British Columbia's provincial health officer concluded his last day in the role with a call to further push the envelope in responding to the province's overdose crisis, which new numbers show killed more than 1,400 people last year.
Perry Kendall said Wednesday the year-end tally of 1,422 illicit-drug overdose deaths – a figure that works out to a rate of 29.6 per 100,000 population and will grow as outstanding death investigations are completed – show that B.C. is "still in the midst of a persistent and continuing epidemic of unintentional poisoning deaths.
"We are going to need to think more broadly, and also think further outside both the box and our comfort zones, if we are going to get ahead of, and turn this epidemic around," he told reporters in Victoria.
The province hardest hit by the overdose crisis has already produced some of the country's boldest responses. The most radical of them all may be a low-barrier pilot project beginning in April that will provide people at high risk of an opioid overdose from illicit drugs with pharmaceutical-grade hydromorphone tablets, a drug similar to heroin, to use as they please.
As well, B.C. produces detailed overdose statistics every month; has distributed 58,000 take-home naloxone kits – which contain first-aid supplies and a medication that reverses the effects of opioid overdoses – free of charge since August, 2012; and has eight operating supervised consumption sites and 18 overdose prevention sites. The province has also directed all health authorities to scale up injectable hydromorphone programs, in which people receive the drug to inject two or three times a day under supervision.
The Globe and Mail looked at what other provinces are doing to combat opioid overdoses, the rates of which vary in scale across jurisdictions. Note that there are differences in provincial reporting metrics and timeliness, and that rates per 100,000 can change substantially for jurisdictions with small populations.
Latest figures: At least 482 people died of opioid-related overdoses in the first three quarters of 2017 – a 40-per-cent increase compared with the same period the previous year. About 80 per cent are related to fentanyl, a rate of 12.4 per 100,000 population across the province.
Recent actions: The Alberta government in May, 2017, formed an Opioid Emergency Response Commission. Health Canada has approved six supervised consumption sites for the province, one of which is now in operation. In coming months, it will launch an injectable hydromorphone pilot that will begin with 50 people each in Edmonton and Calgary.
Latest figures: At least 12 drug overdose deaths in the first three quarters of 2017, with at least nine of those being opioid related, though those figures will rise as death investigations conclude. In comparison, there were at least 79 overdose deaths in 2016, with at least 67 of those being opioid related.
According to the federal government, Saskatchewan's rate of apparent opioid-related deaths in 2016 was between 0 and 4.9 per 100,000. Meanwhile, the Canadian Institute for Health Information reported that Saskatchewan has among the highest rates of opioid-poisoning hospitalizations of all provinces: 21.7 per 100,000 in 2016-17.
Recent actions: On Jan. 1, 2017, Saskatchewan began providing coverage for the substitution therapy drug buprenorphine-naloxone (Suboxone), which prior to that date could only be prescribed to people for whom methadone was not suitable. It launched its take-home naloxone program in November, 2015, and distributed 456 kits free-of-charge in two years. The province says it is not considering supervised consumption sites.
Latest figures: In the first quarter of 2017, at least 30 people died of opioid-related drug overdoses, with fentanyl being a factor in 14 of those deaths. In comparison, at least 146 people died of opioid-related overdoses in all of 2016, with fentanyl playing a role in 33.
Recent actions: Manitoba created an opioid task force in early 2016 and it has met 16 times since. The province also has a take-home naloxone program that distributed 245 kits in 2016. Last June, Suboxone became covered by the provincial drug program.
Latest figures: In 2016, 867 people died of opioid-related overdoses, which is a 19-per-cent increase from the previous year and works out to a rate of 6.2 per 100,000. It's the highest such death toll for the province since 2003. Of the 867 deaths, fentanyl was a factor in more than 40 per cent.
Recent actions: The province in October announced the creation of an Opioid Emergency Task Force to co-ordinate its response to the crisis. The province has received approval for seven supervised consumption sites, four of which are currently offering services. Naloxone kits have been available to the public free of charge in community pharmacies since June, 2016.
Latest figures: Quebec is furthest behind of all provinces in reporting opioid-related deaths, with 2014 being the most recent year with complete data. According to the province's National Institute for Public Health, Quebec averaged 194 opioid-related deaths between 2010 and 2014, for a rate of 3.1 per 100,000. Preliminary numbers show there were at least 222 such deaths in 2015 (3.4 per 100,000) and 140 (2.2 per 100,000) in 2016.
Recent actions: Four supervised consumption sites began operating in Montreal last year. As well, Quebeckers can obtain naloxone free of charge at pharmacies and there are local initiatives to train drug users, their loved ones and other stakeholders in the administration of the overdose-reversing drug.
Latest figures: At least 16 people died of apparent opioid-related overdoses in the first three quarters of 2017, for a mortality rate of about 3.7 deaths per 100,000. Five of those deaths were fentanyl related. For all of 2016, the province recorded 26 opioid overdose deaths, for a rate of 3.4 per 100,000.
Recent actions: A May, 2017, document outlining the addictions and mental health component of the province's medical services provides few tangibles, instead referencing generalities such as plans to improve community-based treatment options and develop "an integrated recovery approach to service delivery across the continuum of care." The province in November announced $150,000 to purchase about 2,500 naloxone kits to distribute to target populations.
PRINCE EDWARD ISLAND
Latest figures: PEI recorded five apparent opioid-related overdose deaths in 2016. Data for 2017 are not yet available, but confirmed deaths so far total fewer than five.
Recent actions: The province in November released an action plan to prevent and mitigate opioid-related overdoses in advance of illicit fentanyl becoming a factor. The presence of the synthetic opioid in street drugs in PEI was only confirmed in June, 2017, when police seized pills that contained it. The action plan includes improved surveillance on opioid-related overdoses and deaths; harm reduction initiatives such as naloxone distribution and enhanced opioid replacement treatment; and a rapid response protocol to address a sudden increase in overdoses. PEI also has a needle exchange program with seven sites.
Latest figures: From January through November of 2017, Nova Scotia recorded at least 45 confirmed and 10 probable opioid-related overdose deaths. Overdose deaths have remained stable at about 60 per year since 2011.
Recent actions: The province in October, 2016, established a committee to develop an opioid use and overdose framework, including expanding access to take-home naloxone kits, ensuing sustainable funding for needle distribution and disposal services and exploring the need for supervised consumption sites. In March of 2017, the provincial government announced $1-million in funding to address the increase in illicit fentanyl.
NEWFOUNDLAND AND LABRADOR
Latest figures: Newfoundland and Labrador recorded 13 accidental drug overdoses in 2016, with 11 of those deaths due to opioids.
Recent actions: Newfoundland launched its opioid action plan in November, 2016. As part of that plan, it began distributing 1,200 naloxone kits to targeted populations and to 52 sites across the province. As well, it removed barriers to prescribing Suboxone, introduced a mandatory safe prescribing course for physicians and released an action plan with dozens of goals aimed at improving mental health and addictions care in the short and long term.