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As we acknowledge the ongoing opioid crisis, we reflect on our role in providing solutions.
As the opioid crisis continues to affect communities across British Columbia, the role of family practitioners has never been more critical. August 31, International Overdose Awareness Day, serves as a poignant reminder of the devastating toll that overdose takes on individuals, families, and communities. In an interview with the Vancouver Division of Family Practice Mental Health and Addictions Committee Chair Dr. Lindsay Mackay, who provides addiction medicine care in the Downtown Eastside, we explore the profound impact of this crisis on the medical community and the pivotal role family doctors play in addressing it. Dr. Mackay sheds light on the challenges faced by practitioners and offers actionable insights into how they can contribute to solutions that go beyond the clinical setting, tackling the broader social determinants of health and toxic unregulated drug supply. Through compassionate care, education, advocacy, and collaboration with other sectors, family physicians are uniquely positioned to make a meaningful impact in mitigating this crisis and supporting their patients and communities.
According to BC’s Coroners Service, 2,511 fatal overdoses were recorded in the province during 2023. This shocking statistic equates to 6.9 deaths each and every day, a 5% increase over 2022. Of the victims, 7 in 10 were between 30 and 59 in age, while more than three quarters were male. Unregulated drug toxicity was the leading cause of death amongst British Columbians between the ages of 10 and 59, accounting for more deaths than homicides, suicides, accidents and natural disease combined. Fentanyl and its analogues were the primary driver, appearing in more than 85% of test results conducted.
The situation is even more alarming in Vancouver’s Downtown Eastside, where the rate of death was 12 times that of the provincial average.
As Dr. Lindsay Mackay, Mental Health and Addictions Committee Chair at the Vancouver Division of Family Practice explains, even these troubling statistics fail to provide the true scope of the problem.
“Not only are the devastating number of deaths rising, there was an average of 116 calls every day to Emergency Health Services for overdoses in 2023, a 25% increase from the previous year” she notes. “Even with expansion of substance use services, harm reduction education, overdose prevention sites and widespread availability of naloxone, the number of fatalities are increasing.”
Dr. Mackay prefers the term ‘toxic drug poisoning crisis’ as opposed to ‘drug overdose’.
“Overdose is a bit of a misnomer,” she explains. “It implies a person took too much, whereas overdoses are typically caused by toxic contaminants and variable potency of the unregulated drug supply.”
The theme of 2024’s International Overdose Awareness Day is ‘Together We Can’, appropriate, considering the societal nature of the problem. Tackling the issue involves addressing mental health, racism, health inequities, toxic drug supply, and social determinants of health.
While family doctors are key to the effort, so too are those within the broader medical system, as well as government agencies, community organizers, people with lived experiences, and the community as a whole.
Despite these limitations, Dr. Mackay provides five key ways that family physicians can (and do) play a pivotal role.
The first step is to start a conversation about substance use. “It’s important to ask questions in a non-judgemental manner, ensuring that the patient feels supported as a partner in their care and doesn’t feel stigmatized,” says Dr. Mackay. Once a conversation is started, family physicians can screen for substance use disorders and discuss the impact substance use is having on their patient’s lives.
Harm reduction education is essential to provide for anyone who uses substances including those without a substance use disorder. It’s important to make sure that people understand the risks associated with substance use and the steps that can be taken to reduce harm.
“Naloxone kits are readily available at pharmacies and patient education should be provided on how to use them, including their family members and friends” says Dr. Mackay. “There is also the Lifeguard Digital Health app for those who use alone. People should be aware of and encouraged to use overdose prevention sites, free drug checking services and harm reduction supplies.”
“As family physicians providing longitudinal care for our patients, sometimes over their lifetime, we are well suited to provide standard of care treatments for opioid and other substance use disorders,”explains Dr. Mackay. “ If a patient is prescribed opioids and is using opioids for pain, family physicians can provide education and monitoring to help prevent harm and the development of an opioid use disorder.”
Family physicians may not feel comfortable or have not been trained in providing care for opioid and other substance use disorders. . In this case, patients can be referred to addiction medicine clinics, psychosocial resources and bed based withdrawal management (detox). There is also a 24/7 Addiction Medicine Clinician Support Line that links providers to addiction medicine specialists for treatment guidance.
“Advocacy, awareness, policy support, and community engagement are all important ways to contribute,” says Dr. Mackay. “This can take place at an individual, institutional, political or a community level. Problematic substance use is not just a medical concern, it involves a multitude of psychosocial and systemic factors and our system has sadly failed far too many people. Advocating for change that helps improve access to care, reduces stigma and harms is essential in saving lives.
Family practitioners find themselves on the front line of this crisis. You see its impacts on your patients, their loved ones and witness the harmful effects it has within your communities. Many family physicians have experienced loss and the devastating impacts from substance use in their own lives.
Our primary care system is in crisis and the capacity of most family practices is extremely limited. Resources are finite and awareness of available resources is imperfect.
Dr. Mackay shares the frustrations of many other physicians when she speaks about the increasing toxicity of the unregulated drug supply.
“ We are all too frequently hearing about new toxic contaminants and increasing potency in the unregulated drug supply, which not only increases the risk of harm, complications and death. Our tool kit of treatments are becoming less effective as unregulated drugs become more potent and toxic. It’s challenging, and a big point of moral distress for family physicians.”
The Vancouver Division of Family Practice is committed to providing support. We do this by engaging you, highlighting existing resources, and keeping you updated on developments. This ongoing effort will require your valuable feedback, which will be critical to the development of an actionable strategy.
If you currently offer substance use care or have been considering it and haven’t yet started, we’d love to hear from you. Your insights are invaluable, and we invite you to reach out to us at membership@vancouverdivision.com. Any collaboration done with family physicians to support Vancouver Division projects will be remunerated at the current sessional rate.
British Columbia Centre on Substance Use (BCCSU) Provincial Opioid Addiction Treatment Support Program
https://www.bccsu.ca/provincial-opioid-addiction-treatment-support-program-poatsp/
BCCSU Licensed Treatment and Supportive Recovery Services in BC
https://www.bccsu.ca/bc-recovery-services/licensed-treatment-and-supportive-recovery-services/
BCCSU 24/7 Addiction Medicine Clinic Support Line
Vancouver Coastal Health Access Central Detox Referral Line
https://www.vch.ca/en/service/access-central-detox-referral-line
Next Steps Towards a Substance Use Strategy
https://vancouverdivision.com/wp-content/uploads/2024/02/20231103-Substance-use-next-steps-v2.pdf
Guidelines for the Clinical Management of Opioid Use Disorder Webinar Recording
A Letter from Dr. Lindsay Mackay, Mental Health and Addictions Committee Chair
International Overdose Awareness Day website, featuring resources and ideas for getting involved.
Public Safety and Solicitor General Report on Toxic Drug Deaths in 2023
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202 – 777 West Broadway, Vancouver, BC V5Z 4J7
Main Office: 604-569-2010
Fax: 604-321-5878
Site Map
Get In Touch
202 – 777 West Broadway, Vancouver, BC V5Z 4J7
Main Office: 604-569-2010
Fax: 604-321-5878
Site Map
Get In Touch
202 – 777 West Broadway, Vancouver, BC V5Z 4J7
Main Office: 604-569-2010
Fax: 604-321-5878
Site Map
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