Have harm reduction advocates learned from their recent defeats?
Nearly ten years after BC's opioid emergency declaration, prospects for an effective response have never seemed bleaker. A US expert argues that feuding factions in drug policy wars have to make peace
With just ten months to go before the tenth anniversary of the declaration the declaration of BC’s toxic drug overdose emergency, the prospects for a viable, coherent and effective response have never seemed bleaker.
Harm reduction advocates, who have driven the policy agenda from San Francisco to Vancouver since 2020, have suffered shattering political setbacks, but no one has emerged to take their place. Enforcement, treatment, prevention, and harm reduction strategies remain in splendid isolation in their respective silos while drug producers refine their products and step up production.
Here in BC, the overdose death toll has slackened but remains at catastrophic levels, taking about five lives a day.
Now Keith Humphreys, former Drug Policy Advisor to President Barack Obama, and one of North America’s most eminent drug policy analysts, has traced the dramatic rise and equally sudden collapse of harm reduction efforts across the Pacific Northwest between 2020 and 2024 in a new study for the Brookings Institution.
His conclusion: if harm reduction advocates “are willing to acknowledge and learn from their mistakes,” including by engaging with advocates outside the harm reduction bubble, “they have the potential to significantly improve drug policy’s effectiveness.”
Former BC Provincial Health Officer Perry Kendall has made a similar appeal on many occasions, so far to no avail.
Of course, harm reduction covers a broad range of responses, from distribution of Narcan to the prescribing of opioid substitutes. Most harm reduction approaches are non-controversial, but the provision of prescribed or non-prescribed alternatives like hydromorphone or dilaudid has triggered widespread resistance.
This province’s long-standing commitment to harm reduction, which stretches back to Canada’s first supervised injection site in Vancouver in 2003, and needle exchanges long before than, hit a brick wall in April 2024, when public outcry about public drug use forced Premier David Eby to cancel the province’s experiment with decriminalization almost before it began.
When Provincial Health Officer Bonnie Henry urged consideration of providing a non-prescribed supply of safer opioids in July, Eby said there was “zero” chance it would happen. His decision was “non-negotiable.”
Henry, who had succeeded Kendall as the province’s chief strategist in the fight against the impact of the toxic drug supply, was effectively silenced.
In November, the Ministry of Mental Health and Addictions disappeared during a cabinet shuffle and was absorbed back into the Ministry of Health. Then, prescribed safer supply, a favourite target of Conservative critics—who seem to think it’s a bigger threat than cartel production—was unceremoniously converted to a monitored program in the wake of a leaked internal document outlining the role of rogue pharmacists in drug diversion.
What’s left?
BC’s focus is now on involuntary care, a complex and challenging effort to move violent, brain-damaged and criminal substance users into treatment, whether they agree or not.
The province has begun rolling out the first of its new involuntary care beds, opening 18 in Maple Ridge on June 3 to join ten opened at Surrey Pretrial Centre in April. The long-term goal is 400 more beds in three years. It’s an important initiative, but not a strategy.
Humphreys argues that harm reduction strategies adopted in the Pacific Northwest between 2020 and 2024 attempted to reduce the role of law enforcement in drug policy “on the theory that this would allow for a more health- and social justice-focused approach to drugs.
“However, the massive decline in drug and public disorder-focused law enforcement did not generate promised improvements. Indeed, fatal overdoses soared from San Francisco to Vancouver, treatment services were not expanded, and crime and disorder rose.” Politicians and policymakers rushed to roll the reforms back as voters challenged them in the Legislature and at the ballot box.
It had been a very different story four years earlier, in the midst of the pandemic and on the heels of police killing of George Floyd in Minneapolis. Anti-police sentiment was hot, and many American cities responded to calls to “defund the police.”
