Exploring potential solutions to B.C.'s opioid overdose crisis

If you want to understand the scope of the long-term crisis British Columbia could face when it comes to fentanyl, it helps to know about a small country of 1.3 million people halfway around the world. 

Estonia had struggled with heroin overdoses for decades — but at the beginning of the 21st century, it was the first country to see significant deaths from fentanyl, through a form known on the country's streets as "China White."

"It was seen as something temporary," said Aljona Kurbatova, the head of Estonia's Drug Abuse Prevention Department at the National Institute for Health Development.

"Things would return to normal, heroin would come back and be the dominating opioid use. But the reality turned out to be different."

Fentanyl fuelled the rise in drug overdoses in Estonia, and by 2012, they had a fatal drug overdose rate of 128 per million — leading to headlines proclaiming the country the leader in European drug fatalities. 

But since 2013, as B.C. has seen its overdose rate skyrocket, Estonia has managed to cut its fatal overdose rate in half.

Kurbatova says that while the number of deaths is now on a downward trend, the country spent too much time debating measures, and not enough time acting. 

"I think the most important thing is you don't waste time. If you really want to learn from us, that's the mistake we made," she said.

"Don't look for some new solutions, because you have them."

Over the next week, CBC Vancouver will be focussing on a few of those possible key solutions that governments, health officials and law enforcement could take in combating B.C's worst drug crisis in a generation.

Here are some of the subjects we'll be exploring. 

1. Short-term Supply

In 2016, there were 85 seizures of fentanyl by Canada Border Services Agency, nearly four times what was seized the year before.

The number of fentanyl-related charges inside British Columbia for 2016 have not been released, but in 2015 there were 2,122 people charged for all drug offenses that didn't involve cannabis or cocaine.

Imports from primarily China and Mexico are widely considered the main source of fentanyl — but the effect of limiting supply through either further domestic or border crackdowns is still being debated.

2. Treatment

Kurbatova says that British Columbia has one big advantage over Estonia: people already have a high-degree of understanding over the concept of harm reduction.  

"We had a very limited availability of substitution treatment. We had very limited ability for needle-exchange services. We didn't have a naloxone program for a long time. We still don't have safe injection sites," she said. 

From the rapid expansion of Vancouver's prescription heroin program, to supporting families better to rethinking how we treat pain in the first place, we'll take a look at how some of the current programs and practices in place can be enhanced.

3. Long-term Demand

And then there are the longer-term proposals, involving changes in our collective national thinking, that could play a role -- from treating root causes like mental illness, trauma and poverty, to overhauling pain education, as well as decriminalization and investing million in programs for kids long before they even consider drugs.

None of these is, on its own, a silver bullet and doing just one in isolation may not be effective.

But Kurbatova's advice to British Columbia is to use all the resources and solutions currently available — before the situation worsens. 

"We took time. We started to increase the funding for policy and services bit by bit. And that's not enough," she said.

"It took us almost 10 years to almost reduce the number of deaths by half. I think you want to do it quicker."

The Fentanyl Fix is a week long series exploring potential solutions to B.C.'s opioid overdose crisis. In 2016, 914 British Columbians died by overdosing on illicit drugs.