SAFER SUPPLY WILL STEM DRUG-TOXICITY DEATHS
Since 2020, overdoses have killed more than COVID in B.C., says Peter McKnight.
These are surely the worst of times.
Since the beginning of January 2020, the health crisis has claimed the lives of more than 4,000 people in B.C. The last few months have seen deaths reach an all-time high, with more than 200 people dying each month, or about six people every day.
It's not COVID. It's that other public health emergency — the one that has killed about 40 per cent more British Columbians than COVID over the last two years. The one that, unlike COVID, keeps getting worse, with death rates more than doubling after the introduction of COVID-related public health measures.
In our tale of two health crises, this one concerns illicit drug overdose deaths. Or, more accurately, drug-toxicity deaths. And in addition to killing more people than COVID, illicit drug toxicity is now “the leading cause of unnatural death in the province, accounting for more deaths than homicides, suicides, motor vehicle incidents, drownings and fire-related deaths combined. Deaths due to illicit drug toxicity are second only to cancers in terms of potential years of life lost in B.C.”
That quote, and much more, comes from last week's B.C. Coroners Service Death Review Panel Report, which examined more than 6,000 overdose deaths from mid-2017 until mid-2021.
While death rates rose dramatically during that period, they continued to increase after mid-2021, with each of the last two months of the year recording the highest-ever number of drug deaths (210 in November and 215 in December) in the province. January of this year was only slightly better, with 207 deaths.
The report stresses that no one is immune from this lethal crisis: While Indigenous people and those with low income and poor housing suffer from disproportionately high rates of overdose deaths, the drug toxicity crisis afflicts people of every ethnicity and socioeconomic class.
The panel pins the blame for illicit drug overdose deaths squarely on two causes: first, contaminated drug supplies, especially those contaminated by benzodiazepines and by the potent opioid fentanyl. That means that much like COVID, most of the deaths from this even more lethal health crisis are preventable.
But what we're doing to stem the tide clearly isn't working — in fact, it's working against us. And that brings us to the second cause identified in the report: the current legal and regulatory framework. Unlike COVID, where regulations aim to facilitate prevention through vaccinations and adherence to public health measures, laws concerning illicit drugs actually facilitate overdose deaths.
While stressing the importance of a variety of measures, including improving the availability and accessibility of drug treatment, the report therefore notes the urgency of regulatory reform. That means both decriminalization of illicit drugs and the implementation of safer supply — the supply of legal, pharmaceutical-grade psychoactive drugs that are normally only accessible through the black market.
Safer supply can take many forms, but the aim is to ensure illicit drug users have access to an uncontaminated supply where they live. This can be provided through a number of venues, including medical clinics, pharmacies, drug consumption sites, and community health and substance treatment centres.
That might sound a little incongruous, since many such facilities are designed to help get people off drugs rather than to keep them on them. And, indeed, the very idea of safer supply seems counterintuitive given our long-standing cultural belief that abstinence is the only answer.
Few politicians are therefore willing to champion the provision of illicit drugs, since any mention of safer supply is met with the usual objection that it amounts to enabling, rather than eradicating, drug addiction. So our current regulatory framework remains, despite the clear evidence of its catastrophic impact.
It's therefore critically important to highlight the fact that safer supply, while crucial given the epidemic of drug toxicity deaths, isn't only about reducing mortality. Rather, evidence suggests it also results in myriad other benefits, including reducing infections and visits to hospital among users, and improving connections to housing, social supports and care and treatment, especially for those who have not used support services in the past.
You know who cites all of that evidence? That's right, none other than the federal government. Yes, while maintaining the criminal prohibition on drugs, and while dragging their feet on Vancouver's (and Toronto's) applications for an exemption from Canada's drug possession laws, the feds nonetheless publicly rehearse the evidence in favour of safer supply. Now that's incongruous.
The coroner's report therefore calls on the federal minister of health to approve, by April 11, Vancouver's application for an exemption. But given the long history of federal inertia on the matter, the report also cites a 2021 paper from the provincial health officer, which outlines a provincial approach to decriminalizing drug possession.
The province could de facto decriminalize possession by adding a regulation under the Police Act that prevents police officers from expending resources on enforcement of simple possession offences.
Aside from that suggestion, the report recommends that the province take a variety of actions by May 9, including creating a provincial framework for safer supply distribution, and rapidly expanding safer drug supply throughout the province, especially to remote and Indigenous communities.
Although these recommendations will meet with the inevitable opposition, they are reasonable and responsible public health measures, much like masking and vaccinations implemented during COVID. And as we have seen with the pandemic, careful, if controversial, public health initiatives might not produce the best of times, but they can surely rescue us from the worst.
While maintaining the criminal prohibition on drugs ... the feds nonetheless publicly rehearse the evidence in favour of safer supply. Now that's incongruous.