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People hold a banner during a march to remember those who died during the overdose crisis and to call for a safe supply of illicit drugs on International Overdose Awareness Day in Vancouver on Aug. 31.DARRYL DYCK/The Canadian Press

More than 200 people died in a single month from illicit-drug toxicity in British Columbia, a bleak milestone in the province’s runaway overdose crisis.

October’s 201 deaths – a figure that could increase as investigations conclude – also make 2021 the province’s deadliest year for overdoses, even though the numbers for the final two months have yet to be tallied. From January to October, at least 1,782 people died from illicit-drug toxicity in B.C., surpassing 2020′s total of 1,765, according to a report being released on Thursday from the BC Coroners Service. In comparison, 201 people fatally overdosed in all of 2009, before the powerful opioid fentanyl came to dominate the illicit drug supply.

Chief coroner Lisa Lapointe and B.C. Minister of Mental Health and Addictions Sheila Malcolmson are expected to discuss the report on Thursday morning.

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Provincial and federal governments face mounting pressure to take bolder actions in response to an epidemic that has killed more than 25,000 Canadians since January, 2016.

The B.C. government has introduced measures that include the rapid expansion of overdose prevention services, investments in addiction treatment, the widespread distribution of naloxone kits to reverse overdoses, and an application to decriminalize personal drug possession provincewide.

But driving the unprecedented surge in deaths is a volatile, unregulated drug supply that is markedly different from what it was a decade ago. B.C.’s efforts to address the problem, including a cautious roll-out of a “safer supply” program, have been called inadequate.

Perry Kendall, who, as B.C. provincial health officer declared a public-health emergency in 2016 in response to the significant rise in fatal overdoses, said this week that the latest figures are “unconscionable” and “it is past time for an adult discussion about drug policy.”

“The [Controlled Drugs and Substances Act] ostensibly aims to ‘control’ certain substances in order to protect individuals from their associated harms, yet the direct and ironic outcome of attempting to prohibit non-medical use of opioids has had exactly the opposite effect,” Dr. Kendall wrote in an e-mail to The Globe and Mail.

He referenced the “iron law of prohibition,” a term coined by the cannabis activist Richard Cowan in 1986 to describe how harsher criminal penalties prompted traffickers to produce more potent forms of a substance to minimize volume and maximize profits.

“Our present societal approach to psychoactive substances is illogical and inconsistent, as well as being ineffective and historically based on racist stereotypes rather than having any basis in pharmacology, economic theory of supply and demand, or human behaviour. … Access to a regulated supply of stimulants and opioids of known quality and consistency would not only save lives, it could also remove the financial incentives that drive the present criminal market.”

Toxicology results from the BC Coroners Service reveal the rapidly changing nature of the illicit supply. Fentanyl, found in less than 5 per cent of drug deaths in 2012, has consistently been in about 85 per cent of deaths since 2017.

More recently, the service has detected a growing number of cases with “extreme” fentanyl concentrations. From April, 2020, to October, 2021, about 14 per cent of cases had concentrations of fentanyl exceeding 50 micrograms per litre, compared to 8 per cent from January, 2019, to March, 2020. In October, 2021, it climbed to 25 per cent.

Benzodiazepines, a class of drugs commonly used to treat sleep and anxiety disorders that increase the risk of overdose when combined with opioids, were detected in 15 per cent of expedited toxicology results in July, 2020. This past October, they were in 53 per cent.

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A paramedic specialist from B.C. Ambulance tries to speak to a drug overdose victim in downtown Vancouver on June 23.JONATHAN HAYWARD/The Canadian Press

B.C.’s Ministry of Mental Health and Addictions said in a statement that it is directing up to $22.6-million over the next three years to the implementation of its new safer supply policy, which will initially offer a range of prescribed opioids, including injectable hydromorphone, hydromorphone tablets, and fentanyl patches and tablets. Health authorities have submitted their plans for safe supply, and new programs and services are expected to be available in coming months, the statement said.

The federal Ministry of Mental Health and Addictions said in a statement that the applications from the City of Vancouver and the province of B.C. to decriminalize personal drug possession “are currently working through the review process.”

In the first three months of this year, 90 per cent of all opioid toxicity deaths in the country occurred in B.C., Alberta or Ontario, according to the Public Health Agency of Canada.

Alberta recorded 1,026 drug deaths in the first eight months of this year, a 20-per-cent increase from the same period last year. Ontario recorded more than 3,450 opioid-related deaths since the COVID-19 pandemic began (March 17, 2020, to June 30, 2021), with the first year of the pandemic (April, 2020, to March, 2021) seeing a 76-per-cent increase in deaths compared to the previous year.

Meanwhile, annual fatal overdoses in the United States topped 100,000 for the first time. An estimated 100,306 people died from overdoses in the 12-month period ending in April, 2021, a 28.5-per-cent increase from the year prior, according to the CDC’s National Center for Health Statistics.

Proponents of safe supply say it’s a way to curb the growing number of Canadians dying each year to a street drug supply saturated with dangerous substances such as fentanyl. Safe supply programs offer pharmaceutical alternatives and studies show they can prevent overdoses and other crime, while critics worry that recipients may sell their prescribed drugs to buy other substances.

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