British Columbia wants to become the first province to decriminalize possession of illicit drugs for personal use, five years to the day since the overdose crisis was declared a public health emergency.
Minister of Mental Health and Addictions Sheila Malcolmson said today the province will seek an exemption from drug possession laws under Section 56 of the Controlled Drugs and Substances Act. The section allows the federal health minister to grant exemptions from the act’s provisions if deemed medically necessary or in the public interest.
Malcolmson also said Tuesday’s provincial budget will include $45 million over three years for expanded supervised consumption sites, naloxone kits and outreach teams to connect people with services.
The announcements come on the heels of B.C.’s. worst year for toxic drug deaths and almost seven months after the government promised an expanded safe supply of substances to reduce users’ risks. Critics say little progress has been made in delivering on the pre-election promise.
“People who use drugs are in a health crisis and they should not face criminal penalties,” said Malcolmson. “By taking this step, we can address and reduce the fear and stigma and shame that keep people silent about drug use, and this will support more people in reaching out for the health care support that they need, the life-saving supports and treatment that they need.”
But advocates and experts say the deadly toll five years after the emergency declaration shows the crisis is not being handled with enough urgency.
“It has not been attended to as an emergency,” said Leslie McBain, co-founder of Moms Stop the Harm. “And here we are, worse off than ever.”
Donald MacPherson, executive director of the Canadian Drug Policy Coalition, said five years ago there was a sense of relief that poisoned drug deaths were going to be urgently addressed.
But with efforts lacking clear leadership, “It’s really difficult to get super excited about the announcements we saw come out today,” he said. “When you call an emergency, treat it like what it is. And ironically, we’ve seen that in full bloom with the COVID-19 response.”
In the five years since B.C.’s first public health emergency was declared for the overdose crisis, around 7,000 people have died of poisoned drugs.
Despite a reduction in deaths in 2019, last year was the deadliest on record as COVID-19 restrictions brought more toxic drugs and more people used alone.
Poisoned drugs are now the fifth-leading cause of deaths in B.C., just behind cancer, stroke, heart disease and diabetes, and above COVID-19.
Acting First Nations Health Authority chief medical officer Dr. Shannon McDonald said Indigenous people are nearly five times more likely to die of an overdose than non-Indigenous people, and the death rate among First Nations people has nearly doubled since 2019.
Asked how an emergency could drag on for five years, Malcolmson told The Tyee the government is also building a system of addictions care that did not exist in 2016. “If that system of care was in place, absolutely we would be further ahead,” she said.
Malcolmson said there’s no timeline for when the province will actually apply for the exemption or when decriminalization could happen.
The province’s approach will centre the lived experience of people who use drugs and frontline workers, she said.
“We’re going to be drawing on their work and their advice to fulfill the detail that the Section 56 application requires, and to do that with a view of the diversity of needs across the province,” said Malcolmson. “This is a provincewide problem.”
Malcolmson said she doesn’t expect B.C.’s decriminalization approach to require mandatory treatment or include administrative penalties, like Oregons’ recently approved model.
The City of Vancouver has also been working on an application for a similar municipal exemption under the act since November in an effort to curb rising drug poisoning deaths. It expects to send its final submission by mid-May.
Provincial health officer Dr. Bonnie Henry supported the province’s request for an exemption.
“They understand that this is an issue we need to deal with holistically,” Henry said today. Arresting and incarcerating people who use drugs puts them at a higher risk of overdose and death upon release, she added. “Putting conditions on people is not helpful and not working.”
Henry called on the province to use its existing powers to decriminalize drugs two years ago, but the government immediately rejected her report.
Chief coroner Lisa Lapointe said today that pandemic border closures made the illicit drug supply even more perilous and there is no longer safe or predictable supplies in the illicit market.
Fentanyl, a powerful synthetic opioid, and its analogues are now found in more than 80 per cent of overdose fatalities, cocaine in half and crystal meth in about 38 per cent of deaths.
Lapointe said she would launch an expert panel review of the deaths later this spring to investigate the actions taken so far and to look into establishing standards for treatment and recovery services in the province.
No such regulations exist, and Lapointe said families continue to struggle to find funded, accessible and culturally safe treatment and recovery supports for loved ones. “As a result, what we have is a very patchwork, ad hoc system,” she said.
Expanded safe supply — prescribing pharmaceutical versions of street drugs to remove people from the poisoned supply — was also promised nearly seven months ago.
Neither Malcolmson nor Henry would provide a timeline on when B.C. will see details of the life-saving intervention, but Henry said the work continues, although it is “painfully slow.”
Physician hesitance is still a barrier to expanding safe supply, Lapointe noted, despite the ethical imperative to support people with substance use issues established through Henry’s 2019 review.
McBain, who sits on an expert advisory committee on the province’s overdose response, called the delays “unconscionable.”
“It’s not clear to me yet how a safe supply is going to roll out, there seems to be no progress,” she said. The Addictions Ministry seems open to the idea, “but they just can’t seem to get it out there.”
MacPherson said the incremental response so far indicates the province is treating this as an addictions crisis rather than a poisoned drug crisis.
“Five people are going to die tonight, somewhere,” he said. Robust and accessible safe supply is “the one thing that can impact people tonight, and that’s what matters.”
Chris Livingstone, founder of Western Aboriginal Harm Reduction Society, was glad to hear the province wants to decriminalize some illicit drugs, but said it needs to go further than small amounts and specific substances.
Prohibition, particularly in First Nations communities, has only caused more potent synthetic substances to take flight, he said. “The need doesn’t go away when we take those substances away.”
“I’d like them to take it further and decriminalize all substances,” said Livingstone, whose traditional Nisga’a name is Ukws Kots’a. After seeing cannabis legalization roll out without considerations for First Nations, “I don’t have a lot of faith that the government would do it right,” he said.
Decolonizing relationships to substances and providing culturally safe, in-community care will be essential components to curbing poisoned drug deaths in First Nations communities and with urban Indigenous people alike, Livingstone said.
The pandemic has also shown that the social determinants of health like housing and health care need to be improved for everyone to stay healthy, he added.
Livingstone used to smoke crack cocaine and has been in recovery for more than 20 years. When he was still using, he and friends could often joke after the fact about a hit they bought turning out to be heroin instead.
But the poisoned supply has now made even occasional substance use potentially fatal.
“Our relationships with substances now are based on fairy tales,” said Livingstone. “And we’ve got to educate ourselves and our families about the real reasons people are using and the things that they need to make their lives better.”