Addressing B.C.’s dual public health emergencies

Four years into a provincial public health emergency as a result of unprecedented drug overdoses, British Columbia had seemed to be making progress. At the end of 2019 and into the first months of 2020, overdose fatalities were steadily decreasing, a result of life-saving harm reduction interventions like naloxone and overdose prevention sites along with expanding access to evidence-based medical treatments for opioid addiction supported by work by the BC Centre on Substance Use (BCCSU).

Unfortunately, much of the progress made has been undone as a result of COVID-19 and the global pandemic. According to the recent illicit drug fatality reports from the BC Coroners Service, people are dying of overdose at greater numbers than anytime during the overdose public health emergency first declared in 2016. The dual public health emergencies have compounded risks for people who use drugs and are living with addiction, causing relapse while at the same time creating challenges to accessing to harm reduction, medical treatment, and recovery – all while also disrupting the drug supply and making it more deadly and toxic than ever.

Dr. Rupinder Brar, a clinician researcher at the BCCSU and a clinical assistant professor at UBC’s faculty of medicine, has witnessed first-hand the devastating impacts that COVID-19 has had on her already marginalized and vulnerable patients.

“We’ve really seen the disparities in access to care,” says Dr. Brar, who also works at the Columbia Street Community Clinic in Vancouver’s Downtown Eastside. In recalling the early days of the pandemic response, she says: “It was really challenging to support our patients, to do the important work of meeting them where they’re at, because of the restrictions that were put in place (because of COVID-19).”

In response, she and a team at Vancouver Coastal Health worked closely with the BCCSU to rapidly develop guidance to support people who use substances during COVID-19.

Risk Mitigation in the Context of Dual Public Health Emergencies” was the result, an interim guidance protocol for clinicians to prescribe safer prescription alternatives to the toxic drug supply. These guidelines were quickly endorsed by the provincial government and released less than two weeks into the pandemic.

“Clinicians play a critical role in separating people from the toxic drug supply,” Dr. Brar says. For her, the guidance represents an emergency response, a stopgap measure urgently needed now while recognizing it’s not sufficient as a long-term solution to the overdose crisis.

The rise in overdoses and overdose fatalities since March realized the concerns that Dr. Brar and many of her colleagues working in addiction medicine had when the global pandemic was first declared.

“We were worried about people being in absolute withdrawal because of disruptions preventing access to substances, including survival income disruption,” Dr. Brar recalls. “There was this looming fear of a surge of COVID-19 in the Downtown Eastside in particular, and we needed to help people isolate and manage their withdrawal to prevent spread.”

Since the launch of the guidance, more than 1,700 British Columbians have been able to access the new treatments (as of June 2020). A promising start representing a lifeline to those who’ve received it, but, Dr. Brar says, still not enough considering that an estimated 25,000 British Columbians who have an opioid use disorder don’t access treatment of any kind.

“What’s needed is a public health approach to substance use,” she says. “We need our government to take a really hard look at drug prohibition, at the harms this approach causes. If we don’t decriminalize people who use drugs, if we don’t regulate the drug supply, we will continue to lose people to preventable deaths.”