IH and ANKORS deliver message of increasing overdose trend

A province-wide increase in overdose deaths has jump-started a conversation to get ahead of the problem.

Interior Health and ANKORS are responding to an increasing overdose trend with education and outreach.

There has been a gradual climb in opioid-drug (pain reliever) related overdose deaths over the last 24 months across the province, according to BC Coroner statistics, which has jump-started a province-wide conversation.

The Interior region is no exception. Fatal overdoses from illicit drugs leapt to 60 last year from 20 in 2008. Preliminary data for 2016 already reports 15 overdose deaths related to illicit drug use, and that’s significant, says Dr. Trevor Corneil, chief medical officer for Interior Health.

The spike is primarily found in big centres like Kamloops or Kelowna, he adds, but the region’s smaller communities are feeling the impact as well. Statistically, Trail and Nelson see anywhere from one-to-five overdose fatalities a year, but because the communities stay under five, and sometimes see none at all, they are not charted in the BC Coroner’s annual report.

“We certainly would like to get ahead of the problem, and we do that by educating the public and also providing resources through contracted agencies and harm reduction such as needle exchanges and take-home Naloxone kits, as well as access to treatment through detox and other modalities,” he said. “It’s important that communities know that a trend that occurs across a province, a region, a trend that doesn’t seem to be hitting any particular group – age, gender or otherwise – be interpreted as applicable to everybody.”

Overdoses are reported among frequent users as well as those who use for recreational purposes. The trending increase is not cut and dry, according to Dr. Corneil, but commonly involves opioids such as OxyContin or heroin, which have become more mainstream.

“There was at one point in British Columbia a clear geography where we would see overdose deaths and that was in the ’90s in the Downtown Eastside of Vancouver,” he explained. “But illicit markets and specifically opioids within the market are now a common place everywhere, including some of the newer more potent opioids such as hydromorphone or fentanyl, so it has opened the door, so to speak, to substance users, those with addictions but also recreational users as well.”

Interior Health has followed the increasing overdose trend for some years but the rise in the past 24 months has been steadfast. Dr. Corneil said the surge could partly be attributed to the introduction of fentanyl into the illicit market, much like cheap manufactured heroin made its wave in Vancouver in 1993, or when crack cocaine became freely available in 1998.

“We think this (overdose trend) may be related to fentanyl, but we are not able to link the two,” he added. “But it is important everyone knows that two-thirds of deaths are due to other drug cocktails, so to speak, in particular, those cocktails that contain opiates,” he added.

Fentanyl is a potent, synthetic drug that is commonly used in pre-procedures as a pain reliever. The opioid is approximately 80 to 100 times more potent than morphine and roughly 40 to 50 times more potent than pharmaceutical grade (100 per cent pure) heroin.

The drug was first synthesized in 1960 and has grown in popularity as time has passed. As of 2012, fentanyl was the most widely used synthetic opioid in clinical practice, with several new delivery methods including a sublingual spray for cancer patients.

Since 2015, Canada has seen widespread fentanyl overdoses, which have been fatal among a vast group of users from teens experimenting for the first time to frequent users.

Alex Sherstobitoff, Rise Up community engagement coordinator for Nelson’s ANKORS, said fentanyl is here, and the proportion of illicit drug overdose deaths for which fentanyl was detected (alone or in combination with other drugs) increased to approximately 30 per cent in 2015

“When we talk about fentanyl it’s a mixed bag,” he said, referring to the form created and distributed by organized crime.

“They don’t have a scientist working on perfecting this drug, it’s just some schmo who’s working for an organized crime that’s mixing this drug, and it’s rudimentary,” he explained. “It’s not mixed properly so sometimes you can get a pill and there’s very little to nothing, and sometimes you can get a pill, and it’s extremely potent and can kill somebody who’s been using drugs for years.”

While fentanyl is making headlines, Sherstobitoff doesn’t discount other opioids like heroin, which has made a come back in the West Kootenay. There is no concrete reason for the recent popularity, he adds, but one theory could be tied to a cut back on prescription opioids and the need to fill that gap.

ANKORS best defense remains the Naloxone kit. The Take Home Naloxone program trains participants to recognize and respond to an overdose situation through reversal.

In such an event, the Narcan solution injected restores breathing within two to five minutes of administration and offers a life line while waiting for help to arrive.

The kits are available at ANKORS, a non-profit society that serves the vulnerable living with and at the greatest risk of acquiring HIV, AIDS and or HCV, due to substance use, mental illness, sexual orientation, gender identity, race and ethnicity. But the kits can also be picked up by at-risk patients through the Trail and Castlegar emergency departments, after a short training session is delivered by a professional.

Sherstobitoff said ANKORS alone has completed about 300 training sessions for overdose prevention, given out approximately 110 Naloxone kits and has received feedback on 18 reversals executed.

Though ANKORS relies mostly on anecdotal evidence, he acknowledges a growing overdose trend in the region and is working toward making connections with other agencies that serve the most vulnerable populations. He stands behind continued dialogue on all facets of drug addiction from prevention to education, treatment, corrections, enforcement, and harm reduction.

Part of this conversation should stem to non-fatal overdoses, adds Dr. Corneil.

Though these are difficult to track because they don’t always occur in hospital, he said there will be a focus on documenting and collecting this data. Within the next six months, Interior Health will be implementing enhanced surveillance in its emergency rooms.

“We are looking at how predictive those flags are and our overall risk score of overdose deaths over time,” he said. “It will be an interesting endeavor that every health authority is undertaking to try and get a better handle on prevention.

“But when we see trends like this over years and then increasingly over months, we don’t need to do surveillance per se to know something is happening, and we need to get the information out there.”

Interior Health’s mental health and substance use services can be reached by phone in Trail at 250-364-6262 or in Nelson at 250-505-7248. ANKORS in Nelson can be reached at 1-800-421-2437.