What are parties’ plans to address deadly opioid crisis?
Experts discuss how parties propose to tackle ongoing national issue
Each day since the federal party leaders hit the campaign trail last month, an estimated 17 Canadians have died from an accidental drug overdose.
And more than 21,000 Canadians died of accidental overdoses between 2016, when B.C. declared a public health emergency, and December 2020, according to statistics from the Public Health Agency of Canada.
Health Canada says that fentanyl and other new opioids are major drivers of the crisis — it estimates that 82 per cent of opioid toxicity deaths in 2020 involved fentanyl. Researchers also found that drug supplies in Canada are increasingly contaminated with synthetic “ultra-potent” opioids, some of which are more powerful than fentanyl.
COVID-19 has only worsened the situation — Health Canada estimates the country has seen an 89 per cent increase in deaths since the start of the pandemic.
“Things have never been worse,” says Garth Mullins, a member of the Vancouver Area Network of Drug Users and the host of the Crackdown podcast. “We keep breaking records all the time. 2020, it was worse than all the years before. 2021 will be worse than 2020.
“It seems like as a society, Canada and its political class has decided that it’s just OK for thousands of people like me to die.”
As this month’s election approaches, the Start spoke to several drug policy experts about how the major political parties are proposing to tackle the overdose crisis.
These experts emphasized the need for life-saving harm reduction strategies, such as the expansion of safe consumption services and safe supply programs. The Liberals, New Democrats and Greens have all promised to invest in the expansion of these interventions. The Conservative platform, on the other hand, emphasizes recovery and treatment programs rather than harm reduction — a shift that experts say is short-sighted.
Meanwhile, only the NDP and Green party have signalled their support for the decriminalization of illicit drugs, a policy broadly endorsed by health officials and drug policy experts.
The Liberal approach
The Liberal election platform includes a pledge to introduce a “comprehensive strategy to address problematic substance use,” and a commitment to invest $500 million “to support the provinces and territories in providing access to a full-range of evidence-based treatment, recognizing that successful treatment is not determined by long-term abstinence.”
The language appears to signal a commitment to expand harm reduction strategies across the country. This approach has been a key component of Canada’s current response to the overdose crisis.
Since 2016, the Liberal government has funded dozens of supervised consumption sites and services (SCS), where people using pre-obtained drugs are monitored by staff who provide education on safer drug use, respond to overdoses, and provide sterile drug use equipment. It has also supported overdose prevention sites (OPS), which are typically “pop-up” safe-injection sites.
There are about 36 SCS facilities across Canada. According to the Canadian Drug Policy Coalition, they “have proven to be cost effective, life saving and create a safer environment for people who use drugs and the broader public.”
The Liberal government also invested in safe supply programs, which aim to reduce the use of toxic drugs that cause overdoses by providing safer substitutes, often under medical supervision.
Rebecca Haines-Saah, an associate professor at the University of Calgary in the department of community health science, says she is encouraged by the Liberals’ pledge to further invest in harm reduction and safe supply.
However, she worries that these investments will not reach provinces led by governments that are resistant to harm reduction. For example, Alberta’s provincial government recently released new regulations for supervised drug sites that require collection of personal health numbers. Experts say such rules create barriers to safe consumption by making it harder for vulnerable people to access.
“What we need are mechanisms to ensure we can access these federal funding programs without the need for provincial oversight or approval,” HainesSaah says. “This is currently a huge barrier to researchers and community groups who are eager to innovate.”
Mullins is also critical of the Liberal government, which he believes is willing to let any provincial or local jurisdiction “do what it wants.”
Mullins says Ottawa should ensure equal access to supervised consumption sites. He cites the Canada Health Act, which sets criteria and conditions under which provinces and territories receive federal funding for health care.
“It’s always different with drug users,” he says. “Imagine if one of the provinces in Canada said, ‘Well, we’re just not going to give people the COVID-19 vaccine here.’ They won’t have it. That’s what we’re asking of the federal government — to intervene so that those Canadians living under that premier could have access to something that saves lives.”
The Conservative approach The Conservative party has pledged to focus on the expansion of recovery and treatment programs, rather than harm reduction services, to address the overdose crisis.
Although its platform does not mention harm reduction strategies, Erin O’Toole told reporters that a Conservative government would not block safe consumption sites — marking a shift in policy from his predecessors, Andrew Scheer and Stephen Harper.
Its plan has been widely criticized by drug policy experts, who say it will not prevent overdose deaths caused by increasingly toxic drug supply.
“It’s incredibly short-sighted,” says Thomas Kerr, a professor in the department of medicine at the University of British Columbia and the director of research at the B.C. Centre on Substance Use.
“There’s no serious academic debate about the merits of supervised consumption sites — they simply work and save lives,” Kerr said.
“So it’s nice that (the Conservatives) say they will tolerate them, but if Mr. O’Toole is really going to be serious and work with people in the area of harm reduction, then he would also be investing in harm reduction and safe supply programs.”
