Authored by Ava Hopper Kendregan, Global & Public Health Sciences ‘26
Upon returning to school after spring break in my junior year of high school, the student body was ushered into a somber assembly: a boy at a neighboring high school had overdosed. He was a year younger than me. Although the loss of such a young soul was a shock to our community, overdose is by no means uncommon in my home province of British Columbia (B.C.). Nearly 10 000 lives have been lost to overdose since a public health emergency was first declared in 2016, at a rate of 31.2 deaths per 100 000 British Columbians [1].
The provincial government’s latest attempt to curb overdose deaths has made headlines: as of January 31st, 2023, it is no longer illegal for adults in B.C. to possess less than 2.5 grams of cocaine, methamphetamine, MDMA, and certain opioids (including heroin, morphine, and fentanyl) [2]. This exemption from the Controlled Drugs and Substances Act is a part of a three year pilot program that has been negotiated with the federal government [2]. Law enforcement officers are instructed to provide information on harm reduction resources and social services in place of arrest, which officials hope will create a safe, destigmatized environment for drug users to access care [2]. The policy has been met with both praise and criticism, with experts weighing in on its potential benefits and drawbacks.
The B.C. Ministry of Mental Health and Addictions reports working closely with healthcare providers, people who use or have used drugs, clinical researchers, and advocacy organizations to develop the pilot [3]. Supporters of the policy argue that it will encourage drug users to seek help without fear of legal repercussions. Lisa Lapointe, B.C.’s chief coroner, advises, “Decriminalization will help shift our focus from punishment, which has resulted in social isolation, stigma and fear, toward a medical model that recognizes substance use as a health issue.” [3] A 2017 study conducted by the Canadian Center on Substance Use and Addiction found that the most common reason 911 was not called in overdose situations was concern about arrest or legal repercussion. [4]
Although B.C.’s government cites success in previous decriminalization policies [2], such as those implemented in Portugal, Germany, and the Netherlands [5][6], critics point out the disparities in access to care between Canada and these nations [7]. Portugal expanded public services to include immediate, free detoxification and rehabilitation treatment [5], while some British Columbians face wait times of over 100 days for a bed in a detox center [8].
Other opponents worry that the 2.5 gram threshold is too low to be effective and may actually cause more harm than good [9]. Experts argue that 2.5 grams is not enough to get a regular opioid user through a single day and could force users into making more frequent, smaller purchases [9]. If these users aren’t able to test their supply at an increased frequency or if they need to make purchases from multiple suppliers, they may be more at risk for consuming unsafe or contaminated substances [10].
Samuel Tobias, a PhD student at the University of British Columbia’s School of Population and Public Health, brings up an even more alarming concern: “Will the imposed legal carry limit of 2.5 grams result in increased potency of fentanyl to fit within the new 2.5-gram threshold?” [11] With fentanyl and its analogues being responsible for 84 % of drug-related deaths in the province, an increase in potency could have deadly consequences [10]. The BC government originally requested a threshold of 4.5 grams, as advised by addictions specialists, but the federal government only approved 2.5 grams [2]. Further negotiations may be conducted over the course of the three year pilot [2].
Overall, the most common critique of the policy is that it fails to address the root causes of addiction and overdose. Community health workers predict that the policy will be rendered ineffective by B.C.’s toxic drug supply, arguing that policy changes should instead focus on ensuring safe, regulated supply for users [12]. Other advocates insist that the overdose crisis will not be solved until the government can properly address underlying causes of poverty, homelessness, mental illness, and trauma [10].
British Columbia has long been a pioneer in harm reduction, a practice which focuses on reducing potential harms – such as overdose, death, or infection – from drug use without an expectation of full recovery from drug users [13]. The province was among the first in North America to introduce safe injection sites, opioid substitution therapies (methadone, suboxone, and hydromorphone), and widely accessible naloxone (a drug that can reverse opioid overdose, also known as Narcan) [14][15][16]. And yet, British Columbians remain plagued with some of the highest overdose death rates in the developed world [17].
Will decriminalization be a turning point in healthcare history or yet another failed attempt to slow the slew of deaths? Only time will tell, as the rest of the world learns from British Columbia’s trials, tribulations, and triumphs in overdose prevention in the coming years.
