The latest figures from British Columbia’s coroners service show fewer people are dying from illicit drug overdoses and there has been a decrease in the number of deaths related to carfentanil over the past two months.
The service says 73 people died of suspected illicit drug overdoses in June, a drop of 35 per cent compared with 113 for the same month last year.
The service says fentanyl was detected in more than four out of every five deaths in 2018 and during the first six months of this year.
The detection of carfentanil peaked at 32 deaths in March, but the service says there was a decrease in the number of deaths related to this synthetic opioid in May and June.
Overall for the first six months of 2019, there were 538 suspected overdose deaths from illicit drugs, down from 763 for the same period last year.
The service says males accounted for 78 per cent of all suspected illicit drug toxicity deaths for the first six months of 2019.
The B.C. Coroners Service says the number of illicit drug deaths was down 30 per cent in B.C. for the first five months of 2019.
The coroner says there were 86 and 84 illicit drug-related deaths in April and May respectively, down from 137 and 116 for the same months in 2018.
Overall, there have been 462 illicit drug toxicity deaths in the first five months, down 30 per cent from the 651 over the same period last year.
The coroner notes that the data is subject to change and totals for 2019 will likely increase as post-mortem testing results are received, but says it is “a sign for cautious optimism.”
More than two-thirds of the illicit-drug deaths this year involved people aged 30 to 59 years, and men account for almost four in every five of all illicit-drug deaths over the same period, the coroner says.
Almost nine in every 10 illicit drug deaths occurred inside and fentanyl was detected in most (83 per cent) of the cases.
Although overall the number of fatalities is down, the number of deaths linked to carfentanil, which is reportedly 100 times stronger than fentanyl, is up compared with last year.
The coroner says carfentanil was detected in 102 of the 383 fentanyl-detected deaths this year. There were 35 carfentanil-detected deaths in 2018.
No deaths have been reported at supervised consumption or drug overdose prevention sites.
Police across the province need to work closer with mental health officials in assessing vulnerable people with whom they have contact, a new study by the B.C. Coroners Services says.
The Coroners Service put together a panel of experts that reviewed the deaths of 127 people who had contact with police within the previous 24 hour and found two-thirds were struggling with mental health and addiction issues.
Their report – Opportunities for Different Outcomes – recommended improving coordination between health services and police, increasing access to mental health assessment and using findings from police encounters for ongoing professional development.
The deaths in the review occurred over five years from 2013 to the end of 2017 and included 56 suicides, 40 accidental or overdose deaths, seven deemed natural and 21 attributable to police used of force. Three deaths resulted from injuries caused by others.
The study noted that 84 percent of the people on the study were men and 61 percent struggled with illicit drug use.
Indigenous people were overrepresented in the numbers, making up 20 percent of the deaths reviewed despite being just six percent of the B.C. population.
The report noted that police have more than 400,000 encounters with civilians each year for criminal-code or traffic-related offences, “and the vast majority of police interactions are resolved without incident.”
Of those calls, more than 74,000 a year are related to mental health issues.
This review found that of the deaths studied, it was often a metal health or substance abuse issue that led to the original call to police.
“More than half of the decedents were exhibiting mental health symptoms at the time of police contact,” the study said.
Many of the deaths were of people living in rural parts of the province.
Michael Egilson, of the B.C. Coroners Service, chaired the review panel, which included 19 experts in policing, police oversight, public health, health services, mental health and addictions.
Egilson said the report highlights the role of police in responding to mental health emergencies in the community.
“These are situations where police officers de-escalate crisis situations, and assess, triage and transport persons for emergency care to health services or to cells,” he said.
“We need to drive home the point that the police have become part of the mental health system and that their role needs to be acknowledged, supported and incorporated into the larger provincial mental health and addictions strategy.”
The deaths highlighted in the report were anonymized with no names or locations included.
VANCOUVER — Statistics Canada has released data showing life expectancy stopped increasing for the first time in four decades as young men and women died at higher rates, mostly due to opioid-related overdoses in British Columbia, followed by Alberta.
