Pacific Summit on Drug User Health 2009

Pacific Summit on Drug User Health 2009 HEALTH STATUSOF PEOPLE WHO USE ILLICIT DRUGS INBRITISH COLUMBIA

Overview: Prevalence of Drug Use in British Columbia • Number of Persons Using Injected Drugs by Geographic Area • Number of Crack Smokers in British Columbia VANDU Pacific Summit 2009 2

Number of Persons Using Injected Drugs Canada : British Columbia : Vancouver : Downtown Eastside : 125,000 40,000 10,000-12,000 5,000 VANDU Pacific Summit 2009 3

Number of Crack Smokers in British Columbia British Columbia: Downtown Eastside: 55,000 (Approx.) 7,000 (Approx.) VANDU Pacific Summit 2009 4

Overview: Prevalence of Drug Use in British Columbia • Number of Persons Using Injected Drugs by Geographic Area • Number of Crack Smokers in British Columbia VANDU Pacific Summit 2009 5

CCENDU Report, 2005 VANDU Pacific Summit 2009 6

Illicit Drug Deaths In 2005, 146 illicit drug deaths in BC (down from 417 deaths in 1998). In 2005, deaths in the DTES were 7 times the provincial rate. Highest rate of overdose deaths for people between the ages of 31-40 Overdoses for men was more than double the rate for women. Individuals of First Nations ethnicity accounted for 9.6% of illicit drug deaths although only 4.4% of the BC population. VANDU Pacific Summit 2009 7

Death rates attributable to illegal drugs VANDU Pacific Summit 2009 8

Illicit Drug Deaths By Local Health Area of death 2006 (n= 223) Source: http://www.harmreductionjournal.com/content/6/1/9 VANDU Pacific Summit 2009 9

Illicit Drug Deaths By Gender VANDU Pacific Summit 2009 10

Illicit Drug Deaths In B.C. by Ethnicity VANDU Pacific Summit 2009 11

VANDU Pacific Summit 2009 12

Overview: Non-Fatal Drug Overdose 1) Ambulance calls for the 2 stations that serve the majority of DTES calls VANDU Pacific Summit 2009 13

Overview: Blood-Borne Pathogens 1) HIV Prevalence and Newly Positive HIV Tests Vancouver and B.C. 2) Newly Positive HIV Tests with Identifiable Risk Factor 3) Reported Hep C Rates in Vancouver, B.C. and Canada 4) Rate of Newly Identified Hep C by Health Service Delivery Area VANDU Pacific Summit 2009 15

HIV Rates The prevalence of HIV among IDUs is reported to be somewhere between 17% to 31%. In Vancouver, HIV prevalence among Aboriginal IDUs has increased from less than 5% in the early 1990s to approximately 40% in 2004. (CCENDU) VANDU Pacific Summit 2009 16

Hepatitis C Rates - Vancouver, BC and Canada * DTES core HCV rate 2007= 788/100,000 Source BCCDC iPHIS VANDU Pacific Summit 2009 18

Overview: Hospitalization Rates 1) Hospitalization Rates Attributable to Illegal Drugs by Region VANDU Pacific Summit 2009 20

Hospitalization Rates Attributable To Illegal Drugs 37% increase 2002 to 2007 VANDU Pacific Summit 2009 21

Overview: Methadone and Opiate Treatments • B.C. Methadone Stats • B.C. Methadone Program Clients by Age and Gender • B.C. Methadone Program Clients Receiving Methadone Maintenance • Info on First Nations Access To Methadone • Info on Buprenorphine VANDU Pacific Summit 2009 22

B.C. Methadone Statistics A small number of physicians are licensed to prescribe methadone The CPSBC no longer reports on the geographic distribution of methadone prescribing physicians, but in 2001, 44% of methadone prescribing physicians were located in the Lower Mainland, 22% on Vancouver Island or the Gulf Islands, 8% in the Okanagan, 7% in Fraser Valley, and 4% in Northern BC. Doses are dispensed on a daily basis, so it is difficult to maintain a regular job for many people The BC government pays pharmacists $16.30 for every daily dose of methadone they dispense. If a pharmacy can get a user to fill all of their prescriptions at its outlet, it receives approximately $6,000 a year in dispensing fees, just for that customer (CBC News, Sept. 2008) In spite of the College of Pharmacists ‘no inducement’ policy, many methadone-distributing pharmacies in the DTES provide coffee and cookies and offer cash kickbacks. VANDU Pacific Summit 2009 23

