More than 15,000 people have died of drug poisonings in British Columbia (BC) since the public health emergency was declared in 2016. Despite the positive impact of a broad range of services, solutions, and interventions, the number of deaths from unregulated drugs (also referred to as illicit drugs) is now more than 2.5 times greater than when the crisis was first declared, with 2023 being the deadliest year so far. Data to date for 2024 are showing a small decrease compared to the first seven months of 2023, with approximately 6.2 people on average dying per day in July 2024.
Unregulated drugs are now the leading cause of unnatural death in BC, accounting for more deaths than suicide, accidents, and natural diseases combined, and have in fact reversed the trend of increasing life expectancy in BC. This emergency reaches into all corners of our province, into every community — our friends, colleagues, neighbours, and family members are all impacted.
Earlier this year, former BC Chief Coroner Lisa Lapointe presented the 2023 year-end data for lives lost to toxic drugs, showing that more than 2,500 people in BC died from unregulated drugs in 2023, the largest number of drug-related deaths ever reported to the coroner’s service. In Lisa’s remarks, she described her experience speaking to parents who lost children to this emergency. They often shared the hope that their children had not died in vain. That other families would not have to go through the same loss. That someone was listening.
Harm Reduction Solutions
Alternatives to unregulated drugs, and enabling access for people who need them — or safer supply — is one harm reduction solution along a continuum of services that aims to save lives by providing drugs of known quality, concentration, and composition. In BC, the current Prescribed Safer Supply (PSS) policy is limited, reaching only a small number of people.
A recent report released by Dr Bonnie Henry, BC’s Provincial Health Officer (PHO), recommends improved access to alternatives to unregulated drugs for people at risk of drug poisoning and death in BC. The PHO report echoes the recommendations from the BC Coroners Service Death Review Panel in 2023, specifically exploring programs that enable access to non-prescribed alternatives.
Root Causes of this Crisis
The social determinants of health such as housing, employment, and access to healthcare, as well as the impacts of colonialism, racism, and stigma, drive inequities and exacerbate an already complex issue. However, the underlying cause of the crisis is drug prohibition.
In Canada, psychoactive substances are highly regulated or prohibited to protect the public’s health and safety; yet these practices cause considerable harms. The current regulatory structure for drugs has led to a highly profitable illegal drug market without protections and quality controls that are seen in, for example, prescription medications and foods available to British Columbians. This in fact impedes public health and harm reduction, increases criminalization of groups already made vulnerable due to social and structural determinants such as racism and colonialism, and creates other societal and economic costs. Prohibiting substances results in a highly toxic unregulated drug supply and the loss of lives everyday.
The Impact for us All
Although you may think this problem only effects those with substance use disorders, that is simply not the case. Many people who are dying do not have a diagnosed substance use disorder. Unregulated drugs deaths in BC are occurring among people from all walks of life, across all age groups and socioeconomic spectrums.
The impacts of this crisis are felt by many, in all communities across our province. In fact, the report points to a 2023 poll that indicated approximately one in five (20 per cent) BC residents personally know someone who died after using “opioid drugs,” and more than one in three (36 per cent) know someone within their community who has used “opioid drugs” within the past year.
Indigenous people are disproportionately impacted by this emergency. Status First Nations people in BC represent 3.4 per cent of the total population yet represented 17.7 per cent of all drug poisoning deaths from January to June 2023. This is yet another example of the consequences of the historical and ongoing colonization, control, and oppression of Indigenous Peoples, creating continual health and socioeconomic disparities, poorer health outcomes, and extensive inequities.
An Urgent Recommendation to Improve and Expand Access
“I envision a future in which people who use drugs are not at the mercy of an unregulated supply and system that puts their lives at significant risk. This requires an urgent shift toward enabling sufficient access to alternatives to meaningfully reduce drug poisonings and deaths. This courageous, innovative, and compassionate action is needed to address the proximal cause of this emergency: the unregulated drug supply.” – Dr Bonnie Henry, as written in Alternatives to Unregulated Drugs: Another Step in Saving Lives, p 54
Citing significant evidence, the report’s main recommendation is to take a public health approach that expands existing programs to allow access to non-prescribed alternatives to unregulated drugs for people at risk. This means providing people who use drugs with products of known quality and purity that can be used instead of unregulated and highly toxic drugs, without a prescription and through the healthcare system. This recommendation would see scaling up access alongside the current continuum of options, including PSS, and in line with the complexity and scope of this crisis.
Alternatives to Unregulated Drugs Models
Alternatives to unregulated drugs is one part of a continuum of services and interventions to address the toxic drug poisoning crisis by reducing overdoses and saving lives, while also linking people to care, and taking an intersectional approach that addresses the determinants of health, such as stigma, poverty, mental health, and housing.
Evidence from BC’s current prescribed alternatives shows these programs:
- lower risk of unregulated drug events and deaths;
- reduce the use of unregulated drugs;
- provide a better connection to health and social services; and,
- improve health, social and economic well-being.
Prescribed alternatives programs are an important tool to combat this emergency, but not the only approach. As we now know, many of the 15,000 people who have died from toxic drug poisoning during this emergency did not have a substance use disorder, and would therefore not be captured as participants in prescribed programs. Also, many people face barriers when accessing healthcare, making participation in prescribed alternatives programs difficult.
Because of the limitations of the PSS model, the PHO also recommends a non-medicalized approach to address the needs of those who may not have access to, or benefit from, the prescriber model. This would mean that alternatives to unregulated drugs could be accessed without a prescription. These approaches are recommended only with ongoing evaluation and monitoring included, and ongoing research to address concerns in relation to areas such as diversion. All solutions must take an anti-racist and decolonized approach, as well as involve people and organizations with lived and living experience of substance use, and partnerships with Indigenous Peoples and Indigenous organizations.
A Public Health Issue – Not a Criminal Issue
The Foundation has long supported harm reduction, overdose response, people with lived and living experience, and stigma reduction experienced by those who use substances. These initiatives include advocating for policy change — particularly for low-barrier availability and new models for prescribed alternatives programs — as well as increased education in communities, and more tangible and inter-connected solutions that strike at the heart of this complex issue with thoughtful, stigma-free, and innovative strategies that support multiple population needs.
The BC Coroners Service 2023 Death Review Panel report estimates that “as many as 225,000 people in BC remain at risk of unregulated drug injury or death.” We know that people are losing their lives, every day, and we need this to end. The toxic drug poisoning crisis will keep growing unless we take bolder, more innovative measures that focus on long-term, comprehensive solutions. This is not a criminal justice issue, rather, it is a public health issue that requires a myriad of solutions delivered in a more equitable, proactive, and compassionate manner.
Read the PHO’s full report here.
