Updated estimates of the costs of substance use in Canada (including tobacco)

In early spring this year updated calculations on the costs of substance use were released by the Canadian Centre on Substance Use and Addiction (CCSA)  and the Canadian Institute for Substance Use Research (CISUR). 

This post highlights key findings on tobacco-related costs from their report "Canadian Substance Use Costs and Harms 2007-2020". 

1. Tobacco is responsible for almost one-quarter (22.7%) of the measured costs of substance use in Canada.

In 2020, the health care, lost productivity and other measured costs from tobacco use were estimated to be $11.2 billion. The total for all substance use was estimated to be $49 billion. The only substance with greater overall costs than tobacco was alcohol ($19.7 billion). Opioids came third, with total costs of  $7.1 billion.

Virtually all of the costs of tobacco use were related to healthcare costs ($5.4 billion in 2020), made up of costs for physician time (36%), prescription drugs (34%) and hospitalization (24%).  Premature death was responsible for half of the $5.25 billion costs of lost productivity associated with tobacco.  

Healthcare and lost productivity costs include both costs incurred by the individual and those paid by government. 

2. Tobacco control efforts have reduced the economic burden of tobacco.

This analysis found that the total  (inflation-adjusted) costs of tobacco use are trending down. The per-capita costs had fallen by one-fifth (20%) between 2007 and 2020 - from $365 per person in 2007 to $294 per person in 2020. This reduction was attributed to fewer hospitalizations and deaths. 

By contrast, the total costs associated with alcohol increased during this period by one fifth (21%). The analysts attribute the difference to the success of tobacco control policies and programs. "The diverging costs of alcohol and tobacco use may be explained by the presence of strong public health policies designed to curb tobacco use. Examples include package warning labels, increased taxation and advertising restrictions. Fewer equivalent, recently updated policies exist for alcohol." 

3. Tobacco causes most substance-related deaths

This analysis estimates that 73,994 deaths from substance use occurred in Canada in 2020. Nearly two in three of these deaths were caused by tobacco products (46,366 or 63%), one-quarter by alcohol (17,098 or 23%) and under one-tenth by opioids (6491 or 9%). Only 336 deaths were attributed to cannabis.

Estimates for overall mortality from tobacco has not varied much over the period of this study, while deaths from alcohol, opioids, cocaine and other CNS stimulants have increased.  

Although the total deaths from tobacco have remained steady over this period, evidence of the impact of tobacco control policy can be seen in the death rates from tobacco, which have fallen significantly. According to the data made available from this study, the actual death rate from tobacco use in Canada has fallen from 144 deaths per 100,000 people in 2007 to 123 in 2020. Eliminating the impact of an aging population by standardizing the death rates shows a decline from 89 to 57 deaths per 100,000 people over the same period of time.

4. Because they cause younger deaths, alcohol and opioids cause a greater loss of productive life-years than tobacco.

The success of tobacco control and reduced smoking rates is reflected in the steadily decreasing quantity of life-years lost as a result of early death.  This study based its measure of potential years of productive life lost (PYPLL) on the number of deaths occurring up to 65 years of age. (This indicator "is an explicit way of weighting deaths occurring at younger ages which may be preventable"). One-third of substance use deaths (24,346) occurred before the age of 65, resulting in 345,091 PYPLLs. 

Following the  methods used in this study, opioids have recently surpassed alcohol as the substance causing the greatest potential years of productive life lost. Early deaths from the use of these substances was estimated to result in the loss of 104 million years of potential productive life lost for alcohol and 112 million for opioids. For tobacco the estimate was the third greatest loss at 53 million years.

5. Provincial estimates are available

Data from the report is online in an interactive form at  https://csuch.ca/explore-the-data/. From this source, estimates for total provincial costs for healthcare and lost productivity are shown to range from $12.7 million (Yukon) to $4 billion (Ontario). Importantly, the analysts were unable to provide estimates for in-patient hospitalizations, day surgeries, emergency department visits or paramedic services in Quebec, which results in a known underestimation of costs for that province. 

Provincial-level estimates of tobacco-caused deaths show, as expected, that most populous provinces have the greatest number of deaths. However, the death rate per 100,000 individuals varied across the country- with the highest rate in Newfoundland (193 deaths per 100,000 people) and the lowest in Alberta (100 deaths per 100,000). 

When standardized for age, death rates were lowest in British Columbia and Ontario (51 and 53 deaths per 100,000) and highest in the territories (168 in Nunavut and 127 in Northwest Territories per 100,000).

The Canadian Centre on Substance Use and Addiction provides extensive information on the methods they used as well as data tables on request.