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British Columbia Real-time overdose data to guide B.C. response to public-health emergency

Randall Hall overdosed in an alley after taking heroin laced with fentanyl in 2014. He lived after receiving naloxone injections.

John Lehmann/The Globe and Mail

Randall Hall's worst overdose happened in the fall of 2014, Thanksgiving long weekend, in a Gastown alley he had frequented many times before.

A friend had warned him of the exceptionally potent heroin that was circulating. Even the half-point (50 milligrams) he had was enough to cause another long-time heroin user to overdose. "I advise you not to take the full half," the friend cautioned.

But it was already half of Mr. Hall's usual dosage. And he isn't much one for taking advice.

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"I did the whole thing, and right away, I dropped," Mr. Hall, 33, said in an interview. He came to – after numerous naloxone injections – feeling like he never had before: confused, incoherent, dazed. The colours seemed to have drained from his world. A dozen people had gathered around him.

"They were telling me, 'You're so lucky, you're so lucky,'" he said. "Even the paramedics were afraid."

Mr. Hall was among about 40 who overdosed in just a few days – the result, lab tests would show, of the powerful synthetic opioid fentanyl being cut into the local heroin supply. Since then, overdoses linked to fentanyl have only surged, prompting B.C.'s provincial health officer to declare a public-health emergency earlier this month.

Should Mr. Hall or others like him overdose again, B.C. health officials now plan to collect detailed, real-time information on both the user and the circumstances of the overdose to help guide the public-health response. If several people overdose at one hotel, for example, health officials could immediately assign a nurse to that building and ensure everyone is trained and has access to naloxone, the opioid antagonist that saved Mr. Hall's life.

But first, officials must agree on the parameters for their data, which will have many implications for findings.

A provincial working group is currently mulling questions such as: What is the definition of an overdose? Will the determination of an overdose be based on the clinical signs and symptoms a person presents with – an immediate but limited diagnosis – or laboratory testing, which takes time? Should only confirmed opioid overdoses be included, or also suspected opioid overdoses?

"It's going to be a real challenge," said Mark Lysyshyn, medical health officer for Vancouver Coastal Health. "We want to make sure that we have a public-health response that is matching the magnitude of the problem, but that we're not getting so many reports that we can't follow up with [those who have overdosed] and it's not doing anything."

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Provincial health officer Perry Kendall declared the public-health emergency two weeks ago, saying that at the current rate, B.C. could record up to 800 illicit drug overdose deaths this year. There were 476 such deaths in 2015, a 30.4-per-cent increase from 2014, when 365 people died. Fentanyl, which was the subject of a recent Globe and Mail investigation, has been detected in a bigger percentage of illicit overdose deaths year after year since at least 2012, reaching 32 per cent last year.

While various bodies in B.C. currently collect overdose data, it can be inconsistent. Police officers, firefighters, paramedics, coroners and emergency-room physicians collect different information – name, age, date of birth, address and location of overdose, for example – and when and whether it is shared can vary. This information is useful for monitoring trends, Dr. Lysyshyn said, but is insufficient for an urgent public-health response.

With additional real-time information, he hopes officials will be able to allocate services right away. Doctors could also follow up with those who have overdosed: Do you have a naloxone kit? Do you know how to use it? Are you on any prescription medications that may have contributed to the overdose?

"The person prescribing that medication might not know that [the patient] is also using street drugs," Dr. Lysyshyn said. "So we could follow up with that prescriber and say, 'The fact that this person is on sedative medications may have contributed to the overdose, so could you not prescribe those?'"

The Globe spoke with several intravenous heroin users in Vancouver's Downtown Eastside, all of whom personally supported the action but noted that others may be reluctant to divulge personal details.

Lee Wheeler attributed it to a distrust of authority figures. "Some might, but a lot of people want to stay anonymous," he said. "It's a 'big brother' type of thing. They might talk to you about it, but they don't want to give their names."

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Kyle Darroch, who said he is troubled by the rise of illicit fentanyl, noted that such detailed information is needed – "but it has to be up to the person's discretion, whether they want to reveal a little bit of information or a lot."

Randall Hall said he supports the action. "If somebody's trying to help you, it's good to give them a little information that's going to help them do their job better," he said.

"But some people are afraid of repercussions. Others don't want [help] because they want to salvage their autonomy. They don't want to deal with the truth, knowing that they messed up and they could have died."

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