Overdoses rarer in rural B.C., but much more deadly: study

A B.C. Centre for Disease Control study suggests rural dwellers are as much as 50% more likely to die if they overdose from tainted drugs

A person who overdoses from tainted drugs is far more likely to die if they live in rural B.C. than in an urban centre, research from the B.C. Centre for Disease Control suggests.

On average, a rural dweller is 30 per cent more likely to die than someone who experiences an overdose in a city, but in some of the most remote areas, the fatality rate is up to 50 per cent higher.

The study’s findings underline the diverse and far-reaching impacts of B.C.’s toxic drug crisis in communities across the province, said its lead author Kevin Hu.

The rate reflects the small number of overdose prevention sites outside cities and the longer response times for emergency services in rural and remote areas, the study suggested.

“There may be a lower overdose frequency in those (rural) areas but there can be a much higher fatality rate,” said Hu, a data analyst at the Centre for Disease Control.

It underlines the importance of establishing harm reduction services and accessible safe supplies of drugs in every community, he added.

The study, published last week in the journal BMC Public Health, looked at overdose data from a variety of emergency and acute health care sources between January 2015 and December 2018 as fentanyl began to contaminate B.C.’s illicit drug supply and drive a rapid increase in drug poisoning deaths.

It sought to identify where a drug poisoning was most likely to kill someone, even if relatively few people are dying in a specific community.

The geographic analysis of 35,569 overdoses showed that about 9.1 per cent of fatal overdoses happened in rural areas, compared to just 5.7 per cent of non-fatal overdoses. About 13 per cent of British Columbians live in rural areas.

Even for people living in the region encompassing Kelowna, Kamloops and Merritt, the odds of dying of an overdose were between 25 and 50 per cent higher than the provincial average.

“It’s helpful to think regionally,” said Amanda Slaunwhite, a senior scientist at the Centre and study co-author. “The crisis exists and looks different in every community.”

The results also showed the life-saving impacts of harm reduction services, even in communities that experience many drug poisoning events.

Lower fatality rate “cold spots” were in Vancouver’s Downtown Eastside and in Downtown Victoria, where overdose prevention sites are concentrated.

“Those cold spots were really promising to see,” said Slaunwhite. “It speaks to the importance of existing services and the willingness of residents to support each other.”

The province declared a public health emergency in April 2016. Since then, more than 10,000 people have died of drug poisonings in B.C. alone. Vancouver, Victoria and Surrey have consistently seen the greatest numbers of deaths, according to data from the B.C. Coroners Service.

But deaths have risen the most quickly in the Interior and Northern Health regions, where fewer harm reduction resources and overdose prevention sites exist. These areas currently have the highest per capita death rates, as well.

Disparities in services also exist among neighbourhoods in larger urban centres.

For example, about half of drug poisoning calls in Vancouver come from the Downtown Eastside, according to B.C. Emergency Health Services.

But someone who is poisoned there is 70 per cent more likely to survive than someone who is poisoned a few kilometres away in southeast Vancouver’s River District, where there are no designated places to use drugs under supervision, the paper found.

“Higher-income neighbourhoods in Vancouver had some of the highest rates of fatal overdose,” said Slaunwhite.

“There is still a lot of stigma there,” she said. “We see a lot more people are using drugs in private homes, and when you use alone, you are more likely to get into trouble because there is nobody around to provide Naloxone.”

The figures shows that harm-reduction services have helped blunt the impacts of rising toxicity in the supply, and are desperately needed everywhere.

A supervised drug use site “in a rural or remote area is going to have a huge impact on fatality rates,” said Hu.

Slaunwhite and Hu plan to repeat the study with more recent data soon, and expect the divides to have intensified since 2018.

Moira Wyton is a reporter with The Tyee.