Baseline Survey on Opioid Awareness, Knowledge and Behaviours for Public Education - Research Report

Prepared for: Health Canada
Communications and Public Affairs Branch (CPAB)
Contract Number: HT372-17-3100/001/CY
POR Number: POR 016-17
Contract Award Date: August 9, 2017
Date of Delivery: December 15, 2017

Contact Information: hc.cpab.por-rop.dgcap.sc@canada.ca

Ce rapport est aussi disponible en français.

Contents

• Executive Summary
• Introduction
• Detailed Findings
• Conclusions
• Recommendations
• Appendix A - Survey Methodology Report
• Appendix B - Survey Instrument

Executive Summary

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of a quantitative research study to understand Canadians’ awareness and knowledge of, as well as behaviours relating to opioids.

Health Canada is running a public awareness campaign to help prevent opioid overdoses and related deaths; reduce harm related to the problematic use of opioids, including opioid use disorder, overdose and death; and, help understand and address stigma related to problematic opioid drug use, problematic substance use disorder (also referred to as addiction) and deaths. 

This study was undertaken to help inform Health Canada’s public awareness campaign. Feedback from the research will provide a baseline for the proposed campaign; help identify and build audience profiles; and, help further shape the proposed campaign messaging.  More specifically, the results will be used to inform the development of the campaign, including:

• Developing a better and more comprehensive understanding of Canadians’ perceptions of the issue;
• Identifying knowledge gaps and misperceptions related to opioids, the misuse of opioids (both legal and illegal versions), problematic substance use disorder, opioid overdose and related deaths;
• Identifying and building profiles for target audiences;
• Developing messaging that is meaningful and will resonate with target audiences; and,
• Establishing a baseline to report on and measure performance (over time).

The main objective of the research was to establish a baseline of the general population’s (13+) current state of awareness, knowledge, attitudes, beliefs and behaviours with respect to opioids. The specific objectives of the research included, but were not limited to:

• Assess Canadians’ level of awareness and knowledge around the issue of opioids, including their misuse, overdoses and deaths;
• Seek a better understanding of Canadians’ views and understanding on this issue (including stigma related to opioid use, problematic substance use disorder and being a user of opioids or other drugs);
• Seek a better understanding of how Canadians have been affected by the opioid crisis;
• Gather what types of information Canadians need and are looking for as it relates to opioids; and,
• Gather information on the channels Canadians use and prefer for opioid-related information and for finding this type of information.

The total contract value of this research was $99,690.86, including HST.

In order to achieve all of these objectives, Earnscliffe conducted an online survey in collaboration with the quantitative sub-contractor, Nielsen Opinion Quest (Nielsen). The online survey was conducted using Nielsen’s proprietary panel and consisted of a sample of 2,556 Canadian residents aged 13 and older.  A total of 1,330 cases were collected as the sample of the general population. Oversamples were also collected, achieving the following sample sizes in each of the four audiences below:

• Youth (13-15) (n=357)
• Parents or caregivers of youth (13-15) (n=389)
• People who used legal drugs in the form of prescribed opioids at some point in the past year (n=596)
• People who used illegal drugs, either counterfeit prescriptions or other drugs, that could be laced with opioids, at some point in the past year (n=489)

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 four target audiences.

Sample sources for the four target audiences

Surveys were conducted between October 18 and November 15, 2017 in English and French. The online survey took an average of 12 minutes to complete, though for some oversamples the survey took an average of 15 minutes.

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 for online surveys.

The final data for the general population and teen oversample 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 sample, by age, gender and region. The key findings from the research are presented below.

Opioid and Illicit Drug Use

• Two in ten (22%) report having taken opioids at some point in the past year, while an additional 20% report having taken them, but not in the past year.
• Among those who have taken opioids in the past year, the majority (66%) report always having had a prescription.  In total, 31% took opioids without a prescription.
• Fewer reported taking illicit drugs in the past year (5%).

Opioid Awareness and Knowledge

• Respondents reported being knowledgeable about opioids and were aware of Canada’s opioid crisis, but teens’ knowledge of the topic was less extensive. Almost two thirds (63%) say they are pretty sure or certain they know what an opioid is without being provided a definition, a number that falls to 30% among teens.
• There are differences between parents, teens, legal and illegal users in terms of the perceived danger of opioids.  While less than half of Canadians (45%) feel all opioids are dangerous, parents are more likely to hold this view (55%) whereas teens (44%) and illegal users (30%) are less convinced.
• There is less familiarity with fentanyl, but most with any familiarity feel it is very dangerous.  
• For the vast majority across all groups, “illegal opioids” means opioids obtained on the street, while for well over half of respondents other than teens, it also conjures up the notion of prescription opioids not prescribed to the user.

Attitudes Relating to Behaviours, Risk and Harm

• Respondents, particularly teens, are concerned about the effect of opioids on them, their friends and their family.
• Respondents do not necessarily feel they are well equipped to help others deal with opioid related issues, though those who currently use drugs feel better able to identify signs of problematic substance use disorder or overdose.
• Regardless of the audience in question, respondents seem confident that they could manage their own interactions with opioids responsibly. Across all oversample groups, over 70% would ask their doctor for further information if prescribed an opioid and over 50% feel they understand what makes opioids so dangerous.

Attitudes Regarding Stigma

• The majority of respondents agree that the opioid crisis is a public health issue, and that people living with opioid use disorder deserve help. A majority also agrees that problematic substance use disorder is a disease, that opioids are overprescribed in Canada, and that we should be using more resources to address the issue.
• Respondents do not have a negative attitude towards opioid users, but it is not overwhelmingly positive either. For example, when asked if they would characterize people who get opioids illegally as good people, the plurality were neutral.
• The major differences in experience, attitudes and stigma surrounding opioids lie in the teen and illegal user groups. Teens’ understanding is slightly different than the general population’s – they are less understanding of individuals with opioid use disorder, and almost half agree a lack of self-control causes problematic substance use disorder, compared to just over 40% of illegal users, and one third of the general population. Illegal users are the most likely of all oversample groups to know someone who has suffered from problematic substance use disorder, overdosed or died, and are less comfortable about disclosing opioid use or seeking help, relative to the general population.

Prescription and Non-Prescription Use

• Expanding the definition of opioid user to include those who have taken an opioid other than in the past year alone, the proportion who have only ever taken opioids with a prescription drops dramatically.  Only a third (34%) say it was always with a prescription. This is contrasted with the 66% of current year users who report always having a prescription.
• The most common way of obtaining opioids illegally was from a friend or relative with a prescription, and the most common reason for taking them was pain relief. When teens were asked where they thought people their age get illegal opioids, the most common source was a drug dealer or other stranger.
• Almost two in three in the general population sample (64%) definitely would not have taken the opioid that was not prescribed to them if they knew it contained fentanyl. However, slightly fewer illegal users (58%) would definitely avoid an illegal opioid that they knew contained fentanyl.
• Illegals users (8%) are twice as likely as legal users (4%) to claim to have sought treatment for an opioid use disorder.
• Parents for the most part report that their children are taking opioids as prescribed, but one in five (19%) feel this is not the case.

