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Posts Tagged "opioid"

16Sep

B.C. wants to be part of global resolution in opioid company bankruptcy claim

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https://vancouversun.com/


Oxycodone tablets and pills


BackyardProduction / Getty Images/iStockphoto

The British Columbia government says any proposed settlement from opioid manufacturer Purdue Pharma needs to include Canadian claims for the devastation created by the overdose crisis.

Purdue, the maker of the pain drug OxyContin, filed for bankruptcy in the United States and proposed a multibillion-dollar plan to settle with thousands of state and local governments.

B.C. Attorney General David Eby says the province has been monitoring the developments including a tentative agreement that proposes to resolve the claims as part of a global resolution.

Eby says the province remains “ready and willing” to participate in the effort to achieve the resolution but if B.C. is not included in the process then the government will to continue its lawsuit that names Purdue and several other opioid makers.

The province filed a proposed class-action lawsuit a year ago alleging drug manufactures falsely marketed opioids as less addictive than other pain medicines, triggering an overdose crisis that has killed thousands.

Eby says if the company wants to achieve a global resolution then any proposed agreement needs to account for payment to Canadian claims.

28Aug

Pharmacist fights for right to take opioid replacement medication on the job | CBC News

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B.C.’s Human Rights Tribunal will hear the case of a pharmacist who claims restrictions on opioid replacement medication for working healthcare professionals is discriminatory — even though he’s been cleared to re-apply for his licence.

The 16-year pharmacist, who is not named or identified in any way by the tribunal, is now free to return to work following a second opinion from an addictions specialist. It’s unclear if he has applied to do so and he argues his screening process took too long.  

The pharmacist argues there’s no scientific reason to restrict healthcare workers from using medications that curb drug cravings and withdrawal in order to aid addiction recovery.

The 16-year pharmacist, who is not named or identified in any way by the tribunal, was initially denied his license when he tried to return to work two years ago after a voluntary suspension due to an “addiction-related disability” that led to a $1,300-per-week heroin habit.

He wanted to use Suboxone — a medication that curbs opioid cravings — and be allowed to return to his job dealing with high-risk drugs. Doctors and nurses in many U.S. states and Quebec are permitted to take Suboxone, and in some cases methadone, while working.

Suboxone allowed him to live ‘a normal life’

According to an  Aug. 22  tribunal decision, the pharmacist struggled with opioid addiction, including heroin, for several years, then returned to work. But he relapsed in 2015, despite a return-to-work plan that included monitoring. The pharmacist voluntarily suspended his license, returning to in-patient treatment.

He was prescribed Suboxone, a medication used to curb craving for opioids and ultimately taper opioid use, in 2016. The pharmacist reported Suboxone helped him live a normal life.

But when he attempted to return to work in 2017, the addictions specialist who evaluated him determined the pharmacist was not fit for duty in a “safety-sensitive” job — such as a clinical pharmacist who handled opioids — if he continued to take Suboxone. 

The pharmacist who launched the complaint to the B.C. Human Rights Tribunal did get a second opinion when he balked at abstinence as having no scientific basis as successful. That doctor agreed. (Shutterstock / Atstock Productio)

The doctor also recommended he enter a 12-step program, faith-based treatment program that requires abstinence from all drugs. He objected because he is an atheist and claimed the drug-free rule wasn’t based on scientific evidence.

The pharmacist sought a second doctor’s assessment and the college eventually accepted new recommendations in August 2018 which allow him to submit an application to register as a full pharmacist.

The first doctor and the College of Pharmacists of B.C. then requested his human rights complaint be dismissed. But the tribunal ruled Aug. 22 that the hearing will proceed, in part.

‘Hurt and shocked’

In the pharmacist’s initial complaint to the Human Rights Tribunal he argued that he was discriminated against because he was referred to a religious-based treatment program when he’s an atheist, and he wasn’t allowed to return to work unless he stopped using medication needed for his disability.

That precondition prevented his return to work in a “reasonable time frame,” he argued.

The pharmacist said the first doctor who assessed him “demonstrated unfair and offensive stigma and stereotyping of people with addiction issues.”

He described feeling “hurt and shocked” when the assessing doctor asked if a return to work would make him feel “like being a kid in a candy store” since he would be near so many drugs.

Tribunal Member Emily Ohler said she read more than 1,300 page of submissions from all parties before determining a hearing was needed.

