Thirty-eight people died from accidental apparent opioid overdoses in 2020 in New Brunswick, according to new figures from the federal government.

It's the highest toll of accidental opioid overdoses in the province since at least 2005, according to figures kept by CBC News, as the country faces an opioid overdose crisis, described by some as a shadow pandemic.

While New Brunswick's numbers fluctuate and are not as stark as those in some other provinces — British Columbia recorded nearly 1,700 accidental opioid deaths in 2020, federal data shows — they're still cause for concern, according to chief medical officer of health Dr. Jennifer Russell.

"There is no question that during COVID, during the pandemic, that mental health and addictions issues and substance-use disorders have definitely increased in terms of number of people being affected, and the severity of the types of symptoms that they see," she said.

Russell co-chairs the special advisory committee on the epidemic of opioid overdoses, along with Dr. Theresa Tam, the chief public health officer of Canada.

They released modelling this month indicating that opioid deaths are projected to remain high or increase, with as many as 1,600 to 2,000 people in Canada predicted to lose their lives to opioid overdoses in each quarter of 2021.

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"A number of factors have likely contributed to a worsening of the opioid overdose crisis during the COVID-19 pandemic in Canada, including the increasingly toxic and unpredictable drug supply; increased feelings of isolation, stress, anxiety and depression; and the limited availability or accessibility of health and social services for people who use drugs, including life-saving harm reduction and treatment," a statement from Tam and Russell says.

Figures from New Brunswick show 13 people died of accidental opioid overdoses between January and June 2021. Those figures sometimes climb as autopsies are completed.

"Will this continue to get worse? I think that can happen based on what is happening with the pandemic," Russell said earlier this month in response to a question about opioid overdoses in New Brunswick.

"Certainly in British Columbia, that has been the trend."

Loss of 38 lives 'devastating'

Hearing that 38 people lost their lives in 2020 is "devastating" for Dr. Sara Davidson.

She is the medical director of River Stone Recovery Centre in Fredericton, a clinic providing "trauma-informed treatment for substance use disorder, with a focus on opiate and stimulant replacement therapy." She sees these deaths as preventable.

Dr. Sara Davidson says the province needs to treat underlying issues, such as trauma and homelessness, before it can address substance use disorder. (Gary Moore/CBC)

"There's so much stigma that's associated with substance use disorder," Davidson said.

"It continues to be something that's very hidden. A lot of people that are dying of overdoses are dying because they're using alone, and COVID-19 has just really exaggerated the amount of isolation that everybody is experiencing."

Many of her clients are dealing with mental health problems, trauma and poverty on top of substance use disorder.

Combined with the pandemic and challenges accessing mental health services, it has created what Davidson described as "a perfect storm."

"It's a tragedy because it is actually a preventable condition," Davidson said.

"It's a treatable condition. It's just one that if we remove the veil of stigma, we'd be able to bring it back into being a health care issue, which it is, and then help it not be a disorder anymore."

Overdose prevention site saw about 200 visits in 18 days

In Moncton, the province's first overdose prevention site has been open for less than a month, but has already seen about 200 visits from 50 different people.

The site, open at Ensemble Greater Moncton's downtown office, offers people a place to test their drugs and use them.

This is the room at Ensemble Greater Moncton where people are able to use their drugs. (Submitted by Debby Warren)

After they use, people can hang out in what they call the "chill-out chairs" to make sure they don't have a negative reaction to what they've taken.

"That's 200 possibilities of people who may have injected elsewhere and may not have had somebody to give them Naloxone or access to 911 or any of that," said Joanne Marshall-Forgie, an overdose prevention site co-ordinator with Ensemble Greater Moncton. Naloxone is a medication that can help reverse the effects of an opioid overdose.

Marshall-Forgie, who works in the consumption room with clients, sees the time people spend at the clinic after using their drugs as vital.

That's the opportunity for staff to chat with clients, who may ask to see a nurse or for help getting into affordable housing.

"Because of the [overdose prevention site], research has shown that people are more likely to access rehab services, more likely to access opportunities for detox, more likely to access health care," she said.

For now, its budget means the overdose prevention site can only stay open during Ensemble's business hours, but Marshall-Forgie would eventually like to see the site open 24 hours a day.

Of the 50 clients who have used the overdose prevention site in its first 18 days, she estimated all but five or six people are precariously housed. Some stay in a shelter, but many are sleeping rough.

"Overdoses are still happening at night outside, where people do not have protection," she said.

Unclear when additional overdose prevention sites could open

Davidson said she's been in talks with Ensemble Greater Moncton to look at developing a safe injection site in Fredericton, with wraparound support that helps people access services such as mental health support.

Implementing overdose prevention sites was listed as a priority in the province's addiction and mental health action plan for 2021 to 2025, but the report doesn't specify when additional sites might open.

New Brunswick has seen more than 2,500 take home Naloxone kits distributed in the province since 2018, according to the province. (Sarah MacMillan/CBC)

Along with safe consumption sites, Davidson said, the province needs greater care for "concurrent disorders," when people are dealing with both addiction and mental health problems, along with homelessness.

"Until all of those are holistically looked at, then we're not really going to be able to help end the issues related to substance use disorder."

According to the province's most recent report on opioid surveillance, 2020 also saw "the highest proportion of hospitalizations for accidental poisonings and the lowest proportion of intentional poisonings."

"The total number of opioid-related poisoning hospitalizations in 2020 were within an expected range; however, there is a notable peak in the proportion of individuals aged 60-69 years compared to previous years," the report says.

Since 2018, more than 2,500 take home kits of Naloxone have been given out through distribution sites in the province.