Dr. Kelli Stajduhar is a professor in the University of Victoria's School of Nursing and Institute on Aging and Lifelong Health. Ashley Mollison is a former harm reduction worker and current project co-ordinator at the Institute on Aging and Lifelong Health
In the years when hundreds of British Columbians were dying from AIDS, we would have been hard-pressed to imagine a worse health crisis.
We know otherwise now. With deaths from illicit drug overdoses killing an average of four British Columbians a day, we're in the midst of a crisis that's claiming more than three times the lives lost to HIV/AIDS in the peak years of the early 1990s. Our province is in unprecedented territory, grappling with a per-capita overdose rate that's double the Canadian average and increasing dramatically with each passing year.
As jarring as these unnecessary deaths are for all of us, they're particularly devastating for workers from community agencies on the front lines of the crisis.
Anyone can be a drug user, but the majority of B.C.'s overdose deaths are happening among people who are poor, homeless or unstably housed and forced to depend on social services. Workers at inner-city shelters and social agencies feel like family to many of these people and vice versa. It's these overwhelmed workers who struggle daily with grief and loss, feeling powerless to do anything as their clients die at a shocking rate.
"The gap in understanding between the health bureaucracy and the front line is so vast that you're just left feeling utterly helpless to fix a problem you are intimately connected to," one such worker told us. "It's like being in a war where you know how to fight a particular battle, but the generals insist on a suicide run."
We're University of Victoria researchers currently studying end-of-life experiences of homeless and unstably housed people. We've witnessed how the overdose emergency has intensified grief in the street community. We hear from service providers experiencing deep frustration, distress and burnout from seeing clients face inequities and stigma in accessing care, lack of services and treatment options and death all around them.
Media coverage of the overdose crisis has focused on victims' biological families and emergency personnel – the paramedics, police and firefighters responding to calls. But the impact on people's "hidden" families – street family, friends and inner-city workers – is equally profound. They're experiencing compounding grief from seeing so many loved ones die preventable and unjust deaths.
Palliative care focuses on quality of life for both the dying and their families. It teaches us about the impact that death and bereavement has on family members. But while service providers are often de facto family members for people living on or near the streets, they're neither acknowledged nor supported as such. Street family in particular can find themselves excluded from decision making, care and support at the end of a loved one's life.
A bare minimum to support the loved ones of a person dead from an overdose is recognition that people who use drugs are human and that their deaths are as tragic as any death. The service providers and street family who are the genuine "first responders" of this crisis need to know that the rest of us are there for them.
Communities across B.C. and Canada have been devastated by what's going on. But addressing this mass bereavement requires major structural change if we're to shift the tide of the overdose crisis, including an end to the criminalization of drug use.
We need equitable access and quality care, free from stigma and paternalism. We need a full spectrum of prevention, support and treatment services. We need to listen to people who use drugs when they tell us what they need.
We need guidance and leadership from the palliative care community on how best to support service providers, who cope with the loss of people they care about while feeling helpless to "fix" a problem that can't be solved at an individual level. Their greatest distress comes from knowing that were this any other population, the response to the crisis would be very different.
Deaths from overdose in B.C. rose 80 per cent between 2015-16 and are on track to rise almost 60 per cent again this year if the pattern of the past six months continues.
Bronwyn Barter, president of the Ambulance Paramedics and Emergency Dispatchers of BC, has characterized such staggering numbers as "the new normal." Knowing how much more could be done to prevent these deaths, we reject that description.
The crisis is painful on many levels. But the more insidious trauma and violence is knowing that so many of these deaths wouldn't happen in a society where every person is valued.