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Overdose Response Indicators

 
The Overdose Emergency Response Centre (OERC), part of the Ministry of Mental Health and Addictions, works in close partnership with the BC Centre for Disease Control (BCCDC) to provide provincial coordination of surveillance, monitoring, and evaluation related to the overdose emergency. This provincial surveillance report provides current data on key overdose-related indicators. 

The OERC facilitates planning at the provincial, regional and local levels, structured upon a set of eight core interventions that capitalize on evidence-informed strategies.  Together, these strategies form an integrated, comprehensive response to the overdose crisis.  

The indicators contained in this report measure progress on these interventions across the province, and can be viewed at the provincial or regional health authority level, broken down by age and sex where possible. This report is updated monthly using the most up to date data available on each indicator. The interpretive text is updated quarterly. 

Explore the interactive visualizations below or download the full Overdose Response Indicator Report (Provincial level charts).

This report is made possible by the contribution of data from the following agencies:
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1. Paramedic Attended Overdose Events


B.C. paramedics attend a range of overdose/poisoning events every day. This indicator focuses on illegal drug overdose events not including prescription drugs or alcohol. Events are included where treatment by ambulance crews included use of Naloxone (the antidote for an opioid overdose) or where the 9-1-1 dispatch code was consistent with possible drug overdose and the corresponding paramedic impression codes indicated use of illegal drugs. The majority of people who experience an overdose and are attended by paramedics survive; while, for those who died, in many cases 9-1-1 was not called. Thus, this indicator, displayed as a monthly rate, represents largely non-fatal overdose events.

The provincial rate of paramedic attended overdoses events (events per 100,000 BC residents) has increased 4 fold in less than three years, from 7 events/100,000 in early 2015 to almost 28 events/100,000 by summer 2018. There are notable peaks in November 2016, May 2017, and July 2018. A brief dip in rates occurred from October to February 2017. More recently, the rate of events has steadied since August 2018 at 25 events/100,000).
  
Paramedic attended overdose rates among men are much higher than in women, and drive the severe rates seen in BC; nonetheless, rates in women are also considered unacceptably high.  In general, trends over time are similar between men and women. However, in 2018, overdose event rates in women rose gradually early in the year, peaked in May, and have steadied since; while rates in males rose sharply early in the year, peaked in July, the highest to date, and have remained high and steady.
 
Individuals between the ages of 19 and 59 have the highest overdose rates. Considering the age and sex breakdown of overdose events in BC, over the most recent year of data, over 40% of all events are in 19-39 year old males and an additional almost 25% are in males 40-59 years. Some differences exist between the health authorities in the distribution of overdose events by age and sex which can be explored in this interactive report.


Refer to the Paramedic Attended Overdose Events data notes for more information about the indicators including definitions, data sources, and limitations.

Data provided by the BC Emergency Health Service.

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2. Illicit Drug Overdose Deaths

Illicit drug overdose deaths reported by the BC Coroners Service include overdose deaths involving street drugs (controlled and illegal drugs: heroin, cocaine, MDMA, methamphetamine, illicit fentanyl, etc.), medications that were not prescribed to the deceased, combinations of these with prescribed medications, and those overdoses where the origin of drug is not known.
 
The provincial rate of illicit drug overdose deaths (deaths per 100,000 BC residents), displayed here as a monthly rate, has been increasing steadily since January 2015.  A sharp increase in deaths occurred in November 2016, peaking in December 2016, and is thought to coincide with the introduction of carfentanil into the illegal drug supply.  Mortality dipped in some months throughout 2017 but remained consistently above the pre-November 2016 levels. 2018 rates peaked in March and, despite month to month variability, remained high and steady for the remainder of the year.
 
In all Health Authorities, rates of death are higher for males than females, although regional differences in the gap between male and females exists.  Some differences exist between the health authorities in the distribution of overdose deaths by age and sex which can be explored in this interactive report.