Trust in Information Sources and Conversations about Opioids

• The most trusted sources of information are parents (for 13-15 year olds), doctors and pharmacists. News outlets and current opioid users, as well as family members, regardless of whether or not they have taken opioids, are among the least trusted.
• Nearly all parents (77%) report having talked to their children about drug use in general, though fewer teens 13-15 (72%) recall having had some sort of conversation.

The Role of Stigma

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.

• Allies 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 (68%) or used opioids without a prescription (25%).
• In terms of their ability to handle an opioid overdose or problematic substance use disorder should they happen to come across one or the other, the relative exposure and experience demonstrated by the Allies does not appear to make them feel any more confident than the Unsympathetic.
• Those who are Unsympathetic are the most likely to feel that problematic substance use disorder stems from issues of self-control.
• Allies are more trusting of most information sources. Of note, there is an over 20% spread between trust in federal and provincial government – 72% of Allies trust the Government of Canada to provide information about opioid use, compared to 56% of the Ambivalent segment, and 50% of the Unsympathetic segment.

Political Neutrality Statement

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 Policy on Communications and Federal Identity 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: December 15, 2017

Doug Anderson
Principal, Earnscliffe

Introduction

Earnscliffe Strategy Group (Earnscliffe) is pleased to present this report to Health Canada summarizing the results of a quantitative research study to understand Canadians’ awareness and knowledge of, as well as behaviour relating to opioids.

Health Canada is running a public awareness campaign to help prevent opioid overdoses and related deaths; reduce harm related to the problematic use of opioids, including opioid use disorder, overdose and death; and, help understand and address stigma related to problematic opioid drug use, problematic substance use disorder (also referred to as addiction) and deaths. 

This study was undertaken to help inform Health Canada’s public awareness campaign. Feedback from the research will provide a baseline for the proposed campaign; help identify and build audience profiles; and, help further shape the proposed campaign messaging.  More specifically, the results will be used to inform the development of the campaign, including:

• Developing a better and more comprehensive understanding of Canadians’ perceptions of the issue;
• Identifying knowledge gaps and misperceptions related to opioids, the misuse of opioids (both legal and illegal versions), problematic substance use disorder, opioid overdose and related deaths;
• Identifying and building profiles for target audiences;
• Developing messaging that is meaningful and will resonate with target audiences; and,
• Establishing a baseline to report on and measure performance (over time).

The main objective of the research was to establish a baseline of the general population’s (13+) current state of awareness, knowledge, attitudes, beliefs and behaviours with respect to opioids. The specific objectives of the research included, but were not limited to:

• Assess Canadians’ level of awareness and knowledge around the issue of opioids, including their misuse, overdoses and deaths;
• Seek a better understanding of Canadians’ views and understanding on this issue (including stigma related to opioid use, problematic substance use disorder and being a user of opioids or other drugs);
• Seek a better understanding of how Canadians have been affected by the opioid crisis;
• Gather what types of information Canadians need and are looking for as it relates to opioids; and,
• Gather information on the channels Canadians use and prefer for opioid-related information and for finding this type of information.

In order to achieve all of these objectives, Earnscliffe conducted an online survey in collaboration with the quantitative sub-contractor, Nielsen Opinion Quest (Nielsen). The online survey was conducted using Nielsen’s proprietary panel and consisted of a sample of 2,556 Canadian residents aged 13 and older.  A total of 1,314 cases were collected as the sample of the general population. Oversamples were also collected, achieving the following sample sizes in each of the four audiences below:

• Youth (13-15) (n=357)
• Parents or caregivers of youth (13-15) (n=389)
• People who used legal drugs in the form of prescribed opioids at some point in the past year (n=596)
• People who used illegal drugs, either counterfeit prescriptions or other drugs, that could be laced with opioids, at some point in the past year (n=489)

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 four target audiences.

Sample sources for the four target audiences

Surveys were conducted between October 18 and November 15, 2017 in English and French. The online survey took an average of 12 minutes to complete, though for some oversamples the survey took an average of 15 minutes.

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 for online surveys.

The final data for the general population and teen oversample 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 sample, by age, gender and region.

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

This study consisted of an online panel survey. This quantitative report is divided into four sections:

• Opioids and illicit drug use;
• Opioids awareness and knowledge;
• Attitudes relating to behaviour, risk and harm;  
• Attitudes regarding stigma;
• Prescription and non-prescription use;
• Trust in information sources and conversations about opioids; and
• The role of stigma.  

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.

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.

In the past year, 22% of respondents have taken opioids. An additional 20% have taken them, but not in the past year. Among those who have taken opioids this year, 66% report always having had a prescription. The same percentage of parents report always having a prescription, while among illegal drug users just 12% have one. Of note, while fewer teens report having taken opioids in the past year (10%) a smaller percentage (37%) report having had a prescription. Opioid use was highest in Alberta (28%) and lowest in the Prairies (16%). In contrast, opioid users in Atlantic Canada were most likely to report always having a prescription (82%) while those in Quebec (59%) those with a household income of less than $40,000/year (55%), and those who know someone who became addicted to opioids (58%) were the least likely to have had a prescription.

Fewer respondents from the general population sample (5%) have taken illicit drugs in the past year. This number is slightly higher for parents (8%), legal users (8%), and much higher for illegal drug users (45%) (Note: Illegal drug users included users of illicit drugs as well as those who used an opioid without a prescription at least once in the past year). Among those most likely to have used illicit drugs in the past year were people ages 18-34 (11%).  

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 have a prescription…?

Opioid Awareness and Knowledge

Overall, respondents report being knowledgeable about opioids. Without being provided a definition, 63% say they are pretty sure or certain they know what an opioid is. That number falls to 30% among teens. Respondents who had completed post-graduate studies are among the most confident they knew what opioids are (76%).

When provided with a definition, 62% of the general population sample claims to be very or somewhat familiar with at least one of the opioids listed. This proportion is higher among legal users (85%) and illegal users (79%). Across the country’s regions, the highest proportion of people who are at least somewhat familiar with one of the drugs listed is in Atlantic Canada (70%) compared with Quebec (56%). A similar proportion of respondents whose household income is over $80,000 per year (70%) report the same level of familiarity.

Exhibit A5: Q11. Which of the following best describes your understanding of what an opioid is?

Exhibit A6: Q12. How familiar are you with these types of opioids?

