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Expert Panel Urges Safe Supply

‘Thousands more lives are at risk,’ says Chief Coroner Lisa Lapointe.

Moira Wyton 9 Mar

Moira Wyton is The Tyee’s health reporter. Follow her @moirawyton or reach her here. This reporting beat is made possible by the Local Journalism Initiative.

An expert panel is urging British Columbia’s provincial government to rapidly expand safe supply and create a co-ordinated strategy that will hold public officials to account to prevent mounting toxic drug deaths.

Thus far, B.C.’s efforts have not been commensurate with the scale and nature of the toxic drug crisis, a death review panel convened by Chief Coroner Lisa Lapointe found.

Its Wednesday report on the deaths of 6,007 people between August 2017 and July 2021 is the office’s most urgent plea for an emergency-scale response to the province’s most long-standing public health emergency.

The last two years saw back-to-back record numbers of toxic drug deaths, claiming the lives of 1,768 people in 2020 and 2,224 people in 2021. About seven people are dying each day now in B.C., more than double the rate when the public health emergency was declared in 2016.

“If we want to ensure we don’t lose another 2,000 community members in 2022, then we need to ensure we take some really courageous actions,” Lapointe said Wednesday. “Thousands more lives are at risk.”

B.C. will require unconventional thinking and bold action to turn around the changing crisis, the report said. Clear goals must be set and accountability for concerned ministries and organizations should be baked into the strategy.

A rise in the presence of benzodiazepines — depressants that, when combined with opioids, increase the likelihood that someone will stop breathing — as well as powerful opioids fentanyl and carfentanil, have made the street supply of substances more potent and unpredictable than before. The increase has been driven by prohibition, the report stressed.

This means that everyone who uses criminalized drugs is at risk of dying, whether they use occasionally, often or have a diagnosed substance use disorder.

It is estimated that about 100,000 people in B.C. have opioid-use disorder, the report said. That number doesn’t include everyone at risk of dying due to a toxic drug supply. The report doesn’t count people who use other drugs or don’t meet the criteria for a disorder.

Forty-three per cent of people who died from 2017 to 2018 had a record of a mental health diagnosis, including substance use disorders, within the last year, the report found.

“Persons with mental health disorders or poor mental health are disproportionately represented,” panel chair and public servant Michael Egilson said, noting that many people without access to proper mental health care turn to criminalized drugs to self-medicate.

But the findings also show that majority of people dying would not be considered addicted. It is necessary to have a medical substance use diagnosis in order to access many first-line treatments and safe supply efforts available in B.C.

In addition to dispelling the myth that only those who are addicted are dying, the report’s findings paint a fuller picture of where and how people are being failed before their preventable deaths.

Toxic drug deaths are now the leading cause of unnatural death in B.C., and second only to cancer in the number of years of life lost. The average age of people dying is 42.

Indigenous people are dying at nearly five times the rate of non-Indigenous people. They represent about 3.3 per cent of people living in the province but about 14.9 per cent of deaths.

This is a result of historical and ongoing colonial violence, including the residential school system, Egilson said, which has resulted in intergenerational trauma and limited health-care access for both urban and in-community Indigenous people.

Nearly three-quarters of people who died had contact with the health-care system in the three months prior to their deaths, which Egilson said means there are missed opportunities to connect people to supports and services.

Of those who died, just eight per cent had sought and accessed substance use treatment. An additional three per cent sought but did not access it.

The panel issued three key recommendations for an all-government emergency response, with deadlines spanning from April 11 to this coming September. None of the recommendations are binding for concerned organizations or government ministries.

A range of safe supply options are needed immediately to address the increasingly toxic supply, the report said.

Safe supply means providing untainted substances to substance users as an alternative to the poisoned and unpredictable street supply.

That should include both medicalized and non-medical forms of safe supply, to provide “a range of medication options that reflect the needs and substance use patterns of those at risk,” the report added.

Currently about 500 people in the Lower Mainland and Victoria have access to prescribed safe supply through small pilot projects. Government claims that 12,000 people have accessed safe supply since March 2020 have been criticized by experts for counting short-term prescriptions for alternatives, which are not reaching those most in need, according to the report.

It is recommended the province creates a plan to implement widespread safe supply and lower barriers by May 9.

“A safer drug supply on its own will not resolve the public health emergency, but it is needed to stop the unprecedented numbers of deaths,” said Egilson.

“The first priority in addressing the toxic drug crisis is keeping people alive.”

The province should also develop a plan to tackle the toxic drug crisis with 30-day goals, 60-day goals and 90-day goals, including clear targets for metrics including mortality and more public reporting similar to the COVID-19 pandemic, the panel recommended.

Lastly, evidence-based treatment and recovery services should be expanded with provincial oversight and a focus on continuity of care to support individuals’ personal health and quality-of-life goals.

In question period at the legislature on Wednesday, the report dominated. Premier John Horgan would not commit to accepting and implementing all recommendations in full, as was asked for by Opposition leader for the BC Liberals, Shirley Bond.

Solving the toxic drug crisis "doesn't take 30, 60, 90 days," Horgan said, noting he had not yet read the report.

Horgan did say he would activate the all-party Select Standing Committee on Health to discuss the issue, as the BC Greens have long called for.

In response to questions from The Tyee about the report's criticism of the government's handling of the crisis, Minister for Mental Health and Addictions Sheila Malcolmson said in a media scrum that safe supply was a federal responsibility that the province couldn't pursue without permission. This is something the report refuted.

"Much of the work the death review panel recommended and was reflected in the report released today is programs that we have in place and are working to expand or are programs we have actively underway, so we really appreciate the reinforcement of the importance and urgency of that work," Malcolmson said in a media scrum Wednesday.

The recommendations echo those made by the last death review panel on this issue in 2018, which focused on expanded harm reduction, treatment and drug-checking technologies.

Now nearly six years into the public health emergency, Lapointe and Egilson said it is clear the current pace and nature of the province’s approach is not enough.

Lapointe, whose role is to investigate deaths and make recommendations to prevent future loss of life, has become increasingly outspoken on the need for safe supply in the months since 2021 was confirmed to be the deadliest year on record.

“If we’re serious about saving lives, then we have to think differently about this,” said Lapointe.

“I hope we will see this meaningful change.”

* Story updated on March 9 at 8:17 p.m. to include information from the legislature's question period and a media response from Minister for Mental Health and Addictions Sheila Malcolmson.  [Tyee]

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