A grim year by the numbers: 2020’s busiest days for overdoses, and what needs to change in 2021

B.C. declared a public health emergency 5 years ago, but the overdose crisis worsened in 2020 when paramedics responded to 74 calls a day

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Paramedic specialist Brian Twaites worked in ambulance dispatch on New Year’s Eve, monitoring 911 calls from across the province. The pandemic had kept many people home, so there wasn’t the usual chaos in bars or on the streets, but there was an alarming increase in another type of plea for help.

B.C. residents reported a suspected drug overdose 110 times on Dec. 31. That day had the eighth-highest number of 911 overdose calls in 2020, a year that also smashed records for drug toxicity deaths.

On Wednesday, it will be five years since B.C. declared a public health emergency on April 14, 2016, after hundreds of people were fatally poisoned by drugs laced with fentanyl and other contaminants. The situation grew even more dire in 2017 and 2018, when about 1,500 British Columbians died each year, but new responses by community advocates, front-line workers and governments lowered that death toll to less than 1,000 in 2019.


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Those improvements would be erased in 2020. Pandemic restrictions imposed last spring led people to use alone and led to a more toxic drug supply. It made 2020 the deadliest year yet, with 1,724 drug users fatally poisoned in B.C. — nearly five people every day.

This has made the fifth anniversary a grim reminder that without significant changes — a safer drug supply, more health-care support, improved treatment options — there is no end in sight to the crisis.

On New Year’s Eve, paramedics were able to save most of the 110 people on the other end of those 911 calls. But they are tough assignments for first responders, and even more difficult for the families and friends who phoned for help — and for the drug users poisoned by their fix.

“It’s such a blur when you’re sitting there and these alerts keep coming across your (dispatch centre) screen: An overdose, an overdose, suspected overdose. And it’s not just the Downtown Eastside. It is every corner of the province. We’re seeing it in Houston, we’re seeing it in Prince George, we see it in Victoria. It’s not limited to the back alleys, it is in Kitsilano, UBC, Shaughnessy,” said Twaites. He’s a 35-year veteran who works both in dispatch to provide clinical support to co-workers on the road and on the street as an advanced life support paramedic.

“This is someone’s kid. This is someone’s father. This is someone’s cousin. This is someone’s best friend. So every time this happens, there’s such a cascade of grief around it, that it’s really tragic. And to be the one to tell somebody that their loved one has died is a really tough part of the job.”


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Paramedic specialist Brian Twaites in Vancouver.
Paramedic specialist Brian Twaites in Vancouver. Photo by Arlen Redekop /PNG

He left work at 2 a.m. on Jan. 1, 2021, hoping the new year would be healthier than 2020.

“How could you not, with everything that’s been going on in the past year, specifically with opioids?”

B.C. Emergency Health Services, the agency that oversees ambulances in the province, provided Postmedia a tally of 911 calls for every day in 2020.

It shows 30 days had 100 or more overdose calls, some immediately after income assistance and disability cheques were issued. Others were celebratory evenings like New Year’s Eve or the day after Halloween. But there are also seemingly random days with high numbers of poisonings.

Ambulance paramedics responded to 27,068 overdose calls in 2020, an average of 74 a day. And the trend appears to be worsening: from an average of 2,255 requests for help a month in 2020, rising to more than 2,500 for the first three months of this year.

“Unfortunately, the high number of overdose calls have continued into 2021,” said BCEHS spokeswoman Shannon Miller.

Here, we take a look at the stark reality of 2020 with the help of paramedics, coroner’s reports, health authority warnings and police bulletins. We do this to ask: Can this narrative be changed in 2021?

March 25-26, 2020: 210 overdose calls

Emergency calls for overdoses were relatively low for most of the first three months of 2020, the BCEHS data shows, but the numbers started to steadily climb after March 20. On that date, in response to the pandemic being declared, the Canada-U.S. border was closed, which experts believe cut off traditional trafficking routes for street drugs and led to a supply being cut with poisonous substances.


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Just as drugs became more dangerous, public health measures to stop social gatherings and prohibit visitors in homes meant many people switched to using alone — with no one around to try to save them.

On March 25, when provincial assistance cheques were released, paramedics fielded 111 overdose calls, followed by 99 the next day. Also in March, the overdose death toll hit 114 people, far higher than the tallies for January or February.

Shane Sander, a paramedic in Cloverdale, said it is a common assumption that overdoses only affect marginalized people, a misconception that he said must be overcome in order to address the crisis.

“Sometimes it’s the housemates checking on their roommate who’s unresponsive due to an accidental overdose, and sometimes it’s the grandmother knocking on the bathroom door, opening it, and finding her grandson unresponsive,” said Sander, a spokesman for the Ambulance Paramedics of B.C. union.

“Sometimes it’s the father at home found unresponsive, or the adolescents experimenting with friends that are found down in an alleyway. Sometimes it’s the person who is off work with a back injury and needed pain relief that began abusing substances as a coping mechanism. We never know what the trigger is, but it’s not our place to judge.”