The agency says life expectancy did not go up from 2016 to 2017 for either men or women after an upward trend from the mid-1990s to 2012, but overall gains then started to stall, even as older Canadians lived longer.
It says the declines were most notable in British Columbia, where life expectancy fell in 2017 for the second year in a row, especially for young men between the ages of 20 and 44.
StatsCan says that while older men are living longer from factors including improved cancer outcomes, drug-related deaths of young men almost completely offset those gains while a similar pattern emerged among young women, but to a lesser extent.
The agency says death rates due to overdose were 2.1 times higher for men and 1.6 times higher for women in 2017 compared with 2015 but those are likely underestimates because the cause of death in some cases has not yet been determined due to ongoing investigations.
Statistics Canada says 4,108 overdose deaths were recorded in Canada in 2017, and nearly 1,100 of those involved people between the ages of 30 and 39.
B.C.’s coroners say there were 90 suspected illicit-drug overdose deaths in the province in January, including more than a dozen in which they detected carfentanil.
The synthetic opioid carfentanil, which began showing up in B.C.’s street-drug supply in late 2016, turned up in 13 illicit-drug overdose deaths in January, according to a B.C. Coroners Service update released Tuesday. Carfentanil was detected in 35 deaths in all of 2018 and 71 deaths in the last seven months of 2017. Carfentanil is many orders of magnitude more potent, and dangerous, than fentanyl.
Fentanyl and analogs were detected in about 87 per cent of overdose deaths last year, up from 82 per cent in 2017, the service said.
Coroners also updated the total number of illicit-drug overdose deaths in 2018 to 1,510, up from the 1,489 deaths it reported last month (the numbers change as toxicology reports are completed and investigations are concluded). Overdoses killed 1,486 in 2017 and 991 in 2016.
The coroners said 90 people died of an illicit-drug overdose in B.C. in January, down from 130 deaths in January 2018, and below the 116 deaths in December 2018.
The coroners service says no one died at a supervised consumption or drug-overdose prevention site.
Most of the deaths in January were in the Vancouver Coastal Health (29) and Fraser Health (27) regions, and 88 per cent occurred indoors, including 62 per cent in private residences and 26 per cent in other residences such as social housing or hotels.
People aged 30 to 59 accounted for 76 per cent of those who died, and 83 per cent were male.
Despite increased work to combat B.C.’s public-health emergency, more people died of an overdose in 2018 than any other year on record, leading to calls to make heroin and alternatives available at the doctor’s office.
The B.C. Coroners Service said Thursday that 1,489 people died of a suspected illicit-drug overdose in B.C. last year, up from 1,487 in 2017. Most who died were men (80 per cent) aged 30-59 (71 per cent), and most died indoors (86 per cent). Fentanyl, an opioid being cut into heroin and other drugs, was detected in about 85 per cent of the deaths, up from 82 per cent in 2017.
People running overdose prevention sites and expanding access to Suboxone treatment and the overdose-reversing drug naloxone have been credited with keeping the crisis from getting worse.
But to actually reduce the death toll in 2019, provincial health officer Dr. Bonnie Henry said B.C. needs to introduce a safer supply of drugs to replace the toxic street-drug supply.
Henry said it’s important to first have low-barrier access to opioid-agnoist treatments like Suboxone and methadone for people on a path to recovery. But for some people, swapping out their fentanyl-poisoned street drugs with pharmaceutical ones needs to be a first step.
“For people who, right now, have an addiction to opioids … and are relying on this contaminated street-drug supply on a daily basis, and they’re not in a place in their lives where they’re willing or able to enter the treatment side of the spectrum, we need to have options to provide them with a safer supply than what they’re getting on the street so that they stay alive during this period of time,” she said.
“They’re at such high risk of death right now.”
Dr. Jane Buxton of the B.C. Centre for Disease Control said people should be able to seek access to a regulated, safer supply of opioids through a physician.
