The overdose crisis in British Columbia

Dr. Arlene King of Fraser Health Authority and former chief medical officer of health of Ontario gave an update on the evolving overdose epidemic in Fraser Health region, which covers communities from White Rock to Hope, British Columbia.  On September 21, the chief coroner of BC had announced 488 overdose deaths to date in BC, a 62% increase compared to the same time in 2015. According to Dr. King, who gave a plenary presentation on September 23 at the 2016 Pacific Psychopharmacology Conference in Vancouver, more than 60% of deaths in Fraser region were related to fentanyl, and if the current trend continues through 2016, 258 people will have died of overdose in the region. Although most people who die of overdose have a chronic substance-use disorder, young, naïve users are at high risk because of the presence of fentanyl in a wide variety of substances sold in the black market in BC. Fentanyl is a potent legal opioid, but the street form is mostly imported from clandestine markets in Asia. Fraser Health Authority is undertaking a variety of measures to prevent lethal drug overdoses; more information is available on Fraserhealth.ca .

On the previous day, Dr. Annabelle Mead, lead physician for Heartwood Centre for Women and an addiction medicine consultant for Vancouver Coastal Health, described the evidence for providing take-home naloxone kits and overdose education to prevent deaths. Naloxone kits are available in communities across BC, and specific outlets are posted on the Web site Toward the Heart which is maintained by the BC Centre for Disease Prevention. The site offers information about a variety of harm reduction approaches including a link to Insite, North America’s first legal safe-injection site in the Downtown Eastside of Vancouver. In other Canadian cities, efforts are underway to open safe-injection sites, which have strong evidence for preventing disease transmission and fatal overdoses, but no site has yet been announced in the Fraser region.

Drs. Ric Procyshyn, Christoph Correll, and Bill MacEwan visit the Downtown Eastside of Vancouver

Drs. Ric Procyshyn, Christoph Correll, and Bill MacEwan visit the Downtown Eastside of Vancouver

Welcome!

The B.C. Psychosis Program at Detwiller Pavilion, UBC hospital, admitted its first patients on Feb 23, 2012. As heir to the Refractory Psychosis ward at Riverview Hospital, the program accepted nine patients from Riverview who were not yet ready to go home. Since then, patients have been admitted from Fraser Health, Vancouver Coastal Health, and Vancouver Island. We have space for patients from Interior and Northern Health Authorities and look forward to referrals from those regions. We have a presence on the Web and our referral forms are available for download.

Many people played a role in organizing the program and helping in the transition from Riverview to UBC Hospital. I was selected to be medical director in December 2011 well after this process was underway. I have not even met some of the people who were instrumental in making the program come together in February with the infrastructure and personnel we need to function. Although I risk offense by leaving some important names out, I want to thank certain people for helping me as I took on this job. They include Bill MacEwan whose counsel has been invaluable, Carole Rudko and Derek Lyons for all the work they’ve done in hiring and training our staff, and Leslie Arnold whose vision and personal interest in this project have made it possible. Sean Flynn, Diane Fredrikson and Veerle Willaeys are physician colleagues who are working to make our clinical program excellent. Bill Honer, Laura Case and Soma Ganesan have provided vital advice and support to me and our team. The steering committee, which includes people from all Health Authorities, continues to meet monthly and is our conduit to the province.

Creating a provincial resource in the ivory tower of UBC is a challenge given the distance to places like Campbell River, Terrace and every other town in B.C. where people and families are affected by severe psychosis. The B.C. Psychosis Program needs to be accessible to them just as it is to people in Vancouver. But the benefit of being at UBC is the ability to attract excellent staff and to create a site for significant research on treatment-resistant psychosis.