit E12 – Q37. [All parents of teens 13-15] And to the best of your knowledge, has your teen ever tried an opioid that had not been prescribed to them?
Parents on teen opioid use
Parent 13-15
2019
(n=397)
A
Parents 13-15
2017
(n=351)
Adults 25+
(n=395)
B
Legal Opioid
Users
(n=101)
C
Illegal Drug users (n=108)
D
Neither
(n=245) E
Men
30-39
(n=40*)
F
Yes 6% 4% 6% 10% 17% 4% 13%
- E  BD ABE -
No 88% 92% 89% 87% 75% 92% 82%
- D  D - C
DK/NR 5% 5% 6% 2% 9% 4% 4%
- - CE - C - -

*Bear in mind the small sample sizes for this question, results should be regarded with caution.

Two-thirds (66%) of youth believe that their peers are relying on a drug dealer or other stranger to get opioids without a prescription. Slightly fewer (42%) believe people their age are using a relative’s prescribed opioids than in 2017 (48%), while there has been little change in the percentage who believe their peers are using a friend’s prescription opioids (40% vs 41%) or a fake prescription (22% vs 24%). Slightly more (21% vs 18%) feel people their age get their opioids on the Internet. 

Exhibit E13 – Q38. [13-15 year-old teens] When people your age get opioids without a real prescription, where do you think they are getting them? Check all that apply.
Method of Obtaining Opioids Without a Prescription
Youth
13-15
2019
(n=331)
A
Youth
13-15
2017
(n=357)
Legal Opioid
Users
(n=45*) B
Illegal Drug users (n=81*) C Neither
(n=261) D
A drug dealer or other stranger 66% 66% 49% 50% 71%
 BC -  - - BC
A relative’s prescribed opioid 42% 48% 33% 36% 45%
A friend’s prescribed opioid 40% 41% 32% 39% 41%
A fake prescription 22% 24% 21% 30% 23%
The Internet  21% 18% 12% 10% 21%
C - - - -
Other  1% - - - -
DK/NR  15% 17% 15% 6% 14%
C - - - -

*Bear in mind the small sample sizes for this question, results should be regarded with caution.

Key takeaways: Risk behaviour profiling

Section F: Opioid information

Primary sources of trusted opioid information concerning the effects of opioid use include doctors (82% trust), and pharmacists (81%). Both were also highly trusted in 2017 (83% each). Youth also trust their parents (80%). In keeping with 2017 data, government follows next – 68% trust their regional/municipal health authority, 59% trust the Government of Canada and 53% trust their provincial government. The least trusted sources of opioid use information include news outlets (31% trust), family members or friends who have never taken opioids before (24%) and people who are currently using opioids regularly (20%).

There are a number of differences between age groups in level of trust. Youth and young adults place greater trust in websites (58% and 53%, respectively) compared to those 25+ (47%). Youth are more trusting of school teachers (67%), news outlets (35%), and friends/family who have not taken opioids before (44%). Young adults are more open to information from someone who had an opioid use disorder (51%).

Illegal drug users are also more trusting of those with previous experience using opioids. For example, 50% would trust someone who had an opioid use disorder, over half (52%) would trust family/friends who have taken opioids before, and more than a third (34%) would trust someone currently using opioids. In 2017, illegal users were also more likely than the general population to trust all of these sources.

Compared to the population as a whole, men 30-39 are generally less trusting of most sources, although the hierarchy of trust is similar to the general population with doctors (75%) and pharmacists (73%) the most trusted sources.

Respondents living in Alberta were the most trusting of friends and family members who have taken opioids before (45%) when being provided with information about opioids. Respondents living in Manitoba and Saskatchewan are significantly more likely (17%) to strongly trust websites focused on health issues and health content for information on opioid use, while those living in Atlantic Canada were the least likely (1%).

Notably, those 55 and older were almost twice as likely (47%) to strongly trust their doctor as a source of information compared to those 16 and 17 years old (27%). Respondents aged 18-34 were twice as likely to trust (28%) a person who currently uses opioid regularly for information on opioids, compared to those aged 55 and older (13%). 

Men were more likely (20%) than women (15%) to strongly trust the Government of Canada as a source of information. Post graduates were three times more likely (31%) than those without a high school degree (10%) to strongly trust the Government of Canada as a source of information on opioid use and its effects.  Those making more than 80,000 were more likely (44%) than those making less that 40,000 (37%) to trust a person who had an opioid use disorder (addiction) or who has survived an opioid overdose for information about opioids.

Exhibit F1 – Q39. Please indicate how much you would trust or distrust each of the following if they were providing you with information on opioid use and its effects. [% strongly trust or trust]
Trust in Information Sources
Gen Pop 2019
(n=1003) A
Gen Pop 2017
(n=1330)
Youth 13-15
(n=331) B
Young adults
16-24 (n=433)
C
Adults 25+
(n=1471) D
Legal Opioid
users (n=726)
E
Illegal Drug users (n=670)
F
Neither
(n=1552) G
Parents
13-15 (n=397) H
Men
30-39
(n=395) I
Your doctor 82% 83% 87% 81% 83% 87% 79% 82% 83% 75%
I - ACFI I I ACDFGI - I I -
Your parents* 80%
(n=23)
89%
(n=51)
81%
(n=331)
- - 73%
(n=45)
73%
(n=81)
84%
(n=261)
- -
A pharmacist 81% 83% 85% 81% 82% 87% 79% 81% 82% 73%
I - ACFI I I ACDFGI I I I -
Your regional/ municipal public health agency 68% 70% 68% 69% 70% 71% 65% 70% 72% 67%
- - - - F F - - F -
The Government of Canada 59% 57% 61% 64% 58% 61% 57% 58% 62% 59%
- -   DFG - - - - - -
Your provincial government 53% 54% 57% 55% 51% 56% 53% 50% 53% 54%
- - - - - DG - - - -
Websites focused on health issues/health content 47% 49% 58% 53% 47% 50% 53% 46% 54% 45%
- - ADEGI ADGI - - ADGI - ADGI -
School teachers 42% 43% 67% 46% 42% 48% 48% 42% 51% 45%
- - ACDEFGHI - - ADG ADG - ADG -
Friends/ family who have taken opioids before 41% 40% 46% 45% 38% 47% 52% 38% 45% 42%
DG - DG DG - ADG ACDGHI - DG -
A person who had an OUDA** or who has survived an opioid overdose 39% 39% 42% 51% 39% 43% 50% 39% 42% 39%
- - - ABDEGHI - D ABDEGHI - - -
A news outlet 31% 32% 35% 28% 30% 32% 35% 29% 39% 26%
- - CDGI - - I ACDGI - ACDEGI -
Friends/ family who have never taken opioids before 24% 28% 44% 29% 24% 31% 34% 23% 37% 31%
- - ACDEFGI ADG - ADG ADG - ACDEGI ADG
A person who currently uses opioids regularly 20% 20% 22% 27% 18% 26% 34% 17% 27% 26%
DG - - ADG G ADG ABCDEGHI - ADG ADG

*Bear in mind the small sample sizes for question 39D (Your parents). Results should be regarded with caution. Only asked of teens 13-15.
**OUDA = Opioid Use Disorder (Addiction)

Fewer parents report discussing drug use in general (63% vs 77% in 2017) and the use of illegal drugs in general (48% vs 66%). Fewer youth say they discussed these topics with their parents than in 2017, though the discrepancy is not as large. Parents are more likely to claim they have discussed problematic drug or opioid use and the use of illegal opioids with their children than youth are to report their parents have discussed these topics with them. The same pattern was observed in the 2017 data.

Exhibit F2 – Q40/41. [parents of teens 13-15] Among the following topics, which ones have you discussed with your teenage child/children, if any? Check all that apply. [TEENS 13-15] Among the following topics, which ones have you already had a discussion with one of your parents about, if any? Check all that apply.
Topics Discussed with Parents/Teens
Parents 2019
(n=397)
Parents 2017
(n=351)
Youth 13-15
2019
(n=331)
Youth 13-15
2017
(n=357)
Drug use in general 63% 77% 64% 72%
The use of illegal drugs in general 48% 66% 52% 57%
Problematic drug or opioid use 31% 35% 25% 25%
The use of illegal opioids, meaning opioids that have not been prescribed to the person using them 30% 31% 25% 24%
Drug or opioid overdoses 29% 31% 31% 29%
How to get help with problematic drug or opioid use  20% 19% 18% 18%
The use of prescribed opioids 19% 23% 19% 16%
DK/NR 17% - 15% -

Key takeaways: Opioid information

Section G: Views on chronic pain and chronic pain management

As part of the qualitative phase, we introduced the topic of chronic pain and chronic pain management into the focus group discussions.  Participants were asked: whether they had or knew someone who had experienced or suffers from chronic pain; how these conditions compare to other health challenges such as diabetes, cancer or heart disease; what sorts of treatments are available for people who suffer from chronic pain; and, what is needed to ensure access to medications and alternative treatments for chronic pain.

Qualitative insights:  Views on chronic pain and chronic pain management

In every group, most participants indicated knowing someone dealing with chronic pain.  Some clearly felt chronic pain affects many people today and expressed that it is still somewhat misunderstood and mysterious.  Some also pointed out that it comes with stigma because their sense is that people living with pain are often questioned about whether their claims of constant pain are overstated or even real. That said, when compared with conditions such as cancer, it was difficult for participants to think of chronic pain as being as serious, given the possible (fatal) outcomes of cancer.

Nearly all participants were aware that one of the most common treatments for chronic pain was prescription drugs; however, the majority of participants did not instinctively make the link to opioids when the topic of chronic pain was raised.  A number of participants suggested that a central challenge in pain management, and health care in general, was gaining access to a doctor. They elaborated that if people are able to obtain a doctor to help manage their condition, there was a widespread sense that they would not have any challenges obtaining opioid medications. 

In terms of other treatments available to those suffering from chronic pain, participants were able to volunteer a number of alternatives such as physiotherapy, yoga, meditation and homeopathic medicines.  However, many complained that these alternatives are not always factored into treatment plans; and, reinforced their earlier comments that doctors do not take the necessary time to understand patients’ needs or to work through what does or does not work for individual patients.  Finally, there was a sense that these treatments are cost prohibitive especially for those without adequate health benefits.  Participants argued the limitations of the fact that most employment benefit plans more readily cover prescription medications than they do alternative therapies.

