Two-thirds of British Columbians who died of drug overdoses in recent years were at some point in their lives in custody or under community supervision, highlighting the need to improve access to treatment behind bars and connect inmates with health care upon release.
That’s one of the findings in a report released on Thursday by a panel struck last fall to examine British Columbia’s significant increase in overdose deaths. Four people die of overdoses every day in B.C., the report said, and all of these deaths are preventable.
“More individuals died over this [review] period of an illicit-drug overdose than died as a result of a motor vehicle incident, suicides and homicides combined,” panel chair Michael Egilson said.
The report found that 66 per cent of those who died interacted with BC Corrections at some point. Of 1,854 people whose deaths between January, 2016, and July, 2017, were reviewed, 18 per cent had died while under community corrections supervision (in prison or on parole) or within 30 days of release from a correctional facility; 25 per cent died while under supervision or within a year of release; and 30 per cent while under supervision or within two years of release.
Inmates in B.C. can request opioid agonist treatment with methadone or buprenorphine-naloxone (Suboxone) upon admission, but some have reported delayed access, or no access at all.
B.C. Mental Health and Substance Use Services, an agency of the Provincial Health Services Authority, assumed responsibility for health care in B.C. correctional services from a private contractor last fall and is remedying the lapse in care.
Laura Shaver was incarcerated several times over a 10 year span and said it would sometimes take three days from her admission to receive her methadone even though medications for her insomnia and stomach issues were available immediately. That meant three days of withdrawal that she describes as “hell.”
“Not only are you locked in a box that’s cement and cold and stinky, you’re feeling like crap,” said Ms. Shaver, who is president of the B.C. Association of People on Methadone. “People don’t understand: It’s shivers, it’s diarrhea, it’s vomiting, it’s stiff, jerky muscles. It was awful.”
Ms. Shaver said health-care staff in prison also said they would give her a prescription for methadone upon release, but did not, which led to her relapsing.
Since assuming responsibility, the substance-use service has added three full-time nurses to most provincial correctional centres to care for inmates with substance-use disorders and ensure continuity of care upon discharge, said Nader Sharifi, medical director for correctional health services.
A list of 80 people waiting for opioid agonist treatment in October has dropped to about 20. Between 30 per cent and 35 per cent of all inmates are on treatment.
The new nurses ensure inmates have a prescription upon discharge, Dr. Sharifi said. Those who go before a judge and are abruptly discharged can now go to any pharmacy, which can then call the health-care clinic at the correctional facility and get a prescription faxed over.
“We want to make sure the methadone and Suboxone continuity is there,” Dr. Sharifi said. “Risk of overdose one week postrelease increases by eight to 12 times, compared to the general population. It’s a very high risk period, so we’re taking it very seriously.
Keith Ahamad, an addictions physician who works in a city jail, said the report confirms what he and his colleagues have long known. He praised the recent efforts of the substance-use service, but noted they are long overdue.
“They’re working to create comprehensive plans for people, but they’re literally playing catch-up for decades of neglect in an area that we know people have been at risk,” Dr. Ahamad said.
The report also found that, of the 1,854 recent deaths reviewed, not one person had Suboxone in their system.
“This is consistent with the evidence demonstrating the safety of buprenorphine/naloxone and the role this medication in preventing overdose deaths,” the report stated. Methadone, meanwhile, was detected in 31 deaths.
Among other findings in the report: About 9 per cent of the people who died were homeless. Indigenous people represented 10 per cent, even though the census says they make up 6 per cent of the B.C. population. Alcohol, which increases risk of respiratory depression and death when combined with opioids, was detected in about 40 per cent of toxicology reports from 615 of the deaths reviewed.
The panel made three broad recommendations: provincial regulation and oversight of recovery programs; expansion of treatments such as oral and injectable opioid agonists; and safer drug use through services such as drug checking.