Thank you, Mr. Chair.
Thank for your this opportunity to present the work that British Columbia has done to respond to this tragedy.
I have a short presentation that will illustrate some of what Lisa talked about.
This response, as our coroner indicated, has been across the health sector and public safety in B.C. This is the first time that we have used the Public Health Act in B.C. to declare an emergency. The provincial health officer, Dr. Perry Kendall, declared an emergency on April 14 of this year, when we started to see the dramatic increase in the number of people who were dying from these overdoses. What that allowed us to do was to collect information that we couldn't necessarily receive without this order, and it allowed us to get information in a more timely and detailed way. One of the things we needed was to understand a little better who was being affected by this.
The data we collect on people who are surviving overdoses is really important in helping direct our programs and our response to this as well. We have started to receive data from emergency departments, from 911 calls, and from our ambulance service about people who are surviving overdoses. That has helped us look at how we can make naloxone, for example, more available. I'll talk about that in a minute.
In June, we had an overdose action summit, where we had people from public safety, law enforcement, and the health sector, as well as people with lived experience and people who use drugs. We had a lot of brainstorming about the things we can do to address the death crisis we are dealing with, but also, longer-term, to address the whole issue of over-prescribing opioids and the other factors that have led to some of the issues.
We have developed new guidelines for prescribing opioids that came out of the College of Physicians and Surgeons of British Columbia. Those are being looked at across the country.
With the help of the federal government, we've made it easier for doctors to prescribe Suboxone, which is a combination opioid substitution treatment that allows people to get away from the use of illicit drugs and gives them the opportunity to take a different path.
In July, the premier appointed a joint task force with health and law enforcement that is co-chaired by Dr. Perry Kendall and Clayton Pecknold, our chief of police services in B.C.
A couple of things happened after that. As you may be aware, InSite, which is one of the only supervised injection service sites in Vancouver, a stand-alone site in Downtown Eastside, expanded its hours because of the data we were collecting, which showed peaks in overdoses and deaths around certain periods of time.
We launched a public awareness campaign, because, as indicated, it is not just about people who are using drugs on a regular basis. There are many different populations being affected, including people who are prescribed opioids for very valid reasons, but in very high doses, and who overdose on those.
One of the big successes we've had is expanding our take home naloxone program. We started that program in B.C. about three years ago, in 2012. We have now distributed over 13,000 free naloxone kits. These are for people who use drugs to help each other, and many overdoses have been survived because colleagues, friends, or family members have used naloxone. Now, thanks to the delisting and approval of nasal spray naloxone, we have police departments, fire departments, and emergency departments now providing naloxone and using it to help. Just in September, naloxone was deregulated, so now it does not need to be prescribed by a pharmacist, and we can distribute it through many of our public health distribution places across the province.
This slide is the data that the coroner described, from which we've seen a dramatic increase in overdose deaths in the last two or three years. The final column on this page, on the far right, is just until the end of August 2016. As you can see, we are on track to far exceed the number of deaths that we saw last year. This reflects the number of deaths; it does not reflect the fact that we're seeing hundreds of people in emergency departments across the province who are surviving their overdoses. That is a critical period of time when we can intervene, and a place where people at the very least can get naloxone and training on how to use naloxone. It's an opportunity to get connected, where they might be amenable to taking another path away from drugs.
I'm going to show a series of maps that we put together once we started collecting more detailed data on where overdoses are occurring in B.C. This is to give you a sense of why there has been such an across-government and across-province response.
This is rates by population. The darker the red, the higher the rates. This is from the distribution of illicit drug overdose deaths in British Columbia in 2016, from January to March. The comparison is with 2010. In 2010, what we used to see, and what people typically think of, were overdoses in the Downtown Eastside in Vancouver. But we're now seeing it happening across the province in communities everywhere in B.C., in the north, the interior, the Island, not just the Downtown Eastside in Vancouver. In Vancouver, it's not just in the areas that we have seen it in the past, but all around Vancouver. People are dying in public places and in their private homes.
This is some of the information that Lisa presented as well, just in a pictorial form. It shows you the percentage of these illicit drug deaths where fentanyl has been involved. It has dramatically increased from less than 5% in 2012 to over 60%, but as she indicated, these don't happen in isolation. Alcohol is very frequently a factor, and other drugs as well. It has been somewhat alarming in that most people we hear from are community members who are partners in this response, and they say there's very little heroin left in B.C. It's all illicit fentanyl. It's much more easily imported than heroin because you need such a small amount, and drug dealers are looking at maximizing their profits. It's easier for them to manufacture it and bring it in than heroin, so there's very little heroin left.
More disturbing, we are now seeing it being mixed with stimulants like cocaine. People do not necessarily expect to find a depressant, like opioids, like fentanyl, mixed with those drugs. They're not necessarily prepared and that's where we're seeing clusters of overdoses in people who are weekend users of cocaine, for example, where they don't have naloxone or the training about what to look for and how to respond.
As indicated, most of the deaths that we're seeing are of young men, many of whom had been using drugs for some time. It's really a case of roulette, if you will. If you're using on a regular basis, your chances of getting a toxic dose of fentanyl just go up that much higher. Every day that we can keep people alive is a day that they may move on a different path.
This is a description of how we have organized our response. We have a joint task force that reports up to our Minister of Public Safety and Solicitor General, and the Minister of Health. It's chaired by Dr. Kendall and Clayton Pecknold, the director of police services in B.C.
We have a large group in the middle of that pink box of people who are stakeholders in this response, from law enforcement and health to people with lived experience, including families of drug users, the drug-using community, people who use drugs. They give us very valuable advice about the issues that are happening on the street, and also about our response, what makes sense and what doesn't make sense for them. It's been an invaluable group to help us in shaping what we can do.
Then we have a number of task groups, and I'll talk about some of the things the task groups are working on. Our immediate three-month work plan has a number of specific issues.
One of the biggest things we wanted to initiate was to expand the reach of naloxone. Its deregulation at the federal level so that it is now a non-prescription substance has been a huge help for us, because we now have an inter-nasal formulation available. It's particularly useful for law enforcement, who didn't feel comfortable using the injectable form. Most of it is the injectable form, and we have a lot of good evidence that the injectable form works well. People can very easily learn to use it. We have some videos that we've developed for young people in particular that are entitled, “Naloxone Wakes You Up”, which tell them how to use it. We'd be happy to share those with people.
We've done a lot of work around opioid substitution treatment, making it more available and teaching physicians how to use it, particularly Suboxone, which is a much safer form of opioid substitution treatment, delinking it from the methadone programs that we've had in the past. We've also expanded its use to the nursing practice so that nurses can monitor opioid substitution treatment as well.