Overall, respondents agree that most opioids are dangerous. Forty-five percent of the general population sample believe all opioids listed are dangerous, while an additional 35% say most are dangerous. Parents are more likely to believe all opioids are dangerous (55%), while teens (44%) and illegal users (30%) are less likely. Respondents in the Prairies (58%) are among the most likely to believe that all opioids are dangerous, while those in BC are the least likely (39%).

Almost all respondents feel that opioids are at least somewhat dangerous for people using opioids illegally (either obtained on the street or through someone else’s prescription), illicit drug users and teens. The majority also feel that opioids are very dangerous for seniors and young adults. Among the Gen Pop sample, 70% feel opioids present a danger to themselves. A smaller proportion of legal users (56%), illegal users (62%) and those ages 18-34 (63%) feel the same way.

While just over half of the general population sample (52%) feel opioids are dangerous even to those who use them as prescribed, under half (42%) of legal users feel opioids are a danger to those who are using them as prescribed. Even fewer Quebeckers (39%) feel the same. Non-users (58%) are more likely to perceive prescription opioids as dangerous for those to whom they are prescribed, as are those who are aware of the opioid crisis (55%) and those who believe it is a serious issue in their community (57%).

For the vast majority across all groups, “illegal opioids” means opioids obtained on the street, while for well over half of respondents other than teens, the term also conjures up the notion of prescription opioids not prescribed to the user.

Almost three-quarters of the general population (73%) are at least somewhat familiar with the opioids crisis, and two thirds (65%) feel it is a serious issue in their community. Teens are less aware (50%) of the crisis, also slightly less likely to describe it as a very serious issue in their community (17% of teens versus 29% among the general population). Awareness of the opioid crisis is highest in BC (44% are very aware) and Alberta (37% are very aware) compared with 16% of Quebeckers and 19% of those in Manitoba and Saskatchewan who say they are very aware. Respondents in these two provinces are also the most likely to rate the opioid crisis as very serious in their community – 52% of BC respondents, and 35% of Alberta respondents. Almost half of respondents who know someone who has become addicted to opioids (47%) also report being very aware of the opioid crisis, and 42% feel the crisis is very serious in their community.

Respondents are less familiar with fentanyl. Just under half (48%) report being at least somewhat familiar with the drug. However, those who are familiar with fentanyl believe it is very dangerous. Familiarity with fentanyl is highest in the Prairies, Alberta and in BC. Over half in both Manitoba/Saskatchewan (56%) and Alberta (55%) are at least somewhat familiar, while 64% report being at least somewhat familiar in BC. Familiarity with fentanyl is lowest in Quebec – just 7% report being very familiar, while 26% are somewhat familiar. Those who know someone who has suffered from opioid use disorder are more familiar with fentanyl (65%).

Exhibit A10: Q23. How aware are you of Canada’s opioid crisis?

Exhibit A11: Q24. Based on your impressions, how serious would you say the opioid crisis is in your community?

Attitudes Relating to Behaviours, Risk, and Harm

Respondents, particularly teens, are concerned about the effect of opioids on them, their friends, and their family. While 42% of the general population sample is concerned that they might become addicted if prescribed opioids, a larger percentage of teens (47%) and those over 55 (48%) worry about the same thing. Legal users were less likely to worry they would become addicted (31%).

Half of the general population sample (50%) worries that opioids might harm the people they care about. In comparison, 58% of teens worry about the same thing. Those who know someone who has become addicted to opioids, and those who think the opioid crisis is a public health issue tend to be more concerned that opioids might harm the people they care about (57% compared to 35% among those who do not feel the crisis is public health issue).

While there is not a widespread sense that following a prescription means it is difficult to become addicted, at 26%, teens are more likely than all others to believe this is the case, followed by those 18-34 (25%). Quebeckers are also more likely, compared to the other provinces and regions, to believe it is difficult to become addicted if you are following a prescription (29%).

The majority (64%) feel they know why opioids are dangerous and would get more information from their doctor if prescribed (77%), but nearly half (42%) still agree they worry about the possibility of becoming addicted themselves if prescribed an opioid. Of note, a larger percentage of those with an annual household income greater than $80,000 report understanding what makes opioids dangerous (69%) compared to those whose household income is under $40,000 (57%).

Confidence in helping others deal with problematic substance use disorder or overdose is lower, particularly among teens. One-third of the general population (33%) feel they could identify signs of a problematic substance use disorder compared to 27% of teens, and 29% of the general population could identify signs of an overdose, compared to 22% of teens. Usage does not appear to greatly influence one’s confidence in handling these situations as both numbers were only slightly higher among legal and illegal users. A similar percentage (26%) say they would know what to do if they saw someone experiencing an overdose. However, confidence does vary between age categories – those 18-34 are more confident that they would be able to identify signs of opioid use disorder (42% versus 32% of those 35-54 and 26% of those 55 and over) and signs of an opioid overdose (36% versus 29% of those 35-54 and 24% of those 55 and over).

Respondents are more concerned about teen opioid use without a prescription (93% of the general population are at least somewhat concerned) than prescription use (76%). Of note, while concern is still strong, teens themselves are less likely to be concerned about both prescription (61%) and non-prescription use (81%).

Attitudes Regarding Stigma

The majority of respondents agree that the opioid crisis is a public health issue, and that people living with opioid use disorder deserve help. A majority also agree that opioid problematic substance use disorder is a disease, that opioids are overprescribed in Canada, and that we should be using more resources to address the issue. Those age 55 and over appear to be the most enthusiastic about additional support for those living with opioid use disorder. For example, 82% agree that those who are addicted to opioids deserve the help they need to lead a healthy lifestyle. Well over half (61%) support using more resources to deal with opioid use disorder, compared to 53% of those 18-34 and 50% of those ages 35-54.

Over half (58%) of the general population sample have known someone who has used opioids and/or been addicted to opioids and/or had a health crisis due to opioids. Most of this knowledge is simply knowing a family member or friend who has been prescribed an opioid. One in four (24%) claim to know someone who became addicted to opioids. Regionally, there is little difference when it comes to knowing someone who had a non-fatal overdose. However, respondents from BC are the most likely to know someone who has died from an opioid overdose – 18%. Respondents in BC and Atlantic Canada are also most likely to know someone who became addicted to opioids – 30% and 32% respectively say they know someone.

Respondents do not have a negative attitude towards opioid users, but it is not overwhelmingly positive either. For example, when asked if they would characterize people who obtain opioids on the street as good people, a large plurality was neutral (48%). While 41% have sympathy for people using opioids, 27% do not.

