While B.C. has been preoccupied with COVID-19 issues, a concurrent health emergency, that has been worsened by the pandemic, has been overshadowed.
However, health officials brought that health crisis back into the spotlight as they responded to a report with grim and troubling news about overdose deaths in the province.
Overdose deaths reach record number
According to an updated report from the B.C. Coroners Service released on June 11, a total of 170 people died of illicit drug toxicity in May, which is the highest monthly total that has taken place in British Columbia. The previous record number of 161 deaths was reported in December 2016.
Fentanyl was detected in approximately 119 (70 percent) of those deaths in May.
The number of deaths for May increased by 44 percent from the 118 deaths in April 2020 and represents a 93 percent increase over the 88 deaths in May 2019.
In addition, B.C. has recorded over 100 illicit drug toxicity deaths for three consecutive months this year. Prior to the pandemic, overdose deaths were declining in B.C. by 36 percent each year.
B.C. Mental Health and Addictions Minister Judy Darcy stated in a news release that collective efforts—including distributing naloxone and increasing access to overdose prevention services and treatment—helped prevent over 6,000 deaths since the overdose crisis began. Consequently, she called the details in B.C. Coroners’ May report “truly devastating to all of us”.
During yesterday’s B.C. COVID-19 update (June 11), provincial health officer Dr. Bonnie Henry became emotional as she spoke about this development in the overdose crisis.
“i cannot express how difficult this news has been to hear,” she said, as her voice wavered and she paused a moment to collect herself.
Dr. Henry said that there has been a “dramatic increase in toxicity of the street-drug supply here in British Columbia” as a result of pandemic issues, such as border restrictions, and drugs becoming less available, more expensive, and more toxic.
“Borders are closed and the usual illegal supply chains are disrupted, leading to drugs that are more toxic than ever,” Darcy explained.
The B.C. Coroners Service report suggests that the number of cases with extreme fentanyl concentrations rose in April and May 2020 compared to previous months, according to post-mortem toxicology testing data. During those two months, approximately 19 percent of cases had extreme fentanyl concentrations (exceeding 50 micrograms per litre) compared to nine percent between January 2019 and March 2020.
“The drug supply is unpredictable and highly toxic, and has led to a sustained increase in fatal and non-fatal overdoses from smoking and injection in recent months,” B.C. Centre for Disease Control harm reduction lead Dr. Jane Buxton stated in a B.C. government news release.
Putting things in perspective, Guy Felicella, a peer clinical advisor with BC Centre on Substance Use and the provincial Overdose Emergency Response Centre pointed out that “more British Columbians died of overdose in one month than died in the whole first wave of COVID-19”.
Now in phase two of the province’s pandemic reopening plan, there have been 167 people who have died of COVID-19 in B.C. to date. In comparison, there have been 554 illicit drug deaths so far this year in the province.
The largest concentrations of overdose deaths in 2020 occurred in Vancouver, Surrey, and Victoria. However, Dr. Henry pointed out that they “are not only seeing people die in the Downtown Eastside,” but across B.C., including on Vancouver Island and in the Interior.
So far this year, the majority of the deaths were among people aged 19 to 49 (70 percent) and males (80 percent), and have predominantly taken place indoors (85 percent) rather than outside (13 percent).
This year, the highest rate of deaths has taken place in the Northern Health Authority (32 deaths per 100,000 individuals), and Vancouver Coastal Health Authority follows with 29 deaths per 100,000 individuals.
The overall provincial rate is 26 deaths per 100,000 people.
“We still know that illicit drug toxicity death rates in B.C. remain the highest for any jurisdiction in Canada, and every region in B.C. has been impacted,” chief coroner Lisa Lapointe stated.
She expressed frustration and sadness about the new milestone of fatalities and said the death toll would be even higher if it weren’t for efforts so far.
“We must continue to build on further access to safe supply in B.C. and for a regulated, evidence-based, supportive treatment and recovery system as important pillars in preventing future deaths,” she said.
No deaths have been reported at supervised consumption or drug overdose prevention sites.
According to B.C. Emergency Health Services, paramedics respond to an average of 2,000 overdose calls per month in the province but there haven’t been any significant changes in call volumes in 2020.
What is being done and what to do
Dr. Henry said that during the pandemic, they have offered guidelines for providing or prescribing pharmaceutical alternatives to street drug supply to reduce dependence on street-based sources. She added that the number of people prescribed safe drugs increased by 150 percent during the pandemic.
She also talked about the importance of eliminating stigma and shame so that drug users can confide in others about their drug use, which she said is often kept private due to fears about ending up facing criminal charges.
“I have called for this before: we must look at alternatives to the criminal justice system to support people in getting the assistance they need,” she said.
Dr. Henry emphasized that the most important thing to do right now is to reach out to these individuals, particularly men between the ages of 20 and 39 who are dying alone at home, to talk about these issues.
“If I don’t know that my family member or loved one is using drugs, I can’t be there for them if they’re using,” she said.
She pointed out that physical separation and social isolation during the COVID-19 pandemic can enable some people to hide their drug use from others more easily “even if they might otherwise have reached out for help or have been very careful about not using alone”.
Darcy added that during the pandemic, “unemployment, social isolation, declining mental health, and increased alcohol and substance use are also the reality for so many right now”.
Dr. Henry said that using drugs alone is “exceedingly deadly” and that the “alarms of missing people have not been going off because we’ve been staying apart to do our best to try and manage the other crisis that we’re dealing with”.
She also spoke about the need to address the core issues that lead to drug usage.
“We know that being able to access a safe supply of drugs is one way that we can connect with people who use drugs and it is connection that helps us address addiction, and it is connection that helps us overcome the many reasons why we use drugs,” she said. “We know…that it has to do with pain, whether it’s physical pain, psychic pain, whether it’s emotional pain, and unless we connect with people, we don’t have the opportunity to help them address those underlying causes.”
The free Lifeguard app, which can be downloaded at the App Store or Google Play, was launched on May 20 to help people who are using drugs while alone. The app, which 423 people have used so far, connects people automatically to first responders if they become unresponsive.
Darcy said that a new 24-hour helpline will be launched on Monday (June 15) that will support doctors, pharmacists, and nurse practitioners as they treat patients with opioid-use disorder and are considering safe prescription alternatives.