I'll start, and then colleagues might have things to add.
The reality is that when it comes to all substance use, it is very difficult to determine the how and why people are using various substances in Canada. We can say that you are right that in fact there has been an increase. While we don't have exact data on who is using and why they are using or why they may be shifting use, we have some things that can provide a bit of insight. One is our drug analysis labs. From 2007 to 2017, there has been a 365% increase in the product seized and analyzed by labs at Health Canada related to methamphetamine, so we know it is being used broadly on the street. We know as well that those highest rates are in Saskatchewan, followed by Alberta, Manitoba and New Brunswick.
The other very interesting part for us is this idea of polydrug use. I think many users are in fact in this area of polydrug use. In Manitoba in particular, there were 35 deaths in 2017 related to methamphetamine, of which eight could be directly related. The rest had some sort of polydrug use associated with it. In 2016, there were four deaths associated with it.
Perhaps what's scarier is that there were 108 opioid-related deaths. Of those we see that there is a meth-opioid interplay. We also see meth being increasingly contaminated with fentanyl, just as other opioids are being contaminated with fentanyl. I believe that the increasing number of deaths related to methamphetamine use, just like the increasing number of deaths related to opioid use, is directly related to the poisoning of the drug supply with fentanyl.