In BC, mortality due to accidental illicit drug overdose is extremely high, particularly in males 40-59 years old as well as those 19-39 years old.

Refer to the Illicit Drug Overdose Deaths data notes for more information about the indicators including definitions, data sources, and limitations.

Data provided by the BC Coroners Service.


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3. BC Naloxone Program Indicators

Naloxone is a medication that quickly reverses the effects of an overdose from opioids such as heroin, methadone, fentanyl and morphine. It is available in BC without a prescription and given as an injection into a muscle.

BC's Take Home Naloxone (THN) program began in late 2012 and provides free personal THN kits to people at risk of opioid overdose or likely to witness and respond to an overdose. Registered THN distribution sites include harm reduction sites, community service organizations, emergency departments, correctional facilities, and community pharmacies, among others. Sites order naloxone from the provincial program and return records of the number of kits distributed to clients. 

The Facility Overdose Response Box (FORB) program, launched in late 2016, provides boxes containing multiple doses of naloxone to eligible not-for-profit community-based organizations. These boxes are designed for staff to use to respond to on-site overdoses. Site locations include supportive and subsidized housing, drop-in centres, and shelters, among others. The program helps staff to be prepared to recognize and respond to an overdose.

There are five core naloxone program indicators based on data available from the provincial naloxone database, which can be viewed as new monthly numbers or cumulative totals over time: 

  • The number of new THN sites enrolled in the provincial program each month. Site enrollment increased in mid-2016 and throughout 2017 in response to the ongoing overdose crisis. A key focus has been strategic expansion of site types and locations to fill gaps in access. The increase seen in December 2017 to February 2018 was due to the enrollment of a large number of community pharmacies across BC. Site enrollment for the remainder of 2018 was steady, focussing on low access areas. 
  • The number of new FORB sites enrolled in the provincial program each month. Site enrollment began in December of 2016. All health authorities have FORB sites. 
  • The number of THN kits shipped to THN sites each month. The number of THN kits shipped to sites in BC has been increasing steadily since early 2016. THN distribution reached a peak in August 2018 with over 21K kits shipped that month and has remained high and steady for the remainder of 2018. The numbers of kits shipped to ordering sites each month is typically higher than distribution records received back. Kits shipped in a given month are not related to kits distributed to clients in the same month.
  • The number of THN kits distributed to clients each month, as reported by sites. Expansion of naloxone distribution or "ramp up" began in mid- 2016 in response to the ongoing crisis and continued throughout 2017. Prior to the program ramp up, less than 1000 kits were distributed per month, during the ramp up period, as many as 6000 kits were distributed in some months. Distribution peaked in summer 2017 and has been stable since with between 4000-5000 kits distributed per month. 
  • The estimated number of overdoses reversed each month, using provincially-funded THN kits. Overdoses reversed are estimated based on the number of clients refilling or receiving a THN kit, who report they used the naloxone in a previous kit to reverse an overdose. The estimated number of reported overdoses reversed using a THN kit in BC began increasing gradually in since December 2015 with a sharp increase beginning in November 2016. Reported reversals peaked in August 2017 and again in August 2018, during which 1,878 and 2,067 overdoses were estimated to be reversed in those months alone.

More information on both naloxone programs can be found at Toward the Heart.

Refer to the BC Naloxone Program Indicators data notes for more information about the indicators including definitions, data sources, and limitations.

Data provided by the BC Center for Disease Control and Regional Health Authorities.


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4. Opioid Agonist Treatment Indicators

Opioid Agonist Treatment (OAT) consists of a range of drug treatments for adults and youth with varying presentations of opioid use disorder.  Increasing the availability of this treatment represents an important component of the health system response to the opioid overdose emergency. BC’s evidence-based OAT treatment guidelines support the availability of a diversity of treatment options. 

