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Alcohol and other drugs in suicide in Canada: opportunities to support prevention through enhanced monitoring
  1. Heather Orpana1,2,
  2. Norman Giesbrecht3,4,
  3. Aliya Hajee5,
  4. Mark S Kaplan6
  1. 1Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
  2. 2School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
  3. 3Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  4. 4Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  5. 5Downtown West Clinic, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
  6. 6Luskin School of Public Affairs, University of California, Los Angeles, Los Angeles, California, USA
  1. Correspondence to Dr Heather Orpana, Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, ON K1A0K9, Canada; heather.orpana{at}


The use of alcohol and other drugs has been identified as a significant factor related to suicide through multiple pathways. This paper highlights current understanding of their contributions to suicide in Canada and identifies opportunities for enhancing monitoring and prevention initiatives. Publications from 1998 to 2018 about suicide in Canada and that referred to alcohol or other drugs were identified using PubMed and Google Scholar. A second literature search restricted to articles including results of toxicology testing was conducted by a librarian. We summarised the literature identified on ecological analyses, attributable fractions and deaths, and research including the results of toxicological analyses. Our literature search yielded 5230 publications, and 164 documents were identified for full-text screening. We summarised the findings from 30 articles. Ecological analyses support the association between alcohol sales, annual per capita alcohol consumption and suicide rates. Based on published estimates, approximately a quarter of suicide deaths in Canada are alcohol-attributable, while the estimated attributable fraction for illegal drugs is more variable. Finally, there is a dearth of literature examining the role of acute alcohol and/or drug consumption prior to suicide based on toxicological findings. The proportion of suicide decedents with drugs or alcohol present at the time of death varies widely. While there is evidence on the role of alcohol and drugs in suicide deaths, there is not a large body of research about the acute use of these substances at the time of death among suicide decedents in Canada. Our understanding of the role of alcohol and other drugs in suicide deaths could be enhanced through systematic documentation, which in turn could provide much needed guidance for clinical practice, prevention strategies and policy initiatives.

  • alcohol
  • drugs
  • mortality
  • public health

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  • Contributors NG conceived the study. AH identified and screened the articles. NG and HO synthesised the data. NG, HO and MSK interpreted the data. NG and HO drafted the manuscript. NG, HO, AH and MSK critically revised the manuscript.

  • Funding MSK’s work on this study was partially supported by a grant from the Fulbright Specialist Program (FSP-P005326).

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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