Michelle Gamage, Local Journalism Initiative Reporter, The Tyee

The Tyee has spent over half a year trying to figure out how many people are overdosing while they are patients at British Columbia’s hospitals.

In February, we published a summary of what we’d managed to learn after filing seven freedom of information requests, or FOIs, and elevating two of those requests to complaints with the Office of the Information and Privacy Commissioner.

The FOIs asked the seven health authorities to share how many patients had experienced non-fatal overdoses in each of their hospitals per year, from 2020 to 2025.

Of those seven health authorities, only Provincial Health Services and Providence Health released any data. Interior Health and Vancouver Coastal Health refused on the grounds the data would violate patient confidentiality, and we’re still waiting to officially hear back from Island, Fraser and Northern Health, despite the FOI process legislating the government body respond to the request within 30 days.

We sent the requests over seven months ago.

The Tyee reached out to Health Minister Josie Osborne and asked for an interview after publishing the summary of what we’d found. Our main goal was to find out how the province was collecting this data from the health authorities in order to make decisions about where and when to open overdose prevention sites adjacent to hospitals.

The Health Ministry proposed we speak with B.C.’s top doctor, provincial health officer Dr. Bonnie Henry, instead.

Henry has been closely watching the unregulated toxic drug overdose crisis for years and has, in the past, called on the province to expand its safer supply program.

The following interview has been lightly edited for length and clarity.

The Tyee: How are health authorities directed to collect data on non-fatal overdoses in health-care facilities?

Dr. Bonnie Henry: There is no direction to collect that data. It isn’t something that is required to be reported, so it can vary depending on the facility.

We don’t have a systematic way of identifying everything that happens to any individual when they’re in the hospital. I often jokingly say we don’t insert a chip into somebody when they’re in the hospital. People move around a lot; they may go to different beds, different wards, different places. There is a discharge summary for everybody who is in hospital and it does contain information on the diagnosis that happened while in hospital. It eventually gets coded and those codes give us a sense of the types of diagnoses that people have when in hospital, but it can be months after their discharge before that data is entered into a database.

That’s what the Canadian Institute for Health Information collects from hospitals across the country, and it helps us get a sense of what’s going on.

But day to day or month to month it is very hard to know.

During the pandemic the only way we knew how many people were in ICU with a COVID-19 diagnosis was if a nurse or ward clerk in the ICU counted the individuals in that day and called it in to the ministry. Those numbers were collated for the numbers we presented.

The purpose of charts, hospitalizations and care is individual. The collection of data on that is secondary, to be honest.

For some people it may not even be recognized that they had an overdose.

Occasionally after someone has had a surgery, especially older people who are prescribed opioids or narcotics for pain, they can overdose on the medication they’ve been prescribed. These overdoses can go undetected.

We do know a little bit about when we have overdose prevention services within a hospital, how many people might be or how many encounters they may have in a period of time, but 10 encounters may represent five people coming twice.

It’s really challenging to pin down a number.

Wouldn’t that data be important? We’re going into Year 10 of this crisis. Doesn’t that seem like something we should be counting or creating a way to track?

What would the clinical purpose be? One of the things we do track regularly are overdoses that occur in community for which there is a response.

Early on, we were collecting numbers of people who went to supervised consumption services, overdose prevention services. But it’s unwieldy to collect that information. We don’t have computers. People don’t sign in. We had a general idea, and that’s how we can say things like 17,000 deaths were averted by having these services in place. We know how many doses of naloxone we give out. We don’t know how many doses are used, but we know how many go out in a different part of the province in any given week or month. We do a systematic review of ambulance calls related to drug overdoses because every single ambulance call is in a database.

But people go to hospital for many different reasons.

For example, somebody may have an overdose, be given naloxone and is picked up by the ambulance because they’re not responding. We’re seeing that an awful lot recently with medetomidine in the drug supply.

[Editor’s note: Naloxone can temporarily reverse an opioid overdose but does nothing for non-opioid tranquillizers such as medetomidine.]

People are having prolonged respiratory depression, so they don’t breathe well for long periods of time and they’re taken to hospital.

While in the emergency department they may get treatment for an ulcer on their leg and they may be admitted because they have an infection and need antibiotics. They may or may not go to the overdose prevention service if they’re available. They may sign themselves out against medical advice.

It’s a very complicated system. It’s not as simple as saying “How many people today in St. Paul’s used too much medication, or illegal medication?” People hide that and we just don’t know.

How does a health authority or the Health Ministry determine, then, if it should open an overdose prevention site at a hospital?

That’s a decision made locally by the hospital that knows what’s going on within their facility. They partner with the health authority to see what services are needed in different places based on what people are experiencing in those facilities at that time. That’s why things like overdose prevention services are designed to be emergency health services that can be flexible.

Back in late 2016 when this all started, we were seeing a dramatic increase in emergency rooms being flooded with people because there was no place for people to go to be witnessed. People were brought in by ambulance, particularly in Vancouver but also here in Victoria and other parts of the province.

It became very clear, when we started looking at it, that it was more than just Vancouver, and what we were seeing was people were using in alleys and places where they couldn’t be found.

We had some very tragic cases of people being found in hospital bathrooms, places where they were trying to hide their use. As things were exploding, these overdose prevention services organically started to assemble, particularly in places like the Downtown Eastside and here in Victoria on Pandora Avenue. It was mostly peer-driven but supported by health authorities. They were places where people felt safe to go use their drugs and if they overdosed there was somebody there who knew what to do.

