Drug overdoses have killed more than 20,000 Canadians since 2016. It’s time to embrace bold prescriptions

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Sophie Breen suffered through trauma and mental illness and pursued a degree in social work. She died at 27. Nick Crazy Bull was a musician and a gamer. He died at 19. Christopher Martin worked as a mine millwright. He died at 40.

Ms. Breen, Mr. Crazy Bull and Mr. Martin are three names on a list that is far too long and getting longer every day – the toll of Canada’s overdose epidemic. Overdoses have killed more than 20,000 Canadians since 2016. Last weekend, The Globe and Mail presented the stories of 100 people who were lost in 2020 to overdoses, because last year was Canada’s worst year yet.

Most governments in Canada have been too slow to respond to an epidemic that shows no signs of abating. There are no magic solutions and no single policy that can instantly reverse the tide, but health experts have long advocated for changes such as drug decriminalization and access to a safer supply of drugs as two important measures that could save lives.

The severity of the epidemic has led to a shift in recent months. Many political leaders previously rejected policies such as decriminalization and safer supply, but the ideas are now, to a growing extent, embraced. The debate is no longer stuck on whether an idea is worth trying. It is more and more about how best to do it.

In late January, Health Canada agreed to formal talks with the City of Vancouver to decriminalize drugs within municipal borders. The next step is figuring out how that will work. Police in Vancouver already rarely charge people for simple possession, but backers of the move to make it official argue it would be a valuable step to ease the stigma around drug use and help people get services and treatment. It marks a fundamental shift in drug addiction, from a question of criminal justice to one of health care.

The details will matter. (And decriminalization of simple possession is not legalization of sale or trafficking.) Replacing arrests with other forms of police oversight would be a half-step, yet that is what is in the Trudeau government’s new Bill C-22, tabled on Thursday. The bill doesn’t go all the way to decriminalization; instead, it would only require police and prosecutors to “consider” alternatives to criminal charges for simple drug possession, such as treatment programs, warnings, or no action at all. Such flexibility is better than none, but if drug addiction is a health issue, it does not make sense for police to be the front-line arbiters.

In any case, decriminalization, however useful it may be, does not address what’s killing people: a poisoned supply of drugs on the street, laced with ever more amounts of fentanyl. This is where so-called “safe supply” comes in – providing prescription pharmaceuticals to people stuck in addiction as an alternative to street drugs.

Last year, Ottawa adjusted its rules and urged provinces to act. The federal government has invested $44-million in programs from B.C. to New Brunswick. A recent study in Vancouver showed a safer supply can reduce use of street drugs and risk of overdose, and regular contact with doctors and nurses can deliver other health benefits, such as addressing physical injuries for people who are often living rough.

The mechanics of safe supply are coming to the fore. B.C. has been training a group of registered nurses so they can write prescriptions, in an effort to broaden access. What sort of drugs are available is also being finalized. As these programs become more common, there are important debates among policy makers about how such drugs are best administered, to avoid creating new harms – such as the resale of provided drugs.

Harm-reduction policies are inherently pragmatic, and inherently imperfect. The ultimate goal is treatment that breaks the cycle of addiction, but long-term substance-use disorders are not easily ended in some 30-day stint in a recovery bed. Relapse is common and relapse is too often the circumstance of a deadly overdose.

In the gap between hoped-for better outcomes and the current grim reality, moves to expand harm reduction make sense. Previous innovations, including supervised consumption sites, have been shown to save lives. Decriminalization and safe supply are two more policy tools worth trying in the fight against a terrible epidemic. The list of overdose deaths does not need to get longer to make the urgency to act more obvious.

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