Overdose deaths have skyrocketed to unprecedented levels in British Columbia, but the issue has barely factored into the provincial election campaign – and next week's vote does not appear likely to spur any bold or swift changes to curb the crisis.
Four people die every day from illicit-drug overdoses in B.C. The province recorded an average of 250 such deaths a year since 2000; if first-quarter 2017 trends keep up, the death toll this year could surpass 1,300.
While the major parties all address the crisis to some degree in their platforms, none are calling for a quick or dramatic shift to how the province approaches the problem, which continues to accelerate despite a public emergency that was declared a year ago and measures that have included expanded naloxone distribution and the expansion of sites where users can consume illicit drugs under supervision.
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And, only the Greens are ready to commit to expanding a radical intervention that addictions experts say is needed: ensuring users have access to pharmaceutical-grade heroin. The BC Liberal Party and the NDP said they would consult experts before deciding.
The Globe and Mail reviewed campaign platforms and spoke with party representatives to gauge what the province's response to the worsening overdose crisis might look like after the May 9 election. Liberal Leader Christy Clark fielded a question on the subject in a Globe editorial board meeting this week, but the party declined to put forward a spokesperson to discuss the issue in detail.
Both the NDP and Green parties put a heavy emphasis on early intervention. The Greens say they would spend $80-million over three years on youth mental health and related initiatives.
Another $4-billion over four years would go to the public-education system, in part to hiring specialty teachers and support staff.
"We know that early intervention can deal with many issues," Green Party Leader Andrew Weaver said recently. "We've had a decade – a generation – of children who have gone through the school system with cuts to child psychologists, cuts to counsellors, cuts to speech pathologists, so that they may not be diagnosed with a hearing or speech issue when they may be struggling in school."
NDP candidate Selina Robinson noted a student can wait several years to receive a psychological assessment in the public education system and said the NDP would commit to improving access to health supports in schools. She added that the party's poverty-reduction plan, which includes proposals such as increasing income assistance and disability rates by $100 a month, would also provide additional support to vulnerable people and families: "These things don't work in isolation."
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The NDP platform says the party would also "provide more support to police efforts to disrupt the supply chain"; license recovery homes, many of which are completely unregulated and offer no guaranteed outcomes; and reopen facilities at Riverview Hospital, a shuttered mental-health institution.
The platform includes $35-million over three years to increase general supports for mental health and addictions.
The Liberal platform lists $45-million for mental-health counselling and treatment for children, $12-million for 28 youth treatment beds and $9-million for the expansion of youth service centres at "up to five sites" and "up to $5-million" to support mental-health services for postsecondary students.
All three parties say they would improve access to substitution therapies such as buprenorphine-naloxone (also known as Suboxone) and methadone. The Liberal government in February began providing full coverage for these therapies for people making less than about $42,000 a year.
But to address the urgent issue of the toxic drug supply washing across the province – at least three kinds of illicit fentanyl have been confirmed and countless more are anticipated – top health officials are calling for a clean drug supply coupled with increased addiction treatment.
Drug policy is a federal mandate, but B.C. does have the ability to expand a prescription- heroin program in Vancouver currently available to fewer than 100 people. Of the three major party leaders, only Mr. Weaver committed outright to providing dedicated funding to expand the program: "The answer is yes – an unequivocal yes," he told The Globe.
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Ms. Clark said her party would commit to dedicated funding if it was recommended by the recently formed B.C. Centre on Substance Use; NDP Leader John Horgan said his party would create a new ministry dedicated to mental health and addictions and defer to that ministry for recommendations. The Green Party would also create such a ministry.
Provincial Health Officer Perry Kendall said countless lives would be saved if the province could supply everyone who wanted drugs with a clean and regulated product – "but I can't see that practically happening."
Addictions physician Keith Ahamad said there is "a huge unanswered question around the stimulant market" and that officials need to think outside the box to address the issue of drug supply. The prescription-heroin program, while an effective last-resort treatment, only caters to heroin/opioid users.
Users of stimulants such as cocaine and methamphetamine are particularly susceptible to fentanyl overdoses because they may not have built up a tolerance for opioids. A review of illicit drug overdose deaths in 2015 and 2016 found that cocaine was detected in nearly half.
"Prescribing cocaine would be a very interesting thing to at least study," Dr. Ahamad said.
Health officials have also called for drug decriminalization, which would steer drug users toward treatment rather than jail. Patricia Daly, chief medical health officer for Vancouver Coastal Health, said it would also reduce the stigma of drug use. About 90 per cent of illicit-drug overdoses are happening indoors, mostly in private residences.
"If we can decriminalize all drugs … it wouldn't eliminate the contamination, but I think it would go a long way to addressing stigma, to acknowledge that substance misuse is a medical condition," Dr. Daly said.
"It might make people more willing to go out to places where they can consume their drugs and be observed, in case they overdose," Dr. Daly said.
Mr. Weaver said he supports this model; Ms. Clark said she agrees addiction should be treated as a health issue but declined to support decriminalization; and Mr. Horgan did not provide a clear answer, saying "everything is in the mix."
Last year's province-wide death toll of 931 surpassed even the grimmest of projections earlier in the year. On Thursday, the city of Vancouver said 15 people had died the week before – bringing the total so far this year to at least 141 – and issued yet another call for provincial assistance.
"This overdose crisis got dramatically worse last week with one of the highest overdose and death tolls in our history," Mayor Gregor Robertson said in a statement.
"This crisis is B.C.'s most tragic public-health emergency in decades and yet urgent health-care interventions that could immediately save lives are not being facilitated. The next provincial government needs to immediately take action on the overdose death crisis because the current government's approach is not working."