It’s Time to Get Real About Canada’s Toxic Drug Supply

The opioid crisis is reaching a tipping point in Canada. It’s a problem that is ripping through major metropolitan centres and rural towns in equal measure but has unfortunately largely taken a back seat to another dominant health challenge of our time, the Covid-19 pandemic. The legacy of opioids will be more enduring, and the challenges ahead of the crisis have fewer clear answers, but it’s a problem that we must tackle head-on.

With an increasingly toxic, unregulated supply of street drugs, it has become almost impossible to ascertain the safety of any processed drug in circulation. The pandemic has only amplified those barriers to effective treatment and harm reduction, and physical distancing has exacerbated the problem further with people taking drugs in isolation and dying as a result.

According to the Public Health Agency of Canada’s data, at least 5,368 Canadians died from "apparent opioid toxicity death”, their term for a death where opioids played a central role, between January and September 2021, the most recent data available. Broken down, this is almost 20 opioid-related deaths per day in Canada. In Ontario, the Chief Coroner has indicated that 2,819 people died due to opioids in 2021. Particularly concerning is where these deaths are happening. The six public health units that reported the highest per capita opioid-related deaths were all in Northern Ontario. So, while this is a national emergency, it’s hitting northern cities and rural communities particularly hard. At this point, most of us know someone affected, either directly or indirectly, by this crisis.

With what we know about the crisis, it’s clear that current measures to address addiction, treatment, and the toxicity of the supply have been futile. Criminalizing addicts for minor possession of controlled substances has proven to be an ineffective means to reduce harm and has arguably had the opposite effect by driving users underground. People who use street drugs, whether it’s due to dependency or it’s their first time, or whatever their reason may be, have no idea what’s in the supply they purchase. Dealers are often cutting their supply with fentanyl, carfentanyl, benzodiazepines, and other substances, so people thinking they’re buying one drug are getting elements of another far more potent and dangerous drug.

What we need to do is stop forcing users underground by criminalizing them, embrace harm reduction, and provide users with counselling and addiction support if they choose. A health-based approach would do far more to reduce overdoses. The government recently made an extraordinary decision, at the request of the BC government and the mayor of Vancouver, to decriminalize the possession of small amounts of opioids, cocaine, MDMA, and methamphetamines, up to 2.5 cumulative grams. Dealers and traffickers will still be subject to criminal law. A similar request was put forward by the mayor of Toronto, but no decision has been made on that case yet.

Importantly, the timing of the move came 1 day before a vote on Bill C-216, a Health-based Approach to Substance Use Act. C-216 would have taken a similar approach, but applied the same standard nationally, and did quite a bit more. It would have allowed record expungement for past convictions for possession, required the Minister of Health to develop a national strategy to address the harm caused by problematic substance use, and provided access to safer supply, harm reduction, treatment, and recovery services. The majority of Liberal MPs joined with the Conservatives to vote down this legislation, which makes little sense. Why would an approach to reduce harm in a major city that has been gripped with opioid addiction work there, but not on a national level? It’s particularly troubling when people in rural and northern communities need services to reduce instances of tainted drugs, and health services to treat addiction, but can’t get access.

At this point, these are not radical ideas. These steps were supported by the government’s own task force on substance use. It was also supported by a number of law enforcement organizations, including the Canadian Association of Chiefs of Police (CAPC). The CAPC has noted that arresting people for simple possession does not save lives and have recommended taking a health-based approach rather than an enforcement-based approach.

This approach is also not a silver bullet. It will not fix the problem overnight. Fentanyl and other powerful yet cheap drugs will remain an issue in the supply, but at least users would feel more comfortable testing for these substances. Supervised sites would allow users to do so safely. And when they are ready, people with dependencies will be able to seek treatment. Continuing the same approach we’ve been seeing for decades has not resulted in a reduction of overdoses, they have only climbed. It’s time we take a different approach.