Opioid use and its associated harms is an issue of great public health interest, both within Australia and internationally. This report shows that opioid harms are an issue in both Australia and Canada. Rates of opioid deaths and opioid poisoning hospitalisations in Australia increased in the last 10 years. In 2016, pharmaceutical opioids were involved in more opioid deaths and opioid poisoning hospitalisations than heroin.