San Francisco’s attorney general, Chesa Boudin, deprioritized drug enforcement and stepped-up oversight of police. A well-funded initiative won state-wide decriminalization in Oregon. Washington State’s Supreme Court ruled existing drug possession laws were unconstitutional. New laws required police to document referrals to addiction treatment before users could be arrested.
In Vancouver, Mayor Kennedy Stewart won council support to freeze the budget of the Vancouver Police Department, setting off a feud with the VPD that contributed to his crushing defeat at the polls in 2022. Kennedy also campaigned hard during this period to have decriminalization occur at the city level.
In the United States, prestigious organizations on the left and the right both supported harm reduction, but for opposite reasons. Libertarian scholars argued that adults should “be free to make their own choices” about drug use, while the more liberal Drug Policy Alliance insisted that “we should respect people’s bodily autonomy.” Other organizations argued harm reduction would expand social justice by reducing police pressure on marginalized communities.
The Canadian Drug Policy Coalition took a similarly aggressive position, claiming that “decriminalizing personal drug possession and necessity trafficking are fundamental, necessary steps” to reduce the harms of opioid use. Low level dealers would be free to carry on business without interference.
Harm reduction advocates, including BC’s Bonny Henry, argued that prohibition of drugs was innately racist because the impact of enforcement fell disproportionately on people of colour. Henry and others argued that provision of a “safer” supply of drugs, either on a prescription or non-prescribed, would be one of the few effective ways to separate users from the crime-driven toxic supply.
Even if these arguments are sound, and Humphreys believes many are not, they were irrelevant to the broader public in the face of public drug markets, increased violence and widespread street disorder arising from drug use.
As decriminalization unfolded across the Northwest, different jurisdictions saw different outcomes. Crime increased in the US, but not in Canada. Overdose deaths rose everywhere between 2020 and 2022. BC had record high overdose death rates for three years in a row. By 2022, the tide had turned sharply against decriminalization across the Northwest. One by one, leaders who had driven forward on harm reduction were thrown out of office or saw their initiatives reversed at the polls.
Humphreys blames the BC NDP’s support for decriminalization, in part, for its near defeat in the 2024 election, a reality Eby acknowledged in his election night speech. Humphreys draws a simple lesson: harm reduction advocates “focused on what they considered the rights and desires of people who use drugs and ignored the rights and desires of everyone else.”
The worst mistake of all, he adds, was “to assume that the public could be persuaded to sympathize deeply with people who deal a drug that kills hundreds of Americans every day.” (To be fair, this is a position that few advanced in BC.)
None of the “four pillars” of a comprehensive drug response is in good shape in this province, despite the expenditure of hundreds of millions of dollars. (The Ministry’s overview shows just how much has been done, listing dozens of initiatives while noting wistfully that “fighting the toxic drug crisis is much harder than it used to be.”)
Although BC has made halting efforts to improve enforcement through better co-ordination among police forces, the government has not moved forcefully to implement the scathing recommendations of a report on BC’s response to organized crime. Perhaps worse, the government has not been able to create a compelling strategy for treatment that provides timely and compassionate access to appropriate care.
Other jurisdictions are trying new approaches. Oregon’s Multnomah County created a “unified command” of agencies managing the drug crisis and began issuing regular bulletins on progress. Nothing comparable exists here.
In the face of these realities, it’s hard to argue with Humphreys’ view that progress will only come by ending the current polarization between “war on drugs” advocates on the one hand and all-out legalization proponents on the other. The solutions lie in between.
Who will go first? BC needs a new strategic approach, with what Humphreys argues are “trade-offs [that] are both broadly evident and broadly popular,” well before the tenth anniversary of the emergency declaration. Hundreds, perhaps thousands of lives are at stake.
Hear Keith Humphreys and Blair Gibbs, a policy advisor to Boris Johnson, propose a third approach to drug policy as they contrast the different approaches to the addiction crisis taken by Alberta and British Columbia in this 2023 webinar with Aaron Wudrick of the Macdonald-Laurier Institute.
Addiction is hard. No one this "cures" it.