Section H: The role of stigma

As was undertaken in the baseline survey, an analysis of the data was completed to better understand the role of stigma in respondents’ views regarding people who use opioids and how those views may relate to support for policies that address the opioid crisis.  Keeping with the segmentation as defined in the baseline survey, three questions were used for this investigation:

I don’t have much sympathy for people who misuse opioids
People who overdose on opioids get what they deserve
A lack of self-control is usually what causes a dependence upon or an addiction to opioids

Each of the statements relates to either withholding sympathy or assigning blame and the level of consistency in agreement, disagreement or neutrality on them was used to divide the population into distinct segments. The “Allies” segment disagrees with all three statements, indicating a consistent pattern of willingness to oppose stigmatizing points of view.  Conversely, the “Unsympathetic” segment agrees with, or are neutral to, all three statements.  The logic of including the neutral is based on the hypothesis that being unwilling to actually disagree with any of these statements suggests a consistent pattern of assuming there are scenarios in which one might agree with these sentiments and scenarios in which one might disagree with them.  The fact that there are times when unsympathetic opinions might be held was deemed enough to identify the respondent as accepting stigmatizing points of view and never disagreeing outright with any of them.  Finally, the relatively large “Ambivalent” segment is the remaining portion of the population that holds a mix of agreement and disagreement, and/or non-response across these three statements.  The inconsistency makes it impossible to define them as truly being an Ally or truly being Unsympathetic. The percentage of each segment as a proportion of the general population sample is presented in Exhibit H1.

Exhibit H1
Stigma segments
Unsympathetic Ambivalent Allies
2019 2017 2019 2017 2019 2017
Unweighted n 258 377 493 671 252 282
Percentage 26% 28% 49% 50% 25% 21%

The “Unsympathetic” segment consists of two subgroups – those respondents who explicitly agree with all three statements, and those who agree with one or two and are neutral on the rest.  For the purposes of this analysis, the tables below highlight differences between Unsympathetic, Ambivalent and Allies.

In terms of demographics, in line with findings outlined earlier in this report, men appear to continue to hold more stigmatizing views and constitute a larger proportion of the Unsympathetic segment (60%) relative to women (40%). Conversely, as found in the baseline survey, a significantly larger percentage of the Allies segment (60%) is made up of women. Allies tend to be older – 47% are over the age of 55, compared to 36% in the Ambivalent segment and 26% in the Unsympathetic segment. Allies also appear to be slightly wealthier than the respondents in the other segments. There is little variation in regional makeup, with the exception of a slightly higher proportion of the Ambivalent segment being from Quebec (27%) compared to the other segments.

Among the oversample groups, most segments have roughly half of its members falling into the Ambivalent segment.  Men aged 30 to 39 have the highest proportion of respondents who fall into the Unsympathetic segment (40%) and in contrast legal opioid users (27%) and young adults 16-24 (28%) have the lowest incidence of Unsympathetic members.  Legal users have the largest proportion of Allies (26%), compared to 18% of Illegal Opioid Users.

Exhibit H2 – Stigma segment demographics
Stigma segments
Unsympathetic Ambivalent Allies
2019 2017 2019 2017 2019 2017
Male 60% 56% 46% 49% 39% 35%
Female 40% 42% 53% 50% 60% 63%
Other 0% 1% 1% - 1% 1%
Atlantic 5% 6% 9% 7% 4% 5%
QC 18% 21% 27% 26% 23% 20%
ON 38% 42% 38% 37% 41% 39%
MB/SK 9% 7% 6% 6% 5% 7%
AB 15% 10% 10% 11% 11% 15%
BC 16% 15% 11% 13% 17% 14%
13-17 10% 8% 7% 7% 2% 3%
18-34 30% 28% 26% 26% 19% 24%
35-54 34% 33% 31% 30% 32% 33%
55+ 26% 32% 36% 37% 47% 40%
Under $40,000 23% 22% 28% 21% 21% 18%
$40,000-<$80,000 36% 27% 27% 28% 30% 29%
>$80,000 30% 39% 33% 37% 38% 42%
DK/NR 11% 13% 12% 14% 11% 10%

Exhibit H3 – Oversample breakdown by stigma segment
Stigma segments
Parents
13-15 (n=445)
Youth 13-15 (n=331) Young adults
16-24 (n=473)
Men 30-39 (n=438) Legal Users (n=726) Illegal Users (n=670)
Unsympathetic 37% 32% 28% 40% 27% 35%
Ambivalent 42% 51% 52% 47% 48% 47%
Allies 21% 17% 20% 14% 26% 18%

The three segments vary in terms of their personal behaviours with opioids and first-hand exposure to users. Allies are more likely to have always followed a prescription when taking opioids (34%) than the Ambivalent (19%) and Unsympathetic segments (17%). Allies also appear to have more experience with opioids in their immediate circle of family and friends. They are more likely to say that they have a family member or friend who has been prescribed an opioid (66%).  Across the segments, similar proportions claim that they know someone who has had a non-fatal overdose, although the portion is slightly higher among Unsympathetic (20%) and Allies (19%) than those who are Ambivalent (15%) and the data suggests these incidence levels are rising among the Unsympathetic and Ambivalent segments. Allies are also more likely to know someone who has become addicted (developed an opioid use disorder) to opioids (42%) and this incidence appears to be rising across all segments.

Exhibit H4 – Q27. Of the opioids you have ever taken, how often were they prescribed for you personally?
Opioid use
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
Always

17% 26% 19% 32% 34% 44%
- - - - AB -
Usually 6% 8% 4% 9% 4% 8%
Sometimes

26% 13% 15% 7% 10% 9%
BC - - - - -
Rarely 43% 40% 50% 40% 47% 31%
Never 9% 10% 8% 9% 5% 7%
DK/NR

1% 2% 5% 3% - -
- - A - - -

Exhibit H5 – Q26A. Please indicate whether the following is true: At least one family member or friend has been prescribed one of these drugs.
Acquaintance with opioids
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
True 47% 43% 51% 46% 66% 68%
- - - - AB -
False 40% 37% 34% 34% 23% 23%
C - C - - -
DK/NR 12% 21% 15% 19% 10% 9%

Acquaintance with opioids
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
True 27% 14% 22% 15% 29% 25%
False 59% 64% 60% 60% 53% 61%
DK/NR 15% 22% 19% 25% 18% 14%

Exhibit H7 – Q26C. Please indicate whether the following is true: I have known someone who has had a non-fatal overdose of one of these drugs.
Acquaintance with opioids
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
True 20% 9% 15% 6% 19% 17%
False 73% 76% 75% 79% 73% 76%
DK/NR 7% 15% 10% 15% 8% 7%

Exhibit H8 – Q26E. Please indicate whether the following is true: I have known someone who became addicted to one of these drugs.
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
True 26% 21% 32% 22% 42% 31%
- - - - AB -
False 64% 64% 58% 64% 52% 61%
C - - - - -
DK/NR 10% 15% 10% 14% 7% 8%

Fitting with their higher proportions of experience with opioids among their family and friends, Allies are also more likely to describe themselves as at least somewhat familiar with at least one opioid (75%) than either the Ambivalent (62%) or Unsympathetic segments (62%).  However, they are not particularly more familiar than the other segments with it comes to fentanyl specifically.  While 57% of Allies feel they are at least somewhat familiar with fentanyl, compared with 45% among the Ambivalent and 48% among the Unsympathetic, most are only describing themselves at somewhat rather than very familiar with fentanyl.

Exhibit H9 – Q13. How familiar are you with these types of opioids?
Aided familiarity with opioids among stigma segments
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
Very familiar with at least one 25% 24% 25% 22% 30% 38%
Somewhat familiar with at least one 37% 36% 37% 35% 45% 39%
No more than a little familiar with at least one 21% 17% 17% 18% 12% 15%
C - - - - -
Not at all familiar with any 16% 19% 19% 22% 12% 7%
DK/NR 1% 4% 2% 3% 1% -

Exhibit H10 – Q19. How familiar are you with fentanyl?
Familiarity with fentanyl among stigma segments
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
Very familiar 14% 12% 11% 8% 13% 18%
Somewhat familiar 34% 36% 34% 33% 44% 48%
- - - - B -
Not very familiar 31% 27% 30% 27% 34% 19%
Not at all familiar 19% 23% 22% 28% 9% 14%
C - C - - -
DK/NR 2% 3% 3% 5% - -

While the majority of members across all three segments feel that most or all opioids are dangerous, the Unsympathetic are more likely than others to see some as less dangerous than others.  Where 9% of Allies and 13% of Ambivalent feel that half or fewer of the opioids listed are dangerous, among the Unsympathetic one in four (24%) feel this is the case.

Perhaps relatedly, there is a mild correlation between segment membership and one’s sense of how serious the opioid crisis is in one’s community.  Allies are more uniformly of the view that the crisis is at least somewhat serious in their community (83%), whereas roughly two-thirds of the Ambivalent (67%) and Unsympathetic (66%) describe the crisis in these terms.

Exhibit H11 – Q14. Is it your impression that: [in reference to the opioid table]
Perceived danger of opioids
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
All are dangerous 37% 45% 38% 42% 44% 52%
Most are dangerous 36% 33% 42% 35% 47% 37%
- - - - A -
About half are dangerous 9% 8% 5% 5% 4% 9%
C - - - - -
A few are dangerous 11% 8% 7% 9% 4% 1%
C - - - - -
None of these drugs are dangerous 4% - 1% 1% 1% 1%
BC - - - - -
DK/NR 3% 6% 7% 8% 1% -
- - C - - -

Exhibit H12 – Q18. How serious would you say the opioid crisis is in your community?
Perceived severity of the opioid crisis
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
Very serious 28% 26% 28% 27% 42% 38%
- - - - AB -
Somewhat serious 38% 39% 39% 34% 41% 39%
Not very serious 17% 18% 15% 17% 9% 11%
C - - - - -
Not at all serious 6% 4% 2% 3% 2% 4%
BC - - - - -
DK/NR 11% 13% 15% 19% 7% 8%
- - C - - -

Among Allies (49%) and Unsympathetic (52%), only half agree they are worried that they could become addicted (develop an opioid use disorder) to an opioid if prescribed one and this number is no higher among the Ambivalent (43%).  While no segment indicates being particularly confident they would be able to identify the signs of an opioid use disorder or an opioid overdose, or would know what to do if they saw someone experiencing an overdose, the Unsympathetic show slightly higher levels of self-confidence on two of these measures.  When it comes to being able to identify an overdose, 43% of the Unsympathetic feel they could, compared to 31% among the Allies and 30% among the Ambivalent.  Similarly, 41% of the Unsympathetic feel they would know what to do if witnessing an overdose, compared to 34% among the Allies and only 22% among the Ambivalent.

