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Canada B.C. opioid overdoses lower for 2019 but experts still cautious amid unpredictable drug supply

Kim Bapsiste, who started working at this overdose prevention site after her daughter overdosed, fills supplies for drug users in Vancouver's Downtown Eastside, on May 15, 2019.

Rafal Gerszak/The Globe and Mail

Overdose deaths in British Columbia are down in the first quarter of 2019 but experts are reserved in their optimism, citing still-high numbers and the unpredictability of the illicit drug supply.

The latest figures released on Wednesday from the BC Coroners Service (BCCS) show that at least 82 people died of illicit drug overdoses in the province in March, bringing 2019’s death toll for the first quarter of the year to at least 268 people.

The average monthly death toll works out to 89 deaths a month – a figure that is down 32 per cent from the same period last year (132 deaths a month). However, this number will increase as death investigations conclude.

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ILLICIT DRUG OVERDOSE DEATHS

AND DEATH RATE IN B.C.

Per 100,000 population

The illicit drug overdose category

includes the following:

Street drugs (Controlled and illegal drugs:

heroin, cocaine, MDMA, methamphetamine,

illicit fentanyl etc.).

Medications not prescribed to the decedent

but obtained/purchased on the street, from

unknown means or where origin of drug

not known.

Combinations of the above with

prescribed medications.

Deaths

Death rate per 100,000 population

35

1,600

1,400

30

1,200

25

1,000

20

800

15

600

10

400

5

200

0

0

2019*

1993

‘95

‘00

‘05

‘10

‘15

*First three months

TRISH McALASTER / THE GLOBE AND MAIL

SOURCE: B.C. CORONERS SERVICE

ILLICIT DRUG OVERDOSE DEATHS

AND DEATH RATE IN B.C.

Per 100,000 population

The illicit drug overdose category

includes the following:

Street drugs (Controlled and illegal drugs: heroin,

cocaine, MDMA, methamphetamine, illicit fentanyl etc.).

Medications not prescribed to the decedent but

obtained/purchased on the street, from unknown

means or where origin of drug not known.

Combinations of the above with prescribed medications.

Deaths

Death rate per 100,000 population

35

1,600

1,400

30

1,200

25

1,000

20

800

15

600

10

400

5

200

0

0

2019*

1993

‘95

‘00

‘05

‘10

‘15

*First three months

TRISH McALASTER / THE GLOBE AND MAIL

SOURCE: B.C. CORONERS SERVICE

ILLICIT DRUG OVERDOSE DEATHS AND DEATH RATE IN B.C.

Per 100,000 population

The illicit drug overdose category includes the following:

Street drugs (Controlled and illegal drugs: heroin, cocaine, MDMA,

methamphetamine, illicit fentanyl etc.).

Medications not prescribed to the decedent but obtained/purchased

on the street, from unknown means or where origin of drug not known.

Combinations of the above with prescribed medications.

Deaths

Death rate per 100,000 population

35

1,600

1,400

30

1,200

25

1,000

20

800

15

600

10

400

5

200

0

0

2019*

1993

‘95

‘00

‘05

‘10

‘15

‘18

*First three months

TRISH McALASTER / THE GLOBE AND MAIL; SOURCE: B.C. CORONERS SERVICE

Margot Kuo, a senior epidemiologist with the BC Centre for Disease Control (BCCDC) and the Overdose Emergency Response Centre, said that while it is important to monitor these numbers, the decline is far from comforting.

“While the numbers are down compared to this time last year, we have maybe become inured to the fact that these are still incredibly high rates,” Ms. Kuo said.

The province has seen apparent decreases in overdose deaths before. In the last four months of 2017, the BCCS reported that B.C. averaged about 96 deaths a month – a figure that ended up climbing to 103 a month as death investigations concluded.

Wednesday’s BCCS report also confirms a troubling resurgence of carfentanil, a tranquilizer intended to immobilize large animals such as elk and moose.

The Globe and Mail reported last month that the drug was detected in at least 71 deaths in B.C. from June to December, 2017, with the figure falling to 35 deaths in all of 2018. In just the first quarter of 2019, carfentanil was detected in at least 64 deaths.

A soon-to-be-published study by BCCDC researcher Michael Irvine credits three major interventions with mitigating some overdose deaths: overdose-prevention sites, take-home naloxone and the increased uptake in availability of opioid agonist therapy (OAT) – also called opioid replacement therapy.

“I think those things could be at least part of the reason why these numbers are slightly down and, certainly, they are the reason why they are not higher,” Ms. Kuo said.

“The drug supply is so toxic, this situation would be much worse if those interventions were not there.”

Among other findings in the latest BCCS report: The most vulnerable population continues to be those who use drugs alone, indoors. Last year, 86 per cent of illicit drug deaths happened in places such as private residences and social or supportive housing. In the first quarter of 2019, the figure increased slightly to 88 per cent.

Jane Buxton, an epidemiologist and harm-reduction lead for the BCCDC, cited a 2018 survey the centre conducted with clients of harm-reduction supply distribution sites across the province in which they were asked why they chose to use alone.

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Among the responses: convenience and comfort; not having anyone else around; not wanting to share drugs and not wanting others to know.

“It’s not necessarily that people are concerned about police or stigma, oftentimes it’s convenience and comfort that people may choose to use in their own homes,” Dr. Buxton said.

Also on Wednesday, Health Canada made two changes to reduce red tape in treating opioid use disorder.

First, the federal agency approved injectable hydromorphone for use as a treatment for opioid use disorder. Its use in such a manner was technically considered off-label until now.

Second, Health Canada added diacetylmorphine (heroin) to its List of Drugs for an Urgent Public Health Need, which allows all provinces and territories to bulk-import drugs that are either currently unavailable in Canada or difficult to access, in urgent public-health scenarios.

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