Benedikt Fischer is a British Columbia-based senior addiction and public health researcher.
The illicit drug death crisis in British Columbia is mercilessly raging on. More than 2,000 individuals, mostly young- or middle-aged, died from an overdose in the province in 2022 – about seven times as many annual motor-vehicle incident fatalities and just under the total number of COVID-19 deaths last year. These statistics are well-known; the solutions for this unfathomable public health emergency, not so much.
Tuesday marks the first day of B.C.’s “drug decriminalization” initiative: Adults carrying up to 2.5 grams of most illicit drugs for personal use will no longer be arrested or have the substance seized by police. For the federal Minister of Mental Health and Addictions, the measure represents “bold actions and significant policy change,” reduces drug users’ “stigma and harm” and provides “another tool to end the overdose crisis.”
This optimistic impact projection is questionable for several concrete reasons. While B.C. features a comparably high rate of illicit drug possession charges, in most instances where only possession as stipulated by the decriminalization initiative is involved, no arrest or charge would ordinarily occur anyway. Moreover, the defined possession amounts are small and do not cover many users’ actual personal use supply. Furthermore, for considerable time now, most fatal drug overdoses occur in private residences – typically far removed from interference by law enforcement.
Despite the charitable prospects of police to “offer information on available health and social supports and … help with referrals,” this measure will do little tangible to reduce drug users’ use of and exposure to the highly potent and toxic drugs that have been killing them.
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Other questions arise besides those concerning impact. Other provinces, such as Alberta and Ontario, also have excessively high opioid overdose rates. The Charter of Rights and Freedom enshrines all Canadians’ right to life as well as equality before the law. If the federal drug law’s partial suspension is assumed to reduce the overdose death toll, why is it not equitably applied across the country?
The decriminalization initiative is a largely symbolic policy measure in the face of an unrelenting crisis where attention toward more effective life-saving strategies is urgently needed. This is also because essential, practical characteristics of overdose deaths have been changing.
For example, while the large majority of deaths still occur from illicit fentanyl or similarly toxic, synthetic opioids, about half by now also involve psychostimulant drugs (such as cocaine and methamphetamine) and a substantial proportion are further contaminated with some form of benzodiazepine constituent. This means current interventions principally geared at opioid-related overdoses – for example, naloxone for overdose reversal or opioid pharmacotherapy for treatment – are increasingly limited in fit and effectiveness for addressing them.
Recent data from the BC Coroners Service show that substantially more than half of fatal drug overdoses have been occurring from inhalation rather than injection use. This is a stunning development, given the belief for decades was that inhalation represented a safer use mode even for high-risk drugs, and would quite reliably protect users from acute overdose death.
But the present drug supply’s exceptionally potent and toxic qualities have turned this also into a historical truth. Current intervention realities mean that a disproportionate number of drug inhalers find themselves at much elevated risk of dying, since only a minority of the supervised-consumption sites operating in B.C. accommodate their method of consumption.
In B.C., we are nowhere nearer to effectively solving the overdose death crisis than five years ago or before the COVID-19 pandemic began. Current interventions still largely address the peripheries of illicit drug use leading to fatal overdoses, rather than the quintessential causal pathway that kills people: exposure to a supply that is toxic and deadly.
Recognizing this stalemate, there are two likely prospect scenarios for the crisis actually moving to an end. One is that it will mysteriously run out of people available for overdosing at the hands of these deadly drugs. The other is that our intervention and policy systems will finally muster the resolve to provide all those involved with and at risk for overdose from illicit, toxic drugs with the legal, quality-controlled and safer supply that will drastically reduce their risk of imminent death.
The better option should be easy to choose.