If progressive Vancouver’s harm-reduction programs are so effective, why does B.C. lead the country on overdose deaths?

It’s a common question in conversations about North America’s opioid epidemic. Now the B.C. Centre for Disease Control (BCCDC) has produced a solid answer.

“The rapid expansion of harm-reduction services in response to B.C.’s overdose crisis prevented more than 3,000 possible overdose deaths during a 20-month period, suggests new research led by the B.C. Centre for Disease Control,” reads a June 5 media release.

During the period analyzed—April 2016 to December 2017—there were 2,177 illicit-drug overdose deaths across the province, according to the BCCDC paper.

“The study estimates that without access to and rapid scale up of harm reduction and treatment strategies, the number of overdose deaths in B.C. would be 2.5 times as high,” it reads.

Specifically, researchers looked at a significant expansion of the distribution of naloxone, the so-called overdose antidote that reverses opioids’ effects; the establishment of new supervised-injection facilities and overdose-prevention sites, where people bring drugs to use under the supervision of staff trained in overdose response; and increased access to opioid-agonist therapies such as Methadose (similar to methadone) and Suboxone (buprenorphine and naloxone), which block the cravings that someone addicted to opioids experiences when they stop or reduce their drug consumption.

Using mathematical modelling, researchers concluded that had B.C. not established and expanded those harm-reduction programs, the dead would not number 2,177 during the 20 months analyzed, but around 5,200. (The paper notes its calculations do not estimate the number of people saved, but rather the number of overdose deaths averted. The two are different because a single person can experience multiple overdoses.)

The research was led by Mike Irvine, a postdoctoral fellow at the BCCDC, B.C. Ministry of Mental Health and Addictions, and UBC’s institute of applied mathematics.

“Without these interventions, there would have been many more deaths,” he said quoted in the release. “Despite a highly toxic street drug supply, the average probability of death from accidental overdose decreased because of the services provided to keep people alive.”

Judy Darcy, B.C. minister of mental health and addictions, is quoted in the release describing harm-reduction programs such as supervised injection—a health intervention that remains controversial in other jurisdictions such as Alberta and Ontario—as crucial to reducing overdose deaths.

“This study speaks to the importance and the effectiveness of harm reduction and treatment efforts and the fact that they save lives,” she said quoted in the release. “These services have saved even more lives since December 2017 and are essential to turning the tide on the overdose crisis."

Drug-overdose deaths in B.C. have increased every year since 2012, according to the B.C. Coroners Service.

IN 2012, there were 270 fatal overdoses recorded across the province, then 368 in 2014, 992 in 2016, and then 1,514 deaths in 2018.

The presence of the synthetic-opioid fentanyl in the province’s illicit-drug supplies is primarily to blame for the increase in deaths. In 2012, fentanyl was associated with four percent of fatal overdoses. By 2018, that number had increased steadily, to 87 percent.

“This work confirms that, in the current environment of a highly toxic street drug supply in B.C., these combined interventions have reduced the risk of overdose death, as compared to not having these strategies in place,” the BCCDC paper concludes.

“A combined intervention approach has been effective in reducing total mortality during British Columbia’s opioid overdose crisis in the period since declaration of a public health emergency (April 2016 to December 2017),” it reads. “However, the absolute numbers of overdose deaths have not changed and further efforts are needed.”