First Nations Access to Methadone The First Nations population has a higher illicit drug use mortality rate than the BC population as a whole. Despite this fact, methadone is not available on reserve Those seeking services may be forced to travel long distances to larger urban areas to obtain methadone. Although First Nations may have access to methadone while living in other jurisdictions there is a lack of comprehensive harm reduction services available to those living in rural and reserve communities. VANDU Pacific Summit 2009 26

Buprenorphine Buprenorphine has been available as SUBOXONE in the United States since 2003. In Europe, buprenorphine was introduced during the mid-90s. It is available in 17 countries in Europe alone. Today, more than 400,000 opioid-dependent patients worldwide have been treated with buprenorphine. SUBOXONE was approved by Health Canada in May of 2007 Buprenorphine may increase safety and treatment access for opioid-dependent patients. Taken on its own, SUBOXONE has lower potential for fatal overdose than a full opioid agonist because it has a limited effect on reducing breathing. The effect of buprenorphine peaks at 1–4 hours after the initial dose. Although buprenorphine has not yet been priced in Canada, in the United States the cost of a month’s supply of the drug may be as much as 10 times that of the cost of a standard month’s supply of methadone. (as of 2006) VANDU Pacific Summit 2009 27

Overview: Needle Exchange & Harm Reduction Supplies • Info on Needle Distribution in B.C. and Needles Distributed by Region • B.C. Needle Distribution Map • B.C. Needle Exchange Map • Harm Reduction Supplies Distributed by the Vancouver Health Service Distribution Area VANDU Pacific Summit 2009 28

Provincial Needle Distribution Needles Per Population The Harm Reduction Supply Service (HRSS) Program, previously known as the Needle Exchange Program was transferred to Provincial Health Services Authority on April 1st 2003 From April 1st 2006, to February 15th 2007, (10.5 months) 5,023,600 sterile needles and syringes were ordered from the BC Center for Disease Control for the entire province. The greatest proportion (52%) was ordered by Vancouver Coastal, followed by the Vancouver Island (24%), Interior (9%), Northern (8%) and Fraser (7%) Health Authorities. VANDU Pacific Summit 2009 29

Harm Reduction Supplies - Vancouver In BC, 5 million syringes; 2.4 million water vials distributed/yr 2008/09 -- 218 x 100 ft plastic tubing – cut into 4 inch mouth pieces; 37,200 wooden push sticks Source: BC Centre for Disease Control pharmacy database VANDU Pacific Summit 2009 32

Overview: Enforcement, Court, Police and Prison • Vancouver and B.C. Enforcement Stats • B.C. Drug Offences by Crime Type • B.C. Drug Offences by Drug Type • Breakdown of Federal Offences • Info on Legal Aid Cuts for Procedural Offences • Canadian Drug Charge Conviction Stats • Stats on Drug Use In Canadian Prisons VANDU Pacific Summit 2009 33

Enforcement In Canada, 70% of federal funding to address the drug problem goes to enforcement-based initiatives. Locally, VPD’s budget for District 2 has nearly doubled ($6.7 million in 1995 ---- $11.2 million in 2001) VANDU Pacific Summit 2009 34

Drug Offences in BC, 1998-2007 Source: Police Services Division, Ministry of Public Safety and Solicitor General, BC VANDU Pacific Summit 2009 35

Drug Offences in BC, 1998-2007 Source: Police Services Division, Ministry of Public Safety and Solicitor General, BC VANDU Pacific Summit 2009 36

Breakdown of Federal Offences (2006-2007) Statistics Courtesy of Corrections and Conditional Release Statistical Overview 2008, available online at: http://www.publicsafety.gc.ca/res/cor/rep/2008-04-ccrso-eng.aspx#a3 VANDU Pacific Summit 2009 37

Legal Aid Cuts for Procedural Offences Legal Aid cuts which came into force on April 1, 2009 have withdrawn access to legal aid lawyers to those charged with procedural offences, including breach of probation, breach of bail conditions or failure to appear. These persons may face sentences of up to six months in jail. The only access to help navigating the justice system will be brief meetings with duty counsel, who can discuss the charges but will not represent these individuals in court. Information courtesy of the CBC News, available online at: http://www.cbc.ca/canada/british-columbia/story/2009/04/01/bc-legal-aid-cuts-could-jam-courts.html VANDU Pacific Summit 2009 38

Drug Charge Convictions Drug-related cases are less likely to result in conviction than cases in general. In 2006/2007, 55% of adult cases and 48% of youth cases involving drug-related charges resulted in a finding of guilt. This compares with 65% and 60% for cases in general. A higher proportion of drug-related cases were stayed, withdrawn, dismissed or discharged compared with cases in general. In 2006/2007, half of all adults convicted of drug trafficking were sentenced to custody, compared with 16% of adults convicted of drug possession. For youth, probation was the most common sentence for both possession and trafficking convictions. VANDU Pacific Summit 2009 39