The teen and illegal user groups show major differences in attitudes and stigma surrounding opioids. In particular, teens’ understanding of the issue is slightly different than the rest. For example, they appear to be slightly less understanding of individuals with opioid use disorder. Almost half (45%) agree that a lack of self-control is what causes problematic substance use disorder, whereas one third of the general population hold that view. Almost one third of teens (32%) do not have much sympathy for people who misuse opioids, and they are more likely to think people who are addicted could stop if they really wanted to (27%). Fewer teens (36%) report that they know someone who has been prescribed opioids compared to parents (53%), legal users (77%) and illegal users (63%).

Illegal drug users appear to be slightly less comfortable seeking help (57%), and less likely to disclose opioid use, whether legal or illegal. Of note, they are still more comfortable seeking help than teens – 57% versus 48%. They are more likely to know someone who has been addicted (40%), overdosed (22%) or died (25%). However, they are not necessarily more sympathetic to those using opioids illegally. Just over 1 in 4 (28%) do not have much sympathy for people who misuse opioids, similar to the general population sample (28%). Similarly, those who know someone who suffered from opioid use disorder are more supportive of additional health care resources for dealing with opioid problematic substance use disorder (64%) and think opioids are overprescribed in Canada (67%), but are not necessarily more understanding of people who misuse opioids. In fact, a larger proportion of this group (23%) than found in the general population sample think people who are addicted to opioids could stop using them if they really wanted to.

There are also notable differences between men and women on attitudes towards opioid-related issues. Women are more sympathetic towards opioid users - 82% think people who are addicted to opioids deserve the help they need to lead a healthy lifestyle, versus 72% of men. A larger proportion of women (67%) also believe that opioid problematic substance use disorder is a disease.  Men have less sympathy for people who misuse opioids (33%) than women (22%), and are more likely to believe that problematic substance use disorder could be caused by a lack of self-control (40% of men versus 27% of women agree), and that people who are addicted could stop taking them if they really wanted to (20% of men versus 14% of women agree).  Finally, a larger proportion of men (21%) feel that the opioid crisis is not as serious a public health crisis as SARS or H1N1, relative to women (13%).

Prescription and Non-Prescription Use

Expanding the definition of opioid user to also include those who have taken an opioid other than in the past year alone, the proportion who have only ever taken opioids with a prescription drops dramatically. Only a third (34%) say it was always with a prescription. This is contrasted with the 66% of current year users who report always having a prescription. Just one quarter of parents (25%) and 7% of teens report always having a prescription, though the sample size is small for the latter. Among those who took opioids legally this year, 54% admit that at some time prior to the past year, they did take an opioid without a prescription.

Among those who always, usually, sometimes or rarely have a prescription, just over half (52%) report storing their prescribed opioids in a location that could only be accessed by them. When asked what they did with the leftovers, 37% of both the general population and legal users said they did not have any left; fewer parents (26%) and illegal users (32%) report not having any leftovers. Illegal users are the least likely to say they returned extra opioids to their pharmacy, hospital or doctor (20%), and the most likely to have saved them in case they needed them again (35%).

Among those who did not always have a prescription, very few report using non-prescribed opioids daily. For the most part, the majority of respondents report using them just a few times or once or twice. The most common source of non-prescribed opioids among the general public (38%) and illegal users (47%) alike was a friend or relative’s prescribed opioid. The most common reason for taking them among both groups was pain relief, by a large margin. Almost two in three in the general population sample (64%) definitely would not have taken the opioid that was not prescribed to them if they knew it contained fentanyl. However, slightly fewer illegal users (58%) would definitely avoid an illegal opioid that they knew contained fentanyl. When teens, regardless of whether or not they used opioids, are asked where they think people their age obtain illegal opioids, a drug dealer or stranger is the most popular answer (66%) followed by a relative’s (48%) or friend’s (41%) prescription.

Parents for the most part report that their children are taking opioids as prescribed, but one in five (19%) feel this is not the case. Very few parents (4%) think their teen has ever tried an opioid that was not prescribed to them.

Illegals users (8%) are twice as likely as legal users (4%) to claim to have sought treatment for an opioid use disorder.

Exhibit A19: Q64. [CURRENT AND PAST OPIOID USERS, IN REFERENCE TO THE OPIOID REFERENCE TABLE] 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?

*Denotes sample size too small to reliably analyze

*Denotes sample size too small to reliably analyze

*Denotes sample size too small to reliably analyze

*Denotes sample size too small to reliably analyze

*Denotes sample size too small to reliably analyze

*Denotes sample size too small to reliably analyze

*Denotes sample size too small to reliably analyze

Trust in Information Sources & Conversations about Opioids

The most trusted sources of information are parents (for 13-15 year olds), doctors and pharmacists. Governments of all levels tend to fall somewhere in the middle, though respondents in Ontario are more trusting in both federal (61%) and provincial governments (57%) to provide information about opioids. News outlets and current opioid users, as well as family members, regardless of whether or not they have taken opioids, are among the least trusted. That being said, school teachers (71%) rank among the most trustworthy sources of information among teens 13-15, and teens 13-15 and 16-17 are also more likely than other Canadians to trust friends or family who have never used opioids (49%). Overall, respondents with a household income of less than $40,000 per year are less trusting of government, both provincial (44%) and federal (47%), teachers (37%), and health care professionals including doctors (76%) and pharmacists (74%).

Three-quarters of the parents (77%) report having talked to their children about drug use in general, though fewer teens 13-15 (72%) recall having had some sort of conversation. Over half of both parents (66%) and teens (57%) report having had a discussion about illegal drugs, but there is a large drop-off in frequency of discussions surrounding opioids specifically.

The Role of Stigma

An analysis of the data was undertaken 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. After reviewing the set of variables included in the survey design and analysis of collinearity, it was determined there are three questions asked that are particularly suited to this investigation:

43. I don’t have much sympathy for people who misuse opioids
44. People who overdose on opioids get what they deserve
48. 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 agreed with, or were 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 A33.

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, but it should be noted that where the Unsympathetic contrast with the other two groups, the contrast is even more striking among those who explicitly agree with all three statements used for the segmentation.

In terms of demographics, in line with findings outlined earlier in this report, men appear to hold more stigmatizing views and constitute a larger proportion of the Unsympathetic segment (56%) relative to women (42%). Conversely, a significantly larger percentage of the Allies segment (63%) is made up of women. Allies tend to be older – 40% are over the age of 55, compared to 37% in the Ambivalent segment and 32% 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 Ontarians (42%) in the Unsympathetic segment and a higher proportion of Quebeckers in the Ambivalent segment (26%).

Among the oversample groups, teens have the highest proportion of respondents who fall into the Unsympathetic segment (33%), and are the most Ambivalent (60%). Just 7% are considered Allies. Legal users have the largest proportion of Allies (27%), compared to 25% of parents, and 22% of illegal users.