Shane Sander, a primary care paramedic and spokesman for the Ambulance Paramedics of B.C., at the Cloverdale ambulance station in Surrey.
Shane Sander, a primary care paramedic and spokesman for the Ambulance Paramedics of B.C., at the Cloverdale ambulance station in Surrey. Photo by Jason Payne /PNG

April 24, 2020: 112 calls | May 28, 2020: 115 calls

Each month last spring, there was a new high for overdose 911 calls. There were 112 on April 24, two days after assistance cheques were issued; there were another 115 on May 28, one day after the handout of cheques.


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A variety of warnings were being issued about the mounting toxicity of the drugs. The Delta school district website, for example, posted a provincial alert on May 6, another was issued May 8 by Northern Health, and a third on May 11 on Vancouver Island.

Paramedics will often respond to several overdose calls in the same shift, and sometimes will recognize patients they’ve revived before. Twaites, a Vancouver paramedic, can’t forget a long conversation with one man he resuscitated, who explained he had a job and wanted to go to the hospital to get help with his addictions.

“It was probably about six or seven months later, and we were doing a resuscitation of a narcotic overdose. And as soon as we woke this person, I realized it was the same guy,” Twaites recalled.

“He just looked at me and he says, ‘I was doing so well. And I had a slip.’ And that’s hard. So calls like that stick with you. You see the turmoil in someone’s life. And then you see the turmoil in their life again, and they’re still fighting it.”

The number of people dying was also climbing, up to 122 in April, and 176 in May.

June 25-26, 2020: 237 overdose calls

June, though, was the deadliest month to date in B.C., with the loss of 185 lives. It also had the highest daily number of 911 overdose calls, with 131 on June 26, two days after cheque distribution.

Paramedic Shelby Weber can remember responding to an overdose call at the New Westminster pier, and then another one in a nearby residence, in late June, sweating in her plastic gown, gloves, face shield and mask, which she was required to wear to avoid exposure to COVID-19.


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“It was hot and sunny and just a lot to deal with in one day … (And) this is the other challenge with COVID: How are people coping with mental health?” asked Weber, also a spokeswoman for the Ambulance Paramedics of B.C.

Paramedic Shelby Weber.
Paramedic Shelby Weber.

Another trend that Weber finds worrying is that it often takes paramedics longer and longer to wake people from overdoses.

On June 18, Northern Health sounded the alarm about benzodiazepines — which slow down brain activity — being mixed with opioids, making users more prone to overdoses and more difficult to rouse.

July 22-25: 425 overdose calls

July was the first month to have four bad days for 911 overdose calls in a row, starting with 106 on July 22 (cheque day) and ending with 121 on July 25.

Overdose advisories continued across B.C. that month, including a provincewide warning July 17 about smoking opioids and stimulants, and a July 20 Interior Health alert about “severe outcomes” from using a dark reddish-brown substance with green specks being sold as an opioid in Cranbrook.

In July, Liberal critic Jane Thornthwaite called on the NDP to invest more in mental health and addictions, “to fill the gaps in the system exposed by the COVID-19 pandemic.”

Aug. 16: 103 calls | Aug. 26: 108 calls

August marked the beginning of a new troubling pattern that would be repeated in the final five months of 2020: An additional high-volume day for 911 overdose calls that did not overlap with assistance cheques.

On Aug. 16, paramedics responded to 103 calls. The day before, Interior Health issued an overdose alert for the Kootenay-Boundary area, warning of “highly toxic amounts of fentanyl and benzodiazepines.”


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Later that month, the NDP’s then-minister of mental health and addictions, Judy Darcy, issued a statement saying the gains her government made to reduce overdose deaths continued to be “strained” by fallout from the pandemic, including losing in-person supports, financial pressures and growing mental health challenges.

But advocates argue the government’s response to the drug crisis needs to be stronger, as nearly twice as many people fatally overdosed in 2020 as had died from COVID-19.

Sept. 5: 103 calls | Sept. 23-25: 319 calls

In addition to three frenzied days around cheque distribution, this month had more than 100 overdose calls on the Saturday of Labour Day weekend.

About a week later, Interior Health issued a warning about a beige drug sold as “down” that contained fentanyl and can cause “hallucinations and death.”

An Insights West poll released in September found one out of every three British Columbians have someone in their immediate family or friend group who struggles with addiction or has fatally overdosed.

Shane Sander, a primary care paramedic and spokesman for the Ambulance Paramedics of B.C.
Shane Sander, a primary care paramedic and spokesman for the Ambulance Paramedics of B.C. Photo by Jason Payne /PNG

“What we don’t emphasize enough is that drug overdoses affect everyone,” said Sander. “Sometimes we’re not just treating the patient in front of us, but also the emotional toll it takes on friends and families.”