Drug Use in Canadian Prisons • 12% of inmates reported using IV drugs only while in prison • 68% admitted to having used them both on the street and in prison • 23% reported sharing a needle only in prison • 47% admitted to sharing needles both in and out of prison A study of self-reported drug users in Canadian penitentiaries found that: VANDU Pacific Summit 2009 40

Overview: Women and Drug Use • Stats on Women’s Health from “Me I’m Living With It, VANDU Women’s Report” • Women’s Health Stats Continued • Child Apprehension and Harm Reduction Stats from the SHEWAY Pregnancy Outreach Program • Stats on the Over Representation of Aboriginal Children VANDU Pacific Summit 2009 41

Women’s Health Health Issues 43.2% had 3 or more chronic health problems 23.6% had 4 or more chronic health problems 56% had Hepatitis C 40% had dental problems 32.7% reported mental health problems 30% had lung problems 16% were HIV positive 14% were diabetic From “Me I’m Living It VANDU Women’s Report”: VANDU Pacific Summit 2009 42

( Women’s Health Continued ) Drug Use 83.7% of the women we spoke to smoked crack 85% of women who reported that they inject drugs also reported smoking crack 95% of women interviewed were on some form of income assistance. Among those women, many identified welfare cheque issue day (or week) as the time they use drugs the most 17% of women reporting an overdose in the past year. VANDU Pacific Summit 2009 43

( Women’s Health Continued ) Other Impacts on Health: 61.2% of women reported having health problems related to their housing situation 79.2% of women reported experiencing violence that currently impacts their physical health and mental health 90% of women talked about problems with access to prescription medications 32% of women interviewed identified mental health concerns as one of their chronic health issues 70% of women interviewed described stigma as a regular aspect of their primary health care experience VANDU Pacific Summit 2009 44

Child Apprehension & Harm Reduction The SHEWAY P.O.P (Pregnancy Outreach Program) Prenatal/delivery care: 30% of women had no medical/prenatal care at intake and at the time of the birth of their children 91% of women were connected to a physician or midwife Improvement in nutritional status: 79% had nutritional concerns at intake and this was reduced to 4% at six months postnatal. Decrease in substance misuse: (estimated) 24% of women accessing services in the 1998 year met one of the three indicators of a positive outcome in relation to their substance use: had accessed alcohol and drug treatment services while also accessing services at Sheway; were not using substances at discharge; and/or were stabilized on methadone at discharge Improvement in housing: 27% had no fixed address and 65% had housing concerns at intake, and by six months after the birth of their child, this was reduced to 6% Parenting and custody: For 22% of mothers, the Ministry did not become involved at all, and for an additional 36% the Ministry was involved for the provision of support only. Thus for over half the mothers (58%) child custody did not become an issue. VANDU Pacific Summit 2009 45

Over Representation of Aboriginal Children In 2006, the number of Aboriginal children in care surpassed the number of non-Aboriginal children for the first time. Less than 16 percent of these children are placed with an Aboriginal caregiver Less than five percent of MCFD staff are Aboriginal (Pivot, Broken Promises Report) “Aboriginal Family” by Don Baker VANDU Pacific Summit 2009 46

Overview: Harm Reduction • Harm Reduction Overview • Safer Crack Smoking Info and Reported Drug Use Stats by VIDUS Cohort • Safe Crack Kit Information • Reach of Traditional Helping Systems • Reach of Comprehensive Four-Pillar System VANDU Pacific Summit 2009 47

Harm Reduction Humanistic Approach to substance use which aims at keeping people safe, minimizing death, disease, and injury associated with higher risk behaviour Examples in British Columbia include: Needle Exchange Programs Safe Injection Facilities Crack Kit Distribution NAOMI Project – Prescription Heroin Trials VANDU Pacific Summit 2009 48

Safer Crack Smoking The CCENDU Report highlights a downward trend in injecting cocaine, speedballs, and heroin. Crack and crystal meth use seem to be on the rise. Studies suggest crack users may seroconvert HIV at a significant rate1, and suggests crack users are less likely to be reached by current harm reduction initiatives2 1. Montaner 2. SCORE Report VANDU Pacific Summit 2009 49

Safe Crack Kits A year after 10,000 safe crack kits were distributed in Vancouver, 100% of the survey participants reported smoking crack, only 39% reported injection drug use, suggesting that over 60% of these individuals may not be reached by other harm reduction initiatives such as needle exchange. SCORE Report VANDU Pacific Summit 2009 50

Pacific Summit on Drug User Health 2009