Hydromorphone playing no ‘significant’ role in toxic drug deaths: B.C. coroner

Hydromorphone, also known under the brand name Dilaudid, is playing no “significant” role in suspected toxic drug deaths in the province, B.C.’s chief coroner confirms.

Lisa Lapointe addressed “questions” about the province’s prescribed safer supply program in a press conference Monday, along with provincial health officer Dr. Bonnie Henry, Dr. Kelsey Louie of the First Nations Health Authority, and B.C. representative for children and youth Jennifer Charlesworth.

“To date, neither hydromorphone nor xylazine are present in any significant numbers,” Lapointe said. “Fentanyl remains the main and most consistent and deadly driver of this public health emergency.”

0:58 B.C.’s chief coroner addresses ‘questions’ about prescribed safer supply program

Fentanyl is “routinely” involved in more than 80 per cent of B.C.’s drug-poisoning deaths, she added, an increase from 67 per cent in 2016. Lapointe said detection percentages of other opioids — such as codeine, hydromorphone, heroin, methadone and others — are so small the BC Coroners Service evaluates them as a single category.

Those other opioids have been present in about 20 per cent of deaths over the past three years. There’s been no increase in the detection of hydromorphone, specifically, she added.

It’s been seven years since the province declared a public health emergency due to the overdose crisis and more than 12,000 British Columbians have died from the toxic, unregulated supply since then.

More than six people die each day in the province from suspected toxic drugs, with 596 lives lost between January and March, and more than 200 deaths in April alone.

During that timeframe, Henry said there has been no change in the number of people with hydromorphone-specific drug toxicity deaths, although other elements of the crisis have changed, including the percentage of people smoking drugs rather than injecting them.

“All of our data have limitations. They’re not perfect,” Henry said.

“We are hearing from physicians that this prescribing, particularly of hydromorphone, is not meeting people’s needs and they are hearing concerning stories, which we’ve heard as well.”

2:14 B.C.’s top doctor acknowledges physician ‘concerns’ about prescribed hydromorphone

The province introduced its safer supply program in 2021 — the midst of the pandemic — to connect people at risk of dying from toxic drugs to safer substances and the health-care system. Fewer than five per cent of drug users who are known to the province have access to that program, which is concentrated in urban areas, Henry added.

“The program needs to be reviewed given the situation we’re in right now. We’re also hearing from people who use drugs that access and barriers remain their biggest challenges.”

While some physicians have expressed concerns about diversion, Henry said there is also evidence showing that safer supply is working for some patients, who experience decreased risk of death and improved mental and physical wellbeing. She acknowledged that some drug users who are part of the safer supply program have said they save some of their prescribed hydromorphone for use themselves later, or to share with a friend in need who doesn’t have access to prescribed safer supply.

In the coming weeks, the provincial health officer said she will work with the BC Centre for Disease Control and other partners to wrap the latest data into clinical guidelines for prescribed safer supply.

6:08 April toxic drug death numbers released

Last month, the Official Opposition raised concerns that prescribed substances, like hydromorphone, were being sold in the black market rather than used by those to whom they were prescribed.

Shortly afterward, federal Conservative Leader Pierre Poilievre’s motion to have MPs condemn Liberal safer supply programs failed to pass in the House of Commons.

Charlesworth condemned the politicization of the crisis, which killed 327 people between the ages of 19 and 29 last year, and 34 children under the age of 19.

“Different perspectives are invaluable in the face of this complex foe, but this is no time for polarizing, fear-driven and often political conflicts,” she said.

“We need to hold the tensions, work together and be willing to try evidence informed actions in an effort to outsmart the manufacturers, dealers and organized crime that are truly hurting our young people.”

Charlesworth said there is no “indication” in her office’s data that youth in B.C. are using drugs diverted from the safe supply. The program remains a critical component of the province’s response to the crisis, combined with treatment, mental health supports, and other efforts targeting poverty and housing, she added.

“For those young people using substances to numb their emotional pain, we must do whatever we can to keep them alive until they are ready to move on to treatment. Safe supply is an alternative to the poison that is available on the street,” Charlesworth said.

2:08 Province contemplating open drug use rules

According to data released by the BC Coroners Service, 71 per cent of those who have died this year were between the ages 30 and 59, and 77 per cent were men.

Vancouver, Surrey and Greater Victoria have been hit the hardest.

In April, the First Nations Health Authority (FNHA) revealed First Nations people died at 5.9 times the rate of other residents in 2022, with 373 toxic drug-poisoning deaths in total — an increase of 6.3 per cent from 2021.

First Nations people represent 3.3 per cent of B.C.’s population, but the FNHA has said 16.4 per cent of those who died from overdoses in 2022 were Indigenous. The crisis is especially dire for First Nations women, who died at 11.2 times the rate non-Indigenous women in B.C.

Last year was the deadliest on record, with 2,314 British Columbians lives lost to the crisis. The highest rates of death were in Vancouver, Terrace, Merritt, Hope and Prince George.

Louie, deputy chief medical officer of the FNHA, said the crisis extends well beyond Vancouver’s Downtown Eastside.

“While much discussion surrounding drug use and its outcomes appears to focus on inner-city residents, and in particular, the Downtown Eastside in Vancouver, we must acknowledge that this crisis affects both urban and rural communities across our province,” he said.

“While one model or program may not be effective in an urban setting, it could have life-altering possibilities in remote or rural communities.”

According to Lapointe, less than 14 per cent of toxic drug deaths in B.C. last year took place in the Downtown Eastside. She said she too was concerned that the community has been painted as “the face” of the crisis, when the vast majority of impacted people reside elsewhere.

The BC Alcohol and Drug Information and Referral Service is available 24/7 to connect those affected by drug and alcohol use to counselling, toll-free at 1-800-663-1441.

Information on harm reduction services and overdose prevention is available on the B.C. government’s website.

A map of safe injection sites and free naloxone pickup locations, and other resources for users, caregivers, and concerned friends and family, are available on the Toward The Heart website.