Exhibit H13 – Q22D, J, K, L. How strongly do you agree or disagree with [% strongly or somewhat agree]
Attitudes towards behaviours, risk and harms among stigma segments
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
I worry that if I am prescribed an opioid I could become addicted 52% 48% 43% 37% 49% 47%
B - - - B -
I think I’d be able to identify signs of an opioid use disorder 45% 38% 35% 27% 42% 39%
BC - - - - -
I think I’d be able to identify signs of an opioid overdose if faced with them 43% 34% 30% 23% 31% 36%
BC - - - - -
I would know what to do if I saw someone experiencing an overdose 41% 32% 22% 18% 34% 36%
B - - - B -

As found in 2017, those who are Unsympathetic are the most likely to feel that problematic substance use disorder stems from issues of self-control. The plurality of Unsympathetic (42%) believe people who are dependent on opioids could stop taking them if they really wanted to.  Few (14%) of the Ambivalent feel this way and almost no Allies (5%) hold this opinion.  The Unsympathetic (53%) are less likely than the Ambivalent segment (61%) and Allies (77%) to believe that opioid use disorder is a disease. Almost two-thirds of the Unsympathetic (64%) continue to agree that a lack of self-control is usually what causes dependence upon opioids.  Directly relating to public policy initiatives to address the opioids crisis, those in the Unsympathetic segment are unlikely to agree that we should be using more health care resources to deal with opioid use disorder – 49% agree, compared to 63% of the Ambivalent segment, and fully 83% of the Allies segment.  That said, it should be noted the proportions agreeing with the notion of using more health care resources to address this problem have risen in every segment compared to the findings from 2017.

Exhibit H14 – Q25A, B, F, G, P. How strongly do you agree or disagree with [% strongly or somewhat agree]
Attitudes towards behaviours, risk and harms among stigma segments
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
When following your doctor’s instructions for taking an opioid painkiller, you can still become addicted* 66% 44% 70% 55% 87% 77%
- - - - - AB
A lack of self-control is usually what causes a dependence upon or an addiction to opioids 64% 64% 33% 30% 0% -
B - - - - -
Addiction to opioids is a disease 53% 54% 61% 60% 77% 76%
- - - - AB -
We should be using more of our health care resources for dealing with opioid addiction 49% 42% 63% 57% 83% 70%
- - A - AB -
People who are dependent on opioids could stop taking them if they really wanted to 42% 36% 14% 13% 5% 3%
BC - C - - -

*Note: Different question structure in 2019 compared to 2017. In 2017, the statement was “If you are following a prescription, it is difficult to become dependent upon or addicted to an opioid.” In order to make the results more comparable, the 2017 data in this table represents the percent who disagree.

When it comes to trust in information sources, there are marked differences between the three segments. As found in 2017, Allies are more trusting of almost every information source tested (the exceptions being teachers, a person who is currently using opioids, and family/friends who have never taken opioids).  Of note from a public policy perspective, there continues to be differences across the segments when it comes to trust in federal and provincial governments – 70% of Allies trust the Government of Canada to provide information about opioid use, compared to 58% of the Ambivalent segment, and 51% of the Unsympathetic segment. Over two-thirds (60%) of Allies trust their provincial government, compared to 48% of the Unsympathetic segment.

Exhibit H15 – Q39. Please indicate how much you would trust or distrust each of the following if they were providing you with information on opioid use and its effects. [% strongly trust or trust]
Trust in sources of opioid information among stigma segments
Unsympathetic Ambivalent Allies
2019
A
2017 2019
B
2017 2019
C
2017
Your doctor 71% 76% 83% 83% 92% 92%
- - A - AB -
A pharmacist 70% 74% 80% 83% 92% 94%
- - A - AB -
Your parents 58% 84% 100% 91% 100% 100%
- - A - A -
Your regional/municipal public health agency 57% 61% 67% 69% 83% 84%
- - A - AB -
The Government of Canada 51% 50% 58% 56% 70% 72%
- - - - AB -
Your provincial government 48% 46% 52% 52% 60% 68%
- - - - AB -
Websites focused on health issues/health content 37% 47% 46% 48% 59% 54%
- - A - AB -
School teachers 37% 39% 44% 43% 43% 46%
Friends/family who have taken opioids before 35% 36% 39% 38% 52% 49%
- - - - AB -
Friends/family who have never taken opioids before 32% 31% 23% 26% 15% 27%
BC - - - - -
Someone who has an opioid use disorder/survived an overdose 29% 30% 39% 39% 54% 53%
- - A - AB -
A news outlet 27% 29% 29% 31% 37% 39%
- - - - AB -
A person who currently uses opioids regularly 23% 20% 18% 18% 23% 23%

Qualitative insights:  The role of stigma

The issue of stigma proved to be complex.  Participants often demonstrated quite contradictory or conflicting impressions of people with substance use disorder.  Throughout the groups, many would organically use descriptions such as homeless or street people when talking about people who run into difficulties with opioids.  When asked to provide a description of people with substance use disorder, there were two general tendencies.  In one tendency, participants described people who were in relatively dire circumstances (e.g., homeless, unemployed, dirty, unreliable, untrustworthy).  For those who offered demographic characteristics, more often than not, they were mentioning between the ages of 30 and 50 and being male.  In the other tendency, participants described that it really could be anyone and were much less likely to say it was any particular type of person more than any other.  Offering proof of their sympathy for those with opioid use disorder, some demonstrated feeling supportive of people with the disorder, while also feeling the need to protect themselves from being taken advantage of or stolen from, because the disorder can make a good person do things they would not normally do to a friend or family member.

Testimonials of “normal” people who develop substance use disorder, particularly those who have successfully recovered, are widely named as what is required to help remove stigma.  Ensuring that people understand that truly anyone can easily develop a substance use disorder, demonstrating what recovery options are available, and sharing how people have helped their loved ones with substance use disorder are the kinds of stories that participants suggest would help remove stigma and achieve better outcomes.

From a communications standpoint, participants did tend to link substance use disorder to both mental health and other health conditions.  In this sense, the notion that substance use disorder could be characterized as a treatable medical condition was accepted.  How communicating this might influence public support for initiatives was unclear, but many felt it could not hurt.

Key takeaways: The role of stigma

Section I: Views regarding alcohol consumption

A third (32%) are familiar with Canada’s Low-Risk Alcohol Drinking Guidelines. The plurality (38%) are not at all familiar, while another quarter (26%) are not very familiar. Young adults are more familiar (38%) than those older (31%) and younger (30%) than them.

Notable demographic differences include 40% of respondents from Quebec reporting they are familiar with Canada’s Low-Risk Alcohol Drinking Guidelines, compared to familiarity among the rest of the provinces which were between 22% and 31% familiar. Indigenous respondents reported being twice as familiar (63%) compared to non-Indigenous respondents (30%).

Exhibit I1 – Q42. How familiar would you say you are with Canada’s Low-Risk Alcohol Drinking Guidelines?
Familiarity with Canada’s Low-Risk Alcohol Drinking Guidelines
Gen pop (n=1003) A Youth
13-15
(n=331)
B
Young adults
16-24
(n=433)
C
Adults 25+
(n=1471) D
Parents
13-15 (n=397) E
Men
30-39
(n=395)
F
Very familiar 6% 5% 8% 6% 9% 8%
Somewhat familiar 26% 25% 30% 25% 35% 30%
- - - - ABD D
Not very familiar 26% 25% 28% 27% 25% 28%
Not at all familiar 38% 40% 30% 38% 29% 29%
CFHI CEF - CEF - -
DK/NR 4% 4% 4% 3% 2% 5%
D - - - - -

There is some agreement that the number of alcohol servings for youth and those over 65 that qualify as “low-risk” are fewer than for men and women in general. Forty-one percent (41%) believe 0-2 drinks per week for youth would qualify as low risk, while another 23% say 3-5 servings would qualify. A third (34%) feel 0-2 drinks would be low risk for those 65+, and a quarter (26%) say 3-5 drinks. When it comes to women, just over a quarter believe 0-2 (27%) or 3-5 (29%) servings qualify as low risk. One in five (16%) believe 0-2 qualifies as low-risk for men, and 29% suspect it is 3-5.

Q43: Canada’s Low-Risk Alcohol Drinking Guidelines provide advice on how many standard servings of alcoholic beverages per week is considered “low-risk alcohol drinking.”  For each of the following, please indicate how many standard servings per week you think would qualify as “low-risk alcohol drinking”.

Exhibit I2 – Q43. Women
Perceived ‘low-risk alcohol drinking’ standard servings
Gen pop (n=1003) A Youth
13-15
(n=331)
B
Young adults
16-24
(n=433)
C
Adults 25+
(n=1471) D
Parents
13-15 (n=397) E
Men
30-39
(n=395)
F
0-2 27% 27% 26% 25% 27% 28%
3-5 29% 30% 32% 29% 24% 23%
- F EF - - -
6-10 19% 16% 13% 20% 15% 15%
CE  - - BCEF - -
11+ 2% 3% 3% 3% 3% 6%
- - - - AD
DK/NR 22% 24% 26% 24% 31% 28%
- - - - AD A

Exhibit I3 – Q43. Men
Perceived ‘low-risk alcohol drinking’ standard servings
Gen pop (n=1003) A Youth
13-15
(n=331)
B
Young adults
16-24
(n=433)
C
Adults 25+
(n=1471) D
Parents
13-15 (n=397) E
Men
30-39
(n=395)
F
0-2 16% 15% 12% 15% 17% 19%
- - - - - C
3-5 29% 29% 35% 28% 27% 23%
- - ABDEF - - -
6-10 22% 23% 19% 21% 16% 17%
E  E - E - -
11+ 11% 8% 8% 12% 9% 13%
- - - BC - BC
DK/NR 22% 24% 26% 24% 31% 28%
- - - - AD A

Exhibit I4 – Q43. Youth (late teens through 24 years of age)
Perceived ‘low-risk alcohol drinking’ standard servings
Gen pop (n=1003) A Youth
13-15
(n=331)
B
Young adults
16-24
(n=433)
C
Adults 25+
(n=1471) D
Parents
13-15 (n=397) E
Men
30-39
(n=395)
F
0-2 41% 42% 41% 40% 39% 36%
F - - - - -
3-5 23% 22% 21% 22% 19% 21%
E - - - - -
6-10 11% 10% 9% 12% 8% 8%
 - - - ACEF - -
11+ 2% 3% 3% 2% 3% 7%
- - - - - ABCDE
DK/NR 22% 24% 26% 24% 31% 28%
- - - - AD A

Exhibit I5 – Q43. Those aged 65 or older
Perceived ‘low-risk alcohol drinking’ standard servings
Gen pop (n=1003) A Youth
13-15
(n=331)
B
Young adults
16-24
(n=433)
C
Adults 25+
(n=1471) D
Parents
13-15 (n=397) E
Men
30-39
(n=395)
F
0-2 34% 34% 39% 32% 33% 33%
3-5 26% 28% 27% 25% 23% 24%
- - -   - -
6-10 15% 12% 7% 17% 11% 11%
CF C BCEF C -
11+ 2% 2% 1% 3% 2% 5%
- - - - - ACD
DK/NR 22% 24% 26% 23% 31% 28%
 - - - - AD A

Half (52%) correctly identify a 341 ml bottle as a standard serving of alcohol. More youth do not offer a response (18%) compared to young adults (12%) and those 25+ (10%). One-in-five (18%) believe it is a pint.

