Toxic supply, policy issues were leading causes of illicit drug overdoses, according to B.C. death review panel

A just-released report to British Columbia's chief coroner finds the primary cause of illicit drug overdoses in the province is a combination of an increasingly toxic supply and a current policy framework that it says forces users to unregulated sources.

The BC Coroners Service Death Review Panel examined more than 6,000 deaths from illicit drug overdose from August 2017 through July 2021. Although it did not look at data collected over the entirety of 2021, the report was released following what was the deadliest year on record in B.C.'s overdose crisis, during which 2,224 lives were lost.

The purpose of these types of panels is to look into the facts and circumstances of deaths in the province and provide recommendations to the chief coroner, who established the group in the first place.

The report said, as the BCCS has before, that illicit drug toxicity is the leading cause of unnatural death in B.C., "accounting for more deaths than homicides, suicides, motor vehicle incidents, drownings and fire-related deaths combined."

Drug toxicity is second only to cancer in terms of potential years of life lost in B.C. Officials have previously said that, in comparison, COVID-19 is 12th.

The expert panel said the supply is a factor in the issue, but so too is the current drug policy framework of prohibition, which it says forces substance users to buy their supply from an unregulated market, putting themselves further at risk.

The panel is calling for action by May 9, giving the province a two-month deadline to stop the death toll from rising.

"I want to remind everyone that we're talking about people – people who reside across British Columbia in communities large and small," death review panel chair Michael Eglison said at a news conference following the release of the report, before getting into the numbers and data.

"People dealing with pain and trauma, people living in poverty or employed and supporting families, people young and old, healthy and unwell, people from diverse ethnic backgrounds, people just like everyone else."

He said the crisis has a devastating impact on families and other loved ones of the deceased.

More than 9,000 people have died since the start of the province's overdose crisis in 2016.

"Twice as many people are now dying as when the public health emergency was first declared," Eglison said.

To put things into perspective, he said, since the public health emergency was declared, more people have died than the populations of Revelstoke, Kitimat, Merritt, Hope or Cumberland, B.C.

"More people have died than would fit in Save-On-Foods Memorial Centre in Victoria," he said.

FINDINGS

The findings outlined by the panel include what those in the province already know: more people are dying, and the supply from street-level dealers is increasingly toxic.

"The average number of deaths per month more than doubled immediately after the start of COVID-19-related restrictions in March 2020 compared with the previous year," the report said.

Health officials have attributed this sudden spike to a variety of factors including border closures, which interrupted the supply users were familiar with, and physical distancing, which meant more people were using alone.

The death rate in 2016 was 20.4 per 100,000 population. That rate is now 38.4.

The panel also noted the age of people dying is younger than at the start of the crisis – the average is now 42 years old – and that Indigenous people, as well as those with poor mental health and mental health disorders are disproportionately represented.

People living in poverty or with housing instability are also more vulnerable, and many of those who died had frequently accessed some type of medical services before their fatal overdose.

Its findings matched those of B.C.'s chief coroner in that the highest number of deaths occurred in the large urban centres of Vancouver, Surrey and Victoria, but the crisis has touched every part of the province and "spans beyond urban areas."

In most deaths, people used substances combined with either fentanyl or something else, meaning they may not have known exactly what they were taking. And smoking, according to the panel, was the most common form of consumption in those who have died.

RECOMMENDATIONS

The report released Wednesday made a series of recommendations the panel believes could be key in addressing B.C.'s nearly six-year-long overdose crisis. The recommendations were made by the panel to the chief coroner, who said she then forwarded them to the appropriate provincial leaders and organizations.

Chief among them is something the coroners service has been pushing for since the early days of the crisis.

The panel suggested access to a safer supply to those at risk of dying is key to saving lives. While B.C. has made efforts to expand access to its own version of safe supply, users have said at previous news conferences that what's actually needed is a clean version of the drugs they use: cocaine, heroin and methamphetamine. 

In its report, the panel said this supply should be "rapidly" expanded across B.C. to ensure it's not only available to those in city centres, but also to rural, remote and Indigenous communities where people are at risk of dying.

The panel called for lower barriers for access to pharmaceutical alternatives as well. Those with lived experience have said previously that there's a misconception that those who are dying have been diagnosed as having an addiction or substance use disorder, but many do not identify with that diagnosis. And it suggested there should be a range of medications available that reflect the patterns of those who use substances.

The panel also called for what it's labelled a "30/60/90-day Illicit Drug Toxicity Action Plan" to develop a new framework with clear goals and time frames for reducing the number of overdoses and enhancing data sharing, among other things. More about this can be read on Page 6 of the presentation embedded below.

This plan would identify action needed immediately, compared to longer-term actions to be taken at a later date, and it would name who is responsible for specific roles outlined in the plan.

And the panel told Chief Coroner Lisa Lapointe that the establishment of an "evidence-based continuum of care" is also among its priority actions, the goals of which would be to closely monitor and evaluate quality treatment and recovery across B.C. and to expand harm reduction services.

It said there needs to be a data-driven system for monitoring this care, which would help identify areas where improvement is needed.

Wednesday's is the first such report published in B.C. since 2018. At that time, the panel looked at 1,854 deaths in a 19-month period. 

Three areas were identified by that panel to reduce toxicity deaths: provincial regulation and oversight into treatment and recovery programs; an expansion of evidence-based addiction care; and the need for safer use through accessible drug-checking services.

Eglison said the recommendations are still pertinent now, but more is needed since the situation evolved.

"Since then, the street drug supply has increased in toxicity due to the increased potency of fentanyl and its analogues, and the addition of other substances such as benzodiazepines," the panel wrote.

RESPONSE

In a statement issued following the release of the report, B.C.'s minister of mental health and addictions acknowledged as she often has that there is more to do and, as she often has, used the opportunity to highlight work already underway in B.C.

"Specifically, (the report) calls on government to build an evidence-based continuum of care to deliver mental-health and substances services, including safer supply. And that is exactly what our government is doing," Sheila Malcolmson said.

"We agree that one of the most important actions we can take to save lives is to separate people from the toxic drug supply," she added, noting that B.C. first put a safer supply program in place two years ago – a first in Canada.

Also a first, B.C. applied to the federal government for an exemption that would effectively decriminalize the possession of a small amount of drugs, something Malcolmson described as an effort to treat substance use "as a health-care issue, not a criminal one."

Still, she said there is more work to do on a provincial level, especially around treatment, recovery, mental health and harm reduction programs.

The federal government refused to give an update Monday on that application, saying that the Ministry of Mental Health and Addictions "cannot comment on exemption s. 56 requests currently under review."

In an email to CTV News, the federal ministry claimed to be committed to addressing the toxic drug supply and sent a link to a webpage that has not been updated since July titled, " Helping people who use substances during the COVID-19 pandemic."

It did not comment specifically on the report released Wednesday, but said federal funding has been used in the past to help fund seven safe supply projects in B.C. The government said that was part of an overall investment of $60 million in safer supply projects across the country.

No new commitments were made and few specific details were provided on what the Liberal government has planned for the future, though it said those plans include "using resources to divert people who use drugs away from the criminal justice system and towards health and social services."

During Wednesday's news conference Eglison acknowledged a number of government initiatives, but said they've been insufficient, and that a new approach is needed.

"The provincial response to the COVID-19 public health emergency has demonstrated that urgent action, co-ordinated efforts and new ways of approaching complex problems are possible and impactful," he said.

"The panel recognized that addressing illicit drug toxicity deaths is a complex problem, and that urgent response is required commensurate with the magnitude of the current crisis."

He said the first priority should be keeping people alive.