Despite being at the epicenter of the crisis and having spent $2.7 billion last year alone, British Columbia’s response is chaotic.
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At the epicenter of Canada’s drug overdose crisis, BC still lacks a coordinated response, despite spending $2.7 billion last year on services and obtaining federal waivers that allow it to provide pharmaceutical alternatives to users. chronic and decriminalize possession for personal use early next year.
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The lack of a comprehensive system across the province is the constant theme heard by a select permanent legislative committee on health in its hearings that began in May on the “urgent and ongoing illicit drug overdose and toxicity crisis.”
You have heard how the five regional health authorities are jealously hoarding information and data. He has heard how the authorities have power, money and data, while the BC Ministry of Addictions and Mental Health has little or nothing. He has heard how even pragmatic solutions aimed at curbing the death toll from nearly six a day last year are stalling.
An option put forth by the Council of Building Associations, which represents 20 construction-related organizations, is a case in point: The council has asked the government to provide naloxone kits to all construction workers in British Columbia. Naloxone can reverse an opioid overdose.
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Yet despite the government’s $2 million-a-year “take-home naloxone programme,” the council is still waiting for a response.
“We saw, in our minds, pallets of naloxone kits coming into the various associations and trades, and we used them as hubs to dispense them to all the workers, so we actually flooded the system with them. And then we would do, at the same time, a side-by-side study to see if we actually reduced the number of deaths related to it,” council chairman Dr. Dave Baspaly told the committee. Monday.
“Since that didn’t happen, people looked for their own solutions within these various things, so it’s very fragmented right now.”
The construction industry has been hit hard by the opioid crisis, as its workforce is made up primarily of men ages 18 to 54, who account for about three-quarters of all overdose deaths.
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“What I find most discouraging about the conversations we’ve heard is the constant reference to the fact that ministries, agencies and departments don’t communicate with each other,” co-chair and former Liberal health minister Shirley Bond said at Monday’s hearing. . .
“We have an opioid crisis, where people are dying every day, and people are somehow still territorial about the work that they do.
“If that doesn’t get to the heart of what the problem is, I don’t know what will.”
More than six years ago, after opioid overdoses were declared a public health emergency, best practices are not being shared. Detoxification and recovery services remain critically scarce, especially for women and youth. The services provided in downtown Vancouver are often not available in rural areas and the north.
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And even the government does not have timely and comprehensive data collected by health authorities.
That means it’s even more difficult to assess the effectiveness of programs like “safer supply,” also known as “risk mitigation guidance,” where users are prescribed pharmaceutical medications as a replacement for street drugs.
Until recently, the only safe supply data available to Dr. Karen Urbanoski, chair of Canada Research on Substance Use, was from March to September 2020. She and her team recently received data through the end of August 2021.
So far, the analysis is not promising.
“There was no apparent effect of a more secure supply on substance-related (emergency department) visits or hospitalizations,” he said. told the committee in mid-June.
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It was associated with a lower mortality rate relative to a control group. But, Urbanoski said, “the difference was not statistically significant.”
In the first six months, 12,721 people were prescribed medications to prevent withdrawal from alcohol, stimulants, opioids and benzodiazepines. Two-thirds of the sample received an opioid medication such as hydromorphone or Dilaudid.
Urbanoski’s colleague, Dr. Brittany Barker, told the committee that “the minimum clinical goal of safe supply” is to prevent users from going into withdrawal.
And as Dr. Christy Sutherland said in the hearings, those doses can be astronomically high. She has patients using 40,000 micrograms of fentanyl a day. For pain relief in the hospital, she said, the usual dose is 12.5 micrograms.
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Urbanoski suggested that the failure of the secure supply to produce better results may be because the intervention itself was flawed: the fentanyl substitute, hydromorphone, is not as powerful; the recommended doses were too low; substitute drugs are not intended to be smoked or snorted, which is the preferred method for opioid users; and, in 94 percent of cases, the drugs had to be picked up daily, which made it impossible for most people who lived outside of an urban center.
Others, including Dr. Chris Fraser of Cool Aid, which provides services to users in Victoria, pointed out that with the COVID lockdown and “other factors” there are more challenges.
“We really don’t know how much of those opioids they use themselves,” Fraser said. “If they have multiple addictions, stimulants and alcohol use disorder, or other things. We really cannot ensure that it is being given to that person in the way that we intend.”
While it remains to be seen whether Urbanoski’s updated analysis, expected later this summer, will show that a safer supply has substantial benefits, she has noted that a safer drug supply “is not going to replace the need to improve the system. The necessary efforts to strengthen the care system in general.”
Committee hearings continue through August and written input is accepted until 3 pm on August 5.
More on the hearings in a future column.
Twitter: @bramham_daphne
