Deadliest year in B.C.'s opioid crisis: Death toll 26% higher in 2021 than previous record

It was clear by the end of October that 2021 would be the deadliest year on record in British Columbia's opioid crisis, but on Wednesday, officials revealed just how many more lives were lost than in previous years.

The province's top coroner said the death toll, which stood at 1,782 in the fall, climbed to 2,224 by the end of the year.

"It is with tremendous sadness that I report that our province is in a worse place than it has ever been in this drug toxicity crisis," Chief Coroner Lisa Lapointe said at a news conference.

That's 508 more than the toll in 2020, which until October held the solemn record. Another 425 people died of suspected illicit drug toxicity in the last two months of the year, data presented Wednesday showed.

It's an increase of 26 per cent, year over year. And 2020 had been a record-breaking year as well, before that toll was surpassed in 2021.

And those numbers, Lapointe has repeatedly stressed during B.C.'s nearly six-year-long opioid crisis, are not just numbers. They represent the lives of people who lived in the province, had dreams, had families.

An average of 6.1 people died each day in B.C. of illicit drug overdose. Many died at home. Many died alone.

Earlier this year, she said drug toxicity has become such a problem in B.C. that it's second only to cancer in terms of total potential years of life lost.

"By comparison, COVID-19 is 12th," Lapointe said in December.

A public health emergency was declared in 2016, when overdose due to illicit drugs such as cocaine, heroin and fentanyl became the leading cause of unnatural deaths in B.C.

Efforts to save lives have expanded since then, but the pandemic is one factor that those fighting the crisis couldn't have anticipated. And it's played a major role.

Supply has been impacted, meaning the substances users are taking may not be the same potency as they're used to. Fentanyl, which was an issue in 2016, is being seen in an increasing amount of fatal overdoses even years later. Other analogues, including the super-potent carfentanil, and substances like benzodiazepines, which block the life-saving effects of the antidote naloxone, are also being cut into drugs sold to users in B.C.

Speaking Wednesday, Lapointe recalled when, in July 2012, she was advised of unusual findings in an investigation into deaths of three men in the Lower Mainland. She had only been in her current role for 18 months at the time, she said.

All three were know to use Oxycodone, and that's what it seemed all three thought they'd taken. Instead, what they'd ingested was fentanyl.

"This was the introduction of illicit fentanyl to B.C.," she said in a news conference 10 years later.

"In 2012, there were 270 deaths due to illicit drugs. Fentanyl was implicated in 20 of them. Over the next few years, we saw more and more deaths as a result of the increasing toxicity of B.C.'s drug supply."

In 2012, the death rate due to toxic drugs was six per 100,000 people. By 2017, the rate was 30 per 100,000. Last year, it was 43.

In the years that followed those first cases, both the death toll and the ratio of deaths tied to fentanyl grew. Then COVID-19 started to spread in B.C.

The pandemic introduced physical distancing, which meant that many opted to use alone, either because of provincial restrictions or in an effort to protect themselves catching from COVID-19. For similar reasons, users who may have felt something was off with their reaction to a substance avoided going to hospital, sometimes until it was too late.

In terms of solutions, Lapointe says access to a safe supply, one that hasn't been cut with substances the user is unaware of, is key to saving lives. While supervised consumption sites and moves to decriminalize harder drugs will help, advocates including the chief coroner stress that supply needs to be addressed.

"We have found no indication that prescribed safe supply is a factor in drug toxicity deaths in B.C.," she said.

In a joint statement Wednesday, Minister Sheila Malcolmson and provincial health officer Dr. Bonnie Henry said the way substance use disorders are looked at needs to change.

"We must reduce the fear and shame that leads so many to hide their drug use, avoid services and use deadly drugs alone. Addiction is not a choice, it's a health condition," they wrote.

The pair also praised the workers who've been involved in a year of many deaths in the province.

"From the COVID-19 pandemic, the toxic drug crises, to heat, floods, and fires, we have never asked as much from our health-care system, front-line health-care workers and B.C. families. And yet, we need to do more," Malcolmson and Henry said.

"We will continue to make systemic changes to our health-care system to build a comprehensive system of care for those experiencing substance use and mental health challenges. There is more to do, and changes can't happen fast enough, which is why we aren't stopping until we turn this crisis around."

Lapointe too said more is needed, including expanded access to treatment programs.

"People are dying on waiting lists," she said.

As for what is working, the data presented Wednesday included that no deaths occurred at overdose prevention sites or supervised consumption sites, and that there is no indication that safe supply is contributing to deaths.

According to Lapointe's data, 71 per cent of people who died of illicit drug overdose last year were between the ages of 30 and 59, and nearly eight-in-10 were men.

The regions that saw the highest number of deaths were Vancouver, Surrey and Victoria, and the health authorities with the highest rates of death were Vancouver Coastal and Northern.

Overall, the rate of these deaths in B.C. was 43 per 100,000 people, as previously mentioned, but in those regions, it reached 49 and 48, respectively.

Broken down more locally, the highest rates of death were in Upper Skeena, Merritt, Enderby, Lillooet and North Thompson.

More than half (56 per cent) of people died in private residences, and 28 per cent were in other types of residences, including social and supportive housing, single-room occupancy hotels, shelters and hotels.

Fifteen percent died outside, in vehicles, sidewalks, streets, parks and other places.

Trends noted last year, according to Lapointe, were that female death rates have been increasing, as has the proportion of deaths in people aged 50 and older.