Three in five men (61%) knew the standard serving size of a typical beer with 5% alcohol is a 341 ml bottle, compared to less than half (44%) of women. Exactly two-thirds (66%) of those living in rural communities were correct, compared to just over half (52%) of those not living in rural communities,

Exhibit I6 – Q44. Thinking of a typical beer with 5% alcohol, which of the following do you think is a standard serving?
Perceived ‘low-risk alcohol drinking’ standard servings
Gen pop (n=1003) A Youth
13-15
(n=331)
B
Young adults
16-24
(n=433)
C
Adults 25+
(n=1471) D
Parents
13-15 (n=397) E
Men
30-39
(n=395)
F
A 341 ml bottle 52% 48% 44% 53% 48% 51%
C - - C - C
A pint 18% 18% 19% 19% 16% 17%
A half-pint 9% 5% 12% 9% 11% 11%
B - B B B BD
A 491 ml tallboy can 4% 4% 7% 3% 11% 5%
  - ABD - ABDF -
Something smaller than any of these 5% 5% 6% 5% 5% 5%
Something larger than any of these 1% 1% 1% 1% 3% 1%
- - - - ACDF -
DK/NR 12% 18% 12% 10% 6% 10%
E ACDEF E E - -

Over half support including ingredients (57%), calories (52%), health risks/warnings (65%), and the number of standard serving sizes per container (63%) on alcoholic beverage labels. Just shy of half (45%) believe nutritional information should also be included. Youth are less convinced of the need to include all this information compared to those older than them. For example, 38% of youth feel calories should be listed, compared to 54% of young adults and 50% of adults 25+. 

Post graduates were much more likely to seek calories (60% versus 28%) and nutritional information (50% versus 30%) compared to respondents who have not completed high school.

Exhibit I7 – Q45. Of the following list of possibilities, which information, if any, should appear on alcoholic beverage labelling?
Alcoholic beverage labelling
Gen pop (n=1003) A Youth
13-15
(n=331)
B
Young adults
16-24
(n=433)
C
Adults 25+
(n=1471) D
Parents
13-15 (n=397) E
Men
30-39
(n=395)
F
Health risks/warnings 65% 61% 69% 66% 60% 54%
F - BEF EF - -
Number of standard servings that are in the container 63% 55% 67% 65% 62% 54%
BF - BF BF BF -
Ingredients 57% 47% 63% 58% 53% 58%
B - BE BE B B
Calories 52% 38% 54% 50% 44% 48%
BE - BE BE - B
Nutritional information 45% 37% 55% 42% 41% 45%
BD - ABDEF - - B
DK/NR 8% 14% 6% 9% 11% 10%
- ACD - - CD C

Respondents seem aware and, in some cases, concerned about the health consequences of alcohol use. Three-quarters (75%) of respondents agree that alcohol increases the risk of developing serious health conditions. Over half (60%) agree that alcohol use among youth is a serious problem. Further, half (51%) strongly disagree that drinking alcohol during pregnancy can be done safely and few (16%) agree that alcohol use is not a public health issue.  Just over half of respondents (56%) feel the federal government should be doing more to address alcohol-related harms.

Respondents living in Alberta (21%) and Ontario (19%) were twice as likely as those living in Atlantic Canada (12%) and Manitoba/Saskatchewan (9%) to agree that alcohol use is not a public health issue. Two in five respondents (39%) from Quebec disagree that people who have alcohol use disorder (addiction) could stop if they really wanted to, this number increases by twenty percent when looking at Ontario (60%). The majority of respondents (82%) living In Manitoba/Saskatchewan agree that alcohol use increases a person’s risk of developing serious health conditions, compared to two-thirds (65%) in Atlantic Canada.

Post graduates were more likely (69%) than respondents with a high school degree (57%) or less (52%) to disagree that alcohol use is not a public health issue. Roughly twice as many post graduates (63%) disagree that people who have alcohol use disorder (addiction) could stop if they really wanted to compared to respondents without a high school degree (34%).

Three-quarters of Indigenous respondents (77%) agree that alcohol use among youth is a serious problem in Canada compared to 59% of non-Indigenous respondents. 

The majority of those aged 55 and older disagree (85%) that drinking alcohol during pregnancy can be done safely compared to 61% aged 16/17, 69% aged 18-34, and 76% aged 35-54.

Exhibit I8 – Q46. Please indicate how strongly you agree or disagree with each of the following statements. [% strongly agree or agree]
Attitudinal statements about alcohol use
Gen pop (n=1003) A Youth
13-15
(n=331)
B
Young adults
16-24
(n=433)
C
Adults 25+
(n=1471) D
Parents
13-15 (n=397) E
Men
30-39
(n=395)
F
Alcohol use increases a person’s risk of developing serious health conditions 75% 76% 71% 75% 77% 67%
F F - F F -
Alcohol use among youth is a serious problem in Canada 60% 57% 62% 59% 62% 48%
F F F F F -
The federal government should be doing more to address alcohol-related harms 56% 64% 60% 57% 60% 50%
- ADF F F F -
People who have alcohol use disorder (addiction) could stop if they really wanted to 24% 35% 28% 23% 32% 35%
- AD - - AD AD
Alcohol use is not a public health issue 16% 19% 22% 16% 25% 30%
- - AD - AD ABCD
Drinking alcohol during pregnancy can be safely done 9% 13% 11% 8% 20% 17%
- AD - - ACD ACD

Qualitative insights:  Views regarding alcohol consumption

In every group, many participants could easily name health effects or diseases associated with alcohol.  Liver disease, addiction and blood pressure were most commonly mentioned. 

Impressions on how many weekly servings of alcohol constitute “low-risk” consumption varied widely and appeared related to one’s own behaviour.  Perhaps the most common range was 5 to 10 drinks per week, although some found the higher end of that range riskier than others.  In terms of what constitutes “high risk” behaviour, participants pointed to drinking more than the low-risk range, binge drinking, drinking to the point of inebriation, etc. as examples.

Almost no participants were aware of the low-risk drinking guidelines, although some certainly assumed they existed. 

Participants tended to feel that youth and underage alcohol consumption was either a major problem or a problem that was not overly worrying.  While many indicated that youth can get themselves into bad situations due to alcohol and that care needs to be taken, some argued that it has always been this way.

Many felt that educating people about the health effects associated with drinking, including going as far as creating a visual campaign like the anti-smoking campaign, could help diminish consumption of alcohol.  Where youth were concerned, however, some questioned whether the current (perceived strict) guidelines around alcohol consumption triggered overconsumption.  Many spoke of the consumption of alcohol in other countries and cultures as less taboo and normalized to the point that they argued youth might not turn to alcohol as a form of rebellion if alcohol consumption was more broadly acceptable.

Key takeaways: Views regarding alcohol consumption

 


Conclusions

 

As was the case in 2017, respondents in this study claim both some familiarity with opioids, prescribed or otherwise, and with the opioid crisis in Canada. Self-assessments on knowledge have increased slightly, and although the claimed sense of familiarity shows little, if any, change, additional evidence exists to suggest familiarity may be higher now than in 2017.  When provided with a list of ways one might have a connection to opioids in their life, responses indicated higher incidences across the board.  The most common connection continues to be the half of respondents who have a family member or friend who has been prescribed an opioid and this has only slightly increased since 2017.  There have been more notable increases in the proportion who know someone who has become addicted (developed an opioid use disorder), know a family member or friend who has used an opioid without a prescription and knowing someone who has had a non-fatal opioid overdose.  Together, this suggests the population has only become more aware of opioids.

Claimed usage of opioids is higher in this survey than was measured in 2017.  This measure has seen increases across all age groups studied.  Without corroborating evidence to support this change, there are a variety of possible explanations for the change in results.  First, it is possible usage has increased.  Second, it is possible that respondents are more accurately indicating their usage of opioids – perhaps due to increased attention paid to the prescriptions that have been given in the past year.  Third, it is also possible there is some sort of error associated with the sample source or process.  These three possibilities are neither mutually exclusive nor the full range of possible explanations.  For the purposes of the study, the data is accepted as respondents provided it.  For statistical information on prevalence, refer to the Canadian Tobacco and Alcohol Survey (CTADS), available at https://www.canada.ca/en/health-canada/services/canadian-tobacco-alcohol-drugs-survey.html or the Canadian Student Tobacco and Alcohol Survey (CSTADS), available at https://www.canada.ca/en/health-canada/services/canadian-student-tobacco-alcohol-drugs-survey.html.

Among those who took opioids in the past year, it continues to be the case that the vast majority report having had at least one prescription and most of those people only took opioids that were prescribed to them. Less than one third of those who used an opioid in the past year did not always have a prescription for the opioid they took, a figure comparable to what was found in 2017.  Youth aged 13 to 15 are less inclined than older respondents to indicate they always had a prescription, although roughly half do make this claim.

Among those who indicated they have used opioids without a prescription, an analysis of their open-ended responses demonstrates that in a significant portion of these cases, their response was not accurate and in fact, they say they have not taken opioids without a prescription.  Among those who have, the most common source remains a friend’s or relative’s prescription.  Among teens 13 to 15 and young adults 16 to 24, a friend’s or relative’s prescription is the most common source, but both of these segments are more likely than others to have acquired them on the street or on the Internet.  Half or more of any target audience studied name pain relief as the reason they took opioids that were not prescribed for them.  However, young adults 16 to 24 are more likely than most others to indicate more recreational or experimental purposes.

Overall, respondents remain concerned about the potential impact of opioids on them, their family and friends and if anything, the level of seriousness attributed to topic of opioids has only increased since 2017.  There continues to be general agreement that opioids are dangerous, particularly for those consuming them illegally, and for teens. Although there appears to have been some slight improvement, most respondents still do not necessarily feel well equipped to respond to opioid use disorder or overdose.  Encouragingly, fewer respondents now feel that it is difficult to develop opioid use disorder if one is following a prescription.