Ohler denied the pharmacist’s claim of discrimination based on religion, as the 12-step treatment program was not mandatory. She did order a hearing into the discrimination claim based on mental disability.

In her ruling Ohler cited an expert who confirmed past workplace addictions policies in this province restricted healthcare workers from using drugs like Suboxone, but said that practice needed more study.

In Quebec, doctors overcoming addiction can use methadone. An American study published by the Mayo Clinic in 2012 reported dozens of healthcare worker discipline programs permitting nurses and doctors to return to work while using similar addiction treatments.

Suboxone is a long-acting opioid medication used to replace shorter-acting opioids like heroin, oxycodone, fentanyl or hydromorphone. It can prevent withdrawal symptoms and reduce cravings. (Sally Pitt/CBC)

26Aug

Opioid crisis: B.C. pleased with Oklahoma Johnson & Johnson ruling as it continues lawsuit

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A sign outside the Johnson & Johnson campus in Irvine, California. A judge has ordered the company to pay $572 million in connection with the opioid crisis in Oklahoma.


Mario Tama / Getty Images

VICTORIA — British Columbia’s attorney general says he is pleased with the findings of a court in Oklahoma that found Johnson & Johnson and its subsidiaries helped fuel the state’s opioid crisis as it ordered the company to pay US $572 million, more than twice the amount another drug manufacturer agreed to pay in a settlement.

The province filed a proposed class-action lawsuit a year ago against dozens of pharmaceutical companies in a bid to recoup the health-care costs associated with opioid addiction.

The untested suit alleges the companies falsely marketed opioids as less addictive than other pain drugs and helped trigger an overdose crisis that has killed thousands since OxyContin was introduced to the Canadian market in 1996.

David Eby likened the aim of the lawsuit in B.C. to the one in Oklahoma.

“The lawsuit we launched in 2018 holds pharmaceutical companies similarly accountable for the harm they have done to British Columbians and for the financial burdens they have placed on our health care system,” he alleged in a statement on Monday.


B.C. Attorney General David Eby.

CHAD HIPOLITO /

PNG

“Along with our recently enacted Opioid Damages and Health Care Costs Recovery Act, this measure is another example of the work that this government is undertaking every day to address the ongoing opioid crisis and build a better system of care and support for British Columbians.”

The civil claim filed by the B.C. government names the maker of OxyContin — Purdue Pharma Inc. — as well as other major drug manufacturers, and also targets pharmacies, alleging they should have known the quantities of opioids they were distributing exceeded any legitimate market.

None of the allegations contained in the civil claim has been proven in court.

A statement of defence from Purdue Pharma could not be found on the B.C. Supreme Court website on Monday, but in a previous statement the company said it followed all of Health Canada’s regulations, including those governing marketing. The company also said it has adhered to the code of ethical practices as a member of Innovative Medicines Canada, a pharmaceutical industry organization that works with governments, insurance companies and health-care professionals.

“Purdue Pharma (Canada) is deeply concerned about the opioids crisis, in British Columbia, and right across Canada,” the company said in a statement after B.C. filed its lawsuit.


Purdue Pharma, the makers of the prescription painkiller OxyContin, are targeted in a proposed class action lawsuit filed by the B.C. government.

George Frey /

REUTERS

“The opioids crisis is a complex and multi-faceted public health issue that involves both prescription opioids and, increasingly, illegally produced and consumed opioids, as indicated in Health Canada’s latest quarterly monitoring report. All stakeholders, including the pharmaceutical industry, have a role to play in providing practical and sustainable solutions.”

Earlier this year, the Ontario government said it plans to join B.C.’s proposed lawsuit.

In Oklahoma, Cleveland County District Judge Thad Balkman’s ruling followed the first state opioid case to make it to trial and could help shape negotiations over roughly 1,500 similar lawsuits filed by state, local and tribal governments consolidated before a federal judge in Ohio.

“The opioid crisis has ravaged the state of Oklahoma,” Balkman said before announcing the judgment. “It must be abated immediately.”

An attorney for the companies said they plan to appeal the ruling to the Oklahoma Supreme Court.

Before Oklahoma’s trial began May 28, the state reached settlements with two other defendant groups — a $270-million deal with Purdue Pharma and an $85-million settlement with Israeli-owned Teva Pharmaceutical Industries Ltd.

