Wednesday, April 14 will mark the 5th anniversary of the declaration of the BC Public Health Emergency of overdose and overdose deaths. This anniversary comes on the heels of BC’s deadliest year ever with 1,716 lives lost to Illicit drug overdoses in 2020.
With 329 deaths already recorded in January and February, without dramatic changes to what we are doing, this year could be as bad or even worse. Since it first began, COVID-19 has had a terrible toxifying impact on the illicit drug market. Today we see increasing amounts of carfentenil and opiates being cut with benzodiazepenes – tomorrow will no doubt bring more or new poisons into the drug supply.
There have been efforts on the part of the province to respond, notably the Risk Mitigation Guidance in March of 2020 that introduced safe supply. Unfortunately, precipitated as it was by the COVID-19 pandemic, the Risk Guidance was limited. The prescriptions available have largely been limited to drugs available for treatment (i.e., oral tablet hydromorphone/dilaudid) and/or in limited amounts. This has meant that many people still do not have a true safe alternative to the poisonous illicit drug supply. There have also been significant challenges with implementation of the Guidance and access to prescribers, particularly for people living in rural and remote regions. So, while there have been some people who have greatly benefited from the safe supply that has been made available, far too many have not.
In September of 2020, BC’s Provincial Health Officer Dr. Bonnie Henry announced an order granting nurses prescribing powers to treat substance use – welcome news. However, to date the small cohort of nurses and psychiatric nurses that have been trained have been limited to prescribing Suboxone only. The province also announced it would be expanding eligibility for safer supply programs and allow more substances to be prescribed. Six months later, we are still waiting to see those changes.
Since the COVID pandemic began, PAN has been meeting regularly with our member and allied organizations and time and again we have heard about the terrible impact of the toxic drug supply on individuals, families and communities. We have heard time and again about the limitations of “pandemic prescribing” and the inability to connect people with prescribers. We have also heard about the negative impacts of the ongoing criminalization of people who use drugs, and how municipal bylaws and policing practices have further stigmatized and isolated people, punishing them, endangering them and putting them in harm’s way. Finally, we have also heard about the levels of despair, grief, frustration and exhaustion that many of the staff and volunteers working on the front lines are experiencing.
We in turn have worked to communicate these shared concerns and challenges to the powers-that-be, to convey the feedback of PAN member and other community-based organizations to the province and decision makers. We have appreciated the opportunity to meet with (former) Minister Darcy and Minister Malcolmson, at the Ministry of Mental Health and Addictions, as well as with different contacts within the Ministry of Health, the Overdose Emergency Response Centre (OERC), the various health authorities, and others.
We have also witnessed and applauded the concerted efforts and leadership of peers, people who use drugs, and grassroots advocates including families that have been directly impacted. It is largely because of their advocacy and their voices that any progress is happening – such as a growing societal willingness to consider decriminalization of simple possession at both the provincial and federal levels.
There has been so much work done by peers, by workers on the front lines, by human rights and other advocates, and by public health. But sadly, we are still so far from addressing this crisis.
One of the big challenges of a medicalized approach to addressing the overdose crisis, that treats all illicit drug use as a substance use disorder is that it requires the involvement of physicians, pharmacists and other health care providers. For different reasons, many doctors have been unwilling or reluctant to prescribe safe supply – and if willing, have tended to interpret the Risk Mitigation in the most conservative way possible. Moving forward, it can be assumed that they would be even more reluctant to prescribe more prescription alternatives to street drugs, such as powdered fentanyl or heroin. For this reason, PAN supports the call being led by peer groups for the creation of community-led compassion club models where people can buy pharmaceutical, regulated drugs (including heroin, as well as stimulants such as cocaine and crystal meth) without fear of contamination.
The other challenge is political will. Despite evidence-based solutions, models and best practices that have worked in other jurisdictions, both the province and the federal government have yet to move forward with the policy changes and actions required to ensure access to regulated, pharmaceutical grade alternatives to the toxic drug supply. They are not yet willing to decriminalize people who use drugs.
As we collectively mark this grim milestone, PAN will continue to call upon both the province and the federal government to act. All of us, as individuals and organizations, must redouble our advocacy for drug reform and systems change at all levels. It is only with urgent and ambitious action, and political courage, that we will see the tragic and entirely preventable ongoing harm and loss of life in this province finally come to an end.
Questions? Feedback? Get in touch! J. Evin Jones, Executive Director, [email protected]