Expert Panel Urges Safe Supply  to Prevent Increasing Toxic Drug Deaths

By Moira Wyton

 Local Journalism Initiative Reporter

An expert panel is urging British Columbia’s provincial government to rapidly expand safe supply and create a co-ordinated strategy that will  hold public officials to account to prevent mounting toxic drug deaths.

Thus far, B.C.’s efforts  have not been commensurate with the scale and nature of the toxic drug  crisis, a death review panel convened by Chief Coroner Lisa Lapointe  found.

Its Wednesday report  on the deaths of 6,007 people between August 2017 and July 2021 is the  office’s most urgent plea for an emergency-scale response to the  province’s most long-standing public health emergency.

The last two years saw back-to-back record  numbers of toxic drug deaths, claiming the lives of 1,768 people in 2020  and 2,224 people in 2021. About seven people are dying each day now in  B.C., more than double the rate when the public health emergency was  declared in 2016.

“If we want to ensure we  don’t lose another 2,000 community members in 2022, then we need to  ensure we take some really courageous actions,” Lapointe said Wednesday.  “Thousands more lives are at risk.”

B.C. will require  unconventional thinking and bold action to turn around the changing  crisis, the report said. Clear goals must be set and accountability for  concerned ministries and organizations should be baked into the  strategy.

A rise in the presence of benzodiazepines _  depressants that, when combined with opioids, increase the likelihood  that someone will stop breathing, as well as powerful opioids fentanyl  and carfentanil, have made the street supply of substances more potent  and unpredictable than before. The increase has been driven by  prohibition, the report stressed.

This means that everyone who uses  criminalized drugs is at risk of dying, whether they use occasionally,  often or have a diagnosed substance use disorder.

It is estimated that about 100,000 people  in B.C. have opioid-use disorder, the report said. That number doesn’t  include everyone at risk of dying due to a toxic drug supply. The report  doesn’t count people who use other drugs or don’t meet the criteria for  a disorder.

Forty-three per cent of people who died  from 2017 to 2018 had a record of a mental health diagnosis, including  substance use disorders, within the last year, the report found.

“Persons with mental health disorders or  poor mental health are disproportionately represented,” panel chair and  public servant Michael Egilson said, noting that many people without  access to proper mental health care turn to criminalized drugs to  self-medicate.

But the findings also show that majority of  people dying would not be considered addicted. It is necessary to have a  medical substance use diagnosis in order to access many first-line  treatments and safe supply efforts available in B.C.

In addition to dispelling the myth that  only those who are addicted are dying, the report’s findings paint a  fuller picture of where and how people are being failed before their  preventable deaths.

Toxic drug deaths are now the leading cause  of unnatural death in B.C., and second only to cancer in the number of  years of life lost. The average age of people dying is 42.

Indigenous people are dying at nearly five  times the rate of non-Indigenous people. They represent about 3.3 per  cent of people living in the province but about 14.9 per cent of deaths.

This is a result of historical and ongoing  colonial violence, including the **>residential<** school system, Egilson  said, which has resulted in intergenerational trauma and limited  health-care access for both urban and in-community Indigenous people.

Nearly three-quarters of people who died  had contact with the health-care system in the three months prior to  their deaths, which Egilson said means there are missed opportunities to  connect people to supports and services.

Of those who died, just  eight per cent had sought and accessed substance use treatment. An  additional three per cent sought but did not access it.

The panel issued three key recommendations  for an all-government emergency response, with deadlines spanning from  April 11 to this coming September. None of the recommendations are  binding for concerned organizations or government ministries.

A range of safe supply options are needed immediately to address the increasingly toxic supply, the report said.

Safe supply means providing untainted  substances to substance users as an alternative to the poisoned and  unpredictable street supply.

That should include both medicalized and  non-medical forms of safe supply, to provide “a range of medication  options that reflect the needs and substance use patterns of those at  risk,” the report added.

Currently about 500 people in the Lower  Mainland and Victoria have access to prescribed safe supply through  small pilot projects.

Government claims that 12,000 people have accessed  safe supply since March 2020 have been criticized by experts for counting short-term prescriptions for alternatives, which are not reaching those most in need, according to the report.

It is recommended the province creates a plan to implement widespread safe supply and lower barriers by May 9.

“A safer drug supply on its own will not  resolve the public health emergency, but it is needed to stop the  unprecedented numbers of deaths,” said Egilson.

“The first priority in addressing the toxic drug crisis is keeping people alive.”

The province should also develop a plan to  tackle the toxic drug crisis with 30-day goals, 60-day goals and 90-day  goals, including clear targets for metrics including mortality and more  public reporting similar to the COVID-19 pandemic, the panel  recommended.

Lastly, evidence-based treatment and  recovery services should be expanded with provincial oversight and a  focus on continuity of care to support individuals’ personal health and  quality-of-life goals.

In a statement, Minister for Mental Health  and Addictions Sheila Malcolmson said the report’s findings reinforce  her government’s need to “do more to combat the illicit toxic drug  crisis.”

Malcolmson did not respond to the report’s  finding that efforts to date have not been urgent enough or commensurate  with the scale of the crisis or targeted enough at the increasingly  toxic supply.

The recommendations echo those made by the last death review panel on this issue in 2018, which focused on expanded harm reduction, treatment and drug-checking technologies.

Now nearly six years into the public health  emergency, Lapointe and Egilson said it is clear the current pace and  nature of the province’s approach is not enough.

Lapointe, whose role is to investigate  deaths and make recommendations to prevent future loss of life, has  become increasingly outspoken on the need for safe supply in the months  since 2021 was confirmed to be the deadliest year on record.

“If we’re serious about saving lives, then we have to think differently about this,” said Lapointe.

“I hope we will see this meaningful change.”

 Moira Wyton        is a Local Journalism Initiative reporter who works out of  THE TYEE . The Local Journalism Initiative is funded by the Government of Canada.

 

 

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