Experts are looking at changes to the drug supply and drug use for clues to why drug deaths in B.C. are dropping.
Deaths related to drug overdoses have declined nine per cent in B.C. over the past year. But experts says it’s unclear if the falling numbers signal a trend, or simply a dip, while the reason behind the decline is also unknown.
Data released by the B.C. Coroners Service earlier this month shows 1,925 people died in drug overdoses in the first 10 months of 2024, a nine per cent reduction over the same period last year. While still horribly high, there were fewer fatal drug overdoses in October than in any other month in the past four years.
The declines across multiple jurisdictions point to the possibility that what B.C. is seeing is part of a larger downward trend, unlike previous drops, which weren’t sustained, said Dr. Alexis Crabtree, a public health physician with the B.C. Centre for Disease Control.
But differences in the drug supply — and differences in approaches to drug use — between cities and regions across North America have made it difficult for experts to pinpoint a specific cause for the decline.
That work, however, is “vitally important,” said Crabtree. Understanding the reasons for the decrease could inform B.C.’s approach to the overdose crisis and ultimately save lives.
Changes in the drug supply
While there is some indication that the “overall fentanyl concentration” in the local drug supply may have slightly decreased, it’s impossible to draw a straight line from that to the death rate, said David Byres, who leads the B.C. drug-checking team at the B.C. Centre on Substance Use.
Three primary fentanyl analogs commonly show up in B.C., each with different effects, said Byres. The opioid is often mixed with other drugs, like benzodiazepines, which also create different outcomes. Untangling the effects of various combinations is complex.
“Our drug supplies end up being very geographically different,” said Byres.
Crabtree said it’s most likely any changes in the drug supply would be happening upstream, at the level of international organized crime. She speculated that perhaps production was becoming more established and the product more consistent, which could lower the risk of a fatal overdose as people understand what they’re consuming.
Five out of 10 pills tested in DEA labs in 2024 contained a potentially deadly dose of fentanyl, compared with seven out of 10 pills in 2023, said Anne Milgram.
“The cartels have reduced the amount of fentanyl they put into pills because of the pressure we are putting on them,” she said.
Police seizures
It’s unclear if that logic holds true in B.C.
Several large police seizures of fentanyl — and the discovery of Canada’s largest illicit drug lab on a rural property in Falkland a few months ago — put a spotlight on local production of fentanyl.
Police believe organized crime is producing more than what’s needed to meet local demand, smuggling the surplus out of the country.
Experts differ in their views on how police seizures impact the local drug supply and might influence the number of people dying of drug overdoses.
Crabtree said that when the drug supply is curtailed it can drive up prices, causing people to consume less. But it can also lead to more harm if people begin mixing drugs to make up for the reduced supply or turn to riskier sources.
“People scramble when the drug supply changes,” said D.J. Larkin, executive director of the Canadian Drug Policy Coalition.
Studies have also shown a correlation between police crackdowns and overdose deaths. Some see the fentanyl crisis in terms of the “iron law of prohibition” — a term coined in 1986 — which dictates that more intense enforcement leads to increasingly potent drugs, which are easier to move and store, but more dangerous.
Changes in people at risk
Crabtree said another area of study for those investigating the drop in overdose deaths is to look at changes in people’s behaviours.
There is some evidence that B.C. high school students are using illicit drugs less than in the past, she said, but it’s unclear if that is true across age groups. There may also be some post-COVID-19 “social recovery” occurring, which could cause natural cessation or prevent more people from starting to use drugs.
Some experts point to the better availability of naloxone, or the general increase in investment in drug treatment across North America, although options and approaches are vastly different between jurisdictions.
Crabtree dismissed one prevalent theory about tolerance to fentanyl.
“People do build up a tolerance over time, requiring higher doses to get the same effect,” she said, explaining how that may, in fact, narrow the margin for error, putting them closer to a fatal dose. “I see high tolerance as a risk factor, not a protective factor.”
Larkin said that eight years into a toxic drug crisis that has killed more than 14,000 people, some of B.C.’s most vulnerable people have died, a grim reality that could also play a role in the death toll today.
Harm reduction policies
Larkin is worried that some of the harm reduction policies that have saved lives in B.C. are under attack.
A study by the B.C. CDC published earlier this year found that prescribing medical-grade opioids reduced the rates of both drug deaths and overdoses.
Larkin said B.C. needs to follow the data in its approach to safe supply. The worst outcome would be for the government to respond to the decline in deaths by walking back harm reduction measures and ending the public health emergency declared in 2016.
“But we’re nowhere near that,” said Larkin. “The level of people dying is still exponential. The decrease is not good enough. It’s not acceptable.”
Crabtree said time and comparative data should eventually provide the clues needed to determine if the drop will be sustained.
In comparing different markets, with different approaches to drug use, it should become clear which changes are most associated with a decrease in overdose deaths, she said: “And we will start to get some answers.”