A specific focus on fentanyl demonstrates that it continues to be been seen as very dangerous by the vast majority of respondents and more than two-thirds of respondents feel that for those who use an illegal opioid, there is a high risk that it might be laced with an opioid like fentanyl.

Investigating the topic of stigma more deeply, the 2019 study finds that most respondents expect that those with an opioid use disorder must find it embarrassing to seek help for it and agree that society is not very friendly toward people in this situation.  Both the quantitative and qualitative research uncover a complex set of opinions that relate to stigma, sometimes indicating evidence that people simultaneous hold contradictory views.  Respondents demonstrate sympathy, but they also demonstrate holding some stigmatizing opinions.  In the survey, only one-in-five respondents would disagree with the statement that people with an opioid use disorder are dangerous or untrustworthy, confirming some of the sentiment uncovered in focus group discussions.  

Qualitative research also found a fair degree of negative word association relating to people with opioid use disorder, even among participants who indicated having sympathy and agreeing that these individuals deserve support and not stigma.  The evidence suggests respondents and participants do not see the stereotyping as stigmatizing.

Multivariate analysis of survey results shows that Canadians continue to be divided into three distinct segments when it comes to stigma: a quarter of the population are “Allies” consistent in their rejection of opinions that signal stigma; conversely, an equal number of Canadians fall into a segment of “Unsympathetic” by consistently agreeing with all three statements that signal holding stigmatizing views of people with opioid use disorder; and the remaining half the population fall into the “Ambivalent” segment that neither rejects all three stigmatizing views or agree with all three.  These proportions are nearly identical to those measured in the 2017 baseline study and as was found in 2017, the segment to which one belongs continues to relate to one’s familiarity with or exposure to opioids, as well as to one’s level of appreciation for public health initiatives.

For the most part, each of the target audiences that were oversampled (parents of teens aged 13-15; teens aged 13-15; youth aged 16-24; men aged 30-39; those who have used legal opioids in the past year; and, those who have used illicit drugs or illegal opioids in the past year) tend to hold views that are very similar to the general population. Parents in particular hold views that are very similar to the general population. However, demographically and across the oversample groups, there are a few patterns that are noteworthy.

Teens vary considerably from both parents and the general population on a number of dimensions, many undoubtedly relating to their age. Compared to 2017, the proportion of teens 13-15 claiming to have taken an opioid in the past year is much higher now, though still much lower than the proportion of adults who have done so.  Most other findings relating to teens are more reflective of what was found in 2017.  As examples, compared to all other Canadians, teens report lower levels of knowledge of and familiarity with opioids and less awareness that there is an opioid crisis in Canada. They are less likely to identify the risks of prescribed opioids, and less likely to want friends or family to know they have been taking an opioid, whether prescribed or not. Teens are also the most likely to feel that opioid use disorder is caused by a lack of self-control and have less sympathy for those who use opioids problematically.

On most questions, youth aged 16-24 tend to be more aligned with the adult population.  The important exception is their higher illicit drug use.  These youth indicate having more confidence than either their younger or elder peers when it comes to identifying signs of opioid use disorder, identifying signs of opioid overdose and knowing what to do if they did witness an opioid overdose.

Legal opioid users continue to be more likely than the rest of the general population to have also used illicit drugs in the past year.

Compared to legal opioid users and the general population, illegal opioid users remain less likely to disclose opioid use (whether legal or illegal) and appear slightly less comfortable seeking help, despite being more likely to know someone who has been addicted (developed an opioid use disorder), overdosed or died. That said, illegal users are twice as likely as legal users to indicate having sought treatment for an opioid use disorder.  They are also less concerned than others about the risk to teens who are using opioid medication as prescribed.  Unlike what was found in 2017, illegal users indicate greater levels of confidence compared to the general population when it comes to ability to identify or handle an opioid overdose or use disorder.

Recommendations

 

Based on the results of this research, we would make the following recommendations.

In support of the basic public health objective of reducing harm, the data suggest there remains more benefit to be achieved by continuing to broaden the awareness of and improving the level of understanding of opioids and the opioid crisis, particularly among youth and perhaps even moreso among young adults aged 16-24. Ensuring that these groups understand the risks of prescribed opioids, and that the decision of whether or not to use opioids is not always a simple matter of personal choice or willpower, may be important to preventing future opioid use disorders or overdose incidents, particularly among that young segment.

It continues to be the case that reducing stigma associated with opioid use disorder could help broaden public support for devoting more resources to the issue and aid in removing barriers to seeking treatment.  While the baseline study proved the existence, scope and impact of stigma, this phase of research deepened the understanding of that factor, shedding more light on the complexity of the challenge.  On the surface, most of the public accepts there is an opioid crisis, accepts that anyone can fall victim to opioid use disorder, and agrees that those who do are probably stigmatized. 

Evidence from this latest research suggests the efforts of Health Canada and others may be having a positive impact.  Among other key metrics, the survey encouragingly shows that the segment of Allies has grown slightly.  The qualitative research added evidence that Canadians have clearly heard messaging from the Government of Canada and are modifying their understanding of opioids and sympathy for those dealing with opioid use disorder.

However, the research suggests a foundation of unconscious bias exists regarding those who develop opioid use disorder and working to remove this bias may lead to an improvement in outcomes.  The findings from this study suggest there is benefit in providing Canadians with real-life stories of the many paths to an opioid use disorder, highlighting that for many, the disorder takes root long before, or without ever, becoming the stereotypical image of a person with a drug use disorder.  Further, the qualitative research suggested there is value in educating Canadians on the success and availability of treatment programs, as well as how and when a person should consider one, and what to expect from the process.  Changing the image of the person who needs attention, understanding and care, and explaining how to identify and deal with a potential disorder at the earliest stages can both improve outcomes and remind people that the individuals they envisage as the ones who have an opioid use disorder are much more like themselves than they currently think.

Continuing to improve Canadians’ ability to recognize and respond to an opioid use disorder or overdose may stimulate additional harm-reduction benefits.  These include increasing awareness of signs of opioid use disorder or overdose treatment, preventative measures to avoid them and what specific steps one should take if they are recognized.

The data re-confirmed the value of using health professionals to help deliver opioid-related messages, given the high degree of trust in these professionals as a source of information on the issue.


Appendix A:  Survey methodology report

Survey methodology
Earnscliffe Strategy Group’s overall approach for this study was to conduct an online survey of a minimum of 2,800 Canadians aged 13 and older using an online panel sample. A detailed discussion of the approach used to complete this research is presented below.

Questionnaire design
The questionnaire for this study was designed by Earnscliffe, in collaboration with Health Canada, and provided for fielding to Leger Marketing.  The survey was offered to respondents in both English and French and completed based on their preferences. All questions were mandatory.

Sample Design and Selection
The sampling plan for the study was designed by Earnscliffe in collaboration with Health Canada, and the sample was drawn by Leger based on Earnscliffe’s instructions. The surveys were completed using Leger’s opt-in online research panel. Digital fingerprinting was used to help ensure that no respondent took the online survey more than once.

A total of 1,003 cases were collected as the sample of the general population. Oversamples were also collected for the following groups:

 

The profile of each of the six oversample groups is presented in the tables 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.  Any respondents found among the oversample of legal opioid users or the oversample of illegal drug users were excluded from total samples among youth 13-15, parents of 13-15, young adults 16-24 and men 30-39, due to their unique skews. 

Youth 13-15 Oversample Parent of Youth 13-15 Oversample Young Adults 16-24 Oversample
Gen pop sample 23 Gen pop sample 60 Gen pop sample 119
Teen oversample 308 Parent oversample 310 Young adult oversample 310
Other oversamples 0 Other oversamples 27 Other oversamples 4
Total 331 Total 397 Total 433
Men 30-39 Oversample Illegal User Oversample Legal User Oversample
Gen pop sample 84 Gen pop sample 138 Gen pop sample 194
Men oversample 300 Illegal user oversample 300 Legal user oversample 302
Other oversamples 11 Other oversamples 232 Other oversamples 230
Total 395 Total 670 Total 726

The final data for the general population and the youth 13-15, young adults 16-24, and men 30-39 oversamples were weighted to replicate actual population distribution by region, age and gender according to the most recent Census (2016) data available. The data for the parent, legal and illegal user oversamples was weighted based on the profile found in the general population, by age, gender and region.

Data Collection
The online survey was conducted in English and French from June 10th to July 3rd, 2019. The survey was undertaken by Leger using their proprietary online panel. For the surveys with respondents under 18, Leger initially screened adults to see whether they were a parent with a child between the ages of 13 and 17.  For those who qualified, we randomly assigned youth or parent interviews to ensure representativeness (rather than filling all youth categories first and then parents).  All necessary and required permissions (including parental/guardian for youth 13-15) were obtained before proceeding with any youth surveys. 

Targets/Weighting
Quotas were used for the general population sample to help ensure that, prior to any additional weighting, minimum numbers of completed surveys by gender, age group and region were achieved. This quota distribution was designed to allow for subsets of the data to be analyzed. Quotas were established on region, age and gender as follows:

Region/province
Atlantic Canada 7.7% 77
Quebec 22.7% 227
Ontario 37.3% 373
Prairies 7.7% 77
Alberta 11.3% 113
British Columbia 13.3% 133
Total 100% 1,000
Age
13-17 6.6% 66
18-34 27.0% 270
35-54 32.7% 327
55+ 33.7% 337
Total 100% 1,000
Gender
Female 50.8% 508
Male 49.2% 492
Total 100% 1,000

The final data for the general population sample was weighted based on 2016 Census information. Weighting was applied based on region, age and gender statistics to help ensure that the final dataset was in proportion to the Canadian population aged 13 and older.

Specific targets with regards to the oversamples were as follows:

 

Quotas by demographics were set for the oversamples of youth 13-15, parents of 13-15 year olds, young adults 16-24 and men 30-39, but were not set for the oversamples of legal or illegal opioid users as the incidence rates are low for these two segments and there was a desire to ensure completions for these oversamples were left to fall out naturally. 

Quality Controls
Leger’s panel is actively monitored for quality through a number of approaches (digital fingerprinting, in-survey quality measures, incentive redemption requirements, etc.) to ensure that responses are only collected from legitimate Canadian panel members.

Results
Final dispositions
A total of 10,112 individuals entered the online survey, of which 2,833 qualified as eligible and completed the survey.  The response rate for this survey was 28%.

Total Entered Survey 10,112
Completed 2,833
Not Qualified/Screen out 1,287
Over quota 5,255
Suspend/Drop-off 737

Nonresponse
Respondents for the online survey were selected from among those who have volunteered to participate in online surveys by joining an online opt-in panel. The notion of nonresponse is more complex than for random probability studies that begin with a sample universe that can, at least theoretically, include the entire population being studied. In such cases, nonresponse can occur at a number of points before being invited to participate in this particular survey, let alone in deciding to answer any particular question within the survey.

