It’s been a year since provincial health officer Dr. Perry Kendall declared the spike in overdose deaths a public health emergency.

But despite major efforts and resources, there is no end in sight.

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“I had hoped for a different outcome,” Kendall said. “Tragically, in that 12-month period, we have seen an additional 919 deaths.”

A total of 922 people died from illicit drug-related overdoses in B.C. last year, compared with 513 in 2015 and 366 in 2014. This year could be even worse: In January and February alone, 219 people died.

> Read the Times Colonist On the Front Lines of Fentanyl series

Most of those have been between the ages of 19 and 49 and male, and most have died in private residences rather than outside or in rooming houses or shelters. In Victoria, they have included men and women, street-involved people, high school students, adults with jobs or volunteer gigs.

First steps

Kendall said initial efforts to curb overdoses with wide distribution of the opioid antidote naloxone and increased access to treatment seemed to be working.

“We saw a bit of a downward trend,” he said. “I suppose what changed is the introduction of carfentanil.”

Fentanyl is the powerful opioid blamed for the initial increase in deaths, present in more than 60 per cent of cases. It is 100 times stronger than heroin or morphine, and a few grains can kill a person. Carfentanil can be up to 1,000 times stronger than that.

The synthetic opioids are easy to order from overseas, relatively cheap and showing up in everything from heroin and cocaine to marijuana.

“I don’t think we can keep these out,” said Kendall, adding more resources and a broader look at addiction health services could make the difference.

“We are seeing that addiction has been overlooked as a health issue. This seriously sheds a light on that.”

Stigma worsening crisis

Vancouver Island’s chief medical health officer said the overdose deaths are the worst public health crisis he’s seen since the HIV/AIDS epidemic in the early 1980s.

“In terms of people dying and not being able to do anything, it’s very similar,” said Dr. Richard Stanwick. While it took years to develop effective medication for HIV/AIDS patients, treatments for addiction are already available. Both crises share the similarity of stigmatization.

“Are there parallels of people saying these people are not worthy? Yes. We need to overcome that,” Stanwick said, citing the fact more than half of the people dying from overdoses are alone in a private residences.

“If you are street-involved and overdose, you have a better chance of being given naloxone. This underscores the stigma still associated with addiction.”

In 2016, 153 people died from illicit drug overdoses on the Island, with another 39 in January and February this year. From March 2016 to April 8, there were 1,676 overdose-related emergency room visits across the Island.

A nimble response

Stanwick said the health authority has responded to the crisis “with extreme nimbleness” as best it could.

More than 7,000 naloxone kits have been distributed, the majority to users and peers. After years of social agencies advocating for supervised consumption services, six overdose-prevention sites opened in Victoria, Nanaimo and Courtenay.

None of the sites has had an overdose death. “Imagine what the death numbers would be without these,” Stanwick said.

Dozens of treatment beds have been added and more doctors trained to provide substitution therapies such as methadone and suboxone.

In February, a Rapid Access Addiction Clinic opened two days a week downtown. It helps people connect with treatment without having to wait weeks for a doctor’s appointment.

Moving forward

Next on the horizon could be prescription heroin, or the more readily available hydromorphone, Stanwick said.

“That would be recognizing there’s a small proportion for whom opioid substitution therapy doesn’t work,” he said.

Katrina Jensen, executive director at AIDS Vancouver Island on Johnson Street, said increasing access to services and looking at the impacts of drug prohibition on people is key to moving forward.

“Looking at our concepts of treatment and other options that are out there are important,” she said. “We need to be listening to people with lived experience and their families as well.”

The non-profit organization has been at the forefront of harm reduction in Victoria, distributing safe drug-use supplies for years. It now has an overdose-prevention site and counsellor.

“We are inundated with requests for supports,” she said.

Major investments in research could also lead to changes in policy and action, advocates say.

More than $14 million in provincial and private funding established the B.C. Centre on Substance Use, which will focus on education, training and clinical care research around addictions.

The Centre for Addictions Research B.C. is conducting a study on the overdose prevention sites in Victoria. Results will be released in May.

And the new drug investigation team formed by the B.C. coroners office to review all illicit drug overdose deaths will release its findings in the fall.

Chief coroner Lisa Lapointe said the team was created to “see if we could find any important patterns related to these deaths.”

Lapointe said coroners from around the province are looking at everything from medical histories to housing security and attempts to access health services.

“It’s a very broad picture so we can see if there are any common patterns so we can get this to the health authorities for evidence-based treatment,” she said.

“We all hoped this crisis would peak and then get better, but that’s not the case.

“It’s very tragic for those who’ve died and their family and friends. It’s very challenging to see.”

spetrescu@timescolonist.com