Oklahoma argued the companies and their subsidiaries created a public nuisance by launching an aggressive and allegedly misleading marketing campaign that overstated how effective the drugs were for treating chronic pain and understated the risk of addiction.

30May

Life expectancy stops increasing in Canada due to B.C. opioid overdose deaths: stats

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28May

Daphne Bramham: More needed to redress the tragic fact that Indigenous people are disproportionately victims of opioid crisis

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Overdose deaths linked to illicit fentanyl-laced drugs rose 21 per cent last year among First Nations people in B.C. even as there was a glimmer of hope that the crisis may have peaked among the general population.

Since the crisis began four years ago, B.C. Indigenous people have been overrepresented in the deadly count. Last year, they accounted for 13 per cent of the deaths, while making up 3.4 per cent of the provincial population.

Put another way, First Nations people were 4.2 times more likely to suffer a fatal overdose and six times more likely to suffer a non-fatal overdose than other British Columbians.

No one is suffering more than First Nations women and girls, who already have the worst health outcomes in Canada because of violence, exploitation and poverty.

They are unique in this epidemic where 80 per cent of the victims in the general population are men. Women, by contrast, account for 39 per cent of First Nations’ overdose fatalities last year and 46 per cent of the non-fatal ones.

They are bearing the brunt of marginalization, says Dr. Evan Adams, chief medical health officer at the First Nations Health Authority. Another measure of that is expected to come next week in the report of the murdered and missing women’s inquiry.

Among the reasons that he suggests for the widening gap between First Nations’ and the general population’s statistics are the effects of colonization including residential schools, the lack of social supports, childhood experiences and limited access to safe spaces and services.

The litany of dreadful statistics compiled by the provincial coroner’s office was read out Monday against the backdrop of a quilt with the names of some of the hundreds who have died. Among those names was Max, the son of the health authority’s knowledge keeper, Syexwaliya. Max died 12 days before his 41st birthday in March 2018.

“My son was just too lost,” she said. “I couldn’t do anything for him. I had to love and accept him as he was.”

Still, Syexwaliya takes heart from the statistics.

“The statistics make me feel that Indigenous people aren’t invisible and what’s brought out in the statistics and in the reports means that work is being done,” she said.

Addiction is a disease of pain — physical, emotional, mental and spiritual. Addiction piles tragedy on tragedy.

“It’s a journey of pain, a journey of suffering and a journey of seeking health services that couldn’t be found,” said the chair of the health authority, Grand Chief Doug Kelly.

Too many Canadians, too many British Columbians and too many First Nations people have already died, but Kelly said that for Indigenous people, things are not getting better. They’re getting worse, especially for those living in cities and most especially for women.

Overdose hot spots include the usual ones: Vancouver’s Downtown Eastside, the Fraser Valley, Chilliwack, Nanaimo, Victoria and Prince George. But for First Nations people, there’s also Campbell River and Kamloops.

Those stark differences mean distinct and targeted solutions are required. As Canada’s first Indigenous health authority, the First Nations authority (with its unofficial motto of “no decisions about us, without us”) is well positioned to do that.

With a goal of addressing causes of addiction, it has its own four pillars approach: preventing people from dying, reducing the harm of those who are using, creating a range of accessible treatments and supporting people on their healing journey.

The authority also strongly supports the call from B.C.’s chief medical health officer to decriminalize possession of all drugs for personal use as has been done in Portugal. (The suggestion was quickly shot down by the B.C. government, which says that could only be accomplished with federal legislation.)

Among the reasons Kelly cites are yet more terrible statistics.

Of Canada’s female offenders in federal prisons, Public Safety Canada reported last summer that 43 per cent are Indigenous. In youth detention, Indigenous kids account for 46 per cent of all admissions — a jump of 25 per cent in a decade.

Addiction is often contributing factor in the crimes committed, as is fetal alcohol spectrum disorder (although the report said there is no evidence that FASD is more prevalent among First Nations than other populations).

Because so many First Nations women are incarcerated, it means their children often end up in government care or with relatives, which only exacerbates the cycle of childhood trauma, loss and addiction.

So far, the First Nations Health Authority has spent $2.4 million on harm-reduction programs. It’s trained more than 2,430 people in 180 communities how to use naloxone to reverse fentanyl overdoses, has 180 “harm-reduction champions” and peer coordinators in all five regions.

