Closing Gaps, Reducing Barriers

Another report for the pile while six people die each day

This submission to The Social Lens: A Social Work Action Blog was a collective effort, written by a number of frontline workers who are concerned about inactivity on the current crisis. Originally published in The Mainlander, November 4, 2022.

On November 1, after four months of consultation & deliberation, a provincial committee released a report titled Closing Gaps, Reducing Barriers: Expanding the Response to the Toxic Drug and Overdose Crisis. In response, individuals and organizations have responded in unison to express disappointment, and call for what is truly needed to address the poisoned drug supply underpinning the overdose death crisis: a predictable and regulated supply of drugs accessible to all within a prescriber model and beyond.

In July, the BC legislature came forward to request public feedback on the drug toxicity crisis response. The next month, it announced that 10,000 lives had been lost to the illicit drug supply since 2016, when it was formally declared an emergency.

Four months after opening the consultation portal, the all-party Select Standing Committee on Health released its long-awaited report to the legislature on November 1, 2022.

The result was another disappointment. While not every recommendation is flawed, the report obscures the issue of a poisonous drug supply, and recommends nothing outside of the status quo. The Minister of Mental Health and Addictions, Sheila Malcolmson, stated the committee report re-affirmed the BC NDP’s current guiding framework – the same framework that currently leads to six deaths per day in the province, and other serious consequences of the emergency.

The report is filled with seemingly deliberately ambiguous recommendations that “engage” rather than order, are “rapid” with no timelines, and create “frameworks” with no regulation.

The report deceptively utilizes the label ‘safe supply’ by having its definition fit a political analysis, rather than what the community has used it to demand. The committee highlights their “robust” debates, done mostly in-camera, making this report feel like a learning exercise and not a crisis response.

To be clear: we need an accessible, predictable, and regulated supply of drugs at a dose that people actually use. Now. We need politicians and public servants with the political will to make bold changes in that direction.

Until then, every overdose is a policy failure.

Key points:

  • The report continues to draw the parameters of the overdose crisis as a ‘health issue.’ The reality is people have always used drugs for a wide variety of reasons, and solutions are necessary for substance use needs that will not and should not be met by the healthcare system. There is no elusive, single reason people use drugs. This was reinforced by the Métis Nation of BC challenging ‘pan-Indigenous’ approaches to substance use to the committee. Focus on stopping drug use obscures the direct cause of overdose deaths – a poisonous supply. Delineating responsibility of the overdose crisis to the much more difficult to solve ‘upstream’ drivers of drug use, like housing and trauma, has been one way to rationalize little action on the drug supply.
  • The report promotes further prohibition, a main driver of the overdose crisis. Prohibition-based policies are a primary systemic cause for the potency and unpredictability of the current drug supply (i.e., as restrictions clamp down, drugs are made less detectable by surveillance, and more potent in the process). The report recommends developing ‘innovative solutions’ to disrupt the supply of illicit drugs – but further supply-side disruption without adequate supply-side intervention risks making the supply even worse.
  • Shockingly, the report recommends more police funding. The report recommends advocating “for an increase in funding from the federal government” for police to refer drug users “who are not charged” to “supports,” under the incoming decriminalization policies. Police should not be the body referring people to treatment services, especially as a coercive option that might otherwise lead to a charge or harassment. In addition to being the agents of prohibition and criminalization of drug users, the police have been a barrier to overdose response and their behaviour is linked to worse outcomes in treatment for some marginalized populations. Literature shows regressive policing is associated with negative health outcomes for some sub-groups of the drug using population. The geographic location of policing also inhibits access to healthcare in urbanized areas for fear of police engagement. There is a significant body of evidence that correlates regressive policing with the reinforcement of inequities, upholding the numerous socioeconomic structural vulnerabilities drug users experience. The report makes space to mention forced treatment without noting that locally, this has shown to have no significant impact on substance use patterns, and recent international research shows that coerced care is associated with more overdose deaths. Premier-elect David Eby has suggested he will try to impose coerced care policies onto some people who use drugs.
  • The report contradicts demands by the BC First Nations Justice Council and other Indigenous leadership to the committee. The BC FNJC called for ways to keep police “out of contact” with people who use drugs. Sto:lo Tribal Council Grand Chief Doug Kelly and Dr. Nel Wieman of the First Nations Health Authority both cited criminalization targeted at Indigenous populations as a major concern; and Dr. Wieman expressed concerns over the insufficient threshold of a 2.5 gram exemption to drug possession outlined in the incoming decriminalization policy. The report makes no recommendation to challenge the 2.5 gram exemption before implementation (only to evaluate it), while it does advocate for an expansion of police.
  • The report conflates funding for assorted mental health services and treatment with funding to combat the drug supply that causes overdoses. The committee states that the federal government has contributed $800 million to combat the overdose crisis nationally – however, these funding streams often have little to do with the drug supply and are not directly related to the drug toxicity crisis.
  • The report cowers away from any demedicalized, supply-side intervention and reiterates fears of prescription diversion – despite access to a diverted supply being safer and more predictable than what is available otherwise on the illicit market.

Overall, the report makes no recommendation that strays from the status quo. It takes no risks in supporting organizations and communities doing work outside of regulatory frameworks. The sole risk the report seems comfortable in taking is the continued risk of lives lost to the poisoned drug supply, while leaning into assessments and research.

This report and its recommendations replicate the same tiresome do-nothing-hope-for-better strategy well-worn by the majority BC NDP government. People who use drugs across the province are stepping up to build their own systems of safe supply, risking surveillance, discrimination and criminalization. As communities grieve thousands lost to this preventable public health emergency, the province’s latest report fails to respond with the urgency that is needed.

Collectively, we are disappointed that the provincial government asked an exhausted and grief-stricken population to provide free consultation on the overdose crisis in exchange for hope, just to continue on its current path. The current path will not save lives. The chief coroner will continue to announce tragic numbers of deaths by the poisoned supply.

If you wish to add your name or organization to the list, email Tyson Singh:

THE SOCIAL LENS: A SOCIAL WORK ACTION BLOG - The views and opinions expressed in this blog are solely those of the original author(s) and do not express the views of the UBC School of Social Work and/or the other contributors to the blog. The blog aims to uphold the School's values and mission.