British Columbia is in the midst of a public health crisis, with 914 documented overdose deaths in 2016.
British Columbia is in the midst of a public health crisis, with 914 documented overdose deaths in 2016. While there has been a steady increase in overdose deaths over the past 2 years, December 2016 had the highest monthly total of deaths ever recorded (128 deaths). This is particularly alarming as it is happening despite a public health emergency announcement in April 2016 and a massive scale-up of the take-home naloxone program that has been used in over 3000 overdose reversals.
The common narrative that has emerged to explain the crisis centres on the introduction of fentanyl into the illicit drug market. Fentanyl is a potent synthetic opioid that has been detected in an increasing number of postmortem toxicology reports as well as drug seizures by law enforcement. Most of the deaths have occurred among people with long-standing opiate use, and the explanation for the overdose is the unexpected toxicity of a particular drug purchase. This makes the recent increase in the number of deaths even more disturbing as the correct dosage, even at the hands of unprofessional clandestine distributors, should have been figured out by now.
Despite the fear of overdosing, the use of opioids and other drugs is driven by a desire to self-medicate, and drug use will continue no matter how high the risk. There are myriad reasons and events that launch people into habitual drug use—trauma, personal tragedy, injuries, sexual abuse, racism, and mental illness to name a few. But one thing is consistent—no one started using drugs to become isolated, stigmatized, destitute, and criminalized. These devastating consequences of drug addiction are directly related to entrenched drug policies that criminalize drug users and a societal indifference to the pain, suffering, and even death of people who buy drugs from the illicit market.
If we acknowledge that opioid addiction follows a chronic relapsing course and that many people are not willing or ready to stop using, then harm reduction interventions along with basic social supports are necessary to reduce suffering and prevent deaths. Proven harm reduction interventions must be scaled up, including supervised injection sites, low-barrier supportive housing, better access to primary-care based opiate agonist therapy (OAT), and an expansion of prescription opioid programs. Physicians have an important role in both speaking out in support of harm reduction initiatives and ensuring that there is adequate access to quality OAT in their communities.
There is evidence that physician prescribing practices have contributed to the current opioid overdose crisis.[2,3] In response, the College of Physicians and Surgeons of British Columbia released Safe Prescribing of Drugs with Potential for Misuse/Diversion in June 2016, a document that provided standards and guidelines to address the high rates of opioid prescriptions. Although the standards are directed primarily at reducing the risk of long-term opioid treatment, there remain challenges in managing patients who already require high daily doses of opioids. In the midst of an overdose crisis that is driven largely by toxic street drugs, any changes in prescription that may drive patients to seek opioids in the illegal market must be avoided.
A year ago it would have been unthinkable that over 900 people would have died of unintentional drug overdoses in the province. Despite intense media attention, community mobilization, and some new interventions, the number of deaths continues to rise. While there are no quick fixes to this crisis, we must challenge drug policies and societal attitudes that criminalize, marginalize, and demonize drug users. Our approach to reducing the death and devastating health consequences of drug use must be based on engagement, social supports, housing, harm reduction, and health care. Without these essential components, treatment and recovery will remain elusive to many.
—Mark Tyndall, MD, ScD, FRCPC
Provincial Medical Director, BCCDC
This article is the opinion of the BC Centre for Disease Control and has not been peer reviewed by the BCMJ Editorial Board.
1. Office of the Chief Coroner. Ministry of Public Safety and Solicitor General. Illicit drug overdose deaths in BC, January 1, 2007–December 31, 2016. Accessed 1 February 2017. www2.gov.bc.ca/assets/gov/public-safety-and-emergency-services/death-investigation/statistical/illicit-drug.pdf.
2. Fischer B, Rehm J, Tyndall M. Effective Canadian policy to reduce harms from prescription opioids: Learning from past failures. CMAJ 2016;188:1240-1244.
3. Smolina K, Gladstone EJ, Rutherford K, Morgan SG. Patterns and trends in long-term opioid use for non-cancer pain in British Columbia, 2005-2012. Can J Public Health 2016;107:e404-e409.
4. College of Physicians and Surgeons of BC. Safe prescribing of drugs with potential for misuse/diversion. 2016. Accessed 1 February 2017. www.cpsbc.ca/files/pdf/PSG-Safe-Prescribing.pdf.
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