Among young adults under 50, rising mortality rates from accidental poisoning (a large proportion of which were due to drug misuse) increased overall mortality rates at these ages during 2011-16, making a small negative contribution to changes in life expectancy at birth in England (PHE, 2018c, ONS, 2018d). High or rising levels of drug overdose mortality are apparent in several high-income countries (eg the UK, Sweden, Canada, Australia) although not approaching the levels in the USA (Ho and Hendi, 2018). In the USA sharply rising death rates from the large-scale drug overdose crisis among younger men and women, and from unintentional injuries overall, are significant contributors to falling life expectancy (Box 6.2) (Sherry et al, 2018). The USA's opioid "crisis" includes use of both illegal opiates and prescribed opioid-based painkillers. Canada is also experiencing a serious opioid crisis, especially among young and middle-aged adults, which is slowing improvements in life expectancy (Government of Canada, 2018).