B.C.’s fentanyl crisis: The view from the front lines

published on November 5, 2016 by Nick Eagland in The Vancouver Sun

Long before the overdose crisis was declared a public health emergency in April, first responders, doctors and the loved ones of drug users could see plenty of hard work and heartache ahead.

Last month, the B.C. Coroners Service announced that 555 people had died from an illicit-drug overdose in B.C. in the first nine months of 2016, compared to 505 for all of 2015. Coroners statistics show that fentanyl “” a powerful synthetic opioid dealers are cutting into drugs of all kinds “” was detected in about 61 per cent of these overdoses.

As the fentanyl crisis continues to devastate communities across B.C., people who live and work through it every day share stories from the front lines.

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Seonaid Nolan, the doctor

The emergency department at St. Paul’s Hospital in Vancouver has seen an “astronomical” number of patients who have overdosed, said Dr. Seonaid Nolan, an addictions physician with the B.C. Centre for Excellence in HIV/AIDS.

“I think it’s really affecting everyone, and not just the people who are using themselves but “¦ frontline workers, families of individuals who use drugs, friends, loved ones,” said Nolan, who has gone on maternity leave since the original reporting for this article. “It’s having an impact on everyone.”

Between Jan. 1 and Oct. 1, Vancouver Coastal Health emergency departments handled 4,628 illicit or unknown drug overdoses, with 70 per cent of them at St. Paul’s.

An increasing number of patients who have overdosed are being referred to Nolan and the addictions team at St. Paul’s. Three years ago, the team would see three or four new referrals every morning, but the fentanyl crisis has changed that dramatically.

“Six is probably the minimum average and we’ve gone up to between 15-20,” Nolan said.

“We’re following 90 patients sometimes and, despite that, looking at the statistics coming through St. Paul’s, I think the addiction-consult service is still only seeing about 20 per cent of patients who present or are admitted for a substance-use disorder.”

Three addiction-medicine physicians and their teams of residents are working to keep up with inpatient referrals. St. Paul’s recently added a 4th physician dedicated to seeing patients in the ER, whose role is to engage opioid-use disordered patients and to staff a new outpatient, rapid-access addiction clinic.