But the biggest barrier is the one that led to Max’s death — lack of accessible treatment.

Last week, FNHA and the B.C. government committed $20 million each to  build treatment centres in Vancouver and Surrey and promised to upgrade six existing ones. Kelly says that’s great. But it’s not enough. They’re still waiting for another $20 million from the federal government for construction.

Still, where will the operating money come from? That’s the next multi-million-dollar question. But it must be found.

Now that there is evidence that First Nations communities — and women in particularly — are suffering so disproportionately, ignoring them is unconscionable.

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Twitter: @bramham_daphne


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7Feb

Daphne Bramham: B.C. opioid deaths up despite spending millions

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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.


Police speak to a man and woman on East Hastings in Vancouver’s Downtown Eastside, Thursday, Feb 7, 2019. More people fatally overdosed in British Columbia last year compared with 2017 despite efforts to combat the province’s public health emergency, the coroner says.

JONATHAN HAYWARD /

THE CANADIAN PRESS

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.


Chief coroner Lisa Lapointe, left, looks on as provincial health officer Dr. Bonnie Henry answers questions during a press conference about the release of the latest provincial statistics by the BC Coroners Service at Legislature in Victoria, B.C., on Thursday, February 7, 2019.

CHAD HIPOLITO /

THE CANADIAN PRESS

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.

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Twitter: @bramham_daphne

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20Nov

Multiple vials of naloxone now required to resuscitate Metro Vancouver opioid users

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An ambulance races down E. Hastings Street in Vancouver, BC Wednesday, January 31, 2018.


Jason Payne / PNG

Emergency first responders, hospital physicians and others trying to revive overdosed drug users are now having to give several doses of naloxone to counteract increasingly toxic concoctions including heroin, morphine, and fentanyl, B.C.’s top public health official says.

Chief provincial health officer Dr. Bonnie Henry said even the free, Take Home Naloxone program kits are now being distributed with three vials since toxic street drugs require more intense antidotes — as many as six to 10 doses in the most challenging cases, according to ambulance paramedics.

Henry said contrary to some perceptions, it’s not that opioid drugs are becoming “resistant” to naloxone, it’s that many drug users are using not only more toxic opioids drugs like carfentanil but in multiple combinations with other drugs. Moreover, the current reality of the overdose crisis is such that users are taking drugs for which naloxone has no effect to revive them, she said. That includes cocaine, speed and GHB.


Dr. Bonnie Henry, Provincial Medical Health Officer

JONATHAN HAYWARD /

THE CANADIAN PRESS

“It’s a sad state of affairs,” Henry said.

“Some of the drugs are so toxic, and drug users are also taking opioids with sedatives like Valium, alcohol or Xanax. So yes, we’re seeing that many people require several doses,” Henry said, adding that hospital emergency departments are also requiring higher doses of naloxone in intravenous drips to save lives.

“What we’re seeing is these potent toxic drugs, even the smallest amounts cause respiratory depression, cause people to stop breathing. So we may be getting naloxone in but we may need more and more, for longer periods of time because it (naloxone) wears off quickly.”

There are an estimated 55,000 individuals in B.C. who have opioid use disorders.

Joe Acker, director of clinical practice for B.C. Emergency Health Services, said in 2017, ambulance paramedics responded to 23,400 overdoses and the number in 2018 will, in all likelihood, exceed that. (The overall number of overdoses in B.C. would be greater because the figure provided by Acker does not include overdoses attended by other emergency personnel or those not attended by such professionals).

Acker said naloxone was administered in about a quarter of cases and he acknowledged that some drug users react with anger when they are revived with naloxone because it not only “ruins their high” but can also cause nasty withdrawal symptoms.

At times, oxygen may be used instead of naloxone to prevent those effects. Paramedics are no longer required to take drug users to a hospital once they have been revived as long as their assessments show that the client is stable.

Acker said some drug users seek out the most concentrated drugs like carfentanil while others are unsuspecting. Paramedics have observed that welfare cheque days are often the busiest and most lethal.

On the worst days, ambulances have been dispatched to as many as 135 overdoses across B.C. in a 24-hour period. Public health experts are expecting between 1,400 and 1,500 deaths in 2018, similar to 2017.

