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In 2019, three years after British Columbia declared a public health emergency, the crisis of escalating drug overdose deaths looked like it was beginning to ease.

That spring, deaths fell by about a third from the record level of 2018. Even with some apparent success, medical experts called for more policy changes. That included decriminalization of small amounts of drugs and a safer supply of regulated pharmaceuticals for people at high risk of dying from toxic street drugs.

Neither idea gained traction. Things were getting better. Then came the pandemic and a suddenly far more toxic drug supply. Overdoses deaths surged higher to new records, across Canada. In 2021, the number of overdose deaths were almost doubled that of 2018. Ontario, B.C. and Alberta accounted for most of them.

Last year, deaths once more began to ease but remained elevated. Rejected ideas such as decriminalization and safer supply had moved toward the mainstream, endorsed in 2020 by groups such as the Canadian Association of Chiefs of Police. B.C. began Canada’s first test of decriminalization early this year and has a small safer supply program. B.C. and Alberta also have started – finally – to put a lot more money into expansion of treatment services.

What also happened is a renewed politicization of the health response to overdose deaths. The United Conservative Party branded its approach as the “Alberta model,” focused on treatment, while less open to harm reduction measures such as expanded supervised drug-use sites and against decriminalization and safer supply. But the so-called model was brand new, its construction scaffolding still in place. The first of a series of treatment recovery centres opened its doors only this spring.

Yet Alberta appeared certain it was right and the NDP in B.C. was wrong.

In January, when it looked like deaths in Alberta were declining faster than in B.C., the chief of staff to Premier Danielle Smith extolled Alberta’s policies, attacked B.C.’s approach as a “highly liberalized drug legalization agenda,” and claimed B.C.’s spending on treatment was on a “very, very small scale.”

The latest data on deaths are, as in 2019, a humbling – and gutting – reminder of how difficult it is to battle drug overdoses, how intractable opioid addictions can be and the continuing deadliness of toxic street drugs. Most of all, the deaths demand an integrated policy response.

It’s as bad as it’s ever been. In B.C., as of the end of May, drug overdoses killed 1,018 people, up 3 per cent from 2022. In Alberta, with new data last week through April, overdoses killed 613 people, up 6 per cent. The situation in Ontario is unclear, because the province doesn’t provide recent data.

Treatment should be everyone’s end goal. As this space has too often noted, the dead cannot be checked into rehab. But to focus on treatment while minimizing or ignoring a range of harm reduction is a mistake – as is the reverse, too much work on harm reduction without ample treatment beds. Treatment absolutely must be available to those who seek it but relapse after initial treatment for opioids addiction is common. To not invest in services like supervised drug-use sites is a grave error. That health policy serves 2,600 Canadians a day, has made almost 300,000 referrals to other services such as mental health and housing, and has never had a person die on site.

Meanwhile, new interventions in B.C. are just starting. Decriminalization, a three-year trial, is five months in. Safer supply gets a lot more public attention – and attacks from the likes of federal Opposition Leader Pierre Poilievre – than its actual impact to date. In early June, B.C. officials said less than 5 per cent of people using drugs have been prescribed access.

“It’s become an ideological debate,” Calgary Mayor Jyoti Gondek told The Globe’s editorial board last week. “What we need to do is understand that there are many different things that can be done.” Safer supply has a role to play, the mayor said, but she more so emphasized the bigger picture: the entwined issues of mental health, addictions, and housing.

Ms. Gondek is exactly right. As this space has argued before, a singular focus at the expense of an open mind to all possible policies is the wrong way forward. The wave of deaths is unrelenting. Governments’ response must be equally unrelenting.

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