It has been more than three years since B.C. declared a public health emergency due to the growing number of drug overdose deaths in the province.

Recently, the tremendous efforts of the affected community, health care providers, and first responders have contributed to a decline in overdose deaths. While this is encouraging, the number of people still accidentally overdosing – and dying – as a result of the toxic drug supply far exceeds other areas of Canada. In fact, deaths due to overdose in B.C. dwarf all other causes of premature mortality such as motor vehicle accidents and suicide.

Last month in Coquitlam, the BC Centre on Substance Use (BCCSU) and Shoppers Drug Mart hosted a town hall where we stood up alongside experts and members of the community to discuss these very issues. The event was created with the goal of sparking a conversation in B.C. – and across the country – that can help end this public health crisis.

While much of the emphasis on opioid overdoses has focused on hard-hit areas like Vancouver’s Downtown Eastside, the BC Coroner’s Service data demonstrate how other areas of the province have also been seriously affected. In the Fraser Valley, for instance, overdose deaths outnumber those in any other region in the province in 2019. Regardless of where you look, the numbers are staggering.

One of the drivers of overdoses is the prevalence of fentanyl and fentanyl-adulterants in the illegal drug supply, with fentanyl being detected in more than 80 per cent of overdose deaths in the province. To date, efforts have focused on responding to and reducing fatal overdoses among those using fentanyl, with some success. We’re better at responding to overdoses when they happen, as recent data from the BC Centre for Disease Control shows.

However, without an equal focus upstream on the fundamental reasons people are overdosing in the first place, we’ll continue to spin our wheels. In addition to providing naloxone and other harm reduction interventions for when overdoses occur, we need to focus on strategies to help individuals get off of fentanyl-laced drugs while also improving the safety of the drug supply that is fueling overdose deaths.

People living with addiction and families who care for them know this better than anyone. They’ve experienced first-hand how ill-equipped the health care system has historically been in delivering evidence-based addiction treatment and care. Establishing a functioning addiction treatment system in B.C. will require a lot more work.

Experts have identified longstanding reasons for the province’s lack of accessible and effective addiction treatment services. For instance, physicians and other health care practitioners receive next to zero training in the prevention, diagnosis, and treatment of addiction in medical school and residency training programs. Addressing this skill gap is an obvious area for intervention that will lead to better outcomes for people with an addiction.

The urgent need to treat substance use as a health issue, to establish a functioning addiction treatment system, and to address the toxicity of the drug supply by expanding access to pharmaceutical alternatives are themes that emerge again and again in communities across the province.

In Coquitlam, we had the opportunity to hear from members of the community whose lives have been upended by opioids – a reality we’ve both experienced first-hand. The consensus was clear. To see meaningful change, we need to devote more attention to the causes of overdose, not just the effects.

Evan Wood MD, PhD is an addiction medicine physician, a scientist with the British Columbia Centre on Substance Use, and a Canada Research Chair and professor of medicine at UBC. Leslie McBain is the co-founder of Moms Stop the Harm.

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