Baseline Survey on Opioid Awareness, Knowledge and Behaviours for Public Education - Executive Summary

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.

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