vancourier.com, February 17, 2012

Insite drug injection site seeing higher number of overdoses

Vancouver has recorded 28 suspected drug deaths in five months.

The number of heroin users at the city’s supervised drug injection site requiring the use of a potentially life-saving medication to counter the effects of an overdose has steadily increased since September.
Coupled with the increased use of Narcan at Insite on East Hastings is the B.C. Coroners Service’s investigation into 28 suspected illicit drug overdose deaths in Vancouver since September, eight of which occurred in January.
None died at Insite but neither the coroners service nor Vancouver Coastal Health would provide the location of the suspected deaths or details of the deceased.
The spike in deaths and the pattern related to Narcan use has led the health agency to circulate posters in the city warning drug users of a potentially dangerous trend emerging.
The health agency believes at least three of the drug overdose deaths in January are linked to heroin—the drug of choice at Insite—but that cannot be confirmed until the coroners service receives results of toxicology tests, likely next month.
“That figure is what we heard, and with some little corroboration from the police, who also heard about them,” said Dr. John Carsley of Vancouver Coastal Health. “No hard figures. It makes it frustrating for us too, obviously, because we want to be able to be on top of it and get the most accurate information we can out there.”
Statistics provided to the Courier from the health agency show the historical average of one to two heroin users per week requiring the assistance of Narcan at Insite climbed to a high of eight in the third week of December.
The statistics show that only for one week in mid-November and in the first week of January did the use of Narcan remain the same, or lower than historical levels since September.
“The thing that we’re puzzling about is why is it up, in general, over the past year,” Carsley said. “We thought initially it just might be a short-lived phenomenon, or maybe there was stronger heroin going on. But I think it’s probably more complicated than that, and I’m not exactly sure why.”
Added Carsley: “There may not be one simple explanation to all of this.”
Mark Townsend of the PHS Community Services Society, whose staff operates Insite in conjunction with the health agency, said the increase in Narcan use and overdose deaths are worrisome.
Townsend said over the past 12 months, staff at Insite have noticed about a 25 per cent increase in overdose interventions. An intervention can range from a nurse giving a user some oxygen to Narcan being used to revive a person from near death. About 600 injections per day occur at Insite.
“It could be a trend, or it could be some evidence of heroin that’s stronger,” Townsend said. “But these things are really complicated. It illustrates that they require vigilance and that’s why the health authority and the police and all these people are doing a much better job at monitoring these things. The good part of this is that people are showing an interest.”
Statistics from the coroners service show there were 66 drug overdose deaths in Vancouver in 2011, although some are still under investigation to determine the exact cause of death.
If the current trend of eight suspected overdose deaths in January were to remain constant, the death toll could reach close to 100 this year.
That would be a substantial increase over previous years, with 57 overdose deaths per year being the average since 2004, according to statistics from the coroners service.
Last year’s 66 deaths were an increase over the 44 in 2010. There were 62 in 2009, 40 in 2008 and 60 in 2007. A total of 454 people died of a drug overdose death in Vancouver between 2004 and 2011.
The coroners service declined to provide detailed information on what type of drug caused the 454 overdose deaths.
However, previous studies and reports have shown heroin and cocaine, or a combination of both, have been the predominant cause of overdose deaths in Vancouver.
A study conducted of Insite users between April 1, 2004 and March 31, 2007 revealed that 42 per cent of injections involved heroin and 26 per cent with cocaine.Morphine was used in 11 per cent of injections.
Studies have also shown many drug users use more than one drug and consume alcohol, which Carsley acknowledged when reminded of what researchers often refer to as “poly drug use.”
“So why should it be different this year than it was last year, in terms of heroin deaths?” Carsley said.
Barb McLintock, a spokesperson for the coroners service, said eight suspected overdose deaths in one month is high for Vancouver.
Statistics indicate only four other times in five years did the city record eight overdose deaths in a month, including April and October 2011.
McLintock said toxicology reports will better determine what caused the recent suspected drug deaths.
“Once we get those, then we’ll send it back to the [coroners service] research unit and get them to dig down into it and see what commonalities we can find,” she said. “Could it be hot heroin? It could, but there’s a lot of other things it could be, too, that could still account for that same spike.”
Meanwhile, the health agency’s posters warning of drug overdose deaths urge drug users to use Insite, to never shoot up alone and to “use a smaller dose on the first hit after a new score, just in case.”
It has been estimated that Vancouver is home to about 12,000 injection drug users, with more than one-third residing in the Downtown Eastside.

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