Pubdate: Thu, 01 Feb 2018
Source: Globe and Mail (Canada)
Copyright: 2018 The Globe and Mail Company
Author: Andrea Woo
Page: A8


Kendall ends term by calling on province to think further outside the
box, its comfort zones

British Columbia's provincial health officer concluded his last day in
the role with a call to further push the envelope in responding to the
province's overdose crisis, which new numbers show killed more than
1,400 people last year.

Perry Kendall said on Wednesday the year-end tally of 1,422
illicit-drug overdose deaths - a figure that works out to a rate of
29.6 per 100,000 population and will grow as outstanding death
investigations are completed - show that B.C. is "still in the midst
of a persistent and continuing epidemic of unintentional poisoning

"We are going to need to think more broadly, and also think further
outside both the box and our comfort zones, if we are going to get
ahead of, and turn this epidemic around," he told reporters in Victoria.

The province hardest hit by the overdose crisis has already produced
some of the country's boldest responses. The most radical of them all
may be a low-barrier pilot project beginning in April that will
provide people at high risk of an opioid overdose from illicit drugs
with pharmaceutical-grade hydromorphone tablets, a drug similar to
heroin, to use as they please.

As well, B.C. produces detailed overdose statistics every month; has
distributed 58,000 take-home naloxone kits - which contain first-aid
supplies and a medication that reverses the effects of opioid
overdoses - free of charge since August, 2012; and has eight operating
supervised consumption sites and 18 overdose prevention sites. The
province has also directed all health authorities to scale up
injectable hydromorphone programs, in which people receive the drug to
inject two or three times a day under supervision.

The Globe and Mail looked at what other provinces are doing to combat
opioid overdoses, the rates of which vary in scale across
jurisdictions. Note that there are differences in provincial reporting
metrics and timeliness, and that rates per 100,000 can change
substantially for jurisdictions with small populations.


Latest figures: At least 482 people died of opioid-related overdoses
in the first three quarters of 2017 - a 40-per-cent increase compared
with the same period the previous year. About 80 per cent are related
to fentanyl, a rate of 12.4 per 100,000 population across the
province. Recent actions: The Alberta government in May, 2017, formed
an Opioid Emergency Response Commission. Health Canada has approved
six supervised consumption sites for the province, one of which is now
in operation. In coming months, it will launch an injectable
hydromorphone pilot that will begin with 50 people each in Edmonton
and Calgary.


Latest figures: At least 12 drug overdose deaths in the first three
quarters of 2017, with at least nine of those being opioid related,
though those figures will rise as death investigations conclude. In
comparison, there were at least 79 overdose deaths in 2016, with at
least 67 of those being opioid related.

According to the federal government, Saskatchewan's rate of apparent
opioid-related deaths in 2016 was between 0 and 4.9 per 100,000.
Meanwhile, the Canadian Institute for Health Information reported that
Saskatchewan has among the highest rates of opioid-poisoning
hospitalizations of all provinces: 21.7 per 100,000 in 2016-17.

Recent actions: On Jan. 1, 2017, Saskatchewan began providing coverage
for the substitution therapy drug buprenorphinenaloxone (Suboxone),
which prior to that date could only be prescribed to people for whom
methadone was not suitable. It launched its take-home naloxone program
in November, 2015, and distributed 456 kits free-of-charge in two
years. The province says it is not considering supervised consumption


Latest figures: In the first quarter of 2017, at least 30 people died
of opioid-related drugoverdoses, with fentanyl being a factor in 14 of
those deaths. In comparison, at least 146 people died of
opioid-related overdoses in all of 2016, with fentanyl playing a role
in 33.

Recent actions: Manitoba created an opioid task force in early 2016
and it has met 16 times since. The province also has a take-home
naloxone program that distributed 245 kits in 2016. Last June,
Suboxone became covered by the provincial drug program.


Latest figures: In 2016, 867 people died of opioid-related overdoses,
which is a 19-per-cent increase from the previous year and works out
to a rate of 6.2 per 100,000. It's the highest such death toll for the
province since 2003. Of the 867 deaths, fentanyl was a factor in more
than 40 per cent.

Recent actions: The province in October announced the creation of an
Opioid Emergency Task Force to co-ordinate its response to the crisis.
The province has received approval for seven supervised consumption
sites, four of which are currently offering services. Naloxone kits
have been available to the public free of charge in community
pharmacies since June, 2016.


Latest figures: Quebec is furthest behind of all provinces in
reporting opioid-related deaths, with 2014 being the most recent year
with complete data. According to the province's National Institute for
Public Health, Quebec averaged 194 opioid-related deaths between 2010
and 2014, for a rate of 3.1 per 100,000. Preliminary numbers show
there were at least 222 such deaths in 2015 (3.4 per 100,000) and
140(2.2 per 100,000) in 2016.

Recent actions: Four supervised consumption sites began operating in
Montreal last year. As well, Quebeckers can obtain naloxone free of
charge at pharmacies and there are local initiatives to train drug
users, their loved ones and other stakeholders in the administration
of the overdose-reversing drug.


Latest figures: Only New Brunswick and Nova Scotia have data available
for 2017, with preliminary figures showing for the first three
quarters of the year, 16 deaths in New Brunswick. From January through
November, 45 death were confirmed in Nova Scotia with a further 10
suspected opioid-related overdoses in that province. In 2016, Prince
Edward Island had five deaths from opioids and Newfoundland and
Labrador counted 11 opioid deaths.

Recent actions: New Brunswick, Prince Edward Island and Newfoundland
each have action plans in place. Nova Scotia has established a
committee to develop an overdose protocol. Fentanyl was first detected
in Prince Edward Island in June, 2017. All provinces either already
distribute naloxone or have plans to. Nova Scotia is exploring the
need for a supervised co-drug-use site.
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MAP posted-by: Matt