Good morning. Thank you for having me. It will be a challenge to confine my remarks to 10 minutes, because there's so much to say about this crisis that is happening, but I will do my very best.
I'm going to tell you a little bit about the coroners service's investigation so you have a bit of an understanding of how we gather this information; some highlights from the data; information on the collaborations we've developed in B.C. in an attempt to reduce the number of deaths that are happening; and then some of the strategies we've developed moving forward.
One of the key points is the importance of thorough death investigations. If you're not doing the investigations and gathering the information, of course you don't know that you have a problem. That sounds very much like common sense, and I'll talk about that in a minute.
Then there is strategic surveillance. Again, if you're not doing the surveillance on the deaths, you don't know you have a problem. It's interesting to see across the country the different surveillance and reporting that's happening on these types of deaths.
The B.C. Coroners Service has 90 coroners across the province. The coroners actually respond to all sudden, unexpected deaths, so they go to the scene of death and do a thorough investigation, which includes an examination of the deceased, an examination of the scene, and then a collection of the medical history of the deceased. That information is critical in determining next steps. If you don't have the suspicion that this death may be linked to drug use, then you won't order the appropriate testing and you won't have the appropriate results. That sounds really like common sense, but it's really important to do a thorough scene investigation of each of these sudden, unexpected deaths.
The coroners work 24-7, and that's important. People die all over the province at different times. We have a very clear investigative protocol, which ensures that consistent information is collected on every death. Again, that is critically important if you're looking for patterns.
We also have in B.C. a dedicated research unit. Again, that seems to be a matter of common sense, but unless you make a decision to do surveillance on a type of death, you won't have the data. Across the country this varies, with every province and territory doing something different. In B.C., we decided to do some pretty focused surveillance on our drug deaths, which has resulted in the data that we now have and been able to share publicly. Those strategic decisions really can be made death investigation by death investigation and province by province, and they will vary across the country.
Something I want to talk about is how we have always heard the term “overdose”. In my coroners service we are starting to shift our terminology, because “overdose” suggests that there's a safe dose. It also has a bit of a pejorative tone, implying that perhaps if the user had used the right dose, they wouldn't have died. In fact, that's really misleading, because for many of these drugs, there is no safe dose. “Overdose” suggests that there's a safe dose; there isn't. We really want to move away from that, so our reporting from now on will no longer talk about overdose deaths. All of these illicit drugs, the opiates and the non-opiates, are manufactured in very suspect circumstances, and you never know what's in the substance that you're taking.
I also wanted to make clear that I know that the meeting today is focused on the opioid crisis, but the deaths we've been reporting are related not just to opioids. While B.C.'s reporting on illicit drug deaths includes opioids, such as heroin and fentanyl, for example, it also includes other illicit drugs, such as cocaine, MDMA or ecstasy, and methamphetamines. The high numbers of illicit drugs, which are going up month by month, include all of those substances, not just opioids. They also include prescription medications that have been diverted; there is a small market for people selling their prescription medications, but we're not seeing a lot of that in this crisis.
Again, toxicology testing is critically important. If you haven't identified that illicit drug use or any substance use may be a factor in the death, then you won't order the appropriate testing. That again speaks to the importance of the initial investigation and then the toxicology testing.
We have in British Columbia something called “expedited” toxicology testing, which means our provincial toxicology centre will give us results within 48 to 72 hours. That doesn't happen elsewhere in the country. I've spoken to my colleagues, chief coroners and chief medical examiners across the country, and they don't have that ability. That expedited toxicology, the ability to get information back from the lab very quickly, is really key in getting the messaging out in a timely manner.
As I think you know, British Columbia so far, to the end of August, has had 488 illicit drug-related deaths. That compares with 505 for the whole of last year. Just to give you a bit of context, in the whole of last year British Columbia had 300 motor vehicle incident fatalities. This epidemic of death is much more significant than the deaths we're seeing on our roads, which we have numerous strategies in place to try to resolve. We're seeing approximately 61 deaths a month due to illicit drugs. If that number continues to the end of the year, we'll have 732 deaths in 2016. That's quite a significant increase. The significant rise started in 2012, which is, ironically, when we first saw fentanyl appear on our horizon.
