In the first six months of this year, 371 British Columbians died due to an overdose. This is a 74.2% increase from the previous year. Almost one quarter of these deaths are people in their 20s, 30s and 40s. Fentanyl, a powerful synthetic opiod was detected alone or in combination with other drugs in up to 60% of overdose deaths. Frequently, people consume Fentanyl unknowingly.
Overdose deaths are now the leading cause of unnatural death in B.C. For many British Columbians, the harsh reality of these numbers is hard to understand until you compare overdose deaths to motor vehicle accident deaths:
In 2015, there were 300 deaths due to motor vehicle accidents. In that same time, there were 474 drug overdose deaths.
This rising number of overdose deaths signalled a crisis so serious that it prompted Dr. Perry Kendall, the BC Provincial Health Officer, to declare a public health emergency on April 14, 2016. The province warned that without additional steps to combat overdoses, B.C. could see 600 to 800 overdose deaths in 2016.
So it seemed strangely surreal that the primary response to this public health emergency was a call for ‘real time information’ alongside the scale up of Naloxone distribution. Collecting real-time information on both the user and the circumstances of an overdose is one way to help guide a public health response. For instance, if a number of people overdose in one rooming house, officials can assign a nurse to that building to ensure everyone is trained and has access to naloxone. Nevertheless, this response to a public health emergency seemed out of sync in a province that had made history by establishing the first supervised injection site in Canada, where harm reduction is official provincial policy and there are strong voices for a public health approach to the decriminalization of illicit drugs. It seemed surreal that these overdose deaths were not seen as a clarion call to expand supervised consumption services (SCS) across the province, alongside ramping up the distribution of naloxone, increasing opiate substance therapy and detoxification services, and an increasing call for drug policy reform.
As early as 2008, the Health Officers Council of B.C. sent out an advisory urging health authorities to implement SCS where needed. Yet no new sites have been established since that time. Finally, eight years later and after the declaration of a public health emergency, there are reports from at least three heath authorities indicating that SCS are either being explored or planned.
Registered nurses have been at the forefront of the drive for SCS. In May, 2011, nursing organizations including the Association of Registered Nurses of British Columbia (ARNBC), BC Nurses Union (BCNU), Canadian Nurses Association (CNA), and the Registered Nurses’ Association of Ontario (RNAO) spoke out publically and in the Federal Supreme Court in support of Insite because of the abundant evidence as to its effectiveness and the care provided by nurses.
This action was possible because of the vision of many nursing leaders. Five years before the Federal Supreme Court hearing, the Canadian Association of Nurses in HIV/AIDS Care (CANAC) put forth a resolution at a CNA Annual Meeting requesting the development of a discussion paper on illicit drug use and harm reduction. Alongside Irene Goldstone, I had the privilege of conducting the evidence review and co-leading the development of the CNA discussion paper on harm reduction that was released the same day as nursing organizations appeared as intervenors before the Supreme Court of Canada. The decision of the Supreme Court was that closure of Insite would prevent access to essential health services and endanger the health and safety of people who use drugs. This would also undermine the intention of the Controlled Drugs and Substances Act and violate the Charter of Rights and Freedoms. Instead, Insite would remain open while having to apply annually for an ongoing exemption.
With this decision, there was hope that other supervised consumption sites would open elsewhere in Vancouver Coastal Health (VCH) and Canada. However, the Federal Government quickly moved to develop stringent guidelines in the form of Bill C-2. In early 2016, when VCH applied for an exemption for the first time since the enactment of the Respect for Communities Act (Bill C-2), VCH stated that, “In order to meet the 27 new conditions for exemption, VCH was required to submit additional volumes of information. In practical terms, these new requirements make it onerous for Insite and other supervised injection services to obtain an exemption.”
Cities like Victoria, Toronto, and Ottawa have identified a need and plans to establish SCS. However, there has been only one new site approved in Canada to date. In January 2016, the Dr. Peter Centre (DPC) in Vancouver became the second approved site in Canada. The DPC delivers an integrated model of SCS and has been operating under the auspices of professional and ethical nursing standards for nearly a decade. Current B.C. Minister of Health, Terry Lake, has identified the need for more SCS in B.C. and says he has written to the Federal Government asking them to reconsider Bill C-2, and reduce the barriers to opening more SCS. To date, there has been no response. Prime Minister Trudeau and Minister of Health Jane Philpott have spoken in support of SCS but to date there has been no shift in the requirements for establishing a site.
We need action if we are to prevent overdose deaths. At the current rate, 61 people per month are dying. There is an urgent and immediate need to establish SCS and expand opiate substitution therapy to prevent further deaths. Taking a public health approach to illicit drugs and decriminalization of drugs is equally as important as a long-term policy reform to prevent the harms of illicit drug use. Today, as nurses, we can continue to lead by calling for a scale up of harm reduction services (supervised consumption services and opiate substance therapy) and an end to drug policy that criminalizes use.
Further Reading:
Illicit Overdose Deaths in BC
Nursing Positions on Harm Reduction: CNA, BCNU
ARNBC Blog on Insite
Research on Insite
BCCDC Naloxone Program:
Public Health Approach to Illicit Drugs
ABOUT DR. BERNIE PAULY, RN, PhD
Dr. Bernie Pauly is an Associate Professor in the School of Nursing, a Scientist with the Centre for Addictions Research of BC, member of the Renewal of Public Health Services Research Team, and priority lead for the Canadian Observatory on Homelessness. The primary focus of her research is reducing health inequities associated with substance use, poverty and homelessness.
Thank you Bernie!
Though I no longer work in Harm Reduction, these unnecessary, needless, tragic deaths still hit me hard. I had no idea that more people have died this year than from auto accidents, that really hit home.
We've known for a long time that InSite and the Dr Peter Centre cannot meet the needs of users who want to use substances in a supervised setting, and access the low barrier, judgement-free healthcare services. We need more, expanded services to enable people to keep themselves safe, regardless of their situation. Detox, naloxone, treatments, supervised consumption, recovery - all have their time and place to meet wherever people are at.
Thank you Bernie. So important for the nurses of BC to fully appreciate why this is such a NURSING issue in all of its complexities. You offer us the empirical and practical understanding that is necessary to enact the human and relational aspect of our care strategies. Important to remember the early work of nurses in bringing a harm reduction ideology to the forefront. And also important to remember the power of our profession when all of its organized bodies can align together on powerful policy matters on behalf of the people we collectively serve.
Keep on doing this amazing work, and your profession will be right behind you cheering you on!
Dr Pauly,
Your strong clear articulate voice makes me proud to be a nurse.
As someone who has lost three primary care patients to overdoses in the last couple of years. I look forward to the day when we have finally bent the curve and opioid deaths are going down.
Great question: why aren’t we using all the tools at our disposal, especially ones for which we have evidence? Yes, politics, fully utilized budgets, inertia, all the regular suspects I suppose. The title of a piece of writing from a previous epidemic comes to mine “And the Band Played On”.
Thank you for raising your voice as a nurse. Thank you for your work to help bend this curve.