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.