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 (44%) than the Ambivalent (32%) and Unsympathetic segments (26%). 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 (68%) or used opioids without a prescription (25%). While not many across the segments claim that they know someone who has had a non-fatal overdose, the portion is higher among Allies (17%) than those who are Ambivalent (6%) and Unsympathetic (9%). They are also more likely to know someone who has become addicted to opioids (31%), relative to the other segments.

Along with having more friends and family who have been affected by opioids, Allies also report knowing more about opioids. Over one third (38%) report being familiar with at least one of the opioids listed in this study, compared to 22% of those who are Ambivalent, and 24% of those in the Unsympathetic group. They are also much more familiar with fentanyl – 66% report being at least somewhat familiar, relative to 41% of those who are ambivalent, and 47% of those who are unsympathetic. Allies are the most likely to believe all the opioids listed in this study are dangerous (52%) and that the opioid crisis is a very serious problem in their community (38%).

In terms of their ability to handle an opioid overdose or problematic substance use disorder should they happen to come across one or the other, the relative exposure and experience demonstrated by the Allies does not appear to make them feel any more confident than the Unsympathetic – only 39% of Allies and 38% of Unsympathetic agree they would be able to identify signs of an opioid use disorder, and just over a third of each would be able to identify an overdose (36% of the unsympathetic group, and 34% of allies). Those who are Ambivalent feel less prepared for both scenarios. Similarly, 32% of those who are Unsympathetic and 36% of Allies would know what to do if they saw someone experiencing an overdose, compared to just 18% of those who are Ambivalent. Of note, almost equal proportions of the Unsympathetic segment (48%) and Allies (47%) worry that they may become addicted to opioids if prescribed one, compared to 37% of those who are Ambivalent.

Those who are Unsympathetic are the most likely to feel that problematic substance use disorder stems from issues of self-control. Over one third (36%) believe people who are dependent on opioids could stop taking them if they really wanted to. They are less likely than Allies (76% agree) to believe that opioid problematic substance use disorder is a disease (54% agree). Almost two thirds (64%) also agree that a lack of self-control is usually what causes problematic substance use disorder.  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 – 42% agree, compared to 57% of the Ambivalent segment, and fully 70% of the Allies segment.

When it comes to trust in information sources, there are marked differences between the three segments. Allies are more trusting of most information sources. Of note, there is an over 20% spread between trust in federal and provincial government – 72% of Allies trust the Government of Canada to provide information about opioid use, compared to 56% of the Ambivalent segment, and 50% of the Unsympathetic segment. Over two thirds (68%) of Allies trust their provincial government, compared to 46% of the Unsympathetic segment.

In summary, the identification of the existence of these segments appears to be useful for understanding how stigma relates to views on addressing the opioid crisis.  Among those who are more likely to hold stigmatizing views such as feeling unsympathetic or blaming those who develop opioid use disorders or suffer an overdose, the data suggests that there is less personal exposure to opioids or to people who have or do use them.  Encouragingly, the data also suggests that opinions on the topic are nuanced and perhaps changeable – greater familiarity with opioids, fentanyl and the opioid crisis could result in more positive views of those who use opioids, and greater support for individuals with an opioid use disorder. Further, it should be borne in mind that even those who are in the Unsympathetic segment do not universally hold negative views of those who use opioids, a majority believe opioid problematic substance use disorder is a disease, and almost two thirds believe the opioid crisis is a public health issue.  The data implies that raising familiarity and awareness may reduce stigma while also broadening the proportion of the population who recognize a need for increased public health intervention.

Conclusions

Respondents in this study claim both some familiarity with opioids, prescribed or otherwise, and with the opioid crisis in Canada. Among those who took opioids this year, the vast majority report having had at least one prescription and most of those people only took opioids that were prescribed to them. One third of those who used an opioid in the past year did not always have a prescription for the opioid they took.

Among those who have not taken opioids in the past year but have done so at some other time in their life, although again the vast majority had a prescription at least some of the time, only about one third have only ever taken opioids that were prescribed to them. Fully two thirds of people who have taken opioids more than a year ago did so without a prescription at least once. Among those who have used opioids without a prescription, the most common source is a friend or relative's prescription. Among teens, the most common source is a drug dealer or other stranger.

While some attitudes towards opioid use and stigma varied between the groups sampled, overall respondents seem concerned about the potential impact of opioids on them, their family and friends.  There is general agreement that opioids are dangerous, particularly for those consuming them illegally, and for teens. Despite their concern about opioids, respondents did not necessarily feel well equipped to respond to a problematic substance use disorder or overdose.

For the most part, each of the four target audiences that were oversampled (parents of teens aged 13-15; teens aged 13-15; 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 all other Canadians, teens report less opioid use and less use of illegal drugs, lower levels of and 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 problematic substance use disorder is caused by a lack of self-control, and have less sympathy for those who misuse opioids.
• Legal opioid users were 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 drug users are 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, overdosed or died. That said, illegal users are twice as likely as legal users to indicate having sought treatment for an opioid use disorder.
• Illegal users indicate a similar lack of confidence as found in the general population when it comes to ability to identify or handle an opioid overdose or use disorder.
• Legal opioid users and illegal drug users are in as widespread agreement as the general population that opioids pose a risk to almost any of the populations in question. However, they are less likely than everyone else to feel that opioids pose a risk to themselves or to people using opioids as prescribed for them.

Recommendations

Based on the results of this research, the following recommendations are provided:

• In support of the basic public health objective of reducing harm, there is likely a benefit to be achieved by broadening the awareness of, and improving the level of understanding of opioids and the opioid crisis, particularly among teens. Ensuring that teens 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.
• As the government continues to address the opioid crisis, the data suggests that reducing stigma associated with opioid use disorder could help broaden public support for devoting more resources to the issue.  The issue of stigma appears to be more of a factor among those with the least exposure to opioids either directly or indirectly.  Given that it is undesirable to broaden the degree of exposure to opioids, presenting targeted communications specifically designed to address stigmatizing points of view on opioid problematic substance use and problematic substance use disorder overall may be effective for achieving the broadest public consensus on tackling the opioid crisis.
• Given Canadians’ hesitancy around their ability to recognize and respond to an opioid problematic substance use disorder or overdose, there may be harm-reduction benefits from increasing awareness of signs of opioid use disorder or overdose treatment, preventative measures to avoid them and what steps one should take if they are recognized.
• The data reinforced the value of using health professionals to help deliver opioid-related messages, given the high degree of trust in the 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 2,556 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 questionnaires for this study were designed by Earnscliffe, in collaboration with Health Canada, and provided for fielding to Nielsen Opinion Quest (Nielsen).  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 Nielsen based on Earnscliffe’s instructions. The surveys were completed using Nielsen’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 1,330 cases were collected as the sample of the general population. Oversamples were also collected for the following groups:

• Youth (13-15) (n=357)
• Parents or caregivers of youth (13-15) (n=389)
• People who used legal drugs in the form of prescribed opioids at some point in the past year (n=596)
• People who used illegal drugs, either counterfeit prescriptions or other drugs, that could be laced with opioids, at some point in the past year (n=489)

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 four target audiences.

