Overdose Deaths Decline in Some Areas of British Columbia

Fewer people are dying from drug overdoses in British Columbia (BC), although this decline has not taken place in every part of the province.

According to the BC Coroners Service, 152 overdose deaths were reported in January, making it the fourth consecutive month in which the number of overdose deaths was below 160.

Unfortunately, the decline did not continue in communities within the Fraser Health and Interior Health regions.

It is too soon to start calling this decline a trend, experts cautioned, and overdose deaths are still too high.

“It’s a relatively small change, and we should not be taking this as some indication that we can take our foot off the gas and pat ourselves on the back because things are good now,” Kora DeBeck, PhD, distinguished professor of substance use and drug policy at Simon Fraser University in Vancouver, told Medscape Medical News.

“Five people per day on average are still dying, so we are still very much in an emergency,” DeBeck said.

Deaths are still higher than they were before the pandemic began, and some regions in BC have seen increases, noted Stephen Hoption Cann, PhD, clinical professor of medicine at the University of British Columbia in Vancouver.

“The decline is welcome, but it’s too early to determine what factors this could be attributed to or whether it will continue,” Hoption Cann told Medscape Medical News.

“It is challenging to determine factors contributing to the decline in BC, as similar declines have been observed across Canada and the United States,” he added. “Changes in behavior following the relaxation of pandemic restrictions and the greater availability and familiarity of naloxone to treat overdoses have been put forward as possible reasons.”

Men at Risk

Using substances alone is an important risk factor for overdose death, said Eugenia Oviedo-Joekes, PhD, professor of population and public health at the University of British Columbia.

“Harm reduction initiatives, including the establishment of safe houses where people can use and receive Narcan or oxygen if needed, reduce overdose deaths. It is horrifying that in Ontario, they have closed the safe injection sites,” Oviedo-Joekes told Medscape Medical News.

Patients dying of overdose are most likely to be men and in their 30s through 50s. Nevertheless, deaths among patients over 60 years of age have increased dramatically in the past 10 years, according to Hoption Cann.

“While deaths in males and in the 30-50-year age range have been a trend for a long time, the increase in deaths in those in their 50s, and certainly over 60, is a more recent phenomenon. It is not fully clear why this change is being seen in older individuals, but it may be due to the low cost and easy accessibility of addictive substances,” he said.

Recreational users are the most at risk, added DeBeck. “Just over half the people who are dying from a toxic drug overdose did not have an opiate use disorder and were not using opiates on a daily basis,” which suggests that these patients are not habitual substance users.

Public Health Changes

Public health programs that might help prevent overdose deaths are currently undergoing changes.

“One major policy change involves the government ending the take-home safer supply program,” said Hoption Cann. “Individuals prescribed opioids such as hydromorphone are now required to take the medication under the supervision of a pharmacist. The decision followed a leak of BC Ministry of Health slides, which revealed that government and law enforcement officials were aware of substantial trafficking of take-home opioids nationally and internationally. Concerns were raised about patients diverting their take-home prescriptions for resale on local, national, and international markets. Particularly for local diversion, there was a concern that flooding the market with cheap opioids would create many new users and thus exacerbate the problem rather than fix it.”

Another major development is the conclusion of the province’s drug decriminalization pilot project.

“Public drug use is being recriminalized, marking a shift in the government’s approach to addressing drug-related issues in public spaces. How and if these changes will affect drug overdoses remains to be seen,” Hoption Cann said.

Criminalization and prohibition are not the way to go, said DeBeck. Instead, moving toward government involvement to ensure that drugs are safe will be, in the long run, a more effective approach to preventing overdose deaths, she asserted.

“We like to think that if we just got people into treatment, if we just had better treatment, then everything would be fine. Yes, this is important, but we need to be addressing the toxic supply of drugs if we want to make a meaningful impact on overdose fatalities,” she said.

The idea that law enforcement approaches will eliminate drugs from our communities is magical thinking, DeBeck said.

“The most radical response, the one I think makes the absolute most sense, given the research and evidence that we have, is to tightly regulate the currently illegal supply of drugs and have government step in and be involved in how drugs are produced, making sure there are tight health and safety standards,” she said.

DeBeck, Hoption Cann, and Oviedo-Joekes reported having no relevant financial relationships.