While paramedics and health professionals use safety-engineered retractable needles to avoid contracting infectious diseases from those to whom they are administering drugs, Henry said public health officials have not changed their minds about distributing such needles to drug users.

The issue of used needles being discarded on city streets and parks where unsuspecting children, adults and pets can step on them came up repeatedly during the civic election campaign. Needles that retract as soon as they are used are a harm reduction strategy in some jurisdictions but Henry said they have been ruled out here because they are harder for injection drug users to handle.

Acker said BCEHS does respond to citizens reporting accidental needle-pokes on streets and in parks but he couldn’t provide a number reflecting the frequency of such calls. Henry said while such cases would be traumatizing to individuals, in B.C. there has never been a case of transmission of HIV or other serious infections caused by such incidents.

Discarded needles seen on Vancouver streets or in parks will be collected if citizens call a hotline at 604-657-6561.


Dr. Patricia Daly, medical health officer, Vancouver Coastal Health

In her presentation on the opioid overdose crisis last week to city council, Vancouver Coastal Health chief medical officer Dr. Patricia Daly said overdose prevention sites and take-home naloxone kits were saving lives; the B.C. Centre for Disease Control estimates thousands of deaths over the last two years have been prevented because of the measures.

Daly said more than 300 people have died from overdoses in Vancouver so far this year, similar to the number at this point last year.

While Canadian life expectancies are rising, in B.C., they have dropped because of opioid overdoses. Last year, drug overdoses led to more deaths than suicides, homicides and motor vehicle accidents combined.

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13Nov

New study sheds light on who’s dying in B.C.’s opioid crisis

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Vancouver Fire Department Medical Unit responds to an unresponsive man after he injected a drug in the Downtown Eastside in Vancouver, December, 9, 2016 in this file photo.


RICHARD LAM / PNG

The first snapshots from a project aimed at providing a better picture of people at greatest risk of illicit drug use reveal that an average of nearly 10 Canadians fatally overdosed each day between 2016 and 2018.

Statistics Canada says the data from the Public Health Agency of Canada show British Columbia is facing the worst of the crisis.

Further data from the agency reveal victims in B.C. range from employed people who have never had contact with the justice, social assistance or hospital systems to those with little work history and long-term legal and social issues.

B.C. Coroners Service numbers included in the study show overdoses leaped from 293 in 2011 to 639 by 2016 and nearly three-quarters of those deaths involved 25- to 54-year-old men.

Of those at risk, the study shows roughly one-quarter were hospitalized in the year before their deaths, more than 40 per cent visited an emergency room at least once in that time, and three-quarters of those who had contact with police for an alleged crime died within a year of that interaction.

The data are from the Opioid Project, a partnership between numerous agencies including Statistics Canada, British Columbia’s Health Ministry, the B.C. Coroners Service and several departments within the City of Surrey, including its RCMP detachment and fire department.

Surrey’s high profile in the project stems from its efforts to develop a real-time overdose reporting system to rapidly respond to areas where a bad batch of drugs may be circulating.

Surrey fire Chief Len Garis, who is also an assistant professor in the school of criminology and criminal justice at the University of the Fraser Valley, said the findings should help focus prevention programs.

Surrey Fire Chief Len Garis.


Surrey Fire Chief Len Garis.

Ric Ernst /

PNG Files

“What we’re trying to do is determine the trajectory of the individual who died so we can find out what his or her pathway was to this particular issue,” he said.

“So far, what we know is that the majority of those individuals who died, their contacts with police were for shoplifting and for the administration of justice, basically failing to comply with an order and for breach of probation,” he said.

That information suggests the justice system needs to try a different approach, Garis said.

“It’s a vicious cycle within the justice system before they die. So we have to change the way we do business.”

He said more resources, such as supportive housing, recovery programs and addiction management, are also needed for people who shoplift to support their addiction.

Garis said the biggest surprise for him was that two-thirds of the people who fatally overdosed had no contact with police.

The data from 2016 also show nearly 25 per cent of people worked in the construction industry and almost half of them were in building maintenance, waste management and support services.

The B.C. Coroners Service recorded more than 3,400 overdose deaths in the province between January 2016 and September 2018. The number of fatalities decreased by 27 per cent in August compared with July.

The top four drugs involved in illicit-drug deaths were fentanyl, cocaine, methamphetamine and heroin.

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