Sample sources for the four target audiences

The final data for the general population and teen oversample 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 sample, by age, gender and region.

Data Collection

The online survey was conducted in English and French from October 18, 2017 to November 15, 2017. The survey was undertaken by Nielsen, hosted in the Confirmit Horizons computer-assisted web interviewing (CAWI) platform used by Nielsen’s data collection operation.

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:

The final data for the general population sample were 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.

Quotas by demographics were not set for the oversample groups as the incidence rates are low and there was a desire to ensure completions for these oversamples were left to fall out naturally. While demographic quotas were not set for people who use legal drugs in the form of prescribed opioids, quotas were watched carefully to ensure appropriate completions by age as per the 2013 CTADS incidences – youth (15-24), 14.8%; adults (25+), 14.9%; and, seniors (65+), 16.2%.

Quality Controls

During the survey period, three data checks were completed by Nielsen. The first was completed just after the launch on the first day. The second was completed after the first full day in field. And the final data check was completed once all surveys had been completed. During each data check it was confirmed that all skip patterns were working, that no data outliers had been recorded, and that all respondents were completing the survey in an appropriate amount of time.

Results

Final Dispositions

Respondents were invited to answer the survey through software Nielsen employs called a router. The router is software that controls the flow of traffic into surveys, sending individuals who are most likely to qualify into a particular survey. Potential respondents (panel members who have opted in) receive a generic email invite to participate in a survey, once they click on the link embedded in their invitation they are asked some pre-screening questions and from there, they are sent into a live survey.

A total of 9,749 individuals entered the online survey, of which 2,556 qualified as eligible and completed the survey.

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

Margin of Error

Respondents for the online survey were selected from among those who have volunteered to participate/registered to participate in online surveys. The data have 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 for online surveys.

Survey Duration

The online survey took an average of 12 minutes to complete, though for some oversamples the survey took 15 minutes to complete on average.

Appendix B: Survey Instrument

Questionnaire

Email Invitation

A New Survey Is Available

The latest Harris Panel survey is now open and we want your opinion! Complete the survey to earn points and trade them in for items in our catalog.

Landing Page

Thank you for agreeing to take part in this short survey on opioids. We anticipate that the survey will take approximately 18 minutes to complete.
[NEXT]

Intro Page to 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.

The survey is registered with Marketing Research and Intelligence Association’s (MRIA) Research Registration System.

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! 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! 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?

• You are being asked to offer your opinions and experiences related to opioids through an online survey.
• We anticipate that the survey will take 18 minutes to complete.
• Your participation in the survey is completely voluntary.
• Your decision on whether or not to participate will not affect any dealings you may have with the Government of Canada.

What about your personal information?

• The personal information you provide to Health Canada is governed in accordance with the Privacy Act and is being collected under the authority of section 4 of the Department of Health Act in accordance with the Treasury Board Directive on Privacy Practices.  We only collect the information we need to conduct the research project.
• Purpose of collection: We require your personal information such as demographic information to better understand the topic of the research. However, your responses are always combined with the responses of others for analysis and reporting; you will never be identified.  
• For more information: This personal information collection is described in the standard personal information bank Public Communications – PSU 914, in Info Source, available online at infosource.gc.ca.
• Your rights under the Privacy Act: In addition to protecting your personal information, the Privacy Act gives you the right to request access to and correction of your personal information. For more information about these rights, or about our privacy practices, please contact Health Canada's Privacy Coordinator at 613-948-1219 or privacy-vie.privee@hc-sc.gc.ca. You also have the right to file a complaint with the Privacy Commissioner of Canada if you think your personal information has been handled improperly.

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 (http://www.bac-lac.gc.ca/).

If you have any questions about the survey, you may contact Eanscliffe 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.

• Yes NEXT SCREEN
• No TERMINATE

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.

The survey is registered with Marketing Research and Intelligence Association’s (MRIA) Research Registration System.

How does the online survey work?

• Your child is being asked to offer his/her opinions and experiences related to opioids through an online survey.
• We anticipate that the survey will take 18 minutes to complete.
• Your child’s participation in the survey is completely voluntary.
• Your decision on whether or not to allow your child to participate will not affect any dealings you may have with the Government of Canada.

What about your child’s personal information?

• The personal information your child will provide to Health Canada is governed in accordance with the Privacy Act and is being collected under the authority of section 4 of the Department of Health Act in accordance with the Treasury Board Directive on Privacy Practices. We only collect the information we need to conduct the research project.
• Purpose of collection: We require your child’s personal information such as demographic information to better understand the topic of the research. However, your child’s responses are always combined with the responses of others for analysis and reporting; your child will never be identified.
• For more information: This personal information collection is described in the standard personal information bank Public Communications – PSU 914, in Info Source, available online at infosource.gc.ca.
• Your rights under the Privacy Act: In addition to protecting your personal information, the Privacy Act gives you the right to request access to and correction of your child's personal information. For more information about these rights, or about our privacy practices, please contact Health Canada's Privacy Coordinator at 613-948-1219 or privacy-vie.privee@hc-sc.gc.ca. You also have the right to file a complaint with the Privacy Commissioner of Canada if you think your child personal information has been handled improperly.

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 (http://www.bac-lac.gc.ca/).

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

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

Section 1: Adult Screening

1. What gender do you identify with?

Male 1
Female 2
Other gender identity 3
Prefer not to answer 9

2. In what year were you born?

[INSERT YEAR]

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

Newfoundland and Labrador 1
Nova Scotia 2
Prince Edward Island 3
New Brunswick 4
Quebec 5
Ontario 6
Manitoba 7
Saskatchewan 8
Alberta 9
British Columbia 10
Yukon 11
Nunavut 12
Northwest Territories 13
Prefer not to say [TERMINATE] 99

4. Are you a parent or legal guardian of a child that is under 18 years old? If so, how many children are in each of the following age categories?

