Hello. Thank you.
I did prepare a slide presentation. Unfortunately, there wasn't time to translate it. Some of you may have it. I'm not going to refer to it greatly because numbers are not very interesting when a person is talking. I'm just going to basically tell you the story of what we're experiencing here in B.C. from the coroner service's perspective.
As you know, B.C. is in the midst of an overdose crisis. We lost 1,500 members of our community last year to overdoses, and we are reporting another 1,500 this year, although that number will increase slightly as more reports come in.
In B.C., we track all illicit overdoses. That is because the vast majority of overdoses are mixed-drug overdoses. It's very rare to find an individual who has died with just one substance on board. Fentanyl, as you know, is involved in 85% of all deaths in British Columbia now. That is predominantly what we're seeing with almost all overdoses. For many years, however, we have tracked other substances as well. I think that's really important.
There has been a lot of focus on opioids and the opioid crisis. In B.C., the only reason we recognized that people were dying at an increased rate of opioid poisoning was that we track all illicit overdoses, and we could see that opioids were starting to have a significant growth pattern. That's really important.
In B.C., more people have died of overdosing in each of the last two years than all motor vehicle accidents, suicides, homicides and prescription drug overdoses combined. Prescription drug overdoses are a very small number of the overdoses in British Columbia. We see fewer than 100 per year. We do not see a pattern in this province related to prescribing. As you know, methamphetamines are an illicit substance. They are primarily purchased on the illicit market. The illicit market is unpredictable and unmanageable.
People talk about drug labs. I don't know if any of you have ever seen a picture of a drug lab. They don't look like any laboratory you've ever seen. They are dirty kitchens and dirty rec rooms. There are cross-contaminated substances. There is no quality control. There is no ability, when purchasing substances in the illicit market, to guarantee dose, quality or even what is in a substance. That's what we think we're seeing now with the increase in methamphetamine deaths.
We have seen an increase in methamphetamine deaths over the last several years. In 2010, this province saw 23 deaths where methamphetamine was detected in post-mortem toxicology testing. In 2017—and we still have 20% of our reports outstanding—we saw 283 methamphetamine-detected deaths.
The reason I report it as “methamphetamine-detected” is that, as I mentioned, most overdoses are mixed-drug overdoses. For example, of 2,042 overdose cases that we have concluded in this province in the last couple of years, illicit fentanyl was detected in 80%. That's not prescribed fentanyl. That's illicit fentanyl purchased on the street. The next most common substance we see is cocaine. Fifty percent of deaths also had cocaine on board. The third most common is methamphetamines/amphetamines. Thirty-one percent of the overdose deaths we investigated had methamphetamine on board.
It's hard to know whether that significant increase, from 11% of the deaths involving methamphetamine in 2010 to 30% in 2017, is because there is more meth being used or because methamphetamine is now contaminated with fentanyl. Virtually every substance in this province is contaminated with fentanyl. We have certainly seen many reports where folks thought they were purchasing methamphetamine/amphetamines, and in fact their may have been some meth—we often find that mix—but there is very likely also fentanyl on board.
That, we believe, is driving the increase in methamphetamine deaths, but it's hard to know. When we arrive at the scene the individual is deceased. These are illicit substances, so they don't leave a record of what they've purchased.
In B.C. the majority of those who die—86%—die indoors and alone, so we don't have anybody to ask what they thought they were buying. Occasionally somebody dies in the company of their friends, and they'll say, “We bought cocaine. We thought we bought ecstasy, and in fact it was contaminated with fentanyl.”
We think it very likely that what people thinks is methamphetamine is methamphetamine, but also contaminated with fentanyl, and that's really driving the increase.
It's great to see the focus on specific substances. It's great to see the focus on opioids, great to see the focus on fentanyl and good to see the focus on methamphetamines. Really, though, what we're seeing is people dying of problematic substance use, and without looking at all the numbers in a broader context, it's really hard to see trends and patterns. We've been very fortunate that we had a database that allowed us to view trends and patterns over time so that we can see, of the number of people who die of illicit substances, what percentage involved opioids and what percentage involved methamphetamine. That's really important.
I remember about two-and-a-half years ago being at a meeting in Ottawa with a number of folks, including CIHI, Health Canada and Statistics Canada, at which there was a strong focus on opioids. I remember mentioning at that time that the prairie provinces were seeing methamphetamine and that maybe we should do a broader review. There was a lot of resistance, a lot of wanting to focus on one thing at a time.
If there's anything I would urge the committee to consider, it is taking a broader perspective. This is a problematic substance use issue. If we have robust infrastructure, robust reporting, robust analysis, then whatever the next substance is that comes to the fore, whether it's MDMA or—who knows what else might be the drug of choice, since it's largely dependent on the source, what's coming into the community and how cheap or expensive it is and how easy it is to get in—then we will be ready to respond to it.
Because I am the chief coroner for B.C., I heartily endorse the Canadian coroner and medical examiner database that is run by Statistics Canada. All coroner and medical examiner offices in the provinces and territories can report into it. Not all services have a robust data collection system, so if there's any opportunity to enhance data collection in the provinces and territories, I think taking it would certainly be beneficial.
Then, of course, the issues surrounding problematic substance use are not confined to one particular substance. We see pain, we see stigmatization, we see marginalization, we see the lack of evidence-based recovery systems and treatment systems and we see criminalization. All of those things serve to work together. If they do not increase the numbers of those dying, they certainly don't work effectively to prevent deaths.
Something else that is, as you may have heard, focused on very much here in B.C. is meaningful measures to address substance use, meaningful measures to reduce harms and meaningful measures to support folks to a full recovery.
In summary, we see an increase in methamphetamine deaths. We have seen an increase, in the last seven years, of 200%. They compose 31% of all illicit drug deaths in B.C. Methamphetamine is on board, but more importantly, in 80% of all illicit deaths fentanyl is on board. We can't say whether, but for fentanyl, the methamphetamine deaths would still be occurring; we don't know. We think it's very likely that fentanyl is driving all of these deaths.
Thank you.