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BC Coroners Service death review panel urges expanded access to safer supply

November 1, 2023 at 9:05 am  BC, News, Politics, Provincial

A report issued by a panel of subject-matter experts recommends the Province immediately pursue additional measures to expand access to safer supply by allowing access for people at risk of significant injury or death without a prescription.

“This report is the result of a tremendous amount of collaboration and problem solving,” said Michael Egilson, panel chair. “The experts on the panel were thoughtful, committed and practical in identifying an approach that we feel can guide future efforts to expand access to viable alternatives to an illicit supply of substances that is only increasing in volatility and toxicity. Our goal was to demonstrate a way forward that reflects a sense of urgency that is commensurate with the scale of the crisis – a way that can be rolled out quickly in order to save lives now. I believe this report accomplishes just that.”

In response to the continued increase in deaths due to drug poisonings, this standing panel was convened by B.C.’s chief coroner in December 2022, with a mandate to consider previous death review panel recommendations that could be quickly implemented on a scale that could reduce substance-related fatalities in B.C.

The panel affirmed the need for a comprehensive and timely approach to the crisis and recommended, in the short term, the fastest way to reduce deaths is to reduce dependence on the unregulated toxic drug supply. This requires creating access to a quality controlled, regulated supply of drugs for people at risk of dying.

Current safer supply initiatives in B.C. exist within a medical model and primarily serve individuals with an opioid-use disorder who already have access to the health-care system. There are limits on the types of medications that can be prescribed, and any expansion of the programs would place additional burden on an already strained health-care system in which more than 20% of British Columbians do not have a primary-care provider. The panel noted that, while as many as 225,000 British Columbians are estimated to use unregulated substances, fewer than 5,000 per month receive safer supply prescriptions.

Given these and other limitations, the panel questioned the current model’s ability to meaningfully address the ongoing public health and safety crisis. The panel’s report, An Urgent Response to a Continuing Crisis, provides a framework to operationalize the first recommendation from the previous death review panel report issued in March 2022. That recommendation, to “ensure a safer drug supply to those at risk of dying from the toxic illicit drug supply,” advocated for a non-medicalized approach to complement the existing medical model. The new approach would be more nimble, scalable and responsive to the unique needs of people in communities that are rural and remote, and/or that lack the infrastructure required by the medical model.

Panel recommendations include:

  1. The provincial Ministry of Mental Health and Addictions immediately begin taking steps to apply to the federal minister of Health and minister of Mental Health and Addictions for a class exemption to the Controlled Drugs and Substance Act (CDSA) to allow access without a prescription to the class of opioid and stimulant drugs, for people at risk of dying due to the toxicity of the drug supply in British Columbia.
  2. The Ministry of Mental Health and Addictions develop an application for agencies to apply for licensure and delegated authority to distribute the regulated substances on a non-prescription basis.
  3. The Ministry of Mental Health and Addictions engage with people with lived and living experience with substance use and family/caregivers in the process of planning, implementation and evaluation to ensure the needs of people most at risk of dying from the unregulated drug supply are met.
  4. The Ministry of Mental Health and Addictions, in conjunction with the Ministry of Health and the Ministry of Indigenous Relations and Reconciliation, and respecting Indigenous self-determination, further fund, support and engage with Indigenous leadership to identify Indigenous solutions to the crisis, potentially including, but not limited to, the actions suggested above.

The panel recognized that many communities in B.C. have expressed concerns regarding public health and safety. The report strongly advocates for a system of checks and balances to ensure that the goals of the program are met and that public concerns are adequately addressed. A robust system of monitoring and evaluation must be created that will allow for real-time monitoring and rapid adjustment as necessary.

Convened by the chief coroner under Section 49 of the Coroners Act, the panel included experts in public health, population health, addictions medicine, First Nations health, law enforcement and substance use and harm reduction. Regardless of their employment or other affiliations, members were asked to exercise their mandate under the Coroners Act and express their personal knowledge and professional expertise.

The report is issued on the same day that the BC Coroners Service released its monthly update into unregulated drug deaths in the province. The new reporting shows 175 lives were lost to toxic drugs in September 2023, an average of approximately 5.8 deaths per day.

Unregulated drug toxicity is the leading cause of death in British Columbia for persons aged 10 to 59, accounting for more deaths than homicides, suicides, accidents, and natural disease combined. The lives of at least 13,112 British Columbians have been lost to unregulated drugs since the public health emergency was first declared in April 2016.

“I extend my sincere thanks and gratitude to the panel members for this comprehensive, thoughtful and thorough report,” said Lisa Lapointe, B.C.’s chief coroner. “It reflects the panel’s recognition of the need for an urgent and dedicated response to a serious and on-going public health and safety risk. The drug-toxicity public-health emergency is now in its eighth year and the devastating death toll in communities across the province continues to grow.

“While the concept of safer supply may be challenging for some to understand, the expert members of the panel have provided a thoughtful and careful way forward and out of this crisis. It is clear that safer supply is only one piece in a necessary continuum of care for British Columbians at serious risk of death. While that continuum of care is being developed, thousands more of our family members, friends and colleagues are at risk of dying. As the panel found, urgent access to a safe alternative to the current toxic, unregulated and ever-growing illicit drug market is necessary to keep people alive.”  

Learn More:

BC Coroners Service Death Review Panel: An Urgent Response to a Continuing Crisis:
https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/an_urgent_response_to_a_continuing_crisis_report.pdf

Unregulated drug death report (data to Sept. 30, 2023):
https://app.powerbi.com/view?r=eyJrIjoiNDI2ZTc0YzUtNDA2MS00NTkwLWFmYzctNjc2NjAzNWZmZmZmIiwidCI6IjZmZGI1MjAwLTNkMGQtNGE4YS1iMDM2LWQzNjg1ZTM1OWFkYyJ9

BC Coroners Service Death Review Panel: A Review of Illicit Drug Toxicity Deaths:
https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/death-review-panel/review_of_illicit_drug_toxicity_deaths_2022.pdf

Youth Unregulated Drug Toxicity Deaths, 2017-22:
https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/youth_drug_toxicity_deaths_2017-2022_-_final.pdf

Mode of Consumption Data – Knowledge Update:
https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/mode-of-consumption.pdf

BC Centre for Disease Control (BCCDC) Knowledge Update on Opioid Use Disorder Among Youth in B.C.:
http://www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/Overdose/2023.06.06_OUD_youth_infographic.pdf

BCCDC Knowledge Update on hydromorphone and illicit drug toxicity deaths:
http://www.bccdc.ca/resource-gallery/Documents/Statistics%20and%20Research/Statistics%20and%20Reports/Overdose/2021.09.15_Knowledge%20Update_Hydromorphone%20and%20drug%20toxicity%20deaths.pdf

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