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People carry an empty coffin during a march organized by the Vancouver Area Network of Drug Users (VANDU) to mark International Overdose Awareness Day, in Vancouver, in August, 2023.DARRYL DYCK/The Canadian Press
“This is, frankly, a crisis,” Dr. Perry Kendall, B.C.’s provincial health officer, said as he announced that, owing to a troubling surge in drug overdoses and deaths, he was declaring a public health emergency.
That was on April 14, 2016.
A full decade and 18,000 deaths later, the crisis persists. The urgency to act? Not so much.
The emergency declaration allowed for better collection of data and sparked a lot of media interest which, in turn, forced governments to act. But years of shocking overdose numbers have left us largely inured to the carnage wrought by the toxic drug crisis.
Annual overdose deaths rose above 2,500 from about 500 pre-emergency, and recorded overdoses peaked at more than 40,000 in 2024. Many survivors suffer lasting sequelae like brain damage.
With 18,000 lives lost, B.C. counts cost of 10-year drug emergency
That’s not to say there hasn’t been a political and policy response. In fact, we’ve thrown everything but the kitchen sink at the toxic drug crisis, just not in any coherent or sustained fashion.
All manner of harm-reduction policies have been tested, from free naloxone kits to supplying free drugs to select users.
But not all the approaches have been embraced, and the more radical ones, like decriminalization, have sparked wicked political backlash.
Well-meaning policies have been complicated by related social problems like homelessness and deinstitutionalization of patients with severe mental illness.
Street disorder, open drug use, and homeless encampments – symbols that law and order have lost control – have infuriated the public.
A decade ago, when the emergency was declared, B.C. had a single sanctioned supervised-consumption site, Insite in Vancouver, which had survived a concerted effort to have it shut down.
Brain injury part of a far-reaching shadow crisis amid overdose deaths in B.C.
Today, there are 58 free-standing supervised consumption and overdose prevention sites in the province and nine others in hospitals. But not all have kept pace with the reality that most opioid-based drugs are now principally smoked, not injected.
There are more than 100 drug-checking sites in the province, but they test only a tiny fraction of what is consumed.
Overdoses in public are also commonplace in cities big and small. The province distributes more 400,000 naloxone kits a year. Paramedics respond to an average of 108 overdoses daily, and firefighters and police do their part too. The trauma among first responders is palpable.
Efforts to control supply of fentanyl and other street drugs have had mixed results. China, the main source of criminal precursors, has cracked down on suppliers, and the U.S. has stepped up pressure on Mexican cartels.
But when borders were shut down during the COVID-19 pandemic, domestic production burgeoned. Public health officials have noted a more toxic drug supply over the past decade.
Street drugs are also increasingly adulterated. It is not unusual anymore for drug users to buy what they think is cocaine or crack and get a powder or pill that is a cocktail of five substances instead.
Advocates have long argued that the best solution to the toxic drug problem is to legalize drugs and provide a regulated supply – essentially what was done with alcohol when prohibition ended.
B.C. health authorities tried to allow purchase of regulated heroin without prescriptions, court hears
There are long-standing “safer supply” programs that have been successful, but there are fewer than 4,000 participants in a province with an estimated 225,000 drug users. The programs have also been plagued by diversion of drugs, an issue that lends itself well to rage-farming.
There was also a three-year experiment where possession of a number of drugs was decriminalized, but it was deemed a failure because it led to open drug use and street disorder.
So now we’re returning slowly to embrace more stick and less carrot. The provincial government is promising more mandatory treatment. Yet, B.C. still has a mere 3,700 addiction treatment beds – only 790 more than when the public health emergency was declared.
The dictionary definition of “emergency” is “a serious, unexpected, and often dangerous situation requiring immediate action.”
What the toxic drug crisis requires as well is sustained and varied co-ordinated policies. The solution to the overdose crisis is not be found in any one action, but in a suite of measures.
A comprehensive strategy was well-articulated in “A Framework for Action: A Four-Pillar Approach to the Drug Problems in Vancouver,” a policy paper authored by Donald MacPherson when he was the drug policy co-ordinator for the City of Vancouver back in 2001.
Had we acted forcefully on those four pillars – prevention, harm reduction, treatment and enforcement – 25 or even 10 years ago, we wouldn’t have the enduring crisis we are suffering today.
