Daphne Bramham: B.C. stressed harm reduction, not treatment, and leads Canada in opioid death rate

In 2022 — the seventh year of a public health emergency — the number of British Columbians who died due to the toxic supply of street drugs was the second highest on record, at least 2,272.

Among the dead were at least 65 children.

2021 was worse, with a record 2,306 deaths.

While the greatest number of deaths were in Vancouver, Surrey and Greater Victoria, it’s in the North that the rate of death is highest.

Over the years, the demographic has remained unchanged. They’re mostly men, mostly aged 30 to 59. Mostly, they die at home. No one calls for help. No help arrives then nor earlier, when some form of intervention might have set them on a different path.

The single deadly thread that runs through it all is seemingly ever higher concentrations of fentanyl regardless of what drug the user intended to buy.

That there has been no mitigation in the misery, despair, grief and suffering is an appalling indictment, particularly since the government has spent more than $1 billion in new services and resources since the health emergency was declared in 2016.

But an indictment of whom?

The B.C. government was lashed by Chief Coroner Lisa Lapointe during the news conference where the numbers were released. She and others blamed British Columbians for stigmatizing drug users and not caring enough to help.

Yet for more than a decade, the advice the government has received from Lapointe, the provincial health officer, the B.C. Centre on Substance Use, the city of Vancouver and others has focused heavily on stopping people from dying.

At their urgings, British Columbia has racked up many firsts.

In March 2020, it was the first jurisdiction in the world to offer free pharmaceutical grade heroin, benzodiazepines, methamphetamines and alcohol to addicts by prescription but without the requirement that they be taken under medical supervision.

It was first in North America to have a supervised injection site, a government-funded supply of pharmaceutical replacements for illicit drugs and a vending machine that dispenses pharmaceutical grade heroin.

One of the first to establish a methadone program, B.C. followed that by enhanced access to other opioid substitution therapies including suboxone and hydromorphone (pharmaceutical grade heroin).

B.C. was at the forefront of making naloxone free and widely available to reverse the effects of an opioid overdose, establishing drug checking sites and hiring peer counsellors.

In 2019, the provincial health officer, Dr. Bonnie Henry, said that these measures had averted 60 per cent of overdose deaths. Her 49-page report that year had a single recommendation: decriminalization.

Now, British Columbia is the first in Canada to decriminalize so-called hard drugs for personal use.

But here’s the worst first. By a large margin, British Columbia remains No. 1 when it comes to deaths per 100,000 — 42.1 for the first six months of 2022. Within the Northern Health Authority, it soared to 60 deaths for every 100,000 people.

In Alberta, where the focus instead has been on streamlining access to treatment and recovery, its rate was 34.9. And while Ontario had the highest number of deaths, its rate was 16.9 per 100,000, less than half British Columbia’s average.

No group has been more deeply and devastatingly affected than First Nations’ people, who are dying at five times the rate of other British Columbians. Making up only 3.4 per cent of the population, they have accounted for over 15 per cent of the toxic drug deaths with Indigenous women dying at 9.8 times the rate of other B.C. women.

The First Nations Health Authority and the B.C. Union of Indian Chiefs has long supported harm reduction including decriminalization. But they have also consistently talked about the need for resilience and recovery.

They’ve argued for a four pillars approach that includes addressing the root causes of addiction, including intergenerational trauma from residential schools, poverty and homelessness.

It includes helping people make healthier choices than turning to drugs or alcohol for solace, building healthier communities and, using every possible tool from Western medicine to traditional ceremonies to not only keep people alive, but help them to thrive.

Outside Indigenous communities, there’s not been a lot of that kind of talk since the early 2000s when a four pillars approach was championed by Vancouver city council.

Back then, one of those pillars was enforcement. Back then, close to 400 people a year were dying — there was no deadly fentanyl laced into every almost every drug sold on the street. So, it’s not entirely surprising that harm reduction rose to the fore.

Since the health emergency was declared, billions have been spent, 11,000 have died and the crisis has only deepened.

“To say that we need extraordinary action, resources and funding is a given,” Dr. Nel Weiman of the First Nations Health Authority said at the news conference. “It’s not so much that COVID warranted more, but we need to ask why does toxic drug crisis receive less?”

Weiman, Lapointe and others suggest that it’s because British Columbians have stereotyped and stigmatized all those who use street drugs.

But I’d argue that it’s not that people don’t care, it’s that they’ve given up trusting that the experts and politicians know what they’re doing.

More than 20 years after the first four pillars plan was passed, the first recommendation of the all-party legislative committee’s November report had a retro ring.

The government needs to “rapidly scale up a flexible, evidence-based, low-barrier, comprehensive continuum of care that spans the social determinants of health, prevention and education, harm reduction, safer supply, and treatment and recovery.”

B.C. families and communities have paid terrible price to get back to the future.

But finally, maybe, now only the barest minority people believe that it’s enough to provide an endless supply of free, “safe” drugs to keep people breathing, but barely alive.

dbramham@postmedia.com

1. First Nations women overrepresented among B.C. toxic drug deaths: Doctor

2. 5 things to know about B.C. decriminalizing possession of drugs for personal use

3. Decriminalization alone is not enough, experts warn

4. Ian Mulgrew: Why B.C.'s decriminalization experiment won't stop the drug deaths and misery

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