Canada needs a new approach to tackle its overdose crisis, says the lead author of a new study that highlights a prevalence of overdoses involving non-prescribed fentanyl and stimulants in British Columbia.
The study, published on Monday in the Canadian Medical Association Journal, looked at 1,789 overdose deaths in British Columbia between 2015 and 2017 in which the coroner was able to determine the substances relevant to the deaths.
It reported that despite decreases in the prescription of opioids across the province, the death rate from illegal drug overdoses has continued to rise.
Dr. Alexis Crabtree, the study’s lead author and resident physician in public health and preventative medicine at the University of British Columbia, says it highlights what isn’t working when it comes to tackling the overdose crisis.
“What we found is that this overdose crisis is not driven by prescribed medications and de-prescribing initiatives alone won’t solve the overdose crisis,” she said in an interview.
In most cases where prescribed opioids were implicated in a death, the toxicology report also flagged the non-prescribed opioids in the person’s system, Crabtree added.
The study’s findings also highlight the declining role of prescription opioids and heroin in the overdose crisis and the rise of synthetic opioids and stimulants.
The current strategies on battling the overdose crisis “must do much more” than target de-prescribing opioids, the study concludes.
There have been more than 15,000 apparent opioid-related deaths in Canada since 2016.
British Columbia has recorded more than 5,000 deaths from illicit drug overdoses since declaring a public health emergency in 2016.
Men continue to dominate the overdose death toll, making up more than 80 per cent of deaths, with people between the ages of 31 and 49 making up the predominant number of deaths.
A safe injection site is pictured in Vancouver in 2017. More access to overdose prevention and supervised consumption sites should be some of the next steps forward in B.C.’s fight against the overdose crisis, according to a new study. (David Horemans/CBC)
Prescribed medications aren’t driving risk, study finds
One aspect that is often overlooked is the efficacy of methadone and buprenorphine, opioids used to treat opioid addiction, Crabtree said.
The study showed that few overdoses involved people with those opioids in their system, which Crabtree said she believes should make doctors feel more comfortable in prescribing them to drug users.
That program, and subsequent concerns raised over the prescribing of illicit-alternative drugs, prompted the decision to publish the study in the Canadian Medical Assocation Journal, Crabtree said.
“A question or concern physicians have is: ‘Is the medication I’m prescribing contributing to overdoses?”’ said Crabtree.
“I can understand why people have that concern. I think these results are really reassuring that prescribed medications are not a driver of overdose risks and supports physicians to prescribe under those risk mitigation guidelines.”
Provincial Health Officer Dr. Bonnie Henry in February. In a 2019 report, Henry called for the decriminalization of possessing small amounts of drugs, saying B.C. ‘cannot wait for action at the federal level.’ (Chad Hipolito/Canadian Press)
Next steps forward
She said she agrees with the recommendations of Provincial Health Officer Dr. Bonnie Henry, who called for the decriminalization of possessing small amounts of drugs in a 2019 report.
At the time, Henry wrote that the province “cannot wait for action at the federal level.”
She reiterated those recommendations in June 2020, which saw 175 suspected overdose-related deaths.
“COVID-19 has made clear the government can act in a very fast and effective way when it prioritizes a response to a public health emergency,” said Crabtree. “I would love to see that same effectiveness applied to responding to the overdose emergency and protecting the health of people who use drugs.”
More access to overdose prevention and supervised inhalation sites should be some of the next steps forward both in B.C. and across the country, she added.
The federal government launched a national consultation on supervised consumption sites last week, seeking comments from a variety of Canadians, including those who operate the sites and those who use them.
Some Ontario doctors have started offering a free shot that can protect babies from respiratory syncytial virus while Quebec will begin its immunization program next month.
The new shot called Nirsevimab gives babies antibodies that provide passive immunity to RSV, a major cause of serious lower respiratory tract infections for infants and seniors, which can cause bronchiolitis or pneumonia.
Ontario’s ministry of health says the shot is already available at some doctor’s offices in Ontario with the province’s remaining supply set to arrive by the end of the month.
Quebec will begin administering the shots on Nov. 4 to babies born in hospitals and delivery centers.