“Depending on who it is, we still know that going through treatment, that suits some people,” she said. “Other people, especially (those) on Suboxone, that can be life-changing. But that doesn’t suit everybody, so we have to have that variety of options.”
She pointed to a program run by the Portland Hotel Society’s Dr. Christy Sutherland, who has started 300 people on liquid hydromorphone and who last month added 50 more spots for people to crush hydromorphone pills and inject them.
When certain people who use drugs are engaged with the health system in this way, they can go on to seek treatment, food, housing and other supports, Buxton said.
“What we’ve seen in the past is that when people have a stable supply, then their life becomes more stable, then they’re able to potentially think about other treatment and being on other opioid-agnoist therapies,” she said.
“Most people are seeking drugs in the illicit market, which are dangerous, and it’s hard to be stable when that’s part of your life and things are so toxic.”
Jordan Westfall, president of the Canadian Association of People Who Use Drugs, said he found hope in the chief health officer’s comments about a safer supply.
“I think the barriers need to be reduced,” Westfall said.
He said programs like the Crosstown Clinic, which provides medical-grade heroin and hydromorphone, are crucial, but for some people the requirement that they visit clinics or nurses several times a day is too high a barrier.
Westfall added that not all people who use drugs seek recovery, and some will continue to seek street drugs to treat their own pain or feel the euphoric effects.
“We need to make sure our programs are as accessible as the street-drug supply which, for many people, is very accessible,” he said.
“You should be able to go to a physician and get a prescription for a drug, if the alternative is you buying that drug on the street and dying.”
Mental Health and Addictions Minister Judy Darcy said her ministry is working on a wide variety of evidence-based solutions to the public health emergency.
“We are going to use every tool in the toolbox,” she said. “We are not going to leave any stone unturned when it comes to safe alternatives for people to the poison-drug supply.”
Darcy said her ministry is working with the B.C. Centre on Substance Use to train more physicians in addiction and 2,100 have enrolled in a program since July.
But Darcy’s ministry must work with federal legislation that prohibits the use of controlled substances, which prevents her ministry from simply allowing doctors to prescribe heroin and substitutes at clinics, she said.
“We’re pushing the envelope within that federal context,” she said.
Jane Thornthwaite, B.C. Liberal opposition critic for mental health and addictions, said she supports making a safer drug supply available to immediately save lives, but said it must be paired with a pathway to treatment and recovery options for anyone who uses it.
“You need to have the support systems in place for these people to actually move forward,” Thornthwaite said. “If we’re not going to get to the root of the problem, then this crisis is not going to get any better. We’ll just have new people getting into the system and it could grow and grow.”
2018 was British Columbia’s deadliest year for illicit drug overdose deaths despite the hundreds of millions of dollars poured into mitigating the continuing public health crisis.
An average of four British Columbians died each day, a rate that has resulted in a drop in the predicted life expectancy for everyone living here.
British Columbia — and Vancouver, in particular — is the centre of the national crisis even though it has long been the testing ground for harm-reduction strategies that have included free needles, supervised injection sites and opioid replacement therapies including methadone, Suboxone and, more recently, pharmaceutical grade heroin.
B.C. has led Canada in getting free naloxone — the antidote for opioid overdoses — into the hands of emergency responders and users. It has set up free drug-testing sites.
Earlier this year, the City of Vancouver funded an expansion of a pilot project to provide pharmaceutical-grade heroin to users on the Downtown Eastside. Soon, addicts may be able to get their daily dose from vending machines.
Yet, the number of the dead hasn’t decreased, it’s only plateaued.
Also unchanged are the characteristics of the majority who died. Men aged 30 to 59 made up 80 per cent of the dead. Of those who died, 86 per cent were at home alone. Four out of every five had contact with the health care system within a year of their deaths, with 45 per cent reporting having pain. Of those dead men, 44 per cent were employed in the trades, transport or service industries.
