British Columbia has declared a public health emergency after another surge in drug-related overdoses and deaths, making it the first province in the country to take such a step as others, including Ontario and Alberta, work to combat the effects of fentanyl.
"This is, frankly, a crisis," provincial health officer Perry Kendall said.
Dr. Kendall's decision comes after B.C. recently suffered its highest monthly total of overdose deaths in nearly a decade.
"We in Canada have been watching with dismay as the number of overdose deaths associated with opioid drugs, in fact all illicit drugs, increases," Dr. Kendall said, adding that despite the efforts of B.C. officials, the number of deaths has continued to climb.
A recent Globe and Mail investigation found that online suppliers have exploited gaps at the border to get illicit fentanyl into Canada, devising ways to conceal the drug and skirt inspection rules. Fentanyl was developed as a prescription painkiller, but gained popularity as a street drug after OxyContin was removed from the market in 2012.
B.C. had 76 illicit drug overdose deaths in January, the highest total in a single month since at least 2007. At its current rate, the province could have 600 to 800 overdose deaths this year, Dr. Kendall said in a news conference on Thursday. B.C. had 474 such deaths last year, a significant increase from 211 in 2010.
The number of B.C. illicit drug overdose deaths linked to fentanyl, an opioid up to 100 times more potent than morphine, has also surged, from 5 per cent in 2012 to about 31 per cent last year. Of the 201 overdose deaths in B.C. so far this year, 64 were associated with fentanyl.
Declaring a public health emergency – the first time B.C. has ever done so – allows officials to collect real-time data on all overdoses, Dr. Kendall said. Overdose information is currently released only when a person dies.
Dr. Kendall, who was joined at the news conference by B.C. Health Minister Terry Lake, said compiling real-time data was a key recommendation in a recent report by the B.C. Drug Overdose and Alert Partnership, which is led by the B.C. Centre for Disease Control.
"We have determined that in order to assist us in providing an enhanced response, a key need is for more information and more detailed information on the who, the where, the when of these tragic incidents," he said.
Dr. Kendall said knowing more about overdoses more quickly will allow health officials to provide a better response. He stressed the medical information will be treated confidentially.
The emergency declaration did not immediately spur other provinces that have been hit hard by fentanyl to follow suit.
A spokesperson for Ontario Health Minister Eric Hoskins referred questions to the province's chief medical officer of health, who could not be reached for comment on Thursday evening.
Health-care workers in Ontario said the province should treat the increase in overdose deaths with the same urgency as B.C. is doing. Several communities have sounded the alarm in recent weeks about a spike in overdoses from street drugs that appear to have been laced with fentanyl.
"If this isn't a public health emergency, then Ontario needs to redefine what constitutes an emergency," said Michael Parkinson, community engagement co-ordinator with the Waterloo Region Crime Prevention Council, which has issued local alerts about the prevalence of illicit fentanyl.
The most recent information on fatal opioid overdoses in Ontario is from 2014, when 173 people died of fentanyl overdoses, accounting for one in four opioid fatalities.
"I think there's enough of a rise in fentanyl that we should be seriously looking at whether this meets the definition of a public health emergency," said Kieran Michael Moore, associate medical officer of health for KFL&A Public Health, an agency representing Kingston and neighbouring communities.
A spokesperson for Alberta's minister of health said the province sought legal advice last fall to determine whether a public health emergency should be declared. The spokesperson said the government decided a declaration was not necessary to move forward with attempts to combat fentanyl and other opioids.
A statement attributed to Alberta Health Minister Sarah Hoffman said her government has taken steps to address the illicit use of fentanyl, including more than doubling the province's supply of take-home naloxone kits.
Hakique Virani, an assistant clinical professor in public health and addiction at the University of Alberta's Faculty of Medicine, has called fentanyl the No. 1 public health concern in the province. He said B.C.'s announcement was welcome, although he would like to have seen such action sooner.
Dr. Virani said it was unclear if other provinces will be encouraged to do the same.
"Why now is it more of an emergency after B.C. has called one than it was last month, when we were still losing somebody every single day ... to opiate overdose? It would be a difficult thing, I think, for a minister or a chief medical officer of health to explain, 'Well, now it's an emergency because B.C. said it was.'
"It's been an emergency for years."
B.C. health officials will work together over the next few weeks to sort out the logistics of collecting the data. Dr. Kendall said a conference will also be held in early June to look at other programs and policies to reduce overdose deaths.
Mr. Lake, who said B.C. leads the country on harm reduction strategies, added the crisis has taken a toll on families.
"To lose a loved one to an overdose is indeed a tragedy," the minister said. "These are our sons, our daughters, our mothers, fathers, brothers, sisters, and friends. We have to do everything we can to stop this toll."