Oct. 7: 114 calls | Oct. 21: 105 calls

There were 114 overdose calls on Oct. 7, a time when drug toxicity levels were clearly high.

On Oct. 5, four people overdosed outside the Campbell River courthouse and were revived by first responders. On Oct. 17, Surrey RCMP said five people overdosed inside one house and each required about four doses of Narcan, a medication to reverse overdoses.


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Twaites, who worked during Vancouver’s heroin overdose crisis in the 1990s, said the potency of today’s drugs often requires him to use 10 or more times the dosage of Narcan than he used three decades ago.

“(Patients) are almost clinically dead because it knocks out their respiratory drive. So we have to get to them quickly … so they don’t get brain damage,” said Twaites, who once responded to 24 overdoses in one shift.

Nov. 1: 100 calls | Nov. 18-20: 331 calls

One of the highest days for overdose calls in November came on the first day of the month, coinciding with a series of drug toxicity alerts.

Island Health advised Greater Victoria residents on Nov. 3 against injecting or inhaling opioids and stimulants. Interior Health warned Nov. 4 about a dark pink or purple drug in Penticton. And, on Nov. 6, Abbotsford police said street drugs were four times more potent, affecting many people in their 20s.

After cheques were issued Nov. 18, there were three days of more than 100 overdose calls, including the Surrey RCMP responding to fatal overdoses at three locations.

With a monthly death toll of more than 160, chief coroner Lisa Lapointe added her voice in November to those calling for significant change.

“We encourage clinicians to support those at risk of overdose by prescribing safe supply and reducing the numbers of lives lost to toxic substances. We also continue to advocate for an accessible, evidence-based and accountable treatment and recovery system.”


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Chief coroner Lisa Lapointe.
Chief coroner Lisa Lapointe. Photo by Jason Payne /PNG

Dec. 16-17: 211 calls | Dec. 31: 131 calls

By the end of 2020, 1,716 people would fatally overdose. Two-thirds were 30 to 59 years old, and four out of every five were men, according to the B.C. Coroners Service. The majority of deaths occurred inside, more than half in private homes. No one died in a supervised-consumption site.

The devastating year brought many demands for action.

After a man died in his tent at the Strathcona Park encampment on Dec. 5, advocate Fiona York said more attention must be paid to the reasons behind the rise in overdoses during the pandemic: homelessness, fewer services, isolation and tainted drugs.

All three levels of government poured money into supports in 2020, including into more housing, more treatment, more supervised-consumption sites and improved access to safe supply — but it was not enough to stem overdoses or deaths.

And so the tough calls continue for B.C.’s paramedics.

Weber, who now works in Surrey’s downtown Whalley neighbourhood, can remember an emotional assignment last winter. A man had locked himself in the bathroom, something that isn’t usual for drug users who want to hide their habit from their loved ones, and his family could see through a window that he was lying on the floor.

“It was a young gentleman who was at home and has been off work because of COVID and an injury. And he somehow got into narcotics to help deal with his pain,” she recalled.

“He ended up dying. And there were young children in the family and his wife that he had left behind. And it was quite a distressing thing to see for the family, which can become quite distressing in our own lives. We all know friends that have lost jobs because of COVID or can’t work because of a physical injury that happened at work. And it’s kind of scary to see how that can spiral.”


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Jan., Feb., March 2021: 7,190 calls

The volume of 911 overdose calls continued to go up in 2021. March 25 matched the daily record of 131 calls, set on June 26, 2020.

In response to this crisis, B.C. Emergency Health Services introduced the Downtown Eastside bike squad, which responds to overdoses on two wheels. The service also schedules more paramedics to work on busy shifts, such as on cheque days, said Miller, its spokeswoman. The Ambulance Paramedics of B.C. union, though, argues the system often doesn’t have enough workers to handle the high call volumes because staff are burning out.

The BCEHS also joined health authorities to help design the Lifeguard App, which was launched in May. Drug users activate the app before taking their hits and must respond to an alarm that sounds 50 seconds later. If they don’t turn off the ringing within 75 seconds, 911 will be alerted of a potential overdose. The app had been downloaded by 4,735 people, led to 62 calls to 911 and resulted in 16 overdose reversals. No one using the app has died, said Miller.

Paramedic specialist Brian Twaites in Vancouver.
Paramedic specialist Brian Twaites in Vancouver. Photo by Arlen Redekop /PNG

When paramedics are called to help with overdoses, patients have a 95 per cent chance of survival, Miller said.

Twaites said the most important thing that people can do is not use alone.

“People are going to be using drugs. We have to face that. And if you’re gonna use drugs, just do it safely,” he said.

“Make sure you have a Narcan kit, make sure you phone 911 right away, and make sure that there’s somebody there that can help you if something goes wrong. Addiction is a disease and we have to find ways to fight it.”


— With files from Nathan Griffiths, Postmedia data journalist

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