That being said, in order to provide some indication of whether the final sample is unduly influenced by a detectable nonresponse bias, the tables below compare the unweighted and weighted distributions of each sample’s demographic characteristics.

All weighting was determined based upon the most recent Census data available from Statistics Canada. The variables used for the weighting of each sample were age and gender within each region for the general population sample.

Genpop 13+ sample profile: unweighted versus weighted distributions

Region Unweighted Sample Weighted Sample
Atlantic 75 68
Quebec 225 234
Ontario 386 386
Manitoba/Saskatchewan 71 66
Alberta 111 113
British Columbia/Territories 135 135

 

Age Unweighted Sample Weighted Sample
13-15 23 34
16-17 25 31
18-34 249 256
35-54 341 320
55+ 365 362

 

Gender Unweighted Sample Weighted Sample
Male 493 484
Female 505 514
Other gender identity/Prefer not to say 5 5
Education Unweighted Sample Weighted Sample
Grade 8 or less 10 12
Some high school/High school diploma 260 269
Apprenticeship/Trade cert/College/CEGEP 279 280
Some/Graduated university (Bachelor’s level) 334 322
Post graduate degree above bachelor’s level 106 105
Prefer not to answer 14 15
Household Income Unweighted Sample Weighted Sample
Under $40,000 239 242
$40,000 to just under $80,000 296 290
$80,000 and above 335 325
Prefer not to answer 110 111
Language Spoken Most Often Unweighted Sample Weighted Sample
English 759 748
French 210 217
Other 24 26
Prefer not to answer 10 11
Ethnicity Unweighted Sample Weighted Sample
Caucasian 777 770
Indigenous 48 55
Black 23 23
Chinese 52 52
Asian (South, Southeast, West) 77 78
Other 55 46
Prefer not to answer 23 23

Margin of error
Respondents for the online survey were selected from among those who have volunteered/registered to participate in online surveys. The data has been weighted to reflect the demographic composition of the Canadian population aged 13 and older. Because the sample is based on those who initially self-selected for participation in the panel, no estimates of sampling error can be calculated. The results of such surveys 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.

Survey duration
The online survey took an average of 16 minutes to complete.

Appendix B:  Focus group methodology report

Methodology

The research program began with an initial qualitative phase which involved ten in-person focus groups with two segments of the Canadian population:  general population (18+) and men aged 30-39.  Two sessions were conducted in each of the following locations across Canada:  Toronto; Halifax; Montreal; Calgary; and, Vancouver.  All groups were 2 hours in length.  The groups in Montreal were conducted in French; all others were conducted in English. 

Schedule and composition of the focus groups

City Group Audience Number of Participants Date/Time
Toronto, ON Group 1 Men 30-39 8 Monday, June 10, 5:30 pm
Group 2 Gen pop (18+) 10 Monday, June 10, 7:30 pm
Halifax, NS Group 1 Men 30-39 10 Tuesday, June 11, 5:30 pm
Group 2 Gen pop (18+) 9 Tuesday, June 11, 7:30 pm
Montreal, QC Group 1 Men 30-39 8 Tuesday, June 11, 5:30 pm
Group 2 Gen pop (18+) 8 Tuesday, June 11, 7:30 pm
Calgary, AB Group 1 Men 30-39 8 Wednesday, June 12, 5:30 pm
Group 2 Gen pop (18+) 8 Wednesday, June 12, 7:30 pm
Vancouver, BC Group 1 Men 30-39 8 Thursday, June 13, 5:30 pm
Group 2 Gen pop (18+) 8 Thursday, June 13, 7:30 pm

Recruitment
Participants were recruited using a five-minute screening questionnaire (included in Appendix D).

The screener contained a series of standard screening questions to ensure participants qualified based on their gender and age (Canadians 18+ and men 30-39), ensuring a good mix of other demographics such as education, household income, ethnicity, etc. 

Our fieldwork subcontractor, Quality Response, relied on panels and databases of Canadians.  This is the approach employed most often.  Quality Response reaches out to members of their database first via email and follows-up with telephone calls to pre-qualify respondents.  We also included a re-screening service in which focus group participants were re-screened onsite upon arrival at the focus group facility to ensure the utmost quality of participants.

Quality Response’s database includes approximately 35,000 Canadians with profiling on a range of attributes including standard personal demographics, household composition, medical background, technology usage, financial services, health and wellness, business profiles, and other relevant criteria.  Their database is constantly being updated and replenished and operates out of their own, onsite telephone room in Toronto, Ontario.  Potential group participants are recruited to their database via mixed-mode:  following a proprietary telephone survey, online, referral, social media and print advertising.  Initial contact is often made via email or online pre-screening for speed and economies, followed up by personal telephone recruitment and pre-group attendance confirmation.

Quality Response understands the nuances of qualitative recruiting and the importance of locating qualified, interested respondents.  Their recruiting is undertaken in strict accordance with the Standards for the Conduct of Government of Canada Public Opinion Research – Qualitative Research.

Reminder calls were made prior to the groups to confirm participants’ intention to attend and to encourage higher rates of participation.  As well, all participants received a cash honorarium of $100 at the end of the group discussion.  This amount is consistent with honorariums for groups of this duration being conducted in major urban centres and is in line with the amount proposed to the federal government for this contract.

A total of 10 participants were recruited for each group.  Upon arrival at the focus group facility, all participants were required to provide photo identification to ensure they were the individual who had been recruited for that particular focus group.  As mentioned earlier, every participant was re-screened upon arrival to ensure they met the screening qualifications, were capable of communicating in the appropriate language of the group, and capable of contributing to the discussion in constructive ways.  We have found that this added verification ensures better quality discussions.

All participants signed a document, prior to conducting the groups, acknowledging their consent to be recorded, for the purposes of review and analysis in preparation of this report.  All groups were digitally recorded, and live online webstreaming was made available for observers to view the groups remotely.

Moderation
We relied on two qualified moderators.  Given the timeline for the project, using two moderators allowed us to conduct all of the focus groups over the course of one week (4 nights).

Both moderators attended the kick-off night of focus groups in Toronto.  This ensured that both were aware of the flow of the focus groups and involved in any conversation about potential changes to the discussion guide or flow of conversation for each subsequent night.

In our experience, there is value in using multiple moderators (within reason) as it ensures that no single moderator develops early conclusions.  Each moderator takes notes and summarizes their groups after each night.  The moderators each provide a debrief on their groups including the functionality of the discussion guide; any issues relating to recruiting, turnout, technology or the facility; and key findings including noting instances where they were unique and where they were similar to previous sessions. Together, they discuss the findings both on an ongoing basis in order to allow for probing of areas that require further investigation in subsequent groups and before the final results are reported.

A note about interpreting qualitative research results
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.  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.

Appendix C:  Discussion guide  

 

Introduction: 10 minutes

Moderator introduces herself/himself and her/his role:  role of moderator is to ask questions, make sure everyone has a chance to express themselves, keep track of the time, be objective/no special interest.

 

[Moderator will go around the table and ask participants to introduce themselves.]

 

Familiarity and awareness of opioids/opioid crisis: 10 minutes

 

[If yes]

 

Understanding of opioids, overdoses and naloxone: 20 minutes

Now I would like to spend a bit of time to get a better understand of your knowledge of opioids.

[If yes]

 

[If yes]

 

[If yes]

 

[If yes]

[For those who have not heard about them]
Supervised consumption sites provide a safe, clean space where people bring their own drugs to consume under supervision. They are staffed by trained staff who can provide basic health services and save lives in case of overdose. They can also act as an entry point to treatment and social services for people who are ready to stop or reduce their use of substances.

 

Awareness of the Good Samaritan Drug Overdose Act: 10 minutes

 

[If yes]

So that we are all on the same page, the Good Samaritan Drug Overdose Act became law in 2017 and provides some legal protection for individuals who seek emergency help (call 911 or your local emergency number) during an overdose. More specifically, the Act protects individuals from being charged with simple possession of a controlled substance(drugs). It covers by-standers who call for help or people experiencing overdose who call for help.  It will protect you if you choose to stay with the victim or leave the scene.  Instances where you are not protected are: outstanding warrants, possessing with intent to distribute, production or trafficking of drugs, other crimes, etc.

 

Views related to stigma/shifting perceptions of people who use drugs: 40 minutes

Now I would like to spend a bit of time discussing your perceptions of people who have substance use disorder (e.g. addiction)

 

Views on chronic pain and chronic pain management: 10 minutes

 

Views regarding alcohol consumption: 15 minutes

For the remainder of our conversation, I would like to focus on alcohol consumption.

[If yes]

Conclusions: 5 minutes

[Moderator to check in the back room and probe on any additional areas of interest]

Appendix D: Recruitment screener

Focus group summary
Group 1 men 20-39 Group 2 general population
  • Male (QS2)
  • Aged 30-39 (QS3)
  • Good mix of demos (age, income, household situation, ethnicity, etc.)
  • Recruit 10 for 8 to show
  • Good mix of demos (gender, age, income, household situation, ethnicity, etc.)
  • Recruit 10 for 8 to show
Toronto Monday, June 10, 2019
Group 1: Men 30-39
Group 2: Gen pop
  Honorarium: $100
5:30 pm
7:30 pm
Halifax Tuesday, June 11, 2019
Group 1: Men 30-39
Group 2: Gen pop
  Honorarium: $100
5:30 pm
7:30 pm
Montreal Tuesday, June 11, 2019
Group 1: Men 30-39
Group 2: Gen pop
  Honorarium: $100
5:30 pm
7:30 pm
Calgary Wednesday, June 12, 2019
Group 1: Men 30-39
Group 2: Gen pop
  Honorarium: $100
5:30 pm
7:30 pm
Vancouver Thursday, June 13, 2019
Group 1: Men 30-39
Group 2: Gen pop
  Honorarium: $100
5:30 pm
7:30 pm
Respondent's name:
Respondent's phone number: (cell)
Respondent's phone number: (work)
Respondent's email:
Sample source: panel random client referral
Interviewer:
Date:
Validated:
Quality Central:
On list:
On quotas:

Hello/Bonjour, my name is _______________ and I'm calling on behalf of the Earnscliffe Strategy Group, a national public opinion research firm. We are organizing a series of discussion groups on issues of importance to Canadians, on behalf of the Government of Canada, specifically for Health Canada. We are looking for people who would be willing to participate in a discussion group that will last up to 2 hours. These people must be 18 years of age or older. Up to 10 participants will be taking part and for their time, participants will receive an honorarium of $100.00. May I continue?

