Deaths climb as visits to overdose prevention sites fall

While provincial health officers, health ministers and premiers give daily updates on the number of deaths due to COVID-19, BC's other provincial health emergency — overdose deaths — has become more acute since the start of the pandemic.

In British Columbia, 117 people died from overdoses in April, continuing the trend of increased deaths in March, when 112 people died. This is the first time since late 2018  there have been over 100 deaths in two consecutive months. 

In the Island Health region, a total of 60 people have died from overdoses so far this year. There were 20 deaths in April, two more than in March and double that of February.

Advocates and health officials believe those spikes are partly due to COVID-19. One factor may be the result of reduced hours at safe injection sites that were put in place at the start of the pandemic.

The medical health officer for the central Vancouver Island area, Dr. Paul Hasselback, says he is “quite concerned” by the most recent statistics. New data shows visits to overdose prevention sites in the Island Health region dropped an average of 57 per cent since February.  The  overdose prevention site in Nanaimo recorded half the number of regular visits during that time.

BC's Provincial Health Officer believes COVID-19 is having a negative effect on illicit drug users. Dr. Bonnie Henry says, “With the challenges that we have with providing services, particularly to people who use drugs who are homeless or under housed, access to overdose prevention sites has been interrupted in some places and we've had to change those models." 

Recent data for other provinces is sparse, but what's available also shows more overdoses and fewer visits to overdose prevention sites. Toronto paramedics responded to 25 fatal overdoses in April — a 108 per cent increase since February. In Ontario, visits to overdose prevention sites fell by 19 per cent in March compared to February, with 5,300 fewer visits. One stark example is "The Works," a safe injection site run by Toronto Public Health, where visits plummeted from 3,852 in February to just 127 in April after it moved to a system where drug users had to make an appointment to access the service.

Some advocates in Nanaimo are taking action themselves to try to fill the gap caused by reduced hours and access to services.

Kerry Watters, who is on the  BC / Yukon Association of Drug War Survivors' board of directors, started working out of her car on Wesley Street at night, handing out harm-reduction supplies and trying to ensure people weren’t using alone.

“It's about actually just safely sitting with them and letting them consume without dying,” she says. “That's pretty much where I'm at with all of this, until things reopen.”

But it hasn't been enough, and at least nine people in Nanaimo have died from overdoses in 2020, with more possibly still uncounted.

Watters says when she was doing outreach on Wesley Street recently, a woman a block away died from an overdose.

“I ran up and I'm watching the [ambulance] take that kid out of there, one fucking block away from me,” she says. “The fact is that kid grew up in a town where there's no hope and there's no help.”

While social distancing and self isolation are cornerstones in the fight to stop the spread of COVID-19, they can prove deadly for drug users. The latest statistics show 83 per cent of overdose deaths in B.C. happened indoors. Dr. Hasselback says "those are the tragedies that tend to show up in fatality statistics.”  He adds, "the majority of individuals who are using substances continue to do so from their own private residence, not on the street, not in an overdose prevention site. We need to be reaching into where they are using substances.”

In response, a new app is being made available to drug users in this province, that officials hope will protect people when using alone and indoors. The Lifeguard app is activated by the user before they take their dose and it sounds an alarm after 50 seconds. If the user doesn't hit a button to stop the alarm to indicate they are okay, the alarm grows louder and after 75 seconds, a text-to-voice call goes to 911, alerting paramedics of a potential overdose.

“It's the first thing that we've been able to truly bring to people's residences” says Dr. Hasselback.

Kim Toombs is a harm reduction manager at AIDS Vancouver Island (AVI) — which runs a number of overdose prevention sites on Vancouver Island. She has seen the impact on the ground in Victoria where there have been 28 overdose deaths.

“It has become more toxic,” says Toombs. “There's definitely been higher concentrations of fentanyl in the dope here in Victoria since COVID-19, and we definitely saw that through April.”

Data from Alberta seems to support the claim that street drugs have continued to become more toxic during the pandemic. Visits to the Safeworks site in Calgary in April were down 33 per cent since February, but the rate of overdoses at the site was almost two and a half times higher than before the pandemic. Overdoses at Safeworks increased by 61 per cent since February, with 87 recorded in April — the most since July 2019. 

Ongoing concerns about the toxicity of street drugs has been made worse by the pandemic, because international supply chains have been disrupted, leading to more drugs being manufactured in BC according to Dr. Henry.

“It's just an unknown drug supply is really the best way of looking at it. “ says Toombs. “We just never know what it's going to be.

Kim Toombs, harm reduction manager for AIDS Vancouver Island says that a smoking tent they sent up in Topaz Park was their most popular harm reduction service during the COVID-19 pandemic. Photo courtesy of the Province of BC.

In an attempt to address the toxicity problem, the federal government made exemptions to the Controlled Drugs and Substances Act in March, that allows doctors to prescribe safer alternatives to street drugs. On March 26, B.C. issued guidelines for prescribers to help facilitate better access to a safer supply. However, there is little data so far on the impact of the changes.  

Dr. Henry admits it's been difficult to encourage some BC doctors to prescribe safe alternatives to street drugs.  She calls it “a challenge” and “something that we are continuing to focus on, making sure that people who use drugs [have] safe, pharmaceutical alternatives to what we know is an incredibly toxic street supply.” 

Last year, Dr. Henry called for decriminalization for possession of illicit drugs, in a special report called "Stopping the Harm." In it, Henry wrote "it is incumbent on government to act urgently" by changing the Police Act "to allow police to link people to health and social services, and use administrative penalties rather than criminal charges for simple possession." But the Minister responsible, Mike Farnworth, rejected the recommendation outright, saying "controlled substances remain under federal jurisdiction."

After the latest overdose numbers were reported last week, Henry said she continues to push government toward decriminalization, telling users and their families "you are not forgotten."

Dr. Hasselback notes another trend in which overdoses seem to be more frequently associated with the smoking of drugs. 

After AVI closed its downtown Victoria site due to COVID-19 restrictions, it set up in Topaz Park to provide services to people in a large encampment there. Toombs says there has been a shift to providing overdose prevention services for people who smoke drugs.

"That was our most popular spot,” said Toombs. “Our visits were huge in the smoking tent and we definitely responded to overdoses in the smoking tent, with a lot in the injection tent as well."

Despite some efforts being made to address BC's overdose crisis during the pandemic, advocates say it's not enough.

“Everyone's worked so hard to try and save lives and to see [overdose deaths] increasing again, as a result of another public health emergency happening at the same time is really disappointing and disheartening and upsetting,” said Toombs. “And it just speaks to the lack of supports and the stigmatization that folks who use drugs face and the fact that they've never actually been adequately supported through this entire crisis.”