The province of British Columbia, at the epicentre of a drug poisoning crisis that has already killed more than 32,000 Canadians since 2016, last week began a three-year pilot programme in which people carrying less than 2.5 grams of drugs such as meth and heroin will not be prosecuted.
But doctors and advocates for drug users argue preventing overdose deaths also requires expanding a “safe supply” of drugs that allows those at risk of overdose to legally obtain banned substances through prescriptions.
In part due to disruptions in supply stemming from the COVID-19 pandemic, street drugs are increasingly laced with toxic or unknown ingredients, resulting in drug users overdosing and dying.
“There (are) no measures involved in decriminalization that address the fact that the supply is very, very variable and volatile and dangerous,” said Gillian Kolla, a drug policy researcher at the University of Victoria’s Canadian Institute for Substance Use Research.
“If you want to have an impact on the overdose crisis you are going to have to target the supply.”
The thinking behind safe supply programs and other “harm reduction” initiatives is that people who use drugs will continue to do so and offering them a safer option keeps them alive. Proponents say they are not meant as an alternative to treatments for addiction but in addition to them.
In part, it reflects a broader shift away from criminal charges as a deterrent to drug use and a move toward treating addiction as a health issue instead.
Still, expanding safe supply on a large scale would mean a major change in the government’s approach to illicit substances, involving it in providing and regulating now-illegal drugs.
Critics worry it could backfire by encouraging drug use and result in the drugs being diverted for sale on the street, something clinicians prescribing drugs say is rare.
Studies show the programmes can be successful. A 2021 study by the British Columbia Centre on Substance Use of 42 participants in a Vancouver programme that distributed hydromorphone tablets – an opioid – found it reduced street drug use and overdose risk and improved health, wellbeing and pain management.
A 2016 Canadian Institutes of Health Research study found a 67% reduction in illicit drug use in a group treated with prescription heroin, or diacetylmorphine, and a 47.7% reduction in a group treated with the opioid methadone.
But not everyone in Canada favours that approach: Alberta, a province with a conservative government that neighbours British Columbia, has emphasized a “recovery-oriented” approach to addiction that favours more abstinence-based treatment.
Under that approach, people with addictions are encouraged to enter residential treatment centres and wean off substances.
Pierre Poilievre, leader of the opposition Conservative party, last week said he would end B.C.’s plan if he were prime minister, arguing that de facto decriminalization has been in place in B.C. for years and had been “a complete disaster” and “hell on earth.”
Police in British Columbia file thousands of drug possession charges annually.
‘SAFER TO LEAVE HOME’
About 32,632 Canadians have died of opioid-related deaths since 2016, with a rate of 20.9 opioid-related deaths per 100,000 people in 2021, compared to a rate of 24.7 in the United States for that year.
Canada faced the challenge of an adulterated illicit drug supply before the United States did and has been quicker to adopt harm reduction tools to address drug overdose cases, said Lindsey Richardson, a research scientist at the B.C. Centre on Substance Use.
British Columbia has been at the forefront of trying new methods to address the crisis, including opening North America’s first official, sanctioned supervised drug consumption site in 2003. Its latest programme is being closely watched elsewhere.
Toronto also asked to decriminalize personal possession of illegal drugs last year and the city says it is working with authorities to decide how that will be defined.
Decriminalization could change life for the better for patients of Scott MacDonald, the lead physician at Vancouver’s Providence Crosstown Clinic.
Many of them receive injectable pharmaceutical-grade heroin because they have severe addictions and cannot tolerate or do not respond to more conventional treatments, said MacDonald, who has 115 diacetylmorphine and hydromorphone patients there.
Some of them still buy street drugs. But he says they may now feel “it’s safer to leave the house; it’s safer to go to the grocery store; it safer to go to a clinic.”
But Ryan Maddeaux, who started taking drugs as a teenager and continues to use them at age 44, says B.C.’s latest plan is of no help to him because he runs the risk of taking something deadly each time he buys street drugs.
“I don’t know what they are, don’t know the exact potency,” he said.