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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, and are broken down by age and sex where possible. 

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 were included where treatment by ambulance crews included use of Naloxone (the antidote for an opioid overdose) or where the paramedic impression codes indicated use of illegal drugs and the corresponding dispatch code was consistent with possible drug overdose (cardiac or respiratory arrest, overdose/ingestion poisoning, unconscious/fainting).  

The majority of people who experience an overdose and are attended by paramedics survive; while, for those who died from overdose, in many cases 911 was not called. The rate of paramedic attended overdoses events (events per 100,000 BC residents) in BC has been increasing steadily since January 2015, with peaks in November 2016 and May 2017. More recently, the rate of events has increased rapidly between February 2018 and May 2018. Rates among men tend to be much higher than women; however the trends over time are similar. Individuals who are between the ages of 19 and 59 have the highest overdose rates. Notable differences exist between health authorities.

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 overdoses reported by the Coroner include overdoses involving street drugs (heroin, cocaine, MDMA, methamphetamine, etc.), medications that were not prescribed to the deceased, combinations of the above with prescribed medications, and those overdoses where the origin of drug is not known.

The rate of illicit drug overdose deaths (deaths per 100,000 BC residents) in BC has been increasing steadily since January 2015.  A sharp increase in deaths occurred in November 2016 and is thought to coincide with the introduction of carfentanil into BC.  Mortality rates since that time have remained consistently above pre-November 2016 levels. In all Health Authorities, rates of death are higher for males than females. Deaths are occurring in adults 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 and other supplies to eligible not-for-profits These boxes are designed for staff at facilities and community-based organizations to
use to respond to on-site overdoses. Site locations include supportive and subsidized housing, drop-in centres, and shelters, among others. 

There are five core naloxone program indicators based on data available from the provincial naloxone database: 

  • The number of new THN sites enrolled in the provincial program each month. Site enrollment increased 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. 

  • 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 October 2015. THN distribution reached its highest peak in May 2018 with 20K kits shipped that month. 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. 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, an average of 1000 kits were distributed per month, during the ramp up period, as many as 6000 kits were distributed in some months. Distribution has been stable since late 2017 to the present time with approximately 4000 kits distributed per month. 

  • The estimated number of overdose reversed each month, using a provincially-funded THN kit. 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 has been increasing since November 2015 with a peak in August 2017, during which 1,875 overdoses were estimated to be reversed in that month 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 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 has been increasing since January 2015, with a more rapid increase starting in approximately October 2015, largely driven by the increase in the number of clients dispensed buprenorphine/naloxone (Suboxone). Methadone prescribing has been stable since 2015.

  • The number of clients dispensed OAT in BC for the first time is defined as the number of clients 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 since July 2015, and this trend is largely driven the number of clients dispensed buprenorphine/naloxone (Suboxone) for the first time. Notably, numbers of new clients on sustained release oral morphine has risen sharply since June 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 June 2016 as Health Authorities and the BC Centre on Substance Use engage physicians in training and preceptorship activities (partnering knowledgeable and novice prescribers).

  • Each month, between 50 and 70 physicians prescribe OAT for the first time, about 10-15 per Health Authority. 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.

An Overdose Prevention Services (OPS) site 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. Supervised Consumption Services (SCS) sites provide similar services to OPS sites, operating under a federal exemption under section 56.1 of the Controlled Substances Act. There are also other models of overdose prevention services, such as peer-to-peer services, that are not site-specific. 

This monitoring indicator is based on data received from BC Regional Health Authorities operating OPS and SCS sites and is designed to monitor trends for OPS and SCS sites combined. 

There are two core indicators for OPS and SCS sites based on data provided by Regional Health Authorities: 

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

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

Each regional health Authority opened one or more OPS sites from December 2016. Since then, the number of sites have increased, along with location changes or service model transitions. While locations may have been open earlier, site reporting is more comprehensive starting from January 2018, as displayed here. 

In addition to standalone OPS and 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.

Each month, data is available for most, but not all BC OPS and SCS sites (see footnotes below graph). 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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