RESPONDING TO FENTANYL
B.C. says it acted prudently
B.C. health officials are defending delays in acting on some recommendations to curb the fentanyl overdose crisis.
Health minister Terry Lake and provincial health officer Perry Kendall said they have moved as quickly as possible to provide the most co-ordinated response — even if it took several months, during which the number of overdose deaths rose to record levels.
Lake announced free coverage for treatment drugs Suboxone and methadone last week for anyone with an income of less than $42,000. While the move was praised, it came more than six months after free coverage and easier access for Suboxone was recommended at a June 2016 meeting of 80 front-line service providers, government, police, advocates and health professionals.
“You can’t do it overnight,” said Lake, who attended the June meeting. “You have to look at your budgets and see if there’s room to do these things. This is going to potentially cost $6 million.
“And we have to make sure we have physicians that are trained, because if we’re going to broaden out and increase the availability of treatment, we have to make sure there are prescribers in place.”
Suboxone is a key drug to help people addicted to opioids like heroin manage their withdrawal symptoms.
But removing barriers has been slow since B.C. declared the fentanyl crisis a public health emergency in April 2016. The province recorded 914 overdose deaths last year, an increase of almost 80 per cent compared with 2015.
It took almost three months for the College of B.C. Physicians and Surgeons to remove restrictions on doctors prescribing Suboxone, and it wasn’t until November that a mass push to train physicians on addictions occurred at the B.C. Centre for Substance Use.
Kendall said expanding Suboxone coverage was timed for January to help people who exhausted their existing drug coverage.
“You can’t just wave a magic wand and stuff happens,” Kendall said. “There’s regulatory processes, there are budgetary processes, so you do what you can to start with and move on aggressively as you can and work on the things that take more time to come into place.”
The same June meeting that recommended Suboxone also came up with other suggestions for action. Some were quickly put in place — like a public-awareness campaign, mobile medical units and expanded availability for the overdose antidote naloxone.
Other progress remains debatable. A push to speed up drug testing in coroner cases instead faces a backlog at the provincial lab. Government increased the number of addictions beds, but critics have said the treatment system needs an overhaul.
Ottawa has faced criticism, too. It has taken longer than expected to test for carfentanil — even more powerful and deadly than fentanyl — due to federal approvals. Federal delays in expanding supervised-injection sites led grassroots groups to create popup facilities in Surrey, Vancouver and Nanaimo.
B.C. deliberately sidestepped Ottawa in December to open 23 overdose-prevention sites, and again Friday to announce druguse rooms in government-funded housing. Then there’s the controversial idea of expanding access to prescription heroin and morphine, to give the hardest-to-treat people clean drugs to stabilize their addictions.
That model was also recommended in June. Last week, health officials urged rapid expansion of the idea, admitting the system had been too slow to respond. Lake urged caution, saying the public needs time to seriously consider such a drastic shift in policy.
NDP critic Selina Robinson, a former youth drug and alcohol counsellor, said B.C. has failed to throw all its resources behind a public health emergency.
“There is so much work to be done here and they are dragging their heels,” she said.
Yet even critics agree there’s not one solution to solve the crisis.
Leslie McBain, who co-founded the group Moms Stop the Harm after her son died of a prescription drug overdose in 2014, was at the June meeting of officials and has worked closely with B.C.’s overdose task force. She had high praise for B.C. officials, whom she said have “done a hell of a good job compared to other provinces,” but are nonetheless encumbered by frustrating bureaucracy.
“Is the government moving fast enough? Well if anybody knows government, and I’m just beginning to the past two years, it’s always at such a glacial speed,” McBain said. “It’s just so ponderous.”
What’s needed is more mental health education in schools, the legalization of illicit drugs and research into the societal cause of addictions and self-medication, she said.
“The speed at which government works is the speed at which it works,” McBain said. “There’s not much we can do. We try to be squeaky wheels. I talk to these folks all the time and are on good terms with them. They are honest and true and good-hearted people doing the best they can.”
We try to be squeaky wheels. I talk to these folks all the time. ... They are honest and true and goodhearted people doing the best they can.