Works Cited
Ministry of Public Safety & Solicitor General. (2023, January 23rd). Illicit Drug Toxicity Report. BC Coroners Service.https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf
Ministry of Mental Health & Addictions. (2023, March 7th). Decriminalizing people who use drugs in B.C. Government of BC. https://www2.gov.bc.ca/gov/content/overdose/decriminalization#:~:text=Under%20this%20exemption%2C%20adults%20
Ministry of Mental Health & Addictions. (2021, November 1st). B.C. applies for decriminalization in next step to reduce toxic drug deaths. BC Gov News. https://news.gov.bc.ca/releases/2021MMHA0059-002084
Canadian Center on Substance Abuse. (2017, March). Calling 911 in Drug Poisoning Situations. CCSA. https://www.ccsa.ca/calling-911-drug-poisoning-situations-ccendu-bulletin
Rego, X., Oliviera, M. J., Lameira, C., & Cruz, O. S. (2021). 20 years of Portuguese drug policy - developments, challenges and the quest for human rights. Substance Abuse Treatment, Prevention, and Policy, 16(1). https://doi.org/10.1186/s13011-021-00394-7
Scheerer, S. (1978). The new Dutch and German drug laws: Social and political conditions for criminalization and decriminalization. Law & Society Review, 12(4), 585. https://doi.org/10.2307/3053306
DeRosa, K. (2023, January 30th). Decriminalization alone is not enough, experts warn. The Vancouver Sun. https://vancouversun.com/news/local-news/bc-begins-drug-decriminalization
Dickson, L. (2022, August 28th). People seeking detox treatment face weeks-long waits. The Times Colonist. https://www.timescolonist.com/local-news/people-seeking-detox-treatment-face-weeks-long-waits-5749399
Ghoussoub, M. (2022, June 3rd). B.C. will decriminalize up to 2.5 grams of hard drugs. Drug users say that threshold won’t decriminalize them. CBC News. https://www.cbc.ca/news/canada/british-columbia/drug-decrim-threshold-1.6477327
Tobias, S. (2023, February 6th). Why the drug poisoning crisis in B.C. won’t be addressed by the new decriminalization policy. The Conversation. https://theconversation.com/why-the-drug-poisoning-crisis-in-b-c-wont-be-addressed-by-the-new-decriminalization-policy-199239
Health InfoBase. (2023, March). Opioid and Stimulant Related Harms in Canada. Government of Canada. https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/
Paperny, A.M. (2023, February 7th). Analysis: Canada’s decriminalization experiment no match for toxic drug supply. Reuters. https://www.reuters.com/world/americas/canadas-decriminalization-experiment-no-match-toxic-drug-supply-2023-02-07/
Canêdo, J., Sedgemore, K.-olt, Ebbert, K., Anderson, H., Dykeman, R., Kincaid, K., Dias, C., Silva, D., Charlesworth, R., Knight, R., & Fast, D. (2022). Harm reduction calls to action from young people who use drugs on the streets of Vancouver and Lisbon. Harm Reduction Journal, 19(1). https://doi.org/10.1186/s12954-022-00607-7
Dooling, K., & Rachlis, M. (2010). Vancouver's supervised injection facility challenges Canada's drug laws. Canadian Medical Association Journal, 182(13), 1440–1444. https://doi.org/10.1503/cmaj.100032
Eibl, J. K., Morin, K., Leinonen, E., & Marsh, D. C. (2017). The state of opioid agonist therapy in Canada 20 years after Federal Oversight. The Canadian Journal of Psychiatry, 62(7), 444–450. https://doi.org/10.1177/0706743717711167
Tsang, B.W.L., Buxton, J.A. (2021, April). History of naloxone kits in BC: From inception to expansion. British Columbia Medical Journal, 63(3), 122-125. https://bcmj.org/special-feature/history-naloxone-kits-bc-inception-expansion
Belzak, L., & Halverson, J. (2018). Evidence synthesis - the opioid crisis in Canada: A national perspective. Health Promotion and Chronic Disease Prevention in Canada, 38(6), 224–233. https://doi.org/10.24095/hpcdp.38.6.02