Photo of a naloxone kit, which helps reverse the effects of an opioid overdose, courtesy of the Province of British Columbia.

Safer supply guidelines could be expanded to include injectable hyrdomorphone and prescription heroin says provincial health officer

There were 175 deaths from overdoses in July, according to the BC Coroners Service, bringing the total to 909 in 2020. That's a 135 per cent increase from July 2019 and the third month in a row where deaths from illicit drugs were over 170, an average of 5.6 deaths a day in the province.

"The number of people dying in B.C. due to an unsafe drug supply continues to surpass deaths due to homicides, motor vehicle accidents, suicides and COVID-19 combined," said chief coroner Lisa Lapointe at a news conference.

The provincial death rate from toxic street drugs is 30.5 per 100,000, just less than the peak of the overdose crisis in 2018.

There were four deaths from overdoses in Nanaimo and 10 in the central Vancouver Island health service delivery area. On Vancouver Island as a whole there were 33 new deaths for a total of 165 this year.

"We have been working flat-out to reduce overdose deaths since we formed government,” said Mental Health and Additions Minister Judy Darcy in a statement. “Since COVID-19 hit, we have escalated our response to counter the effects of the pandemic and to get more people on a path to treatment and recovery.”

Part of that response was the introduction of new “risk mitigation guidelines” that would make it easier for physicians to prescribe alternatives to street drugs.

Lapointe said that there is “no evidence” that prescription alternatives are playing a role in the overdose crisis and urged doctors to prescribe opioid agonist treatment to patients who need it.

However, the implementation of those “safe-supply” guidelines was slammed today by Guy Felicella, a peer clinical advisor with BC Centre on Substance Use and the provincial Overdose Emergency Response Centre.

Data from the Ministry of Mental Health and addictions shows that in June there was 1,962 people prescribed hydromorphone, a 190 per cent increase since March, though data is tracked on overall dispensing, not if the person had a substance use disorder and was prescribed under the new guidelines.

Calling the interim guidance an “important first step” Felicella called on the government to go further and expand it to include injectable hydromorphone and powdered fentanyl.

“If hydromorphone [tablet] is our answer, then we're failing miserably,” he said. “We need to expand. We need to look at not giving drug users the least sought after drugs, but the drugs that they're actually seeking.”

Felicella said that what the province is doing “is not working” and they need to try something new because “if we don't try, people die.”

Provincial health officer Dr. Bonnie Henry said that she is looking at expanding the program to include injectable hydromorphone and other opioids such as prescription heroin, which is not widely available in Canada.

Henry said she expects a revision of the risk mitigation guidelines to be out sometime next month.

Visits to Overdose Prevention Sites on Vancouver Island increasing, but not yet back to pre-pandemic levels

Data from Island Health shows that while the use of overdose prevention sites increased to 11,003 visits in July, it is still only seeing 81 per cent of the number of visits from before the pandemic.

The COVID-19 pandemic disrupted overdose prevention services as sites reduced hours and capacity and the effects have been uneven in the region.

The CMHA Wesley Street site in Nanaimo saw 691 visits in July, just 65 per cent of the number of visits that it was seeing in February. Meanwhile, the overdose prevention sites in Port Alberni and Duncan are both seeing 84 per cent of their pre-pandemic levels, with 1,502 and 1,987 visits respectively.

The South Vancouver Island area has seen one of the largest increases of overdose deaths in the province compared to before the COVID-19 pandemic.

It has also seen a shift from established overdose prevention sites to ones in a local arena and various hotels that BC housing bought to help house homeless people in who were staying at encampments.

While some overdose prevention sites in Victoria have closed or have seen visits drop by 60-91 per cent, the number of visits to the new sites have helped with a total of 3,264 visits in July, accounting for about half of the visits in Victoria.

Overall, the number of visits to overdose prevention services in Victoria are 81 per cent of their pre-pandemic levels.