BC has the tools to address the drug poisoning emergency. Do we have the will to use them?

Drug poisoning is the leading cause of death among people aged 10 to 59 in BC and takes six lives per day in the province. BC’s Provincial Health Officer declared a public health emergency in relation to drug poisoning in 2016, making it the only issue other than the COVID-19 pandemic that has prompted the use of this unique legislative power to unlock policy tools and resources. These deaths are due to the increasingly toxic supply of unregulated drugs, which contain unpredictable concentrations of substances such as fentanyl and carfentanil.[1]

Untapped and underused options are available to prevent deaths in our communities, including decriminalization and safer drug supply. In 2019, a report from the Provincial Health Officer detailed ongoing harms of criminalizing drug use and explicitly recommended decriminalization of drug possession for personal use.[2] Further, the BC Coroners Service has recommended the creation and expansion of a safer drug supply through both medical and nonmedical models.[1]

Decriminalization of drug possession is crucial to reduce drug poisoning harms in BC. Due to stigma and risk of legal punishment, people using drugs often avoid contact with the health care system and other services that can prevent overdose deaths. BC decriminalized possession of small amounts of drugs in February 2023 but has since introduced strict new laws against public use. The benefits of drug decriminalization in BC are at risk of being eroded before they can be realized: this approach has been described by advocates as recriminalizing drug use[3] and has been criticized by BC’s Chief Coroner as pushing drug use “into back alleys and back corners.”[4] Commitment to the goals of decriminalization is needed.

Meanwhile, safer drug supply can reduce the underlying hazard of a poisoned drug market. Medical models to provide safer opioids have existed for decades, including well-known opioid agonist therapies such as methadone. Research has found that a safer supply of drugs such as diacetylmorphine (heroin) can also reduce the risk of drug poisoning and other harms.[5] Safer supply in Canada, however, is provided at a trickle relative to the need. While approximately 100 000 people in BC have diagnosed opioid use disorder, and as many as 225 000 are at risk of poisoning from unregulated drugs,[6] only 4476 people were prescribed safe supply medications in July 2023.[7] Many remain at risk for drug poisoning, and BC’s Chief Coroner has called for urgent expansion of programs.[8]

However, medical safe supply does not fit the needs of all who are at risk, such as those who may encounter barriers to prescribed models. Nonmedical models to provide a safer drug supply can help increase access. For example, a community-based organization in BC has used compassion club drug testing to confirm the makeup of drugs distributed to members. To date, no deaths have been reported related to drugs distributed using this model.[9] With support to acquire pharmaceutical supplies of drugs, expert community-based organizations could provide users with known amounts of uncontaminated drugs. Medical and nonmedical safe supply models each provide distinct benefits.

Policies and practices to prevent drug poisoning deaths are available, including accelerated action on decriminalization, safe supply, mental health, and the social determinants of health, such as housing. Will these directions be taken with the same sense of urgency applied to novel measures early in the COVID-19 pandemic? Action must be pursued at a scale and urgency matched to the catastrophic toll of the drug poisoning emergency.
—Michael Schwandt, MD, MPH

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References

1.    BC Coroners Service. BC Coroners Service death review panel: A review of illicit drug toxicity deaths. 2022. Accessed 19 October 2022. www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/review_of_illicit_drug_toxicity_deaths_2022.pdf.

2.    Office of the Provincial Health Officer. Stopping the harm: Decriminalization of people who use drugs in BC. 2019. Accessed 19 October 2023. www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/reports-publications/special-reports/stopping-the-harm-report.pdf.

3.    McSheffrey E. ‘Set up for more deaths’: Advocate decries BC’s new bill restricting public drug use. Global News. Updated 5 October 2023. Accessed 19 October 2023. https://globalnews.ca/news/10007795/reaction-bc-bill-restricting-public-drug-use.

4.    DeRosa K. Proposed BC law would make drug use illegal in almost all public spaces. Vancouver Sun. Updated 6 October 2023. Accessed 19 October 2023. https://vancouversun.com/news/local-news/proposed-b-c-law-would-make-drug-use-illegal-in-almost-all-public-spaces.

5.    Berridge V. Heroin prescription and history. N Engl J Med. 2009;361:820-821.

6.     BC Coroners Service. BC Coroners Service Death Review Panel: An urgent response to a continuing crisis. 2023. Accessed 27 November 2023. 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.

7.    BC Ministry of Mental Health and Addictions. Escalated drug-poisoning response actions. 2023. Accessed 19 October 2023. https://news.gov.bc.ca/factsheets/escalated-drug-poisoning-response-actions-1.

8.    BC Coroners Service. At least 198 lost to toxic drugs in July as public health emergency continues. News release. 29 August 2023. Accessed 19 October 2023. www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/news/2023/bccs_august2023_reporting.pdf.

9.    Drug User Liberation Front. Compassion club and fulfillment centre. Accessed 19 October 2023. www.dulf.ca/_files/ugd/fe034c_46d04259d6f44d1b920fe3e1500c676d.pdf.