There are four core OAT indicators based on prescription drug data available from the provincial database, PharmaNet:

  • The number of clients dispensed OAT in BC is defined by the number of unique clients who were dispensed OAT at a BC community pharmacy. This number began rising in 2016, largely driven by an increase in the number of clients dispensed buprenorphine/naloxone (Suboxone).  Methadone prescribing has been stable since 2015.

  • A new OAT client is defined as a client dispensed OAT for the first time at a BC community pharmacy.  The number of clients dispensed OAT in BC for the first time has increased throughout 2016, and this trend mainly relates to the increase in clients dispensed buprenorphine/naloxone (Suboxone) for the first time.  Notably, numbers of new clients on sustained release oral morphine has risen sharply in 2017 although this treatment option still accounts for fewer new starts than methadone or buprenorphine/naloxone.

  • The number of OAT prescribers in BC is defined by the number of BC clinicians prescribing OAT as assessed by prescriptions filled at community pharmacies. The number of OAT prescribers in BC has been rapidly increasing since mid-2016 as Health Authorities and the BC Centre on Substance Use engage physicians in training and preceptorship activities (partnering knowledgeable and novice prescribers). The trend is largely driven by clinicians prescribing Buprenorphine/Naloxone (Suboxone). An increasing trend in the number of Sustained Release Oral Morphine prescribers is seen starting in mid-2017.

  • In 2018, an average of 62 physicians prescribed OAT for the first time across BC. Physicians prescribing for the first time are most likely to prescribe buprenorphine/naloxone (Suboxone).

Note that the category ‘ANY OAT’ counts the unique number of clients dispensed (or clinicians prescribing) any of the listed drug types in a given month, so counts across treatments may not be additive.  For example, if in a given month, the same person was started for the first time on methadone and buprenorphine/naloxone (Suboxone), they will be counted in each of those categories but will only be counted once in the ANY category.  

Refer to the Opioid Agonist Treatment Indicators data notes for more information about the indicators including definitions, data sources, and limitations.

Data provided by BC Ministry of Health.


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5.Overdose Prevention Services Indicators

Overdose Prevention Services consist of a range of services designed to respond to and prevent overdoses and overdose deaths and includes both overdose prevention sites and supervised consumption sites. This monitoring indicator is based on data received from BC Regional Health Authorities operating the sites and is designed to monitor trends for OPS and SCS sites combined (OPS/SCS).

An OPS is a client service location with staff trained in overdose recognition and naloxone administration available to respond to prevent brain injury and death should overdose occur. Across BC, OPS vary considerably in structure and function and were first mandated to open in all BC health authorities in December 2016 by Order of the Provincial Health Officer. SCS sites provide similar services to OPS sites, operating under a federal exemption under section 56.1 of the Controlled Substances Act. There are different models of overdose prevention service delivery, such as peer-to-peer services. 
 
There are two core indicators for OPS/SCS sites based on data provided by Regional Health Authorities:

  • The number of client visits to OPS/SCS sites each month. Sites visits related to observed consumption of substances have been increasing in 2018. 

  • The number overdoses responded to by staff at OPS/SCS sites each month. Overdoses events at OPS/SCS have remained relatively stable in 2018. 

Each regional health Authority opened at least one site from December 2016. Since then, the number of OPS/SCS sites has increased, along with location changes or service model transitions. Site reporting on the monthly number of substance-related visits and overdose events is displayed here from January 2018. As of January, 2019, there are more than 30 OPS/SCS locations around BC. Most but not all locations are included in this reporting (see footnotes).
 
In addition to standalone OPS/SCS sites reported here, there are other forms of overdose prevention services based in a wide range of settings. For example, in the Vancouver Coastal Health region, there are over 25 Overdose Prevention Services sites that are based in housing settings.

Refer to the Overdose Prevention Services Indicators data notes for more information about the indicators including definitions, data sources, and limitations. 

Data provided by the Regional Health Authorities.

SOURCE: Overdose Response Indicators ( )
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