Packaged fentanyl seized by police sits on display earlier this year.

Packaged fentanyl seized by police sits on display earlier this year.

West Shore Crisis: First responders busy with overdose calls

Local first responders being trained in use of naloxone to combat overdose situations

West Shore first responders are on the front lines battling a silent killer and it’s a situation that is only expected to get worse in the coming months.

Earlier this year the B.C. government declared its first-ever public health emergency to deal with the sharp increase in opioid drug overdoes across the province. It’s a situation the West Shore is not immune to.

B.C. Emergency Health Services responded to 109 suspected overdoses or poisonings on the West Shore in 2015. By the end of August of this year, they had already responded to 100 calls. Although, these statistics include all suspected overdoses and poisonings.

Colwood Fire Rescue, among others on the West Shore, is preparing for an increase in calls. “I’m sure, unfortunately, we’re going to see a rise,” said Assistant Chief Greg Chow. Part of that, means the department now carries naloxone. Naloxone is a drug that can reverse or block the effects of opioids and is used in emergency situations to treat suspected overdoses. It can also cause immediate withdrawal symptoms and sometimes after it is administered, patients come out swinging as some first responders can attest to. “All of our members are trained with the new naloxone regulations,” he added.

Chow describes situations where the department has responded to a suspected overdose where the patient is unconscious and firefighters have had to administer naloxone, before B.C. Ambulance staff can arrive. Fortunately, Chow said in those situations they have seen positive results but their firefighters are still aware of the negative side effects the drug can have. “There’s always that potential,” he warned.

Island shows highest rate of drug overdose deaths

The latest numbers from the B.C. Coroners Service showed that from Jan. 1 to Aug. 31 of this year, there were 93 illicit drug overdose deaths on Vancouver Island and 488 deaths provincewide. Provincially, that’s an increase of more than 60 per cent from the same time frame in 2015.

Island Health recorded the highest rate of such deaths per 100,000 residents (18.1) among all health authorities in the province, and saw the largest increase from 2015, at 135 per cent.

Fatigue is starting to set in for the people dealing with these calls, warns Dr. Richard Stanwick, Island Health’s chief medical health officer.

“It’s wearing on the first responders,” he said, adding that only two years ago authorities were only dealing with a fraction of those overdose calls. “This is something that is straining the entire system.”

Stanwick said staff in emergency rooms are also starting to feel the pressure and have shared stories of their experiences. The potency of the drugs causing overdoses is forcing medical staff and first responders to administer several doses of naloxone – Stanwick has heard of six being required in some cases. At that point, he noted, other medical problems are being masked and could go overlooked. “It’s one of those things that looks simple, but there’s that complex wrinkle.”

Illicit use of fentanyl causing numbers to spike

Fentanyl remains a major contributor to the high number of deaths, according to the B.C. Coroners Service. Between Jan. 1 and July 31, there were 264 deaths provincewide where fentanyl was detected, roughly 60 per cent of all illicit drug deaths.

Five years ago, Stanwick noted, there was a spike in overdose deaths, but with outreach and other programs they were able to bring those numbers down. However, two years ago fentanyl started appearing on the illicit drug market and those numbers started to climb again.

Fentanyl is often used in medical procedures and can be administered in patch form to cancer patients. While some hospital grade fentanyl is on the streets, Stanwick noted, “most of it is 100 per cent more potent than what you’d find in a hospital setting.” This new and improved fentanyl – for lack of a better term – is so strong, he said, that a portion as small as a grain of salt “will give you a very potent high (but) two grains could kill you.”

Since such small doses are so powerful, fentanyl is easier than other drugs to smuggle across borders and there’s no shortage of manufacturers around the world turning it out, Stanwick said.

But the rise in overdose death rates isn’t just related to the potency of fentanyl, he noted. One cause could be the distribution of the drug-using population on the Island, which can make it hard for service providers to reach users, especially those at the greatest risk.

Getting harm reduction tools and street outreach to that population often hits hurdles. Unwillingness to change zoning bylaws to allow for supervised consumption sites – a topic discussed this week at the Union of B.C. Municipalities convention – is one such hurdle.

Stanwick, among the Island Health officials who toured safe injection sites in Germany and Switzerland in recent years, noted “it can be done in a way that is minimally disruptive,” and added many businesses around the sites they toured didn’t even know they were there.

The expectation is that all health authorities in B.C. will send a proposal for supervised injection sites to Ottawa by the end of the year. Stanwick noted Vancouver has led the way for others on that subject.

The Vancouver Coastal Health Authority reports there have been more than three million visits to its Downtown Eastside safe injection site since 2003. During that time there has been nearly 5,000 overdose interventions without any deaths reported.

“I don’t know how much more evidence you need,” Stanwick added.

But the underlying circumstances that cause people to turn to drugs also need to be addressed, Stanwick said, while more also needs to be done to increase access to low barrier shelter beds.

Stanwick warns that if the death toll continues to rise, accidental overdose deaths will soon overtake traffic fatalities as the number one cause of premature loss of life, and that is a tragedy he said.

“Part of this is understanding the scope … every one of these individuals have families.” But it’s not just habitual drug users making up these statistics.

While he said the typical case, with roughly four out of five overdose deaths, is a male individual between the ages of 25 to 45, known to be a regular drug user, found alone without naloxone, he noted recreational drug users are also starting to make a mark in the statistics. He personally knows two people that have lost someone to accidental overdoses.

“These drugs are out there,” he said, warning that everyone who uses drugs, recreationally or otherwise, runs the same risk. To think otherwise would be a mistake, he added, noting that if a person plans to use any amount of drugs, having naloxone on hand needs to be a part of that equation.