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

The debate in Parliament about British Columbia’s experience with drug decriminalization was already operating at extremes before Pierre Poilievre used the term “wacko.”

During question period on Monday, the Conservative leader said the Liberal government had unleashed “drugs, disorder, death and destruction.” Other Conservative 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?” Conservative MP Kerry-Lynne Findlay asked.

Health Minister Mark Holland stood and suggested partisanship should be put aside in the face of an epidemic of opioid addiction and overdose deaths. When the minister sat down, Conservative MP Todd Doherty stood up to claim the prime minister’s “extremist drug policies” had “turned our neighbourhoods into war zones.”

On Tuesday — shortly before 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.

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

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

In November 2022, at B.C.’s request, the federal government granted the province an exemption to the Controlled Drugs and Substances 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 federal 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 recalibration might be that the scourge of opioid addiction continues to defy simple answers. But all such nuance is in danger of being drowned out by the shouting.

The competing claims on decriminalization

The Conservatives are resolutely opposed to decriminalization — both the existing exemption for B.C. and the pending request for an exemption 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 alternative 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 enforcement officials during a meeting of the House of Commons 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 Vancouver Police Department, also suggested that public consumption 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 Association of Chiefs of Police.

As the Conservatives have pointed out, Dwayne McDonald, the deputy commissioner of the RCMP, did disagree with a Bloc Quebecois MP’s suggestion that the positives of decriminalization outnumbered the negatives.

But McDonald also said that there “are positive results from decriminalization … in terms of the number of people charged with criminal offences and attempts to divert them away from the criminal justice system. However, we note challenges in public consumption and similarly 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 illicit market was a source of concern — though not a particularly 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 enforcement efforts.”

While condemning British Columbia’s approach to the opioid crisis, the Conservatives have praised the approach taken by Alberta. That province has not moved to decriminalize drug possession and it has been less enthusiastic 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 debate into a simple choice between two different approaches.

Piecing the puzzle together

In an interview with CBC Radio’s The Current this week, a city councillor for New Westminister, B.C. lamented the fact that the move to decriminalize 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 decriminalization as perhaps some sort of silver bullet,” said Daniel Fontaine, referring to the “four pillar” approach that some jurisdictions have adopted to deal with drug problems.

Lindsey Richardson, a professor at the University of British Columbia and the Canada Research Chair in social equity and health inclusion, said it’s hard to determine whether or how much decriminalization has contributed to an increase in public drug use in B.C., as opposed 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 decriminalization is simply to reduce the number of interactions 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 employment.

But decriminalization ideally would be a part of a comprehensive response that considers everything from supply to treatment to the socioeconomic factors that drive drug use, she said. Research also suggests, she added, that no single approach will work for everyone dealing with a drug problem.

“You can’t expect decriminalization 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 deployed a different figure of speech.

“I always talk about decriminalization as being one tiny piece of a much, much larger puzzle,” Wilson said, “and in order to put that puzzle together to see what the picture is, we need increased education and increased prevention.

“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 Parliament, we might now find room for a nuanced debate about a complex and deadly serious problem.