British Columbia's approach to treating addiction amounts to "a series of disconnected silos" that in some instances increases the likelihood someone will overdose, says the province's chief medical officer. Perry Kendall said a patient who goes through withdrawal and returns to the community without proper support and then relapses is seven times more likely to overdose than if they had remained on illegal drugs. This is because of the speed with which the body loses its tolerance to opioids, he added.
"People say the system is broken, but that's a misstatement because it implies there was a system," said Kendall, speaking at a Canadian Mental Health Association conference in Vancouver on Wednesday.
"A system is defined as a series of interlinked parts that function to make a whole."
Kendall has been at the forefront of an opioid crisis that claimed 922 lives in B.C. last year alone. The updated death toll is higher than the 914 fatal overdoses initially reported.
Last April, Kendall declared a state of emergency in order to raise public awareness around a sharp spike in overdose deaths, and to open lines of communication between the different public bodies dealing with the public-health emergency.
Paul Farnan, an addictions-medicine specialist who also spoke at the conference Wednesday, said the B.C. system would benefit from better co-ordination in shepherding patients through the various stages of what should be a long-term approach to treatment.
"When you stand back and look at it, you say, 'Well, this is totally disjointed. I can't get a person into detox.' And then the detox people are just trying to get them out for the next people," Farnan said. "So nobody is really co-ordinating the next step."
He commended those who work in detox, describing them as swamped and overwhelmed, but said it is "ill-advised" to invest in helping people go through withdrawal without providing funding for those crucial, later stages of support.
Farnan also lamented the stigma around addiction, saying he dislikes the myth that detox is a cure for a "dirty addict," as opposed to the first phase in treating a chronic illness.
"The public has this idea that you dip people in the spin cycle of a detox or a rehab (and) they're all better," he said. "They're not better. They're just on the start of a very long journey."
Provincial data shows that, beginning in 2003, B.C. saw about 200 fatal overdoses a year until about 2011, when the death count began to rise.
In 2016, the deadliest year to date, the jump in fatal overdoses declined slowly between March and November before surging in December, when a record-setting 142 people died. The chief medical officer attributed that spike to the arrival of carfentanil, a synthetic opioid he said is 100 times more powerful than fentanyl.
The provincial coroners' office said the proportion of overdoses in B.C. where fentanyl was detected increased from five per cent in 2012 to 62 per cent in 2016. Four out of every five people dying from opioid overdoses in B.C. are young men and the highest-risk days are Saturday and Sunday.