Canada’s healthcare system absorbed $16.4 billion in costs attributable to substance use in 2024. That figure comes from a major new report by the Canadian Centre on Substance Use and Addiction (CCSA) and the Canadian Institute for Substance Use Research (CISUR). The findings lay bare the scale of what legal and illegal substance use is doing to one of the world’s most strained public health systems.

The Canadian Substance Use Costs and Harms (CSUCH) Healthcare Report covers 2017 to 2024. It is the most comprehensive national accounting of substance use healthcare costs of its kind. Crucially, it goes well beyond poisoning events or acute overdoses. It captures the full downstream burden: cancers, cardiovascular disease, liver disease, infectious diseases, diabetes, and a broad range of chronic conditions that substance use drives into the healthcare system year after year.

Alcohol and Tobacco Drive Substance Use Healthcare Costs

Of the $16.4 billion recorded in 2024, alcohol alone was responsible for $7.8 billion. That is nearly half the total at 47.6%. Tobacco contributed a further $6.8 billion, or 41.3%. Together, the two most commercially available substances accounted for approximately 90% of all substance use healthcare costs.

That figure alone should reframe how policymakers think about the problem. The dominant costs do not come from illicit street drugs. They come from products sold legally, marketed widely, and consumed daily by millions of Canadians. The CSUCH report underscores this point directly. It confirms that legally available substances remain the primary drivers of healthcare expenditure related to substance use.

Prescription medications and inpatient hospitalisations together accounted for roughly 60% of total substance use healthcare costs. Prescription medications cost $4.9 billion (30%) and inpatient hospitalisations reached $4.6 billion (28%). These figures make clear that the healthcare burden of substance use runs through the entire system. It is not a niche concern confined to emergency departments or addiction clinics.

Physician time added a further $3.9 billion (24%). Specialised treatment services accounted for $1.8 billion (11%). These costs are not limited to treating substance use disorders. They also include managing the many acute and chronic conditions that substance use causes or worsens over time.

Opioid Healthcare Costs Rising Fastest of All Substances

Opioids represent a smaller share of total substance use healthcare costs at 4.4%, or $0.7 billion in 2024. However, the trajectory of those costs is the most alarming of any substance category. Per person healthcare costs attributable to opioids increased by approximately 27% between 2017 and 2024. They rose from $13.60 to $17.30 per person. No other substance category showed a comparable rate of increase over the same period.

The report attributes this trend partly to the ongoing toxicity of the unregulated drug supply. Dangerous adulterants like fentanyl and nitazenes have transformed a public health problem into a volatile, unpredictable crisis. People are being hospitalised by drugs they did not know were in what they consumed.

Hospitalisation data reinforce the concern. Opioid attributable hospitalisations declined to 21 per 100,000 population in 2019. They then spiked during the pandemic period, peaking at 28 per 100,000 in both 2021 and 2023. By 2024, the rate had eased slightly to 25 per 100,000. That still represents an increase of approximately 19% since 2019.

Opioid related hospital admissions that were wholly attributable to opioids also increased by 22% over the study period. They rose from 16.6 to 20.3 per 100,000 population. These are cases where substance use is not merely a contributing factor. It is the direct and sole cause of the hospital admission.

Regional Gaps Widen Substance Use Healthcare Costs

The CSUCH report also reveals the wide variation in substance use healthcare costs across Canada’s provinces and territories. Nationally (excluding Quebec, for which full data were unavailable), the annual per person cost was $440 in 2024.

That national average masks significant regional inequality. The Northwest Territories recorded the highest per person costs at $982.70. Nunavut followed at $958.60 and Yukon at $779.00. Atlantic provinces also showed costs well above the national average. New Brunswick and Nova Scotia each exceeded $570 per person.

These figures reflect a combination of higher substance use prevalence rates, geographic barriers to healthcare access, and elevated costs of delivering services in remote communities. Communities with fewer early intervention options tend to present later with more acute and expensive conditions. That is precisely why prevention investment upstream of the healthcare system matters so much.

Tobacco Still Leading the Hospitalisation Count

Despite declining per person tobacco healthcare costs over much of the study period, tobacco remained the leading driver of substance attributable hospitalisations in 2024. Tobacco accounted for 337 hospitalisations per 100,000 population. That represents 48.6% of all substance use related hospitalisations nationally.

Alcohol followed closely at 293 per 100,000 (42.2%). Together, tobacco and alcohol accounted for more than 90% of all substance use related hospital admissions. This closely mirrors their dominance of total healthcare costs.

Wholly attributable alcohol hospitalisations also tell a significant story. In 2024, alcohol accounted for approximately 70 wholly attributable hospitalisations per 100,000 population. That made up around 60% of all wholly attributable substance use hospital admissions. These are not ambiguous cases. They are hospitalisations caused directly by alcohol consumption.

Cannabis Healthcare Costs Stabilising After Legalisation Spike

Cannabis related healthcare costs followed a distinct trajectory over the study period. Per person costs rose from $7.20 in 2017 to $8.50 in 2020. This increase spanned the period leading up to and immediately following non medical cannabis legalisation in Canada in 2018. Costs then declined, stabilising at approximately $7.00 from 2021 onwards.

The report’s authors suggest this plateau may reflect stabilising use rates. Health Canada’s Canadian Cannabis Survey data points to similar trends in prevalence. However, the researchers are careful not to interpret stability as safety. Continued monitoring is essential, they stress, particularly given growing concerns about high potency products and younger users.

Wholly attributable cannabis hospitalisations increased by 14% between 2017 and 2024, rising from 4.7 to 5.4 per 100,000. Even a stabilising cost trend does not mean the population is being protected from harm.

Prevention Is What the Numbers Are Really Asking For

What the CSUCH report documents is the financial ledger of decisions made, or not made, years or even decades earlier. Every hospitalisation attributable to tobacco reflects a lifetime of exposure to a product long known to cause cancer, cardiovascular disease, and respiratory illness. Every alcohol related liver disease admission tells the story of a drinker who was never adequately informed of the risks they were carrying.

The per person substance use healthcare costs remained relatively stable over the study period. They decreased just 2.3% from $406 in 2017 to $396 in 2024. That is not a success story. It is a floor below which costs have not fallen, largely because the upstream conditions driving substance use have not fundamentally changed. The substances are still heavily marketed. Price signals remain insufficient to deter high risk use. Prevention education does not reach enough people early enough.

As the CSUCH authors conclude, these findings provide a detailed baseline for assessing the impact of policies and investments across the continuum of care. The question is whether governments will use that baseline to genuinely recalibrate. Putting more resources into reducing substance use before it enters the healthcare system would cost far less than continuing to absorb the $16.4 billion bill after it already has.

That number is not just a budget line. It is a measure of preventable suffering, and it will not fall until the decisions that produce it begin to change.

Source: dbrecoveryresources