Parents in Quebec with babies under six months or those who are older but more vulnerable to infection can also book immunization appointments online.
The injection will be available in Nunavut and Yukon this fall and winter, though administration start dates have not yet been announced.
This report by The Canadian Press was first published Oct. 21, 2024.
-With files from Nicole Ireland
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
ISLAMABAD (AP) — Polio cases are rising ahead of a new vaccination campaign in Pakistan, where violence targeting health workers and the police protecting them has hampered years of efforts toward making the country polio-free.
Since January, health officials have confirmed 39 new polio cases in Pakistan, compared to only six last year, said Anwarul Haq of the National Emergency Operation Center for Polio Eradication.
The new nationwide drive starts Oct. 28 with the aim to vaccinate at least 32 million children. “The whole purpose of these campaigns is to achieve the target of making Pakistan a polio-free state,” he said.
Pakistan regularly launches campaigns against polio despite attacks on the workers and police assigned to the inoculation drives. Militants falsely claim the vaccination campaigns are a Western conspiracy to sterilize children.
Most of the new polio cases were reported in the southwestern Balochistan and southern Sindh province, following by Khyber Pakhtunkhwa province and eastern Punjab province.
The locations are worrying authorities since previous cases were from the restive northwest bordering Afghanistan, where the Taliban government in September suddenly stopped a door-to-door vaccination campaign.
Afghanistan and Pakistan are the two countries in which the spread of the potentially fatal, paralyzing disease has never been stopped. Authorities in Pakistan have said that the Taliban’s decision will have major repercussions beyond the Afghan border, as people from both sides frequently travel to each other’s country.
The World Health Organization has confirmed 18 polio cases in Afghanistan this year, all but two in the south of the country. That’s up from six cases in 2023. Afghanistan used a house-to-house vaccination strategy this June for the first time in five years, a tactic that helped to reach the majority of children targeted, according to WHO.
Health officials in Pakistan say they want the both sides to conduct anti-polio drives simultaneously.
WASHINGTON (AP) — Millions of people with private health insurance would be able to pick up over-the-counter methods like condoms, the “morning after” pill and birth control pills for free under a new rule the White House proposed on Monday.
Right now, health insurers must cover the cost of prescribed contraception, including prescription birth control or even condoms that doctors have issued a prescription for. But the new rule would expand that coverage, allowing millions of people on private health insurance to pick up free condoms, birth control pills, or “morning after” pills from local storefronts without a prescription.
The proposal comes days before Election Day, as Vice President Kamala Harris affixes her presidential campaign to a promise of expanding women’s health care access in the wake of the U.S. Supreme Court’s decision to undo nationwide abortion rights two years ago. Harris has sought to craft a distinct contrast from her Republican challenger, Donald Trump, who appointed some of the judges who issued that ruling.
“The proposed rule we announce today would expand access to birth control at no additional cost for millions of consumers,” Health and Human Services Secretary Xavier Becerra said in a statement. “Bottom line: women should have control over their personal health care decisions. And issuers and providers have an obligation to comply with the law.”
The emergency contraceptives that people on private insurance would be able to access without costs include levonorgestrel, a pill that needs to be taken immediately after sex to prevent pregnancy and is more commonly known by the brand name “Plan B.”
Without a doctor’s prescription, women may pay as much as $50 for a pack of the pills. And women who delay buying the medication in order to get a doctor’s prescription could jeopardize the pill’s effectiveness, since it is most likely to prevent a pregnancy within 72 hours after sex.
If implemented, the new rule would also require insurers to fully bear the cost of the once-a-day Opill, a new over-the-counter birth control pill that the U.S. Food and Drug Administration approved last year. A one-month supply of the pills costs $20.
Federal mandates for private health insurance to cover contraceptive care were first introduced with the Affordable Care Act, which required plans to pick up the cost of FDA-approved birth control that had been prescribed by a doctor as a preventative service.
The proposed rule would not impact those on Medicaid, the insurance program for the poorest Americans. States are largely left to design their own rules around Medicaid coverage for contraception, and few cover over-the-counter methods like Plan B or condoms.
