On July 16, the British Columbia Coroners Service released its monthly overdose fatality report. The impact of the lost lives will linger long after the headlines fade: 175 people died of illicit-drug overdoses in British Columbia in the month of June. That’s the highest monthly death toll here since the province declared the overdose crisis a public health emergency in April 2016.
It was a grim reminder, for those who needed it, that this emergency is far from over, and that urgent work still needs to be done to prevent such deaths—because preventable is what they are.
The new figure represents a 130 percent increase compared with June 2019. The areas with the most deaths were Vancouver, Surrey and Victoria. Eighty-five percent of the deaths happened indoors: 57 percent in private residences and 28 percent in other indoor locations, including social or supportive housing and single room occupancy hotels. The remaining deaths happened outside, including in cars and on the streets.
A new wave of the overdose crisis is being created by COVID-19 mixed with prohibition.
The report revealed the devastating impact that the other, better-publicized, public health emergency is having on people who use drugs. COVID-19 has been unforgiving—causing increasing drug use; people in recovery relapsing; a reduction in people accessing lifesaving harm reduction services such as safe consumption or overdose prevention sites; and disruption in the drug supply, resulting in more toxic, deadly drugs. All of these factors have left more people more vulnerable to overdose.
Unfortunately, we don’t know how badly COVID-19 has hit drug users in other Canadian provinces. British Columbia is alone in releasing monthly data from its coroners office. Nationally, the Public Health Agency of Canada recently released overdose data for 2019. Nearly 3,900 lives were lost last year, but little-to-nothing is yet known about the national impact of the pandemic on drug users. While COVID-19 has been accompanied by worldwide daily data reports, people who use drugs do not even have the luxury of knowing the exact extent of harms inflicted upon them.
Although it’s difficult to formulate a response without comprehensive data, what British Columbia has shared tells us that the drug supply is getting far worse. With international border closures, there has been huge disruption to supply chains. The precursor chemicals for synthesizing illicit drugs are becoming harder to access, resulting in a toxic cut supply. A new wave of the overdose crisis is being created by COVID-19 mixed with prohibition.
The report also tells us, clearly, what needs to be done: Stop the criminalization of drug users, vastly improve access to harm reduction, and end organized crime’s monopoly on the illicit drug supply.
Try as it might, law enforcement cannot stem the flow of drugs making it onto our streets. As a sign of this futility, enforcement officers cannot even stop illicit drugs from getting into the supposedly controlled environment of prisons. There have already been three overdose deaths in British Columbia’s prison population in 2020; that may not seem many, but these people are in the custody of the government. The prison population is one bad batch away from far worse harms.
In light of the pandemic, the federal government enacted temporary exemptions to the Controlled Drugs and Substances Act, which allowed British Columbia to better implement “pandemic prescribing”—the prescription of pharmaceutical alternatives to illicit drugs. This is a positive first step, and long overdue. But it’s not nearly enough, and needs to be expanded to include drugs such as regulated fentanyl and diacetylmorphine (“pharmaceutical heroin”).
As British Columbia’s overdose statistics reveal, pandemic prescribing alone is not going to end the overdose crisis. All 175 people who died of overdose in this province last month could, theoretically, have obtained safer, legal drugs from a healthcare professional, but for whatever reason, they didn’t. Perhaps because they didn’t have a primary healthcare provider or couldn’t find one who was willing to give them the drugs they needed. Like people across the country, they were then forced to buy adulterated drugs off the street—and they died.
We have been in an overdose crisis for years before COVID-19 was an evening headline, but it still goes unnoticed.
It is hard not to compare the response to the carnage of the overdose crisis with the response to COVID-19, which has so far caused almost 9,000 deaths in Canada. When the novel coronavirus began to look like a threat in March, unprecedented measures were taken. The entire country went into lockdown, requiring people to physically isolate and socially distance. Billions of dollars of economic growth were sacrificed. Public health updates were provided daily. Mathematical modelling and projections were presented.
The lack of a comparable response to overdoses is noticeable and unconscionable. We have been in an overdose crisis for years before COVID-19 was an evening headline, but it still goes unnoticed as the “other” crisis.
Since the COVID-19 public health emergency was declared in March, nearly four times more people have died of illicit-drug overdoses in British Columbia than have died of the novel coronavirus. This is a testament to the effective and timely management of one of British Columbia’s public health emergencies. It is also a damning critique of the response to the other.
At the root of the government’s inaction is stigma—the idea, widely held, that some lives matter more than others. People might think that way because, having never experienced it themselves, they see drug use as bad and addiction as a straightforward choice. People decide to use drugs for many reasons, including pleasure, but no one decides to become addicted. Most people with addiction have one form of trauma or another.
Stigma and discrimination have played a major role in the deaths of many drug users, stopping people from reaching out for lifesaving help, for fear of legal and social repercussions. Stigma and discrimination are a major factor in why people use alone. Apparently, they also stop our policymakers from extending a helping hand.
Creating a permanent, accessible safer supply and decriminalizing people who use drugs should have happened a long time ago. It is obvious that doing away with the persistent stigma around drug use would save many lives. For this to be possible, policymakers need to show leadership by recognizing and addressing their own prejudices.
As someone who has lost countless friends to overdose over the last few years, I cannot stand to see another deadly month of inaction go by.
Photograph of an ambulance in Vancouver by Mitchell Smith via Flickr/Creative Commons 2.0