None ASSIGN TO GENPOP, SKIP TO Q8
Under 13 years of age ASSIGN TO GENPOP, SKIP TO Q8
13-15 years of age RANDOMLY SELECT AS PARENT (GENPOP/Parents 13-15) OR YOUTH (13-15)
16-17 years of age RANDOMLY SELECT AS PARENT (GENPOP) OR YOUTH (GENPOP 16-17)

Section 2: Youth Screening

5. What gender do you identify with?

Male 1
Female 2
Other gender identity 3
Prefer not to answer 9

6. In what year were you born?

[INSERT YEAR]

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

Newfoundland and Labrador 1
Nova Scotia 2
Prince Edward Island 3
New Brunswick 4
Quebec 5
Ontario 6
Manitoba 7
Saskatchewan 8
Alberta 9
British Columbia 10
Yukon 11
Nunavut 12
Northwest Territories 13
Prefer not to say [TERMINATE] 99

Section 3: Drug Use Screening

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

Have taken in the past year [“OPIOID USER”] 1
Have taken, but not in the past year [“PAST OPIOID USER”] [SKIP TO Q10] 2
Have never taken [SKIP TO Q10] 3
Prefer not to say [SKIP TO Q10] 8
Don’t know [SKIP TO Q10] 9

[IF Q8=1 (OPIOID USERS), ASK Q9]

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

Always have a prescription in your name [“LEGAL OPIOID USER”] 1
Usually have a prescription in your name [“ILLEGAL OPIOID USER”] 2
Sometimes have a prescription in your name [“ILLEGAL OPIOID USER”] 3
Rarely have a prescription in your name [“ILLEGAL OPIOID USER”] 4
Never have a prescription in your name [“ILLEGAL OPIOID USER”] 5
Prefer not to say 8
Don’t know 9

[OPIOID USER: Q8=1. LEGAL OPIOID USER: Q9=1. ILLEGAL OPIOID USER: Q9=2 THRU 5.]

10. Have you ever taken any of the following: cocaine (such as coke, snow, powder), ecstasy (such as E, X, Molly), heroin (such as smack, H, skag, junk), crack cocaine (such as rock, freebase, angie), methamphetamine (such as meth, crystal meth, crank, speed) or hallucinogens (such as Psilocybin, also known as magic mushrooms/shrooms, LSD, also known as Acid, blotters, etc.)?

Have taken in the past year 1
Have taken, but not in the past year 2
Have never taken 3
Prefer not to say 8
Don’t know 9

[ILLEGAL DRUG USER: Q9=2 THRU 5 OR Q10=1.]

Section 4: Awareness, Impressions and Basic Understanding

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

I had never heard the term “opioid” before this survey 1
I don’t really know what an opioid is 2
I might know what an opioid is, but I’m unsure 3
I am pretty sure I know what an opioid is 4
I am certain I know what an opioid is 5
Don’t know/prefer not to say 9

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.

12. How familiar are you with these types of opioids?

Not at all familiar with any 1
No more than a little familiar with at least one 2
Somewhat familiar with at least one 3
Very familiar with at least one 4
Don’t know/Prefer not to say 9

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

None of these drugs are dangerous 1
A few are dangerous 2
About half are dangerous 3
Most are dangerous 4
All are dangerous 5
Don’t know/prefer not to say 9

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

14. You, personally

15. People who use opioids prescribed for them and taken as prescribed

16. People who use opioids prescribed for someone else (friends, parents…)

17. People who use opioids obtained on the street

18. People who use illegal drugs such as cocaine, ecstasy

19. Teens

20. Young adults

21. Seniors

Not at all dangerous 1
Not very dangerous 2
Somewhat dangerous 3
Very dangerous 4
Don’t know/prefer not to say 9

22. When you hear the term, “illegal opioids” which, if any, of the following do you think it means? Please check all that apply.

Prescription opioids not prescribed to you (shared prescription) 1
Opioids obtained on the street 2
Other, please specify: 3
Don’t know/Prefer not to say 9

23. How aware would you say you are of Canada’s opioid crisis?

Not at all aware 1
Not very aware 2
Somewhat aware 3
Very aware 4
Don’t know/Prefer not to say 9

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

Not at all serious 1
Not very serious 2
Somewhat serious 3
Very serious 4
Don’t know/Prefer not to say 9

25. How familiar would you say you are with fentanyl?

Not at all familiar 1
Not very familiar 2
Somewhat familiar 3
Very familiar 4
Don’t know/Prefer not to say 9

26. [IF Q25>1] To the best of your knowledge, how dangerous is fentanyl?

Not at all dangerous 1
Not very dangerous 2
Somewhat dangerous 3
Very dangerous 4
Don’t know/Prefer not to say 9

Section 5: Attitudes Relating to Behaviours, Risk and Harm

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

27. I’m worried that opioids might harm people I care about

28. There are certain times when it is acceptable to share an opioid prescription with someone else

29. If I was prescribed an opioid, I would ask my doctor for more information about the risks, the side effects or alternatives to using an opioid

30. I worry that if I am prescribed an opioid I could become addicted

31. I think people in my family and/or friends could experience an opioid-related overdose or poisoning

32. I think people in my family and/or friends could become dependant or addicted to opioids

33. If you are following a prescription, it is difficult to become dependant or addicted to an opioid

34. I understand what it is about opioids that is so dangerous

35. If I needed to, I am confident I could easily find help for dealing with problematic opioid use (or an opioid addiction)

36. I would know what to do if I saw a person experiencing an overdose

37. I think I’d be able to identify signs of an opioid overdose if faced with them

38. I think I’d be able to identify signs of an opioid use disorder (addiction)

Strongly disagree 1
Disagree 2
Neither agree nor disagree 3
Agree 4
Strongly agree 5
Don’t know/Prefer not to say 9

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

Not at all concerned 1
Not very concerned 2
Somewhat concerned 3
Very concerned 4
Don’t know/Prefer not to say 9

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

Not at all concerned 1
Not very concerned 2
Somewhat concerned 3
Very concerned 4
Don’t know/Prefer not to say 9

Section 6: Attitudes Regarding Stigma

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

41. People who are dependant upon or addicted to opioids could stop taking them if they really wanted to

42. Addiction to opioids is a disease

43. I don’t have much sympathy for people who misuse opioids

44. People who overdose on opioids get what they deserve

45. People are overdosing on opioids because they used drugs that they didn’t realize had opioids or higher doses of opioids than they expected

46. Most people who use prescription opioids not prescribed to them are good people

47. Most people who use opioids obtained on the streets are good people

48. A lack of self-control is usually what causes a dependence upon or an addiction to opioids

49. We should be using more of our health care resources for dealing with opioid use disorder (addiction)

50. If I were prescribed an opioid, I would not want my friends or family to know that

51. If I were to use a prescription opioid not prescribed to me, I would not want my friends or family to know that

52. If I were to use an opioid obtained on the street, I would not want my friends or family to know that

53. If I ever became dependant upon or addicted to opioids, I would feel completely comfortable seeking help

54. People who have an opioid use disorder (addiction) deserve the help they need to a lead healthy lifestyle

55. I think opioids are overprescribed in Canada

56. Canada’s opioid crisis is not as serious a public health crisis as SARS or H1N1 were

57. The opioid crisis in Canada is a public health issue

Strongly disagree 1
Disagree 2
Neither agree nor disagree 3
Agree 4
Strongly agree 5
Don’t know/Prefer not to say

Section 7: Risk Behaviour Profiling

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

58. At least one friend or family member has been prescribed one of these drugs

59. At least one friend or family member has used one of these drugs without a prescription in their name or purchased on the street

60. I have known someone who has had a non-fatal overdose of one of these drugs

61. I have known someone who died of an overdose of one of these drugs

62. I have known someone who became addicted to one of these drugs

63. [GENPOP PARENTS OF 13-15 ONLY] I have a teen child who has been prescribed one of these drugs in the past year

True 1
False 2
Don’t know/Prefer not to say 9

64. [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…?