But Vancouver is unique. It has the highest rate of overdose deaths and those deaths are concentrated in the Downtown Eastside in the low-barrier shelters, supportive housing units and SRO rooming houses that exist cheek-by-jowl with supervised injection sites, naloxone stations and testing sites.
Heading into the fourth year of a public health emergency, politicians need to set a new course.
The course that Dr. Bonnie Henry, B.C.’s chief medical health officer, plans to recommend is even more harm reduction. She said it will include “de facto decriminalization,” more pharmaceutical grade heroin, more drug testing sites, more Suboxone, more naloxone, more supervised injection sites.
On Thursday, Henry did admit that her plan will require that she “evaluate it effectively so that there are not unintended consequences.”
Chief among those unintended consequences is that if British Columbia goes it alone, it would be at risk of becoming even more of a magnet for users from across Canada, even from other countries. What drug user, let alone addict, could resist the allure of free, pharmaceutical grade drugs?
There is also a financial risk to going it alone. Last year, British Columbians’ bill for methadone and Suboxone was $90 million. The number of people on the opioid replacement therapy had risen to 22,012 people from 11,377 in 2009 and is predicted to double again by 2020-21.
British Columbians are already paying for more than 300 people who get injectable hydromorphone (pharmaceutical heroin) daily at a cost of approximately $25,000 a person every year and in January, 50 Vancouverites were enrolled in a pilot program where they get it in the cheaper pill form, which they then crush and inject under supervision.
While a provincial strategy is needed, the crisis isn’t unique to B.C. From 2016 until June 2018, more than 9,000 Canadians have died of overdoses largely from fentanyl-laced drugs.
The opioid crisis isn’t just a big city problem. According to the Canadian Institute for Health Information, hospitalization rates were 2.5 times higher in small communities of 50,000 to 100,000 compared with Canada’s largest cities.
Across Canada, hospitalization for opioid-related poisoning has risen 27 per cent in the past five years to an average of 17 a day.
While there is no good data on damage suffered by survivors of near-fatal overdoses, it’s estimated that 90 per cent of drug-overdose patients in intensive care have some sort of brain trauma. The trauma ranges from temporary memory loss to complete loss of brain function.
A comprehensive national plan is required. But it must focus not only on keeping people alive, but on helping them to get healthy.
Decriminalization — as opposed to legalization — might be part of the answer. Certainly, evidence from Portugal, which was the first in the world to decriminalize possession of small amounts of all drugs, indicates that it can be effective.
But Portugal’s success has come only because decriminalization is accompanied by strict enforcement of the amounts that individuals can possess as well as a dissuasion system that provides both a carrot and a stick to get users into treatment.
The opioid crisis is complicated. It’s been fuelled by over-prescription of highly effective pain reducing synthetic opiates, whose manufacturer convinced physicians that it wasn’t addictive.
Those synthetics then made their way to the street and while some users are unaware that their illicit drugs are laced with fentanyl, others go looking for its intense and often fatal high.
So far, staunching the flow of those drugs on to the street has proven to be little more effective than the harm reduction measures aimed at keeping users safe.
For this crisis to abate, there needs to concerted efforts on all fronts by all governments. It won’t be cheap, but then neither is the alternative.
Judy Darcy, B.C.’s minister of mental health and addictions (left), with Dr. Patricia Daly, the chief medical health officer at Vancouver Coastal Health, at the Lookout Housing and Health Society facility on Powell Street in Vancouver. Jason Payne / PNG
Vancouver Coastal Health’s chief medical officer is urging health authorities to make it easier for people to start and stay on treatments for addictions as a way to spare lives during B.C.’s continuing overdose crisis.
Dr. Patricia Daly presented an update on the crisis at a public board meeting Wednesday that included four recommendations. She wants the health authority to implement treatment standards and monitor outcomes for patients’ addictions care, expand access to “opioid-agonist therapies” such as Suboxone and methadone, establish a safe and regulated supply of drugs, and expand addiction-prevention programs.