Although we're seeing deaths among all ages, the deaths we're seeing primarily are among males between the ages of 19 and 39. Most of the deaths involve those who use illicit drugs habitually, but we have seen deaths of recreational users, such as people who all use drugs at a party. We've had situations, in fact two or three in the last couple of months, where five or six people at a party “overdosed”, for lack of a better term, became very ill, and were treated. In most of those cases they've all survived. although we've had one or two fatalities. Generally, then, it's the people who use drugs habitually that we're seeing among the deceased, but we are also seeing some recreational users.
As well, a number of people who use drugs quite consistently are what we would call “high-functioning users”. That sounds pejorative, and I don't mean it to be, but it's people who go to work, hold steady jobs in all sorts of occupations, and routinely use illicit drugs. That's a fairly significant population as well.
Most of the deaths we're seeing involve mixed substances. Very few involve just heroin, or just fentanyl, or just cocaine. In fact we looked at 207 results recently, and 96% of those were mixed-drug deaths. Cocaine was involved in 46%, alcohol 36%, methamphetamines 34%, and heroin 30%—and that was with fentanyl.
The proportion of illicit drug deaths where fentanyl has been detected has grown substantially since 2012. We saw 5% of our illicit drug deaths in B.C. involving fentanyl in 2012. That's up to 60% in 2016. That's a significant increase. That's not to say that fentanyl is the cause of all of those deaths, but fentanyl was detected at varying levels in the toxicology results of all of those deaths. If there were no fentanyl, we don't know how many deaths we would see. If we removed all the fentanyl deaths, we would have at least 200, but our numbers for previous years suggest that it would be between 200 and 300. The involvement of fentanyl appears to be doubling the deaths we're seeing.
I won't spend any time talking about what fentanyl is. I think you know that it's a synthetic opioid traditionally used for pain management. It's become increasingly prevalent on the illicit markets, brought in from other countries, primarily Asian countries, but also manufactured in clandestine labs in B.C. When you think of a lab, you tend to think of white coats and sterile circumstances. In fact these labs are people's kitchens and people's basements. They are quite random, in a way. They're trying to measure substances appropriately, but they're blending them in juice blenders and Mixmasters. The compounds are by no means secure or safe. These labs are often, as we can see with the number of deaths, getting their mixtures wrong. The police are well aware of that. They're finding fentanyl in pill form and in liquid form. It's used in a variety of ways.
What we're experiencing in B.C. are deaths due to illicit drugs, including a significant percentage due to fentanyl. We're often seeing unsuspecting use. People think they're purchasing cocaine, for example, and it's laced with fentanyl. They're either becoming very ill and being treated and surviving, or they're dying.
We found a paradox with warnings. We've tried to work closely with our police community on this. The language around this epidemic is very important. We've had our law enforcement partners often wanting to go out and say “There's very strong heroin on the street”, or that fentanyl is “very strong” or “powerful”, but those words can be triggers.
Paradoxically, we now have people actively seeking fentanyl because of the bigger high. It's really important to remember that we should be talking about the risks and the toxic effect, but not necessarily that this is a more powerful drug or a stronger drug.
I'll wrap up. One of the really important things is the messaging. We've gone out with public messaging and talking about what to say and what not to say. In B.C., we've adopted a harm reduction approach. Shaming and blaming does not help. We want to ensure that people, if they're going to use, have medical assistance nearby. That's the biggest message that we're giving: “Don't use alone, but have somebody there who can help you out if get into trouble.”
We have a multi-sectoral partnership. If not for the collaboration of a variety of groups, we wouldn't have been able to approach this crisis the way we have. We have BC Ambulance, the health communities, the corner service, law enforcement, and the labs all working together to try to collaboratively come up with solutions.
One of the changes that BC Ambulance has adopted is a policy not to call police every time they respond to an overdose. Again, the emphasis on encouraging people to ask for help, as opposed to being afraid they're going to be arrested or that somebody is going to be in trouble. It's that the shift toward preventing deaths. Thank you.