The Conservative platform commits to investing $325 million over three years “to create 1,000 residential drug treatment beds and build 50 recovery community centres across the country.”
Most recovery centres in Canada are based on abstinence models. They provide care and medical treatment with the goal of reducing or eliminating drug use.
Advocates agree that any approach to drug policy should include recovery treatment. However, drug addiction is what medical experts refer to as a “chronic relapsing condition,” which means that most drug users are expected to relapse several times, even after entering treatment. In other words, no matter how many treatment beds are available, only a fraction of people using drugs will be in abstinence-oriented recovery at any point. The rest remain at risk of a fatal overdose.
“Beds are furniture. They’re not a medical intervention and they’re not an effective approach to overdose prevention.” says Haines-Saah.
Experts suggest that the focus on abstinence and treatment beds stems from a misunderstanding of the crisis: rather than focusing on stopping drug use, they say, the focus should be on preventing drug poisoning through life-saving measures.
“What we have is a poisoning epidemic,” says Kerr. “And the best way to displace toxic drug supply is by providing people with pharmaceutical-grade alternatives, or equipping people who use drugs themselves with drug-checking technologies so that they can test their drugs and use them safely and or provide them to others. Focusing on recovery and treatment is not enough.”
“There will probably be over 6,500 people who die across Canada this year,” says Gillian Kolla, a post-doctoral researcher at the Canadian Institute for Substance Abuse Research at the University of Victoria. “One thousand treatment beds of potentially questionable quality — and we don’t know when they would be coming online — is not even going to make a dent in that problem.”
The Conservative platform pledges $1 billion for Indigenous mental health and drug treatment programs, promising to “enhance the delivery of culturally appropriate addiction treatment and prevention services.”
Haines-Saah welcomes that commitment, but says Indigenous communities should have control over how that money is spent. “These communities need meaningful Indigenousled services, services not confined to four walls and a bed.”
New Democratic and Green parties’ approaches
Like the Liberals, the New Democrats and the Greens have pledged to expand safe consumption services and safe supply programs. Where they diverge is on decriminalization.
The NDP platform commits to “ending the criminalization and stigma of drug addiction,” while cracking down on “real criminals — those who traffic in and profit from illegal drugs.” The Greens have not released a platform, but say they would commit to the “immediate decriminalization of possession of small amounts of illicit drugs.”
Drug policy experts have long called for decriminalization, saying that treating addiction as an issue of health rather than criminal justice would reduce the stigma around drug use and save lives.
“Decriminalization is really the boldest policy choice to address the crisis, but we haven’t had the courage to push through federally,” says Haines-Saah.
“When your [drug] use is stigmatized, this is what exacerbates you not seeking medical help — hiding use from all the people that care about you, having to participate in illegal market and put yourself in dangerous positions, not seeking medical care because of the crap that you receive in hospital and from health-care providers and the sheer harassment from police officers,” she adds.
“It’s just a vicious, never-ending cycle. We can tinker away at the margins all we want. But until we see that change, I don’t think it’s going to get better.”
Kolla notes that decriminalization has broad support. In February, an Angus Reid study found that the majority of Canadians support the decriminalization of illicit drugs as part of the response to escalating drug deaths. Last summer, the Canadian Association of Chiefs of Police recommended the decriminalization for simple possession of illicit drugs.
“When you have so many policy actors, medical officers of health, public health officers across the country calling for decriminalization, as well as the police, then this would seem to be a very easy federal law to enact,” she says.
The Liberal platform does not indicate that the party would move toward decriminalization, but Liberal Leader Justin Trudeau suggested in August that he would be open to working with jurisdictions that consider decriminalization of some illicit drugs.
O’Toole told reporters last month that he believes “people with addiction should not be the focus of the criminal justice system.” However, the Conservative platform does not include any commitments to decriminalization.
“If you’re a drug user, you have to live outside of society,” Mullins says. “Decriminalization is an invitation for people to rejoin society, a society not that they left, but that kicked them out.”
In February, an Angus Reid study found that the majority of Canadians support the decriminalization of illicit drugs as part of the response to escalating drug deaths
The Bloc Québécois
The Bloc Québécois sees health as a provincial matter and does not address the drug poisoning crisis in its platform.
However, in a letter sent to the advocate group Moms Stop the Harm, the BQ did signal its support for harm reduction, safe supply and decriminalization.
The federal government has several policy tools and strategies to tackle the overdose crisis. However, since 2016, experts say these strategies have been overlooked, underfunded, or blocked by provincial governments that are hostile to harm reduction efforts.
“We still see drug use as a moral issue, rather than a public health crisis,” says Kolla, citing the uneven response compared to the COVID-19 crisis.
“We have daily [COVID-19] briefings to inform the public how many people are hospitalized and how many people are dying, and what measures are being put in place. But we have not done that for the overdose crisis. It’s incredibly demoralizing for people who are working on this issue,” she says.
“The huge amounts of suffering caused within the drug-using community has been neglected, frankly, at all levels of government.”