Never 1
Rarely 2
Sometimes 3
Usually 4
Always 5
Don’t know/Prefer not to say

65. [IF Q64>1 (Rarely, Sometimes, Usually, Always)] When you had opioids prescribed to you, would you say you stored them….?

In a location that could only be accessed by you 1
In a location that could be accessed by others 2
Don’t know/Prefer not to say 9

66. [IF Q64>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

Does not apply, had no leftover pills/patches/liquids 0
Returned to pharmacy, hospital or doctor 1
Gave them to someone who needed them 2
Flushed them or disposed of them in garbage 3
Saved them in case I need them again 4
Did something else with them 5
Don’t know/Prefer not to say 9

67. [IF Q64<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?

Once or twice 1
A few times 2
Many times 3
Almost daily 4
Don’t know/Prefer not to say 9

68. [IF Q64<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

A friend’s or relative’s prescribed opioid 1
On the street 2
The Internet 3
Other: [SPECIFY] 4
Don’t know/Prefer not to say 9

69. [IF Q64<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]

Pain relief 1
To try it out/see what it felt like 2
For the feeling it causes 3
To get high 4
Other (Please specify: [TEXT BOX]) 5
Don’t know/Prefer not to say 9

70. [IF Q64<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?

Definitely would not 1
Probably would not 2
Probably would 3
Definitely would
Don’t know/Prefer not to say

71. [IF OPIOID USER OR PAST OPIOID USER] Have you ever sought treatment for an opioid use disorder (opioid addiction)?

Yes 1
No 2
Don’t know/Prefer not to say 9

PARENT OF 13-15 YEAR-OLD LEGAL OPIOID USERS SECTION

72. [IF Q63=1] 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?

Yes 1
No 2
Don’t know/Prefer not to say 9

PARENT OF 13-15 YEAR-OLD WHO HAS NOT BEEN PRESCRIBED OPIOID IN THE PAST YEAR

73. [IF Q63>1] To the best of your knowledge, has your teen ever been prescribed an opioid?

Yes 1
No 2
Don’t know/Prefer not to say 9

[ASK OF ALL PARENTS OF TEENS 13-15]

74. [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 for them?

Yes 1
No 2
Don’t know/Prefer not to say 9

13-15 YEAR-OLD TEENS SECTION

75. [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

A fake prescription (e.g. a forged, altered or counterfeited prescription) 1
A friend’s prescribed opioid 2
A relative’s prescribed opioid 3
A drug dealer or other stranger 4
The Internet 5
Other: [SPECIFY] 6
Don’t know/Prefer not to say 9

Section 8: Opioid Information

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. [RANDOMIZE]

76. Friends and family who have taken opioids before

77. Friends and family who have never taken opioids before

78. Your doctor

79. [FOR TEENS 13-15 ONLY] Your parents

80. The Government of Canada

81. Your provincial government

82. Your regional or municipal public health agency

83. Websites focused on health issues/health content

84. School teachers

85. A news outlet

86. A person who had an opioid use disorder (addiction) or who has survived an opioid overdose

87. A pharmacist

88. A person who currently uses opioids regularly

Strongly distrust 1
Distrust 2
Neither trust nor distrust 3
Trust 4
Strongly trust 5
Don’t know/Prefer not to say 9

[ASK OF PARENTS 13-15 ONLY]

89. Among the following topics, which ones have you discussed with your teenage child/children, if any? Check all that apply.[RANDOMIZE]

Drug use in general 1
The use of prescribed opioids 2
The use of illegal opioids, meaning opioids that have not
been prescribed to the person using them 3
The use of illegal drugs in general 4
Problematic drug or opioid use (drug or opioid addiction) 5
Drug or opioid overdoses 6
How to get help with problematic drug or opioid use (drug or opioid addiction) 7
Don’t know/Prefer not to say 9

[ASK OF TEENS 13-15 ONLY]

90. 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]

Drug use in general 1
The use of prescribed opioids 2
The use of illegal opioids, meaning opioids that have not
been prescribed to the person using them 3
The use of illegal drugs in general 4
Problematic drug or opioid use (drug or opioid addiction) 5
Drug or opioid overdoses 6
How to get help with problematic drug or opioid use (drug or opioid addiction) 7
Don’t know/Prefer not to say 9

Section 9: Demographics

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

91. What is the language you speak most often at home?

English 1
French 2
Other (SPECIFY) 3
Prefer not to answer 9

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

Yes 1
No 2
Prefer not to answer 9

93. [IF Q92=2 or 3] Are you…? [SELECT UP TO THREE]

White 1
South Asian (e.g., East Indian, Pakistani, Sri Lankan, etc.) 2
Chinese 3
Black 4
Filipino 5
Latin American 6
Arab 7
Southeast Asian (e.g., Vietnamese, Cambodian, Malaysian, Laotian, etc.) 8
West Asian (e.g., Iranian, Afghan, etc.) 9
Korean 10
Japanese 11
Other [SPECIFY] 12
Prefer not to answer 99

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

Grade 8 or less 1
Some high school 2
High school diploma or equivalent 3
Registered apprenticeship or other trades certificate or diploma 4
College, CEGEP or other non-university certificate or diploma 5
University certificate or diploma below bachelor’s level 6
Bachelor’s degree 7
Post graduate degree above bachelor’s level 8
Prefer not to answer 9

95. [GENPOP 16+ ONLY] Which of the following categories best describes your total household income for 2016? That is, the total income of all persons in your household combined, before taxes?

Under $20,000 1
$20,000 to just under $40,000 2
$40,000 to just under $60,000 3
$60,000 to just under $80,000 4
$80,000 to just under $100,000 5
$100,000 to just under $150,000 6
$150,000 and above 7
Prefer not to answer 9

96. What are the first three digits of your postal code?

[INSERT FIRST THREE DIGITS OF POSTAL CODE. FORMAT A1A]

Prefer not to answer 9

This concludes the survey. Thank you for your participation!

If the survey makes you feel like you would like to talk to someone about this topic, visit Get help with problematic substance use (https://www.canada.ca/en/health-canada/services/substance-abuse/get-help/get-help-with-drug-abuse.html) to find someone in your province.

Looking for help specifically for teens? Visit We're here for you (https://kidshelpphone.ca/).