Many more people could die from toxic drugs in the coming days and weeks unless the province takes emergency action to help people who use drugs who have evacuated or are sheltering in place due to flooding and mudslides across southwestern B.C.
With highways washed out and essential roads and pharmacies submerged in floodwaters, access to harm reduction supplies and prescribed medications for drug users is extremely limited.
And flooding has made it more difficult for the limited number of people who are able to access first-line opioid substitution medications to continue their treatment at all.
The lack of a regulated safe supply of street drugs puts all drug users at heightened risk of relapse or overdose if measures aren’t taken to provide emergency supplies and deliver medications, say drug user advocates and experts.
“We’ve seen huge increases in substance-related harms during the pandemic… and in these acute situations [like floods], which are less predictable and more devastating, the stakes are even more substance use related deaths,” said Dr. Abhimanyu Sud, an assistant professor and expert in substance use and addiction treatment at the University of Toronto.
With highways shut down, the street supply “will get even more dangerous very quickly,” wrote Karen Ward, a drug user advocate and advisor to the City of Vancouver, in a message to The Tyee. “Doctors are very busy, and we don’t need to wait and see how bad this will get.”
In B.C., people who use drugs don’t have access to a safe, regulated supply of drugs, and when they are able to access prescription treatments, strict prescribing rules make it difficult for them to continue the treatments under normal circumstances.
This is particularly the case for rural and remote communities outside Vancouver where there are limited harm reduction and treatment options, including Merritt and cities along the Fraser Valley, where some residents have had to evacuate.
“The systems that are set up are fragile to begin with, and they create the vulnerability that people who use substances face during these emergencies,” said Sud in an interview.
Even in normal times, a missed fax at a pharmacy can derail someone’s treatment and lead them to relapse to prevent withdrawal, Sud said. In disaster times, it is even more onerous to keep up with one’s treatment.
“We have a system that is archaic and rigid… we live in the climate apocalypse, and this is going to keep happening,” said Garth Mullins, a board member of the BC Association for People on Methadone and Vancouver Area Network of Drug Users.
Drug user rights are inherently tied to climate justice, Mullins said. The impacts of the climate crisis — like record forest-fire seasons that left the province vulnerable to the intense floods occurring now — hammer Indigenous, Black and other marginalized communities the most, within which substance users are overrepresented.
More than 3,000 people have died of toxic drugs in B.C. since March 2020, and this year is on track to be the most fatal year on record for the second year in a row.
While British Columbians are advised to have at least 72 hours to two weeks supply of all their medications in their emergency kit, people who use drugs can’t follow that advice.
The two major first-line treatments for substance use disorders, methadone and Suboxone, are given through supervised consumption at pharmacies or specialized clinics, with a limited amount of take-home doses — known as “carries” — permitted under loosened pandemic rules.
Mullins has seen and heard anecdotal evidence that patients with carries are not being allowed to take doses home anymore by certain prescribing physicians and pharmacists, something he has advocated to the province to change in recent months.
With highways washed out and many pharmacies flooded, Mullins is worried many people who would normally be able to access a known and regulated dosage may begin to experience withdrawal or access the criminalized supply to prevent illness.
And the risk of overdose is particularly high for those who haven’t used in a while and whose tolerances have decreased.
“If you’re so dope sick you can barely move, how are you going to be able to evacuate yourself?” he asked. “It’s easy to get drugs that will kill you; it’s very hard to get drugs that will save you.”
In a recent literature review, Sud examined the impacts of other natural disasters on opioid treatments in countries around the world to understand what actions the pandemic requires in Canada.
What he and his co-investigator found was disturbing. Amid limited access to pharmacies and emergency prescriptions in the first place, some patients, already in withdrawal, were being told they had to continue in withdrawal to prove they needed medications.
“And those were the people presenting to health care in the first place,” he said.
Both Mullins and Sud said that ensuring patients have carries and emergency stockpiles is essential for disaster preparedness now and in calmer times.
In a message, Ward says she wants Health Minister Adrian Dix to temporarily remove the requirement for prescriptions for methadone and Suboxone, which the provincial cabinet can do through an order-in-council, to allow users to access medications no matter where they have been displaced.
The Ministry of Mental Health and Addictions acknowledged the state of emergency and flooding heightens risks of harm to people who use drugs in an emailed statement to The Tyee.
“We’re working with the BC Centre on Substance Use, health authorities, including the First Nations Health Authority, people with lived and living experience and other partners, on actions to ensure people living with opioid use disorder can maintain their treatment plans while staying safe," wrote a spokesperson.
The Tyee reached out to Fraser Health but has yet to hear back.
Six clinics offering substance use services, including prescription treatment — and harm reduction collectives in the affected regions contacted by The Tyee — also did not respond or did not have capacity to respond today given the disaster, one said.
Mullins said the full extent of harm likely won’t be known for days or weeks after the flooding subsides.
But both he and Sud stressed that this must be a learning moment to overhaul prescribing guidance that treats drug users as untrustworthy and makes it hard for them to access supports and health care without discrimination.
“This harm is avoidable if we can learn some of these lessons around how we can reform care, and normalize and regularize care for people using substances,” said Sud.