Death panel calls for rapid expansion of safe supply to tackle toxic drug crisis

The BC Coroners Service published its second death panel report on toxic drug deaths, calling for rapid expansion of safe supply within two months.

The death panel, convened on Dec 15 last year, reviewed 6,007 deaths over just four years, between Aug 1, 2017 and July 31, 2021.

It followed a first death review panel, which reviewed 1,854 deaths between Jan 1, 2016 and July 31, 2017, and published its report nearly four years ago, in April 2018.

In 2021, BC saw 2,224 toxic drug deaths, the first time the province has exceeded the 2,000 mark in a year. That included a record-breaking 78 deaths in Burnaby.

The recommendations

Yesterday’s report put forward three main recommendations, which Michael Egilson, chair of the death review panel, said he was “confident will contribute to addressing illicit drug toxicity deaths” in BC.

“If we really do want to ensure that we don’t lose another 2,200 members of our community in 2022, then there needs to be some really courageous, different approaches taken,” said chief coroner Lisa Lapointe.

The broad theme, Egilson noted in a news conference, was to look outside the box.

“It may be that we need to knock the sides of that box down and increase our options,” he said.

1. Safe supply

The first recommendation, which the panel said should be implemented by May 9, was for the province to rapidly expand safe supply to not only an accessible medical model but to a non-prescriber model.

Advocates have pointed out that while many of those who have died do experience substance use disorders, a significant number of others did not. The deaths include recreational and casual drug users, and a medical model would necessarily exclude those individuals.

“We will not prescribe our way out of this crisis,” said Egilson in the news conference. “A range of safer supply models will be required to meet the different needs of people at risk of dying as a result of toxic drugs.”

The safer supply recommendation included eight individual recommendations for achieving it, including things like setting up frameworks for distribution, identifying eligibility criteria to lower barriers to a safe supply, and ensuring oversight and monitoring of such a program.

2. A ‘30/60/90-day’ plan

The panel also recommended the province, by May 9, develop a “30/60/90-day illicit drug toxicity action plan”—that is, to develop a broader framework for the province’s response to the public health emergency.

Such a framework would also set clear goals and targets with “deliverable timeframes” for reducing toxic drug deaths. And it would enhance data collection and sharing, as well as establish metrics “to identify relevant needs, levels, availability, and accessibility of substance use services and treatment.”

As part of that recommendation, the panel called on the federal government to approve the BC government’s application for decriminalization of personal possession and use of drugs by April 11.

3. Access to treatment

The final recommendation revolved around treatment.

That included things like developing a framework for establishing a care system around substance use by June 9 and identifying roles of various provincial authorities—including ministries and health authorities—for implementation of that framework.

Lapointe and Egilson shared some level of optimism that the government can act on their recommendations.

And Egilson said the government has shown, through the pandemic, that it’s capable of responding quickly and substantively to crises.

The two also declined to place blame for the failure to act, with Egilson saying “we’re probably all responsible” if the recommendations are not meaningfully implemented.

“When I said that we’re all responsible, I think what I really am referring to is not just government—certainly government has a big responsibility—but us as citizens of the province, making our views known about how important this is,” Egilson clarified later.

Activating the health committee

The government did agree yesterday to convene the select standing committee on health to tackle the toxic drug crisis, a move opposition parties lauded but noted had come years after they had first called for this move.

“I applaud the premier for doing this today. I would have applauded him much louder if he did that last June,” said BC Liberal Party mental health and addictions critic Trever Halford.

BC Green Party Leader Sonia Furstenau, too, weighed in, saying she was relieved to see a commitment to activating the committee, but noted it came after “nearly a year of advocacy” by opposition parties.

Minister of Mental Health and Addictions Sheila Malcolmson was not made available for questions yesterday, instead opting to put out a written statement.

That statement was broadly self-congratulatory, saying the panel’s report “confirms the urgency of the work underway by our government.”

“Specifically, it calls on government to build an evidence-based continuum of care to deliver mental-health and substance[-use] services, including safer supply,” reads the statement attributed to Malcolmson.

“And that is exactly what our government is doing.”

‘Historic investments’

The minister said the government is making “historic investments” into mental-health and substance-use services, touting its safer supply program.

But experts and advocates are broadly in agreement that the program is overstated by the government, is too slow and inaccessible, and is not commensurate with the scale of the public health emergency.

Earlier this year, Malcolmson claimed 12,000 people in the province have access to a safer supply of drugs, but that figure appears to conflate safe supply with opioid agonist therapies like suboxone and methadone. Many experts say those are two separate things.

Malcolmson did acknowledge in her statement that there was “more to do along the entire continuum of care” but pinned some of that responsibility on the federal government.

“Since the federal government regulates controlled drugs and substances, we are focused on what we can do within our provincial jurisdiction—a prescribed safer supply model implemented through health authorities,” she said.

Opposition parties react

Opposition parties said they were underwhelmed by Malcolmson’s response.

“Month after month, and year after year, the call is the same. It is heartbreaking to watch the consistent message of non-medicalized safe supply be ignored by this government, while the death rate climbs,” said Furstenau.

“This government talks of stigma as a barrier, but we have safe supply in BC. Alcohol is regulated. Tylenol is regulated. Marijuana is regulated. It is a matter of political will to introduce non-medicalized safe supply, and we have to start wondering who in this government is resisting this necessary harm reduction approach to an increasingly deadly crisis.”

Halford said he concluded from the panel’s report that “the NDP’s response to the overdose crisis has failed and that more must be done urgently.”

His statement called on the province to implement all of the recommendations in the report, but focused heavily on the treatment side of things.

“Five years after the creation of a specific ministry for mental health and addictions, people in need are no better off as they face deadlier street drugs, months-long waitlists for treatment, a lack of beds for withdrawal management, and unaffordable privately run services,” said Halford.

“The NDP’s patchwork approach is not working.”

While his written statement made no mention of safe supply, he did, when asked by Burnaby Beacon, say it is a “key aspect” of getting the numbers of deaths down.

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