What we’ve done over the last number of years is tried to develop some clinical guidance to support people. It’s been a very challenging decade.

I was asking specifically about opening overdose prevention sites at hospitals. You mentioned hospitals know what’s going on, so they can determine what services they need, but then you’re also saying it’s too challenging to have a single form of reporting for overdoses. Doesn’t that sound like there’s a form of reporting that’s already happening?

I don’t think those are the same things, Michelle. I’m trying to explain to you. At the health authority we know where overdose prevention services are, but that’s not following an individual in a hospital on any given day who may or may not be using illegal drugs, may or may not be overdosing. They’re two separate things.

In hospitals where we’ve had a couple of hospital facility overdoses — here in Victoria for example, and in Nanaimo — there’s been some controversy about whether these are needed or not. That speaks to how it depends on who is coming in on any day, how many people are there, who is looking after them and what services are available for them. That’s a decision made by the hospital, by the local health authority, by the addictions physicians who are involved. It’s a very challenging thing.

Speaking of overdose prevention sites, where are the nine overdose prevention sites that are operating in hospitals across the province?

They’re all overdose prevention services. They’re not sites, because they move around and can be in different places at different times. The ministerial order that allows them to exist under a public health emergency directs health authorities to provide overdose prevention services where they’re needed. Because they move around, I actually don’t know off the top of my head. But they are listed on the BCCDC website, which is updated periodically.

[Editor’s note: The BC Centre for Disease Control lists harm reduction services on its Toward the Heart website. The site lists 21 hospitals that are distributing harm reduction supplies, such as naloxone, safer sex supplies or sterile drug equipment. Overdose prevention services are not listed, even at the current St. Paul’s Hospital, which has operated an overdose prevention site since 2018.]

Providence Health Care CEO Fiona Dalton says the new St. Paul’s Hospital may or may not get an overdose prevention site. I was surprised by that because last summer the Health Ministry was talking about how it wanted to open more overdose prevention sites, or services, because of how successful the St. Paul’s location was. Why end this service?

I don’t know what the plan is for the new facility but if the services are needed, then they’ll be added to the facility. It doesn’t need to be a specific space necessarily, but it will have the ability to have overdose prevention services if they’re going to be needed at that new facility.

If there are only nine overdose prevention services operating at hospitals across the province, is that because only nine are needed?

That’s because those are areas where people have determined that, locally, that’s where they’re needed. I know some of them have changed over time and that some of them have decreased because they’re not needed as much. Lately with the increased number of people that we’re seeing, it’s been a really challenging time, primarily in the community.

I know you didn’t make this decision, but through the FOI process — when The Tyee tried to access non-fatal overdose numbers in hospitals — we were told we couldn’t have the amalgamated data for a year because the information could be identifying. I’m still confused by how saying that, hypothetically, there were five or 300 non-fatal overdoses in a hospital in a year could be identifying in any way. What am I missing here?

One of the things we are very protective of is the ability to link data that’s publicly available, small numbers and individuals. The big thing that we’re statistically worried about is small numbers in a small population. A small number in a Vancouver hospital is not a big deal. It’s not identifiable. But a small number, even two people, in Bella Bella is, because you can put it together with the person, place and time. If you know who is in hospital and you know what context it’s in because it’s released publicly, then people can connect to an individual, potentially.

So there’s a couple of things we look at: the population size, where the hospital is, the number of people, or how rare an event is. We will do things like use age groups, like one to 10, instead of reporting “age six,” to make it less identifiable.

I know this personally, but people can take what seems like very innocuous information and there’s many things you can bring to it. It’s called the mosaic effect. We’re very sensitive about that.

So if we protect patient confidentiality in that way, why report the number of fatalities?

Fatality numbers are the ones that are reported by the coroner. Anybody who dies unexpectedly, whether it’s in hospital, at home or in community, by law gets reported to the coroner. The coroner has the authority and the ability to report those on a periodic basis and they’re not generally identified into the small numbers in hospitals. They’re reported in health regions for that very reason, so they’re not a small area with a small population where somebody could see themselves in the data.

Premier David Eby said the new St. Paul’s Hospital will focus on getting people into treatment. But not all people who use drugs want to go into treatment and they may just want to access health services without being put into treatment. What concerns would you have if the hospital closed its overdose prevention site and just focused on treatment?

Not everybody actually has an opioid use disorder and needs treatment.

Having said that, I think focusing on supporting people to get on opioid agonist treatment while they’re in hospital is something that we need to do better at. There’s some good data that’s coming out very soon, and other data from other places. We know that if people have started opioid agonist treatment in hospital, they’re more likely to stay on it and their risk of overdosing after leaving hospital and coming back to hospital goes down quite dramatically. It’s a goal we have. It’s not as black and white as “People will only get treatment.” We’ve got to see whether overdose prevention services will be needed at the new St. Paul’s.

I’m just so surprised that an overdose prevention site might not be opening at the new site.

I know it’s not satisfactory in its entirety. My belief, and I’ve had a conversation with the minister about this very recently, is that we still strongly support the need for overdose prevention services where they’re required. I can say that I believe that the new St. Paul’s, as with the old St. Paul’s and the Dr. Peter Centre, will have the services that are required for the people that they support in the community. 

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