BC’s Low Autopsy Rate Is ‘Extremely Concerning,’ Says MLA

A BC United MLA and an advocate normally on opposite sides of B.C.’s drug policy debate say they’re both alarmed by information uncovered by The Tyee that shows the BC Coroners Service does autopsies in just 15 per cent of suspected overdose deaths.

That’s far below the rate in other provinces, where autopsies are done in 60 to 100 per cent of suspected drug deaths.

And it has left families wondering what really happened when a loved one was declared a victim of drug poisoning without a full investigation.

Elenore Sturko, the BC United MLA and critic for mental health and addiction, called on the minister of public safety to take action.

“Minister [Mike] Farnworth needs to look into these allegations that there may be wrongful classification of some of these deaths, possibly as overdoses when they may not in fact have been overdoses,” said Sturko.

“I think that’s extremely concerning and it’s something that the minister should take note of and immediately take action on.”

Karen Ward, a drug policy advocate, said B.C.’s practice of rarely doing autopsies for suspected overdoses could be leading to a knowledge gap when it comes to how different combinations of substances are affecting people who use drugs.

The BC Coroners Service uses toxicology testing instead of autopsies and also interviews family members and physicians to establish whether the deceased person was known to use drugs.

But relying on toxicology could mean other health issues are being missed, Ward said — especially for marginalized people who often have multiple health conditions along with their drug use.

“Did they die from [the drug]? That’s the thing. What about the guy who has lung cancer? What about the guy who has a stroke?”

The Tyee asked Farnworth, the NDP’s minister of public safety, whether he was concerned about the low autopsy numbers. He defended the practice of the BC Coroners Service using toxicology testing rather than autopsies.

“Coroners make those determinations based on their professional training, their professional experience, and the circumstances in which things occur,” he said. “That’s what they’re hired for. It’s not a political appointment.”

B.C. is currently looking for another chief coroner after Lisa Lapointe retired last month after 13 years on the job.

Farnworth said he was aware that there is a “difference of opinion” when it comes to the use of autopsies. B.C.’s decision to do autopsies less often than other provinces is not based on costs, he said.

He said his ministry would not be involved in the hiring process for the next chief coroner and public service will conduct a merit-based hiring process.

The National Association of Medical Examiners recommends autopsies be done for all suspected overdose deaths, citing studies that have shown there is no substitute for the accuracy of an autopsy.

Sturko, a former RCMP officer, said she was particularly concerned about comments Lapointe made to The Tyee characterizing autopsies as a “grossly invasive” procedure that many families do not want.

“I have actually attended an autopsy when I was a police officer working on a sudden, unexplained death,” Sturko said.

“And I can tell you that the care that pathologists take to maintain the dignity of those who they’re tasked with investigating cause of death is second to none. They do such a beautiful job of maintaining the dignity of that individual that it just boggles my mind to think that our chief coroner would have had that attitude towards these investigations.”

Sturko is a staunch opponent of safe supply, the practice of prescribing drugs to people who use them and are at risk of an overdose because the illicit drug supply is so tainted and unpredictable.

Sturko said she’s concerned that drugs prescribed as safe supply, like the prescription opioid Dilaudid, are being diverted to the illicit market and sold to teens.

While Lapointe had pushed back against that concern, saying there was little evidence to support it, Sturko said learning of the low autopsy rates now makes her question B.C. government data on overdoses and which drugs are causing them.

Sturko has been advocating on behalf of one of her constituents, Greg Sword. Sword’s 14-year-old daughter, Kamilah, died of an overdose in 2023, and he later told media he believed B.C.’s safe supply program led to her death. Sturko told The Tyee that despite her young age, an autopsy was never ordered for Kamilah.

“That was a red flag,” said Sturko.

Ward, who has seen her Downtown Eastside community decimated by overdose deaths, says expansion of safe supply is badly needed to provide an alternative to the illicit drug supply. In 2023, 2,539 people lost their lives to drug poisoning, according to the coroner, the highest number ever recorded.

Ward said the lack of thorough death investigations for people who use drugs is characteristic of the ongoing stigma drug users face.

“The fact that they’re not finding out — would people who died of any other suspected cause of death be cast aside like that?” Ward said.

Matthew Orde, a forensic pathologist who is critical of B.C.’s low autopsy rates, said autopsy findings would likely change cause of death for a small number of cases.

“Anecdotally, I would hazard a guess that in a thousand cases sent to me for autopsy which were initially thought to be an illicit drug overdose, perhaps a couple of hundred or so will end up having significant other disease or injury identified at autopsy — findings which could at least on occasion potentially ‘trump’ the toxicology findings,” he told The Tyee.

But in the absence of regular autopsies to make sure of the cause of death, Orde said, B.C.’s overdose death number may well be an overestimate.

With files from Andrew MacLeod.