A new mandate in British Columbia to collect comprehensive information on all fatal overdose victims aims to provide a fulsome look at why people use illicit drugs – from past medical issues to economic status – to help curb problematic drug use and prevent overdose deaths.
The BC Coroners Service's new Unintentional Drug Overdose Protocol requires coroners fill out an 11-page document for every person who dies of a suspected overdose. The data gathering is the most ambitious in the country. Last week, B.C. released data showing 780 people died of illicit drug overdoses between January and June this year. The province has been the hardest hit by the opioid crisis that is rapidly spreading across Canada.
On top of fields in a standard coroner's report – postmortem and toxicology exam details, location of death, physical clues at the scene – the new protocol looks at residency type; occupation; previous health diagnoses, including mental health; whether the person has experienced trauma; drug-use history and previous treatment sought or received.
The data could help answer questions such as how often drug dependence starts with prescribed medications, how poverty factors in, or why treatment – if sought – didn't work.
Chief Coroner Lisa Lapointe said the goal is to identify patterns and trends, get a clearer picture of who is dying from illicit drug use and why and ultimately inform practice and legislation and prevent similar deaths.
"I'm not sure it will be absolutely definitive, but we know that nobody else in the country is gathering this type of comprehensive information," Ms. Lapointe said. "People who are dying – are they representative of drug users generally? Of the general population?"
To gather this information, coroners interview friends and family members and work with partner agencies such as the Ministry of Health, social services and BC Housing.
The new protocol will further explore why Indigenous people are disproportionately affected by the overdose crisis. Data released last week show that First Nations people are five times more likely to experience an overdose – and three times more likely to die of one – than non-First Nations people.
"We recognize the root cause of where we are today," First Nations Health Authority (FNHA) deputy chief medical health officer Shannon McDonald said last Thursday, "and that root cause rests in colonization, displacement, connection that has been broken."
In partnership with the FNHA, the coroners service last year began collecting data on whether an overdose victim identified as Indigenous and, if so, First Nations, Métis or Inuit.
The BC Coroners Service's Drug Investigation Team began using the new protocol in December, when a record 159 people died of overdoses in a single month. It is aiming to release preliminary findings in the fall.
The new protocol is yet another way in which B.C. has plowed ahead in its response to the overdose crisis. Faced with skyrocketing overdose deaths, the province and its partner agencies opened around 20 "overdose prevention sites," expanded supervised injectable opioid-assisted therapies and opened shared using rooms in social housing buildings to encourage drug users not to use alone.
It also highlights the different paces at which provinces are responding. Alberta, for example, recently started releasing quarterly overdose statistics. That province's centralized data show that, of the 343 people who died of apparent overdoses linked to fentanyl last year, 24 per cent had filled a prescription for an opioid in the 30 days prior and almost 40 per cent were prescribed opioids from three or more health-care providers. That highlighted the fact that physicians and pharmacists could serve as crucial touch points in the fentanyl crisis.
Ontario's most recent data, more than a year old, found that at least 412 people died of opioid overdoses in the first half of 2016. In B.C., overdose deaths increased 66 per cent from first quarter 2016 to first quarter 2017.
At least 780 people died of illicit drug overdoses in B.C. in the first half of the year. Preliminary data suggest that fentanyl is now being detected in about 78 per cent of all overdose deaths, compared with 67 per cent last year.