Overdose deaths would be at least twice as high without emergency harm reduction

The rapid expansion of harm reduction services in response to B.C.’s overdose crisis prevented more than 3,000 possible overdose deaths during a 20-month period, suggests new research led by the BC Centre for Disease Control (BCCDC). The study estimates that without access to and rapid scale up of harm reduction and treatment strategies, the number of overdose deaths in B.C. would be 2.5 times as high.

“This study speaks to the importance and the effectiveness of harm reduction and treatment efforts and the fact that they save lives,” said Judy Darcy, Minister of Mental Health and Addictions. “This is why we took immediate action increasing funding and supports to connect people with overdose prevention services, harm reductions supplies, and treatment options. These services have saved even more lives since December 2017 and are essential to turning the tide on the overdose crisis."

The study reviewed the period between April 2016, when the public health emergency was declared, and December 2017. It examined the impact of three strategies scaled up across B.C.: the distribution of naloxone in the community through the Take Home Naloxone program, expansion of overdose prevention services and supervised consumption sites, and increased access to treatments for opioid use disorder such as methadone and Suboxone^TM, also known as opioid agonist therapy.

 “Without these interventions, there would have been many more deaths,” said Dr. Mike Irvine, a postdoctoral fellow at the BCCDC, Ministry of Mental Health and Addictions and Institute of Applied Mathematics at UBC, who led the research. “Despite a highly toxic street drug supply, the average probability of death from accidental overdose decreased because of the services provided to keep people alive.”

The study used data on overdose deaths, paramedic-attended overdoses and other sources between 2012 and 2017 to mathematically model the probability of death from accidental overdose with and without the interventions. The research provides estimates on the number of overdose deaths averted which is not the same as the number of people saved; a single person may experience multiple overdoses.

Key findings:

• Between April 2016 and December 2017, there were 2,177 overdose deaths in B.C.
• During the same period, an estimated 3,030 deaths were averted by all three interventions combined. Individually, the interventions averted:
  • 1,580 deaths by the Take Home Naloxone program

(5,074 naloxone kits distributed between 2012 and 2015; 83,685 naloxone kits distributed in 2016 and 2017).

• 230 deaths by overdose prevention services and supervised consumption sites

(23 overdose prevention sites operating by the end of 2017).

• 590 deaths by opioid agonist treatment

(18,095 average number of people receiving opioid agonist therapy monthly between 2012 and 2015; increased to 22,191 in 2017).

Note: the deaths averted by individual interventions do not add up to the combined total because the interventions have a greater impact when all three are used together.

• Overdose deaths in B.C. would be 2.5 times as high if no harm reduction and treatment interventions were implemented.

This work confirms that, in the current environment of a highly toxic street drug supply in B.C., these combined interventions have reduced the risk of overdose death, as compared to not having these strategies in place.

“Thankfully, the Take Home Naloxone program was already in place when the crisis hit so we could quickly expand and get naloxone into the hands of people who needed it to reverse overdoses and save lives,” said Jane Buxton, harm reduction lead for the BCCDC who oversees the Take Home Naloxone program. “Since the program ramped up in mid-2016 in response to the ongoing crisis, we’ve distributed between 4,000 and 5,000 kits every month.”

Even though many deaths have been averted, unintended death due to overdose remains the leading cause of preventable death in B.C. The majority of overdose deaths occur among people using substances alone and in private residences. The authors note that further strategies are needed to address the contaminated drug supply. The research also observed that when no interventions are in place, the probability of death from overdose rises.

“This is among the first evidence to show that a combination of harm reduction and treatment interventions saves lives,” said Irvine. “It is useful information for jurisdictions considering how to respond to the overdose crisis.”

The findings build on 2018 research published in Lancet Public Health that showed the rapid expansion of B.C.’s Take Home Naloxone program in 2016 significantly reduced overdose deaths.

Learn More:

• The new study was published online today in the journal Addiction.
• Explore current data on overdose-related indicators