Yes Continue
No Thank and terminate

Participation is voluntary. We are interested in hearing your opinions; no attempt will be made to sell you anything or change your point of view. The format is a 'round table' discussion led by a research professional. All opinions expressed will remain anonymous and views will be grouped together to ensure no particular individual can be identified. But before we invite you to attend, we need to ask you a few questions to ensure that we get a good mix and variety of people. May I ask you a few questions?

Yes Continue
No Thank and terminate

Read to all: "This call may be monitored or audio taped for quality control and evaluation purposes.
Additional clarification if needed:
  • To ensure that I (the interviewer) am reading the questions correctly and collecting your answers accurately;
  • To assess my (the interviewer) work for performance evaluation;
  • To ensure that the questionnaire is accurate/correct (i.e. evaluation of CATI programming and methodology - we're asking the right questions to meet our clients' research requirements - kind of like pre-testing)
  • If the call is audio taped, it is only for the purposes of playback to the interviewer for a performance evaluation immediately after the interview is conducted or it can be used by the Project Manager/client to evaluate the questionnaire if they are unavailable at the time of the interview - all audio tapes are destroyed after the evaluation.

S1. Do you or any member of your household work for…
  Yes No
A public opinion or marketing research firm 1 2
A magazine or newspaper, online or print 1 2
A radio or television station 1 2
A public relations company 1 2
An advertising agency or graphic design firm 1 2
An online media company or as a blog writer 1 2
The government, whether federal, provincial or municipal 1 2
The field of drug treatment 1 2
Law enforcement 1 2
The medical and/or pharmaceutical sector 1 2

[If "yes" to any of the above, thank and terminate.]

S2. [Do not ask] - note gender [grid]

[Group 1 all are male. Group 2 is a mix - aim for 50/50.]

S3. Could you please tell me which of the following age categories you fall in to? Are you... [grid]

[Group 1 all are between the ages of 30-39. Group 2 is a mix of ages. Ensure good mix in all groups.]

S4. Do you normally reside in the [insert city] area?

S5. What is your current employment status? [grid]

S6. Which of the following best describes the industry you primarily work in? [read list] [grid]

Ensure good mix

S7. Which of the following categories best describes your total household income? That is, the total income of all persons in your household combined, before taxes [read list]? [grid]

S8. What is the last level of education that you have completed? [grid]

S9. To make sure that we speak to a diversity of people, could you tell me what is your ethnic background? [Do not read] [grid]

S10. Have you participated in a discussion or focus group before? A discussion group brings together a few people in order to know their opinion about a given subject.

S11. When was the last time you attended a discussion or focus group?

S12. How many of these sessions have you attended in the last five years?

S13. And what was/were the main topic(s) of discussion in those groups?

[If related to opioids, drugs, government policy on drugs, thank and terminate]

S14. Participants in discussion groups are asked to voice their opinions and thoughts. How comfortable are you in voicing your opinions in front of others? Are you… (read list)

S15. Sometimes participants are asked to write out their answers to a questionnaire, read materials or watch TV commercials during the discussion. Is there any reason why you could not participate? [Read if needed: I can assure you that everything written or discussed in the groups will remain confidential.]

[Interviewer note: terminate if respondent offers any reason such as sight or hearing problem, a written or verbal language problem, a concern with not being able to communicate effectively or if you have a concern.]

S16. The discussion group will take place on [date @ time] for 2 hours and participants will receive $100.00 for their time. Would you be willing to attend?

Privacy questions

Now I have a few questions that relate to privacy, your personal information and the research process. We will need your consent on a few issues that enable us to conduct our research. As I run through these questions, please feel free to ask me any questions you would like clarified.

P1) First, we will be providing the hosting facility and session moderator with a list of respondents' names and profiles (screener responses) so that they can sign you into the group. This information will not be shared with the Government of Canada department organizing this research. Do we have your permission to do this? I assure you it will be kept strictly confidential.

P1A) We need to provide the facility hosting the session and the moderator with the names and background of the people attending the focus group because only the individuals invited are allowed in the session and the facility and moderator must have this information for verification purposes. Please be assured that this information will be kept strictly confidential. [Go to P1A]

Now that I've explained this, do I have your permission to provide your name and profile to the facility?

P2) An audio and/or video tape of the group session will be produced for research purposes. The tapes will be used only by the research professional to assist in preparing a report on the research findings and will be destroyed once the report is completed.

Do you agree to be audio and/or videotaped for research purposes only?

P2A) It is necessary for the research process for us to audio/video tape the session as the researcher needs this material to complete the report.

Now that I've explained this, do I have your permission for audio/video taping?

P3) Employees from Health Canada and/or the Government of Canada may be onsite to observe the groups in-person from behind a one-way mirror.

Do you agree to be observed by Government of Canada employees?

P3A) It is standard qualitative procedure to invite clients, in this case, Government of Canada employees, to observe the groups in person. They will be seated in a separate room and observe from behind a one-way mirror. They will be there simply to hear your opinions first hand although they may take their own notes and confer with the moderator on occasion to discuss whether there are any additional questions to ask the group.

Do you agree to be observed by Government of Canada employees?

Invitation

Wonderful, you qualify to participate in one of our discussion sessions. As I mentioned earlier, the group discussion will take place the evening of [Day, Month, Date] @ [Time] for up to 2 hours.

Do you have a pen handy so that I can give you the address where the group will be held? It will be held at:

Toronto Monday, June 10, 2019
CRC Midtown
1867 Yonge St., Suite 200
Toronto, ON M4S 1Y5
T: 416.488.2328
  Honorarium: $100
5:30 pm
7:30 pm
Halifax Tuesday, June 11, 2019
Corporate Research Associates Inc. (CRA)
5001-7071 Bayers Road
Halifax, NS B3L 4V2
T: 902.453.0344
  Honorarium: $100
5:30 pm
7:30 pm
Montreal Tuesday, June 11, 2019
MBA Recherche
1470 Peel Street, Suite 800
Montreal, QC H3A 1T1
T: 514.284.9644
  Honorarium: $100
5:30 pm
7:30 pm
Calgary Wednesday, June 12, 2019
Qualitative Coordination
707 10th Avenue SW, Suite 120
Calgary, AB T2R 0B3
T: 403.229.3500
  Honorarium: $100
5:30 pm
7:30 pm
Vancouver Thursday, June 13, 2019
Vancouver Focus
503-1080 Howe Street
Vancouver, BC V6Z 2T1
T: 604.682.4292
  Honorarium: $100
5:30 pm
7:30 pm

We ask that you arrive fifteen minutes early to be sure you find parking, locate the facility and have time to check-in with the hosts. The hosts may be checking respondents' identification prior to the group, so please be sure to bring some personal identification with you (for example, a health card, a student card, or a driver's license). If you require glasses for reading make sure you bring them with you as well.

As we are only inviting a small number of people, your participation is very important to us. If for some reason you are unable to attend, please call us so that we may get someone to replace you. You can reach us at [insert phone number] at our office. Please ask for [name]. Someone will call you in the days leading up to the discussion to remind you.

So that we can call you to remind you about the discussion group or contact you should there be any changes, can you please confirm your name and contact information for me?

First name:
Last Name:
email:
Daytime phone number:
Evening phone number:

[If the respondent refuses to give his/her first or last name or phone number please assure them that this information will be kept strictly confidential in accordance with the privacy law and that it is used strictly to contact them to confirm their attendance and to inform them of any changes to the discussion group. If they still refuse thank & terminate.]

Appendix E: Survey instrument

Landing page

Thank you for agreeing to take part in this short survey on opioids. We anticipate that the survey will take approximately 15 minutes to complete.
[Next]

Intro page all respondents

Background information
This research is being conducted by Earnscliffe Strategy Group, a Canadian public opinion research firm on behalf of Health Canada.

The purpose of this online survey is to collect opinions and feedback from Canadians that will be used by Health Canada to help inform government actions and decisions regarding opioids.

13-15 year-old teens only (13-15): Your parent or legal guardian has given permission for you to participate in this very important study. Your participation is voluntary, so it is up for you to decide whether you are willing to answer, but we hope you do! Your responses are confidential and will only ever be reported in aggregate - never in any way that can identify any individual respondent or their responses. You can do the survey on your computer, laptop, tablet or phone. You can stop at any time, or just choose not to respond to any question. To protect your privacy, you will not be able to go back to previous pages for some questions and once you complete the questionnaire, it is locked. Your answers will not be shown to your parent(s), legal guardian(s), teachers or anyone else, so please be as honest as you can.

16-17 year-old teens only (16-17): Your parent or legal guardian has agreed to let us invite you to participate in this very important study. Your participation is voluntary, so it is up to you to decide whether you are willing to answer, but we hope you do! Your responses are confidential and will only ever be reported in aggregate - never in any way that can identify any individual respondent or their responses. You can do the survey on your computer, laptop, tablet or phone. You can stop at any time if you feel uncomfortable, or just choose not to respond to any question. To protect your privacy, you will not be able to go back to previous pages for some questions and once you complete the questionnaire, it is locked. Your answers will not be shown to your parent(s), legal guardian(s), teachers or anyone else, so please be as honest as you can.

How does the online survey work?

What about your personal information?

What happens after the online survey?
The final report written by Earnscliffe Strategy Group will be available to the public from Library and Archives Canada.

If you have any questions about the survey, you may contact Earnscliffe Strategy Group at info@earnscliffe.ca.

Your help is greatly appreciated, and we look forward to receiving your feedback.

[Continue]

If selected for youth interview: Parent page consent

We would like to include your teenager in this very important study and are asking your permission to include them in our sample.

Background information
This research is being conducted by Earnscliffe Strategy Group, a Canadian public opinion research firm on behalf of Health Canada.

The purpose of this online survey is to collect opinions and feedback from Canadians that will be used by Health Canada to assess the knowledge, attitudes and behaviours of Canadians when it comes to opioids. The goal is to obtain the most unbiased and candid answers possible to help inform government actions and decisions regarding opioids.

How does the online survey work?

What about your child's personal information?

What happens after the online survey?
The final report written by Earnscliffe Strategy Group will be available to the public from Library and Archives Canada.

If you have any questions about the survey, you may contact Earnscliffe Strategy Group at info@earnscliffe.ca.

Your assistance is greatly appreciated, and we look forward to receiving your feedback.

Programming notes:
Section titles should not appear on screen for respondents.
Do not present question numbers on screen for respondents.
Include a progress bar.
All questions are mandatory but include a don't know and/or a prefer not to answer option.

Section 1: Adult Screening

1. What gender do you identify with?

In what year were you born?

[insert year]

Which of the following provinces or territories do you live in?

