The health harms posed by the non-medical use of opioids remains high in North America, but have started to decline in late 2023 and in 2024.

• Opioid overdose deaths reached historical highs in the United States of America and Canada between 2021 and 2023 but have since started to decline, returning to pre-2020 levels in the United States, but not in Canada.
• In Canada, fentanyl analogues may be partially replacing fentanyl in overdose deaths.
• In the United States, the share of women among those who died of opioid-related overdoses varies by type of opioid, and is currently highest for overdoses related to pharmaceutical opioids (39 per cent).
• In Canada, the share of women among people who died in relation to apparent opioid toxicity varies between 25 and 30 per cent each year and has not changed systematically since 2016 (data not shown).