Thank you.
Good morning. I'm Dr. Bonnie Henry. I serve as the provincial health officer here in British Columbia.
I also want to acknowledge that I'm speaking to you today from the traditional unceded territories of the lək̓ʷəŋən-speaking people, the Esquimalt and Songhees first nations. I'm very grateful to be able to speak to you today.
I want to start by also remembering and recalling that these are our people, our communities, our brothers, uncles, children, colleagues and neighbours. Poignantly, I have heard from our first nations, Inuit and Métis leaders that too many young people in their communities are being lost to this crisis. Indigenous peoples, we know, are disproportionately affected due to the compounded ongoing effects of colonial racist practices and structures, including residential schools and intergenerational trauma.
We can't lose sight of this, that this trauma, this crisis, is affecting real people in our homes and in our communities. We can't lose sight of that as we debate and discuss in sometimes disconnected settings.
I want to talk a bit about what's reflected in the challenges we're facing right now in this “wicked problem”, as Dr. Bach just described.
We know that the number of deaths increased dramatically in 2020 due to compounded effects for myriad reasons: isolation and anxiety wrought by the pandemic; added stressors that we are facing now in our communities around inflation, food insecurity, visible homelessness and poverty; and major disruptions to the global drug trade that have led to the unrelenting changing toxicity of drugs on the street.
Really, I want to make the point that the proximal cause of this crisis is the increased potent and unpredictable drugs on the street. That is something that is very different from what we faced prior to this crisis. The potency of what is on the street right now is because fentanyl or synthetic opioids have replaced plant-based opioids like heroin—which were causes of problems in the past—because they are cheap and easy to produce.
We do ourselves a disservice when we call what's on the street “fentanyl”, because it is not. It is a hastily manufactured synthetic drug that has fentanyl-like properties but is produced in uncontrolled conditions and mixed with adulterants. Those adulterants are changing dramatically on an almost daily or weekly basis.
We know now that the average concentration in street “down”, or drugs on the street, has increased, and that more potent drugs mean that people are more likely to experience drug poisoning and to die, even if they've tried something for only the first time.
It's also very unpredictable right now. It changes. There are no labels and no quality control, and current adulterants are making these drugs much more toxic: things like benzodiazepine-like substances; xylazine, which is another sedative that's used as a tranquilizer, as we know; and non-fentanyl synthetic opioids, like nitazenes, which are increasingly being found in the drugs.
We also know that stimulants that have been used are now contaminated much more commonly than they had been in the past, and we're seeing that non-fentanyl synthetic opioids are.... Sometimes it's from intentional contamination, and sometimes it's because of a mix-ups where these drugs are being produced. Things like cocaine and MDMA are actually now much more commonly contaminated with these synthetic opioids that are manufactured in uncontrolled conditions. That is the proximal cause of why people are dying right now.
I also want to focus my short remarks on some of the concerns we have seen with what has become a very polarized and, sadly, political process.
First, I think it's very important to recognize that harm reduction and recovery and treatment are not in competition. It is not either-or. They are both essential and necessary parts of a continuum from prevention and from understanding what's on the street to harm reduction, to treatment and to recovery, and it includes everything from naloxone and access to drug checking to overdose prevention services and prescription medications for people to get them away from the toxic street drugs, with alternatives and medical assisted treatment, or OAT, as we know.
I want to refer the committee to the report I released in February of this year reviewing our prescribed alternatives or safer supply program here in B.C. It has been submitted to the clerk, but not in time to be translated. It is also publicly available. There's a lot of nuance in there that I think is important for us to understand some of the problems we are faced with.
Also in there is an ethical review of what we're faced with right now and why these programs are so important.
I also want to acknowledge that recovery is a spectrum. I accept that many in the recovery community and many clinicians equate recovery to abstinence. Many recovery homes won't accept, for example, people who are even on medically assisted therapy.
I believe this is a false dichotomy as well. We talk to people who have used drugs. The term “recovery” is not a medical term. It's not about abstinence; it's a process. It's a process through which people improve their health.