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British Columbia’s first drop in overdose deaths since 2012 signals not the end of the public health crisis but the beginning of refocused efforts to prevent overdoses in the first place, health officials say.

Data released by the BC Coroners Service on Monday showed that there were at least 981 deaths in 2019 – a 36-per-cent decrease from 1,543 deaths in 2018. (The figure will likely grow as death investigations conclude.) It’s the first decrease since 2012, before which illicit fentanyl – a major driver of the overdose crisis – was so uncommon that it was not routinely tested for postmortem.

In 2012, the opioid was detected in less than 5 per cent of overdose deaths. In 2019, it was detected in 84 per cent.

At a news conference in Victoria on Monday, health officials attributed the drop to the many harm-reduction initiatives launched in B.C. in recent years. They include an expansion of supervised drug-consumption sites, widespread naloxone distribution and the availability of drug-checking services.

But the death toll is still nearly five times what it was in the 2000s, and merely keeping people alive is not enough. Perry Kendall, co-interim executive director with the BC Centre on Substance Use, spoke of long-term brain damage resulting from non-fatal overdoses and said the scope of impact to communities is only just beginning to be understood.

“Surviving an overdose is not enough. Stopping death is important, but it isn’t enough,” Dr. Kendall said. “We must refocus on implementing strategies to prevent overdoses from occurring in the first place, however politically challenging that may be.”

Innovative treatments such as injectable hydromorphone and diacetylmorphine (pharmaceutical-grade heroin) are still “barely accessible,” he noted. And, the province swiftly dismissed a blueprint to decriminalize people who use drugs, released by Provincial Health Officer Bonnie Henry last year.

“Let’s take a moment to acknowledge that our collective efforts are having an impact,” Dr. Kendall said. “But also, this can only be seen as the beginning of our response – not the end. There is much work still to be done.”

Dr. Henry said the priority must now be on providing pharmaceutical alternatives for people dependent on illicit drugs.

“There are a number of projects that have been started but we are not yet where we need to be to support the members of our community who need our help through this crisis," she said.

While fentanyl is the drug most commonly found in “down” – the colloquial term for illicit opioids such as heroin – it’s far from the only one. Carfentanil, a tranquilizer intended to immobilize large animals such as elk and moose, was detected in 130 overdose deaths in 2019, up from 35 in 2018. Benzodiazepines and other similar drugs are also being cut into down, increasing the risk of overdose, rendering users unconscious for hours at a time and putting them at risk of being robbed or assaulted.

In recent years, the coroners service renamed overdose deaths as “illicit drug toxicity deaths” in its reports to reflect that people are dying not from taking too many drugs, but from a highly volatile drug supply.

Lance Stephenson, director of patient care delivery with BC Emergency Health Services, said Monday that paramedics respond to roughly 24,000 overdose events a year, and saw a 2 per cent increase in 2019.

Nel Wieman, senior medical officer of mental health and wellness with the First Nations Health Authority, said a separate data release on the impact of B.C.’s overdose crisis on Indigenous people is forthcoming, but that it is proportionally greater than that of the general population.

“The reasons for our higher numbers are obvious to us: the impacts of colonization, the disempowerment and enduring trauma of experiences such as the Indian residential schools, the Sixties Scoop and the still prevalent racist stereotyping and discrimination of Indigenous people,” Dr. Wieman said. “We know that substance use disorder can be symptoms of a person’s distress. For Indigenous people, this distress is often rooted in grief, loss, disconnection and unresolved intergenerational trauma.”

Since Jan. 1, 2016, more than 5,010 people have died in B.C. due to a volatile illicit-drug supply contaminated with fentanyl, carfentanil, benzodiazepines and other adulterants.

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