Substance use is quietly adding significant stress to the currently strained health-care system in Canada. 

Health-care costs related to substance use account for nearly 30 per cent ($13.4 billion) of the overall costs of substance use. Over two hundred people in Canada die every day because of issues related to substance use. 

Our health-care system is already grappling with significant workforce shortages and the lasting impacts of the COVID-19 pandemic. Issues related to substance use health add strain to an already strained system. Continued monitoring of the costs and harms of substance use and implementing more diverse and innovative strategies is critical to addressing the impact of substance use on the health-care system and reducing the financial costs.

Major costs associated with substance use in health care

Since 2016, the Canadian Substance Use Cost and Harms (CSUCH) project has studied crucial insights into substance use trends and estimated direct and indirect costs of substance use, including the cost to the health-care system. The Canadian Centre on Substance Use and Addiction (CCSA) and the University of Victoria’s Canadian Institute for Substance Use Research (CISUR) collaborate on the CSUCH project to better understand the overall cost and harms of substance use in Canada. The project determined that substance use cost the Canadian economy $49.1 billion in 2020.

The $13.4 billion in health-care costs attributed to substance use in 2020 include day surgeries, emergency department visits, inpatient hospitalizations, paramedic services, prescription drugs, physician time and specialized treatment for substance use disorders.

These three areas account for the highest costs:

• Physician time: $4.48 billion

• Prescription drugs: $4.24 billion

• Inpatient hospitalizations: $3.29 billion

These costs and the implications for the health-care system cannot continue to go unaddressed, especially since we know they can be reduced.

The Government of Canada is starting to act. The new Canadian Drugs and Substances Strategy calls for equitable access to the “full continuum of care, including treatment, harm reduction and recovery options as well as other social services and supports to help people reduce their substance use and related harms.” This means putting evidence-based practice into place in both specialized treatments and broader health and social services and through establishing a foundation of compassionate care.

Taking new approaches to substance use care 

Several bold and innovative ideas have recently been put in place by member organizations of HealthCareCAN, the national voice of hospitals and health-care and health research organizations across Canada, to help tackle the stresses of substance use issues on the health-care system.

Health Sciences North hospital in Sudbury opened the Addictions Medicine Unit in 2021 for patients in a state of crisis due to alcohol use disorder or other substance use disorders. Uniquely, this unit operates with the understanding that the patients may continue to use substances while in care and supports them with safe injection kits, including clean needles and cookers, where needed.

The Addictions Medicine Unit employs a diverse team of addiction workers, social workers, peer consultants, registered nurses and psychiatrists. While the unit is not a treatment centre, the nonjudgmental and stigma-free environment helps providers build trust with patients and connects them to community programs such as getting on a waiting list for subsidized housing. Not only has the program helped patients, but it has also inspired providers to learn and, in turn, teach nursing students about substance use disorder, which is an aspect of health care not usually included in their curriculum. Accreditation Canada has called it a “novel and leading practice in addiction medicine.”

Several of HealthCareCAN’s member organizations offer Rapid Access Addiction Medicine (RAAM) clinics. While most substance use treatment centres require appointments or a formal referral, RAAM clinics are easy to access and offer walk-in consultations for targeted treatments in a timely manner. The clinics also offer counselling and referrals to community services. A 2020 report by CCSA found that hospital-based RAAM clinics were engaging and retaining patients in ongoing substance use treatment, thereby reducing emergency department visits, repeat visits and inpatient care, all while being cost-effective. 

Additionally, the University Health Network in partnership with the City of Toronto, United Way Greater Toronto and community partners are implementing a new social medicine supportive housing project. A first of its kind in Canada, this initiative will offer 51 units in a four-storey building for people who use substances. The project will address the social determinants of health, including housing, food and financial security, all while offering a range of onsite services related to mental health, career development, income, and food security. The project will also provide connections to primary care and health services, which sets this project apart from other subsidized social housing initiatives.

Moving forward  

Initiatives like these illustrate that meaningful investment in research and innovation are foundational to reducing the costs and harms of substance use.

Accurate and timely research and data are vital in supporting evidence-based decision making and informing innovative approaches. Projects like CSUCH build the capacity to understand the impact of harms related to substance use, but further investment is needed to support the targeted data collection required to understand trends and impacts among diverse and vulnerable populations across Canada.

Investment and innovation in substance use must not stop here. It means rethinking initiatives on prevention, education and harm reduction that go beyond those that are typically associated with heavy or risky substance use. It means focusing on strategies that address risk factors (e.g., adverse child events, trauma, mental health, chronic pain) and promote protective factors (e.g., coping skills, social inclusion, safe environments) related to substance use and its harms. Incorporating substance use education in health-care training and standardizing requirements for substance epidemiology monitoring and reporting will also advance and promote the health and well-being of people living in Canada.

With a daily death toll of over two hundred people, there is no time for incremental change. Investments to rapidly identify, spread and scale innovative and effective approaches like the Addictions Medicine Units, Rapid Access Addiction Medicine clinics, and social medicine supportive housing will help advance the system transformation needed to better serve people at risk and the health-care providers that care for them.

By Chandni Sondagar Aisha Giwa and Siri Chunduri

Chandni Sondagar and Aisha Giwa, Canadian Centre on Substance Use and Addiction. Siri Chunduri, HealthCareCAN