Re: BC has the tools to address the drug poisoning emergency. Author replies

I thank Drs Smith and Mallet for their correspondence.

The toxic drug poisoning crisis is a complex issue, requiring action across a continuum including mental health, trauma prevention, addiction treatment, and harm reduction. It cannot be concluded that harm reduction measures to provide a safer supply of drugs have failed, when at current scale these measures have reached only a small fraction of those potentially at risk. Further, while there is little to suggest that availability of a safer supply normalizes and increases drug use, there is evidence of positive impacts among those who might otherwise access the toxic illicit supply. In fact, in the weeks since publication of this editorial, a new BC-based study has been released showing decreased drug poisoning and all-cause mortality among people receiving safer supply.[1]

The number of people at risk of illicit drug poisoning in BC is large, and estimates of this heterogenous population are by their nature inexact. Expert researchers have applied peer-reviewed and published methodologies to examine the population at risk. For example, using linked health data sources, a team of BC researchers identified a provincial cohort of people with substance use disorder comprising 162 099 individuals.[2] Meanwhile, people who use drugs but do not meet criteria for a substance use disorder in administrative health data are also at risk: people fitting this description make up a substantial proportion of those dying of illicit drug poisoning in BC. Estimates and related ranges realistically reflect uncertainty regarding the number of people at risk from using illicit drugs, and an estimated at-risk population of up to 225 000 is quite coherent with the more restrictive population estimates of people with substance use disorder in BC.

The crucial fact is that many British Columbians are at ongoing risk of death due to the toxic illicit drug supply. The product of this population size and the unpredictability of the drug supply are such that an average of seven people in our province die of illicit drug poisoning every day. Long-standing and important programs of opioid agonist treatment and addiction treatment have not adequately addressed this issue, and safer supply approaches remain underutilized.

The evidence base for safer supplies of drugs continues to grow, and urgent action could help prevent further deaths in our communities.
—Michael Schwandt, MD, MPH

This letter was submitted in response to “Re: BC has the tools to address the drug poisoning emergency (1)” and “Re: BC has the tools to address the drug poisoning emergency (2).”


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1.    Slaunwhite A, Min JE, Palis H, et al. Effect of risk mitigation guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies: Retrospective cohort study. BMJ 2024;384:e076336.

2.    Homayra F, Pearce LA, Wang L, et al. Cohort profile: The provincial substance use disorder cohort in British Columbia, Canada. Int J Epidemiol 2021;49:1776.

Michael Schwandt, MD, MPH. Re: BC has the tools to address the drug poisoning emergency. Author replies. BCMJ, Vol. 66, No. 2, March, 2024, Page(s) 40 - Letters.

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