The next phase of B.C.'s crisis: fewer deaths but more overdoses than ever before

Officials are cautiously optimistic about a 2019 dip in fatal overdoses but other indicators suggest B.C.'s health emergency continues with no end in sight

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      Overdose deaths in B.C. have declined through 2019. So far, it’s the first time since 2012 that the monthly average of deaths is lower than that of the year before. Is the crisis abating?

      Although fatal drug overdoses are down, the number remains miles above what was once considered “normal”. Other indicators persistently suggest there is still no end to the crisis in sight.

      “On the whole, things are getting worse,” said Eris Nyx, a member of the Vancouver-based Coalition of Peers Dismantling the Drug War (CPDDW). “People who use drugs are not safe. They’ve just gotten better at preventing each other from passing away.”

      Most of CPDDW’s members work at Insite or another supervised-injection facility in Vancouver’s Downtown Eastside. During the first five months of 2019, there were 434 overdoses at Insite compared to 478 during the same period in 2018, according to Vancouver Coastal Health. At overdose-prevention sites, there were 1,053 overdoses during the first five months of 2019 compared to 805 the previous year. (No one has ever died of an overdose at any of B.C.’s harm-reduction facilities.)

      “The psychological trauma that is being inflicted on people is increasing as the number of overdoses go up,” Nyx said. “Even if they are nonfatal, the absolute number of responses are increasing, and this is having very negative effects on people’s mental health.”

      Statistics compiled by the B.C. Coroners Service and B.C. Emergency Health Services reveal the picture is roughly the same across British Columbia: although fatal overdoses are down, 911 calls for overdoses are up.

      Travis Lupick / B.C. Coroners Service

      Overdose deaths declined from a monthly average of 127.9 last year to 92.4 in the first five months of 2019.

      It’s good news. But at the same time, B.C. saw 23,700 emergency calls for a drug overdose last year and is now on track for a projected 24,800 in 2019.

      Dr. Patricia Daly is chief medical health officer and vice president of public health for Vancouver Coastal Health. She said the primary reason for the diverging trajectories of overdoses and fatal overdoses is likely B.C.’s push to expand harm-reduction services.

      “The risk of an overdose is still the same, but you’re less likely to die because we’ve expanded [access to] naloxone and created more opportunities for people to consume [drugs] under the observation of others who can reverse an overdose,” Daly explained. “We are seeing the benefit of harm-reduction services: the distribution of [the overdose-reversal drug] naloxone and overdose-prevention sites.”

      A June B.C. Centre for Disease Control study supports that. Researchers calculated that supervised-injection and other harm-reduction programs prevented more than 3,000 fatal overdoses in B.C. during a 20-month period starting in April 2016.

      Travis Lupick / B.C. Emergency Health Services, Vancouver Coastal Health, B.C. Centre for Disease Control

      Janice Abbott is the founder and chief executive officer of Atira Women’s Resource Society, a nonprofit housing provider that also runs Vancouver’s sole women-only supervised-injection facility. Her anecdotal reports from Atira’s Downtown Eastside hotels match the province’s statistics.

      “We’ve gone the longest stretch in as long as I can remember without having an overdose-related death,” Abbott said. “But I haven’t seen any difference in the number of overdose reversals in our buildings.”

      Abbott noted that 911 calls for overdoses are very likely lower than the actual number of overdoses. That’s because Atira staff and tenants no longer bother to call 911 for every overdose they see. “As staff, peers, and tenants get better at reversing overdoses, they’re less likely to call 911,” Abbott explained. Other supportive-housing providers told the Straight the same.

      Atira CEO Janice Abbott says overdose deaths in her buildings are down but that doesn't mean B.C.'s opioid epidemic is nearing an end.
      Travis Lupick

      There’s one statistic that everyone interviewed for this story discussed with more concern than any other. North America’s overdose crisis is now primarily driven by fentanyl, a synthetic opioid significantly more dangerous than heroin. But since the fall of 2016, something even worse has adulterated Vancouver’s illicit-drug supply: carfentanil.

      “From Jan-May 2019, carfentanil has been detected in 102 suspected illicit toxicity deaths,” reads a B.C. Coroners Service report. “This is almost three times as many toxicity deaths where carfentanil was detected compared to all of 2018.”

      Meanwhile, the number of B.C. organ transplants involving a donor who died of a drug overdose has trended up from 13 percent in 2015 to 22 percent in 2016, 35 percent the year after that, and plateaued at 32 percent in 2018.

      B.C. Coroners Service

      Abbott said she’s worried that the current drop in fatal overdoses won’t last.

      “We’re good at preventing deaths; we’re not good at preventing overdoses,” Abbott said. “People are still using and people are still at risk. If we don’t get to the root of the problem, we might see a spike in deaths again. I’m not convinced that this [2019’s decline in deaths] is the way it’s always going to be.”