There might be no agency in British Columbia that understands the severity of B.C.’s overdose epidemic better than the province’s coroners service. Over the last five years, more than 3,800 bodies have passed through its offices in cases where the cause of death was subsequently identified as an illicit-drug overdose.
Now the B.C. Coroners Service has released a major report on the crisis. It makes three broad recommendations for how the province and health authorities should respond.
First, B.C. needs to begin regulating addictions-treatment programs, establishing unified standards of care that ensure accountability, the report states.
“By September 2019, the Ministry of Health and the Ministry of Mental Health and Addictions in collaboration with First Nations Health Authority will develop and or revise provincial regulations for public and private addiction treatment facilities and services; to set standards for provision of evidence-based treatment and require that these programs be systematically evaluated and monitored to ensure compliance,” the report reads.
Second, B.C. should expand access to opioid substitutes such as methadone and Suboxone—medications that block the euphoric effects of opioids like heroin and OxyContin and dull cravings to those drugs.
The coroners service’s report also emphasizes that B.C. should lower barriers to less-traditional opioid substitutes, including prescription heroin (diacetylmorphine) and hydromorphone (Dilaudid), a semi-synthetic opioid that’s similar to heroin.
“The literature finds that for opioid addiction, methadone and Suboxone are more effective than abstinence-based treatment,” the report reads.
“In B.C., Providence Crosstown Clinic is the only clinic to offer medical grade heroin and hydromorphone within a supervised clinical setting to chronic substance use patients,” it continues. “The scale up of iOAT [injectable opioid agonist therapy] should be undertaken as part of a continuum of care whereby individuals would be able to step down to less intensive treatments once successfully stabilized on iOAT.”
Third, for people who are using illegal drugs, B.C. should make it safer for them to do so.
It recommends that naloxone (brand name Narcan)—a drug that reverses the effects of opioids to save someone’s life in the event of an overdose—should be easier to access, especially for people exiting B.C.’s prison system (who are found to be at a higher risk of overdose).
It also states that B.C. should expand access to drug-testing strips that can detect the presence of fentanyl and fentanyl analogues.
“By April 2019, the Ministry of Mental Health and Addictions will establish and evaluate community based drug checking services,” the report reads.
The group behind the document is officially known as a “death review panel” and consisted of 21 health-care professionals and law-enforcement officials, among others. It analyzed a 19-month period covering January 2016 to the end of July 2017, a time during which 1,854 people in B.C. died of an illicit-drug overdose.
“The clearest finding that has come through this review is the reaffirmation that the biggest problem we face in terms of overdose deaths is the recent increase in drug toxicity,” said Michael Egilson, chair of the coroners service's death review panel. “In particular, the potency and content of illicit substances is unpredictable; this is why we’re advocating for access to safer drug use, including opioid agonist therapy, tools like drug checking and Take Home Naloxone kits, as well as an evidence-based treatment and recovery system of care.”
The report was published on the same day that the B.C. Coroners Service released its latest monthly update on illicit-drug-overdose deaths, which covers up to the end of February 2018.
That month, there were 102 fatal overdoses in B.C.
It’s a number that’s less than the 126 deaths recorded in January 2018, but one that maintains what has come to be termed the “new normal” of more than 100 fatal overdoses each month in B.C.
From October 2016 to November 2016, overdose deaths jumped from 76 to 141. Since then, an average of 124 people in B.C. have died each month after taking an illicit narcotic.
That compares to an annual average of 204 deaths that was recorded in B.C. from 2001 to 2010.
The synthetic opioid fentanyl was detected in 83 percent of deaths during 2017, up from 67 percent the year before and from 29 percent in 2015.