Supervised Use Sites: Fact-Checking Vancouver’s Drug Overdose Death Rate

The debate over supervised use sites in Denver is heating up, with both advocates and opponents of such facilities — which would legally allow people to use drugs including heroin, methamphetamine and cocaine under medical supervision — throwing out all sorts of facts and figures to support their respective side of the argument.

Westword’s current cover story, “Out of Site,” explores the push for a supervised use site in Denver and the leaders behind it. One of the places where Coloradans are looking for information is Vancouver, which established North America’s first official supervised use site, called InSite, in 2003. Since then, Vancouver has allowed other, unofficial supervised use sites to be established around the city, with the understanding that such sites help prevent overdose deaths. There are no records of anyone dying at a supervised use site...not just in Vancouver, but at sites in any of the other eleven countries that allow them.

Opponents of a site in Colorado have pointed to an increase in overdose deaths in Vancouver as an argument against the concept. However, the numbers cited on radio stations such as KNUS, as well as at demonstrations against supervised use sites, have been all over the map — and are not always accurate.

Multiple times, we’ve heard opponents of supervised use say that in Vancouver — which, with 630,000 people, has a slightly smaller population than Denver’s 710,000 — over 1,380 people died from drug overdoses in 2017, compared to 201 people in Denver that year.

“That says it all right there,” declared KNUS host Peter Boyles on his show, using the aforementioned statistics and blaming the seemingly large discrepancy in deaths (close to 1,200 more people!) on the fact that Vancouver has supervised injection sites, which he believes are spreading drug addiction.

But a fact-check of the numbers shows that 1,380 is actually the number of 2017 overdose deaths for all of British Columbia, not just Vancouver. In fact, according to the City of Vancouver, the number of overdose deaths in that city was actually 375 in 2017.

While 375 deaths is still higher than Denver’s 201 deaths in 2017, there is another key difference between what’s going on in Vancouver and what's happening in Denver, and that’s the prevalence of fentanyl. Along with Vancouver’s precipitous rise in overdose deaths (as seen on the chart below), there has been an increasing prevalence of fentanyl, a synthetic opioid that’s far more potent and unpredictable than heroin.

When Westword interviewed the head of Colorado’s largest syringe-access program, Lisa Raville, about the presence of fentanyl in Denver, she said that her organization, the Harm Reduction Action Center, provides fentanyl testing strips to its participants. The organization has found fentanyl present in about 40 percent of street drugs tested in Denver.

“Some of our folks are telling their dealer, ‘Hey, we know there’s fentanyl in here,’ and sometimes the dealers don’t even know,” she says. The percentage of drugs — even meth — laced with fentanyl or fentanyl analogs appears to be increasing in this city, but is still far lower than in Vancouver, Raville adds. 

“We’ve heard that people are no longer testing their drugs for fentanyl in Vancouver, because people just assume it’s in all their drugs there now,” she says. “Knowing about the presence of fentanyl is important, because you’ll want to change dosage, or do the plunger slower, or make sure a friend has [anti-overdose drug] Narcan on them.”

Fentanyl accounted for 81 percent of the 375 overdose deaths in 2017, according to Vancouver officials. That’s way up from 2015, when Vancouver’s overdose death rate started to rise sharply. That year, fentanyl accounted for 23 percent of the city’s 139 overdose deaths.

A broader study released in late 2018 by the British Columbia Coroner’s Service notes that in 2017 and 2018, fentanyl accounted for roughly 80 percent of overdose deaths across the region. When comparing the overall death rate in the region with that of earlier years, the agency concludes: “Illicit fentanyl-detected deaths appear to account for the increase in illicit drug overdose deaths since 2012 as the number of illicit drug overdose deaths excluding fentanyl-detected has remained relatively stable since 2011.”

The British Columbia study does not mention supervised use sites. But the City of Vancouver’s website does, and actually recommends expanding access to them: "While various harm reduction efforts have been, and continue to be, hugely successful in saving lives, the situation will only really improve with intensified efforts on expanded outreach and harm reduction."