Thank you for the opportunity to present today. I'm a public health physician and a professor at the School of Population and Public Health. I'm also the harm reduction lead at the BC Centre for Disease Control.
I wish to provide some evidence about the overdose crisis in B.C., the emergence of fentanyl, and the importance of calling 911.
The BC Drug Overdose and Alert Partnership was developed following an increase in illicit drug overdose deaths in 2011. Members include stakeholders from health enforcement, emergency services, coroners, researchers, and people with lived experience. The goal is to coordinate communication and action to enable timely alerting and responses to illicit drug issues.
The B.C. take-home naloxone program was introduced in 2012 and provides overdose training and naloxone to people in the community. It enables naloxone administration by bystanders while waiting for any emergency health services to arrive. We've had over 2,000 overdose reversals reported.
An opioid overdose crisis is occurring in Canada. A public health emergency was declared in B.C. in April 2016 due to rising opioid overdoses. In 2015, there were 505 illicit drug overdose deaths, which is the highest number ever recorded, and in the first seven months of 2016, there have been 433 deaths. We're on route for 750 deaths in the current year.
The proportion of deaths where fentanyl has been detected increased from 5% in 2012 to 30% in 2015 and to a staggering 62% in 2016 year to date. Fentanyl is also increasingly identified in Alberta and across Canada. Fentanyl is a synthetic opioid often described as 80 times more potent than morphine. In an unregulated market, there is no control of the amount and dose of fentanyl in illegal drugs. The Health Canada laboratory has found pure fentanyl in powder sold as heroin and in varying, and sometimes fatal, concentrations of fentanyl in fake OxyContin tablets.
Although some people may intentionally take or seek out fentanyl, many don't know they have taken it. In a study performed in B.C. last year, we found almost three quarters of those who had fentanyl detected in their urine were unaware that they had taken fentanyl.
In an opioid overdose, the breathing slows and a person becomes unconscious. Lack of oxygen to the brain even for a short period of time can cause brain damage and death. The onset of a fentanyl overdose is much faster than other opioids. As we've heard, the effect of naloxone wears off after 20 minutes, and the high concentration of fentanyl in drugs requires large and often repeat doses of naloxone. It's vitally important to restore breathing as soon as possible and seek professional help for immediate and ongoing assistance.
People who administer naloxone in B.C. complete an administration form. The program emphasizes the importance of calling 911, and although the proportion that call 911 has increased over time, in 2015, 30% of people responding to an overdose did not call 911. It varies by region. Approximately 82% of people in Vancouver call 911, but less than 60% in regions outside of Vancouver do. The differences by region may reflect previous interactions with the police and policing policy, and the influence of other bystanders.
Enforcement members of the Drug Overdose and Alert Partnership have shared that most police would not make an arrest for simple possession of drugs in B.C., but this may vary by province. A good Samaritan act would ensure consistency across the country.
We also found people were more than 10 times more likely to call 911 if the overdose took place on the street rather than in a private residence. That may be because they're concerned about the residence being identified and the ability to flee if police arrive.
To explore reasons why people didn't call 911, we interviewed 20 naloxone program participants. They shared the barriers to contacting emergency services during an overdose, which included concerns about being arrested for illegal activities such as drug possession, breach of probation or parole, and outstanding warrants. Police were noted to be collecting the names of those present at an overdose scene and checking the police database.
We also heard stories about people who had overdosed being dragged down stairs into the street before 911 was called, and people calling 911 and then leaving the scene rather than staying with the person until first responders arrived.
According to a review by the U.S. National Conference of State Legislatures, good Samaritan or 911 drug immunity laws are enacted in 37 states and provide immunity from supervision violations and low-level drug possession and use offences. However, a recent study of young adults in Rhode Island found fewer than half were actually aware of the good Samaritan law.
It's important if Bill C-224 were to be enacted that this would be communicated broadly to the populations at risk of witnessing or having an overdose. Dissemination will require different approaches for youth experimenting with drugs and afraid of arrest and parents being informed compared to those with substance use disorders.
In summary, fentanyl prevalence in illegal drugs is increasing. Fentanyl has a rapid and long duration of action and overdoses may need large and repeat doses of naloxone. Therefore, it is imperative to call 911 and receive rapid and professional help. There is evidence that fear of arrest deters people from calling 911, and that good Samaritan laws can increase the likelihood of calling for medical assistance if people are aware. Expanding immunity in Bill C-224 beyond simple possession to include supervision violations could increase the rate of calling 911 and thus prevent further brain damage and save lives.
Thank you for your attention.