Despite all the shouting, the opioid crisis continues to defy simple answers

The debate in Parliament about British Columbia's experience with drug de‐ criminalization was already operating at extremes be‐ fore Pierre Poilievre used the term "wacko."

During question period on Monday, the Conservative leader said the Liberal gov‐ ernment had unleashed "drugs, disorder, death and destruction." Other Conserv‐ ative MPs said the Liberals were pursuing a "horrific" and "radical" experiment.

"Will the prime minister prioritize recovery and stop killing Canadians with his radical ideology?" Conserva‐ tive MP Kerry-Lynne Findlay asked.

Health Minister Mark Hol‐ land stood and suggested partisanship should be put aside in the face of an epi‐ demic of opioid addiction and overdose deaths. When the minister sat down, Con‐ servative MP Todd Doherty stood up to claim the prime minister's "extremist drug policies" had "turned our neighbourhoods into war zones."

On Tuesday - shortly be‐ fore he was ejected from the House of Commons Poilievre suggested that the increase in overdose deaths in B.C. in recent years can somehow be laid at Justin Trudeau's feet.

WATCH | Conservative Leader Pierre Poilievre was back in House of Commons on Wednesday:

"Will the prime minister reverse his extremist policies and the death they bring?" the Conservative asked.

The approximate cause of this rancour is a decision the B.C. government announced five days ago.

In November 2022, at leader

B.C.'s request, the federal government granted the province an exemption to the Controlled Drugs and Sub‐ stances Act to decriminalize the personal possession of some hard drugs - part of a three-year "pilot project" aimed at fighting the opioid epidemic. That change went into effect in January 2023.

Last Friday, apparently in response to concerns about open drug use and public disorder, B.C. asked the fed‐ eral government to amend the exemption in order to ban the consumption of drugs in public spaces and hospitals.

One conclusion to be drawn from that partial recal‐ ibration might be that the scourge of opioid addiction continues to defy simple an‐ swers. But all such nuance is in danger of being drowned out by the shouting.

The competing claims on decriminalization

The Conservatives are res‐ olutely opposed to decrimi‐ nalization - both the existing exemption for B.C. and the pending request for an ex‐ emption from the City of Toronto. They also oppose British Columbia's use of "safer supply" programs, which prescribe drugs as medication to those addicted to opioids as a safer alterna‐ tive to potentially toxic drugs that might be purchased on the street.

To support their case, the Conservatives recently pointed to comments made by two senior law enforce‐ ment officials during a meet‐ ing of the House of Com‐ mons health committee.

Those officers, testifying two weeks before B.C. moved to change its drug policy, did raise concerns about public drug use. Fiona Wilson, deputy chief of the Vancou‐ ver Police Department, also suggested that public con‐ sumption was a source of concern for the Vancouver Police before the exemption was sought.

But those officials also didn't seem eager for a full return to criminalization.

"At the heart of it, police agree that people should not be criminalized as a result of their personal drug use," said Wilson, who is also president of the British Columbia Asso‐ ciation of Chiefs of Police.

As the Conservatives have pointed out, Dwayne McDon‐ ald, the deputy commis‐ sioner of the RCMP, did dis‐ agree with a Bloc Quebecois MP's suggestion that the pos‐ itives of decriminalization outnumbered the negatives.

But McDonald also said that there "are positive re‐ sults from decriminalization … in terms of the number of people charged with criminal offences and attempts to di‐ vert them away from the criminal justice system. How‐ ever, we note challenges in public consumption and simi‐ larly criminal behaviour."

McDonald was then asked directly whether he thinks simple drug possession should be criminalized again.

"No, that's not what I'm saying," he replied. "What I'm saying is decriminalization has not come without its challenges."

On the question of safer supply, Wilson acknowledged that the diversion of legally prescribed drugs into the illi‐ cit market was a source of concern - though not a par‐ ticularly new phenomenon. But she said it's the toxicity of the illicit drug supply - not safer supply - that's to blame for opioid-related deaths in British Columbia.

"They're not dying from diverted safe supply and they're not actually dying from diverted prescription medications," she testified. "They're dying from fentanyl, coke and meth and that's where we really focus our en‐ forcement efforts."

While condemning British Columbia's approach to the opioid crisis, the Conserva‐

tives have praised the ap‐ proach taken by Alberta. That province has not moved to decriminalize drug posses‐ sion and it has been less en‐ thusiastic about safer supply - the "Alberta model" is said to put more emphasis on treatment and recovery.

But opioid-related deaths in Alberta have increased markedly over the past year. According to data published in March by Health Canada, the rate of opioid toxicity deaths per 100,000 people through the first 10 months of 2023 in Alberta (41.6) was only slightly below the rate in British Columbia (47.5).

Those numbers should at least complicate any attempt to turn the drug policy de‐ bate into a simple choice be‐ tween two different ap‐ proaches.

Piecing the puzzle to‐ gether

In an interview with CBC Ra‐ dio's The Current this week,a city councillor for New West‐ minister, B.C. lamented the fact that the move to decrim‐ inalize possession in the province was not paired with sufficient new investments in treatment, prevention and enforcement.

"What we saw unfold is a one-pillar approach where the main focus was on de‐ criminalization as perhaps some sort of silver bullet," said Daniel Fontaine, refer‐ ring to the "four pillar" ap‐ proach that some jurisdic‐ tions have adopted to deal with drug problems.

Lindsey Richardson, a pro‐ fessor at the University of British Columbia and the Canada Research Chair in so‐ cial equity and health inclu‐ sion, said it's hard to deter‐ mine whether or how much decriminalization has con‐ tributed to an increase in public drug use in B.C., as op‐ posed to broader social forces like poverty or a lack of affordable housing.

She also said that when a jurisdiction decides to move away from a century-old policy of prohibition and criminalization, there's no guarantee it will go exactly right the first time.

In the short term, said Richardson, the goal of de‐ criminalization is simply to reduce the number of inter‐ actions with police and the criminal justice system - and in that respect, it seems to be working. In the medium term, researchers hope to see improved outcomes in things like housing and em‐ ployment.

But decriminalization ide‐ ally would be a part of a com‐ prehensive response that considers everything from supply to treatment to the socioeconomic factors that drive drug use, she said. Re‐ search also suggests, she ad‐ ded, that no single approach will work for everyone deal‐ ing with a drug problem.

"You can't expect decrimi‐ nalization to be a silver bullet for what is a more complex problem." Richardson said in an interview this week.

In last month's testimony before the health committee, Deputy Chief Wilson de‐ ployed a different figure of speech.

"I always talk about de‐ criminalization as being one tiny piece of a much, much larger puzzle," Wilson said, "and in order to put that puz‐ zle together to see what the picture is, we need increased education and increased pre‐ vention.

"We also need some harm reduction services, such as having our members carry naloxone kits, and we need safe injection sites. Really, it's a multi-faceted approach to this problem. It includes safe supply initiatives, but any one thing on its own is not going to be effective."

Simply discarding some of those puzzle pieces might only make it harder to put the picture together.

In the wake of Tuesday's tumult, question period on Wednesday was noticeably quieter than usual. Perhaps MPs felt chastened.

And perhaps, instead of more talk about the dire state of decorum in Parlia‐ ment, we might now find room for a nuanced debate about a complex and deadly serious problem.