Are you a parent or legal guardian of a child that is under 18 years old?

Section 2: Youth Screening (13-15 or genpop 16-17)

What gender do you identify with?

In what year were you born?

[insert year]

Which of the following provinces or territories do you live in?

Section 3: Drug Use Screening

The first questions are about what drugs or medicines you may have taken in the past year.

Have you taken any of the following?
Generic name Trade name (examples) Street names
Buprenorphine BuTrans® Bupe, bute, subs, tems
Buprenorphine-naloxone Suboxone® Subby, bupe, sobos
Codeine Tylenol®2,3,4 (codeine, acetaminophen) Cody, captain cody, T1, T2, T3, T4
Fentanyl Abstral®, Duragesic®, Onsolis® Patch, sticky, sticker, Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, Tango and Cash
Heroin Diaphin Smack, H, brown sugar, junk, skag, horse
Hydrocodone Tussionex®, Vicoprofen® Hydro, Vike
Hydromorphone Dilaudid® Juice, dillies, dust
Meperidine Demerol® Demmies
Methadone Methadose®, Metadol® drink done, metho, jungle juice, dolls, wafers
Morphine Doloral®, Statex®, M.O.S.® M, morph, red rockets
Oxycodone OxyNEO®, Percocet®, Oxycocet®, Percodan® Oxy, hillbilly heroin, percs
Pentazocine Talwin© Ts, Ts & Cs
Tapentadol Nycynta® Unknown
Tramadol Ultram®, Tramacet®, Tridural®, Durela® Chill pills, ultras

[if Q8=1 (opioid users), ask Q9]

When you took any of these drugs or medicines in the past year, did you ?

Not Applicable / Have never asked for this 0

Have you taken any of the following? [randomize]

[illegal drug user: Q9=2 thru 5 or Q11a=1 or Q11b=1 or Q11c=1 or 11d=1.]

Section 4: Awareness, impressions and basic understanding

Which of these best describes your level of understanding about what an opioid is?

Opioids are medicines and/or drugs generally used to manage pain. They relieve pain by acting on specific nerve cells of the spinal cord and brain. Opioids are also used to control moderate to severe cough, control diarrhea, and treat opioid use disorder.

For the purposes of this survey, opioids refers to any of the following:
Generic name Trade name (examples) Street names
Buprenorphine BuTrans® Bupe, bute, subs, tems
Buprenorphine-naloxone Suboxone® Subby, bupe, sobos
Codeine Tylenol®2, 3,4 (codeine, acetaminophen) Cody, captain cody, T1, T2, T3, T4
Fentanyl Abstral®, Duragesic®, Onsolis® Patch, sticky, sticker, Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, Tango and Cash
Heroin Diaphin Smack, H, brown sugar, junk, skag, horse
Hydrocodone Tussionex®, Vicoprofen® Hydro, Vike
Hydromorphone Dilaudid® Juice, dillies, dust
Meperidine Demerol® Demmies
Methadone Methadose®, Metadol® drink done, metho, jungle juice, dolls, wafers
Morphine Doloral®, Statex®, M.O.S.® M, morph, red rockets
Oxycodone OxyNEO®, Percocet®, Oxycocet®, Percodan® Oxy, hillbilly heroin, percs
Pentazocine Talwin© Ts, Ts & Cs
Tapentadol Nycynta® Unknown
Tramadol Ultram®, Tramacet®, Tridural®, Durela® Chill pills, ultras

How familiar are you with these types of opioids?

In thinking about the types of opioids included in this list, is it your impression that…

Based on your impressions, how dangerous would you say opioids are for each of the following? [randomize]

When you hear the term, "illegal opioids" which, if any, of the following do you think it means? [check all that apply]

How aware would you say you are of Canada's opioid crisis?

Based on your impressions, how serious would you say the opioid crisis is in your community?

How familiar would you say you are with fentanyl?

[If Q19>1] To the best of your knowledge, how dangerous is fentanyl?

[If Q19>1] To the best of your knowledge, for those who use an illegal non-opioid drug like methamphetamine or cocaine, how much of a risk is there that the drug might be laced with an opioid like fentanyl?

Section 5: Attitudes relating to behaviours, risk and harms

Please indicate how strongly you agree or disagree with each of the following statements. [randomize]

How concerned are you about the risk to teens who are using opioid medication as prescribed?

How concerned are you about the risk to teens who are using prescription opioids without a prescription?

Section 6: Attitudes regarding stigma

Please indicate how strongly you agree or disagree with each of the following statements. [Randomize, separate into 2 blocs]

Section 7: Risk behaviour profiling

Generic name Trade name (examples) Street names
Buprenorphine BuTrans® Bupe, bute, subs, tems
Buprenorphine-naloxone Suboxone® Subby, bupe, sobos
Codeine Tylenol®2,3,4 (codeine, acetaminophen) Cody, captain cody, T1, T2, T3, T4
Fentanyl Abstral®, Duragesic®, Onsolis® Patch, sticky, sticker, Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, Tango and Cash
Heroin Diaphin Smack, H, brown sugar, junk, skag, horse
Hydrocodone Tussionex®, Vicoprofen® Hydro, Vike
Hydromorphone Dilaudid® Juice, dillies, dust
Meperidine Demerol® Demmies
Methadone Methadose®, Metadol® drink done, metho, jungle juice, dolls, wafers
Morphine Doloral®, Statex®, M.O.S.® M, morph, red rockets
Oxycodone OxyNEO®, Percocet®, Oxycocet®, Percodan® Oxy, hillbilly heroin, percs
Pentazocine Talwin© Ts
Tapentadol Nycynta® Unknown
Tramadol Ultram®, Tramacet®, Tridural®, Durela® Chill pills, ultras

Please indicate whether any of the following are true, to the best of your knowledge or recollection. [randomize]

Opioid users section
Generic name Trade name (examples) Street names
Buprenorphine BuTrans® Bupe, bute, subs, tems
Buprenorphine-naloxone Suboxone® Subby, bupe, sobos
Codeine Tylenol®2,3,4 (codeine, acetaminophen) Cody, captain cody, T1, T2, T3, T4
Fentanyl Abstral®, Duragesic®, Onsolis® Patch, sticky, sticker, Apache, China girl, China white, dance fever, friend, goodfella, jackpot, murder 8, TNT, Tango and Cash
Heroin Diaphin Smack, H, brown sugar, junk, skag, horse
Hydrocodone Tussionex®, Vicoprofen® Hydro, Vike
Hydromorphone Dilaudid® Juice, dillies, dust
Meperidine Demerol® Demmies
Methadone Methadose®, Metadol® drink done, metho, jungle juice, dolls, wafers
Morphine Doloral®, Statex®, M.O.S.® M, morph, red rockets
Oxycodone OxyNEO®, Percocet®, Oxycocet®, Percodan® Oxy, hillbilly heroin, percs
Pentazocine Talwin© Ts, Ts & Cs
Tapentadol Nycynta® Unknown
Tramadol Ultram®, Tramacet®, Tridural®, Durela® Chill pills, ultras

[If opioid user or past opioid user] You previously indicated that you have taken at least one of the opioids on this list. Of the opioid(s) you have ever taken, how often were they prescribed for you personally?

[If Q27>1 (Rarely, Sometimes, Usually, Always)] When you had opioids prescribed to you, would you say you stored them….?

[If Q27>1 (Rarely, Sometimes, Usually, Always)] When you had opioids prescribed to you, what did you do with leftover pills/patches/liquids? Check all that apply

[If Q27<5 (Never, Rarely, Sometimes, Usually)] Thinking of the opioids you took that were not prescribed to you, how many times would you say you used them?

[If Q27<5 (Never, Rarely, Sometimes, Usually)] Thinking of the opioids you took that were not prescribed to you, where did you get them? Check all that apply

[If Q27<5 (Never, Rarely, Sometimes, Usually)] When you had opioids that were not prescribed for you, for what reason(s) did you take them? [select all that apply]

[IF Q27<5 (Never, Rarely, Sometimes, Usually)] If you knew that the non-prescribed opioid you were taking contained fentanyl, would you still take any of it?

[If opioid user or past opioid user] Have you ever sought treatment for an opioid use disorder (opioid addiction)?

[If Q26f=1 (parent of 13-15 year-old legal opioid user)] You indicated that you have a teenager who has been prescribed an opioid in the past year. To the best of your knowledge, has your teen been taking his or her opioid medication as prescribed?

[If Q26f>1 (parent of 13-15 year-old who has not been prescribed opioid in the past year)] To the best of your knowledge, has your teen ever been prescribed an opioid?

[If parent of teen 13-15] And to the best of your knowledge, has your teen ever tried an opioid that had not been prescribed for them?

[If 13-15 year-old teen] When people your age get opioids without a real prescription, where do you think they are getting them? Check all that apply

Section 8: Opioid Information

[If parent of teen 13-15] Among the following topics, which ones have you discussed with your teenage child/children, if any? Check all that apply. [randomize]

[If 13-15 year-old teen] Among the following topics, which ones have you already had a discussion with one of your parents about, if any? Check all that apply. [randomize]

Section 9: Alcohol

Switching topics, the next few questions are about alcohol.

How familiar would you say you are with Canada's Low-Risk Alcohol Drinking Guidelines?

Canada's Low-Risk Alcohol Drinking Guidelines provide advice on how many standard servings of alcoholic beverages per week is considered "low-risk alcohol drinking." For each of the following, please indicate how many standard servings per week you think would qualify as "low-risk alcohol drinking." [Randomize order, open-end numeric response.]

Of the following list of possibilities, which information, if any, should appear on alcoholic beverage labelling? [Randomize order. Select all that apply.]

Ingredients
Calories
Nutritional information
Health risks/warnings
Number of standard servings that are in the container
Don't Know/Prefer not to answer

Please indicate how strongly you agree or disagree with each of the following statements. [randomize]

Section 10: Demographics

The last few questions are strictly for statistical purposes. All of your answers are completely confidential.

What is the language you speak most often at home?

Are you an Indigenous person, that is, First Nations (North American Indian), Métis or Inuk (Inuit)?

[If Q48=2 or 9] Are you…? [select up to three]

What is the highest level of schooling that you have completed?

[If> 15 years of age] Which of the following categories best describes your total household income for 2018? That is, the total income of all persons in your household combined, before taxes?

What are the first three digits of your postal code?

[Insert first three digits of postal code. Format A1A]
Prefer not to answer 9

[Pre-test only add questions A thru J]

This concludes the survey. Thank you for your participation!

If the survey makes you feel like you would talk to someone about this topic, find out how you can get help near you.

Looking for help specifically for teens? Visit https://kidshelpphone.ca/.