Daly’s first recommendation is to ensure that people who begin treatments for opioid addiction don’t slip through the cracks over time. She said residential treatment centres should have a standard of care and keep track of patients’ treatments.
“When we start people on treatment for their opioid addiction, they’re not retained on treatment in the long-term. So we need to have a system that will really track people over the long-term, including when they go into detox and recovery,” Daly told Postmedia. “There are people who are dying who just left detox and recovery because they’re not put on opioid-agonist therapy or being maintained on it.”
Daly wants it to be easier for people to access treatment in the first place. Many aren’t wiling to go to visit a clinic to begin opioid-agonist therapies, so the health authority needs to consider dispensing such treatments from emergency departments, and working with pharmacists to make it easier for people to access methadone, including at multiple pharmacies, Daly said.
People who are subsequently hospitalized or jailed must not miss doses of those treatments and risk relapse, she added.
Despite the expansion of harm-reduction measures such as naloxone and overdose-prevention sites, people are still dying from a fentanyl-poisoned street drug supply, which is why Daly is recommending a safer supply for people when other treatments fail.
She pointed to four sites offering injectable therapies, including a pilot program run by Dr. Christy Sutherland of the Portland Hotel Society which has started more than 300 people on injectable hydromorphone since 2016, and which in January introduced a tablet version of the drug for 50 new participants to crush and inject under observation.
The B.C. Centre for Disease Control has been planning for a similar pilot program that allows participants to take the pills with them, which Daly said is important for people who struggle to make multiple daily visits for supervised injection.
“I think we have to acknowledge that we’re in this crisis because of what’s happened to the illegal drug supply, and people are going to consume illegal substances,” she said. “We have to do everything we can to reduce the risk of people developing substance-use disorder, providing evidence-based treatments.”
Ensuring access to stimulants should be a next step, Daly added.
According to her report, 39 per cent of people who died of an overdose in Vancouver in 2017 used opioids daily, but another 19 per cent drank alcohol daily, 12 per cent used stimulants daily, and 18 per cent used both alcohol and stimulants daily.
Finally, Daly wants to see expanded addiction-prevention programs for youth, people living with chronic pain and First Nations people, who are five times more likely than non-First Nations people to experience an overdose, and three times more likely to die.
Wooden stakes at Oppenheimer Park in downtown Vancouver in 2018 represent the number of confirmed overdose deaths in B.C. DARRYL DYCK / CANADIAN PRESS files
British Columbia is launching a project aimed at reducing the number of overdose deaths by inmates recently released from correctional facilities.
A coroner’s death review panel last year found about two-thirds B.C. residents who died of an illegal drug overdose over a 19-month period had recent contact with the criminal justice system.
The panel said that between January 2016 and the end of July 2017, 333 people died within their first month of release from a correctional facility.
The Health Ministry says in a news release that five new community transition teams have been set up in Surrey, Prince George, Kamloops, Nanaimo, and Port Coquitlam to help people with opioid use disorders get treatment.
The teams consist of a social worker and a peer who has used drugs and may also been incarcerated to work with a person who’s been released to help provide needed support.
Lynne Pelletier, with B.C. Mental Health and Substance Use Services, says people in the justice system are some of society’s most vulnerable, yet they are the hardest to reach in the current overdose emergency.
“Integrating correctional care with community-based care gives us an opportunity not just to prevent overdose, but also connect to health services and possibly change the trajectory of their lives by addressing some of the social and economic realities that brought them to us in the first place.”
Dr. Nader Sharifi, medical director for Correctional Health Services, says about 40 per cent of people in corrections facilities are getting treatment for opioid use disorder.
He says people are at a heightened risk when they leave a facility and don’t have access to a physician.
“There are barriers to continuing the treatment they start with us. Clients are facing stigma. They might have no income and no fixed address. It’s not as easy as visiting the nearest doctor’s office,” he says in a news release.
The community transition teams began connecting with their first clients this month. The Provincial Health Services Authority says it hopes to scale up the project next year based on results of the service.
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