Re: BC has the tools to address the drug poisoning emergency (2)

I urge Dr Schwandt, a member of the BCMJ Editorial Board, to resist the temptation to quote British Columbia’s outgoing chief coroner, Lisa Lapointe, as though her statements are fact. Dr Schwandt quoted the following misrepresentation from the November 2023 BC Coroners Service Death Review Panel report[1] in his editorial [BCMJ 2023;65:365-366]: “as many as 225 000 [people] are at risk of poisoning from unregulated drugs, [but] only 4476 people were prescribed safe supply medications in July 2023.”

The impression these numbers give is that fewer than 5000 people out of 225 000 are receiving treatment. In both Dr Schwandt’s editorial and the coroner’s report, the goal is to demonstrate an urgent need to expand safe supply.

However, the problems with these numbers are manifold. First, there is an important number that is simply missing: 25 000. That is the approximate number of people in BC being prescribed opioid agonist therapy—primarily methadone and suboxone—which is an effective treatment for opioid use disorder. This number was buried in the coroner’s report in an appendix on page 42—far enough from the prominent pull quotes as to be almost invisible.

The number 225 000 is also problematic. This number is derived from a 2019 national survey of illegal drug use, which was then retroactively applied to BC. The resulting statistic was of such uncertain accuracy that its 95% confidence interval was 92 000 to 221 000. This number was then arbitrarily inflated based on an assumption that drug use “has increased” since 2019. The final result—a range of 125 000–225 000[1]—is of clearly limited statistical value, and yet the upper figure has been quoted often enough in the press (and now the BCMJ) that it has begun to acquire an undeserved ring of truth.

What makes this data invention even more egregious is that the original 2019 statistic included all illicit drug use, including cocaine, methamphetamine, ecstasy, hallucinogens, heroin, and salvia. Could all these drug users benefit from increased access to safe supply opioids? Of course not. Many of them do not even use opioids. Their inclusion in the data serves only to exaggerate the need for expanded safe supply.

If we look at actual facts instead of carefully edited and invented statistics, we see that far more people are already on effective treatment than the chief coroner would have us believe: 30 000 instead of 5000. Furthermore, far fewer people would benefit from expanded safe supply: perhaps 100 000–125 000. Not 225 000.
—Mark Mallet, MD, CCFP
Victoria

This letter was submitted in response to “BC has the tools to address the drug poisoning emergency. Do we have the will to use them?” Read the author’s response in “Re: BC has the tools to address the drug poisoning emergency. Author replies.”

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References

1.    BC Coroners Service. BC Coroners Service Death Review Panel: An urgent response to a continuing crisis. Report to the chief coroner of British Columbia. 2023. Accessed 10 January 2024. www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/an_urgent_response_to_a_continuing_crisis_report.pdf.