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‘We cannot keep up with how the drugs are changing, and it continues to make our work more difficult,’ says Dr. Paxton Bach.
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On April 14, 2016, B.C. declared a public health emergency after a surge in overdose deaths, primarily caused by synthetic opioids such as fentanyl.
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The province said it would work with health authorities, emergency room doctors, first responders and the B.C. Coroners Service to gather data to help prevent future overdoses and deaths through targeted outreach, bad-drug warnings, awareness campaigns and distribution of naloxone training and kits.
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But 10 years later, the drug supply has become even more potent and more unpredictable.
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Sunrise
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In the past decade, more than 18,000 British Columbians have been killed by toxic drugs. While the 1,826 lives lost in B.C. in 2025 due to unregulated drug toxicity was a 21 per cent decline from the year before, that dip was seen throughout North America, likely to due a combination of factors, including a small decline in fentanyl concentrations.
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Rates of addiction have not changed substantially, said Dr. Paxton Bach, an addiction medicine specialist at St. Paul’s Hospital in Vancouver.
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“We cannot keep up with how the drugs are changing, and it continues to make our work more difficult. People are still dying at unimaginable rates,” Bach said. “It’s very scary.”
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In 2017, Dr. Perry Kendall, then B.C.’s chief medical officer and the official who declared the crisis, suggested the Portuguese model of drug policy — a four-pillar approach focused on harm reduction, prevention, mandatory treatment and enforcement — could work in B.C.
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Over the years, B.C. introduced a safer supply program, overdose prevention sites, and a three-year pilot program to decriminalize people who use street drugs. It also expanded treatment and recovery programs, as well as access to naloxone.
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The results have been mixed.
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Safer supply
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A prescribed safer supply program was introduced in B.C. in 2021, the first province to do so. It provided users with prescribed opioids, stimulants or benzodiazepines. Eligible clients were provided a one-day supply that they could take home to consume.
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But the program was partly rolled back in 2025 after a leaked health audit showed “a significant portion” of the opioids being prescribed, primarily hydromorphone and oxycodone, were being diverted into the community.
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The province changed the take-home practice so consumption would have to be “witnessed by health professionals, ensuring they are consumed by their intended recipient.”
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Surrey MLA Elenore Sturko, a former RCMP officer, said the focus on the supply side of the problem has been misguided, and that both the safer-supply program and decriminalization have had unintended consequences.
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“Through the misrepresentation of drugs as ‘safe supply,’ we created a black market for dealers to market their own drugs as safe supply,” said Sturko.
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The scrapping of the take-home model was decried by advocate Leslie McBain, whose son died of an overdose in 2014 after becoming addicted to oxycodone after being prescribed opioids following a work accident.
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“Many people who are in addiction are employed, are housed, and can’t go four times a day to be witnessed. They will just go back to the black market, which is much easier, and then there will be more toxic overdoses and more fatalities,” said McBain, the family engagement lead for the B.C. Centre on Substance Use.
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Decriminalization
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In 2023, the B.C. government introduced another first — a three-year pilot program decriminalizing the possession of small amounts of certain illicit drugs.
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The intent was to keep drug users out of the prison system, end the shame and stigma associated with drug use, and make it easier for people struggling with addiction to come forward and get help.
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But the program came under scrutiny due to increasing public drug use in parks and hospitals. “Decriminalization left people in the community feeling increasingly unsafe,” said Sturko.
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B.C.’s medical health officer during the decriminalization pilot, Dr. Bonnie Henry, said Monday she was disappointed with the lack of political support.
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“I absolutely believe there was political pressure,” said Henry, speaking at a roundtable discussion on the crisis with B.C. Health Minister Josie Osborne sitting next to her.
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“I watched and observed, and I saw language that was being used by political leaders in these comments and across the country that I felt was very stigmatizing and pushed us back, and I believe that affected people’s understanding of the nuance around things.”
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Decriminalization was especially misunderstood by the public, said Henry.
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“We didn’t have the degree of support and understanding in the community, particularly around decriminalization. It’s the decriminalization of people. It’s about people. And I think it got mixed up, because it’s very easy to say, ‘Oh, you legalized drugs, and that’s the cause of this problem’ — which is, of course, not true.”
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It’s about allowing people who use drugs to come forward without fear of being pulled into the criminal justice system, said Henry.
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In January, at the conclusion of the pilot, B.C. announced the pilot would not be renewed, as it had “not delivered the results we hoped for.”
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“We continue to believe that addiction is a health issue, not a criminal justice issue,” Osborne said then.
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Overdose prevention sites
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In late 2016, the province announced it was allowing health authorities to set up overdose prevention sites on an emergency basis in overdose hot spots that would ensure people have a place where they can be “safely monitored and treated immediately if they overdose.”
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Overdose prevention sites are distinct from permanent supervised consumption sites, which have supervision services embedded and other health and social services, including mental health and substance use services, and require federal approval.
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Last year, the B.C. government said it was introducing new minimum standards for overdose prevention sites to enhance safety and oversight. Osborne, the health minister, has said such sites have helped prevent thousands of deaths and serve as a “first point of entry for many people into the substance-use system of care.”
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But these harm-reduction services continue to draw scrutiny.
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Federal Conservative Leader Pierre Poilievre has said he would require that overdose prevention sites convert to supervised consumption sites. He would also restrict where supervised consumption sites could be located.
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Alberta and Ontario have both announced closures of overdose prevention sites and supervised consumption sites, in favour of recovery and treatment programs.
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In justifying the closures, Alberta cited a study by the Canadian Centre of Recovery Excellence, an Alberta Crown corporation, that concluded the closure of an overdose prevention site in Red Deer did not lead to an increase in overdose mortality and led to a small increase in treatment-seeking. But the study was criticized for small sample sizes, and flawed methodology.
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McBain called such closures “completely counterproductive to stopping deaths.”
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Naloxone
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B.C.’s take-home naloxone program is one of the success stories, said Bach.
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Naloxone was first introduced in B.C. in 2012 as a tool to reverse heroin overdoses, and made more widely accessible after the crisis was declared in 2016. Since that time more than 2.9 million take-home naloxone kits have been delivered in the community.
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In February 2026, the province announced a one-year commitment to make nasal naloxone more widely available.
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While naloxone has improved overdose outcomes, overdoses are becoming more complicated for front-line and emergency medicine workers, said Bach.
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The potency, variability and unpredictability of fentanyl, and contaminants that naloxone can’t reverse, such as benzodiazepines, xylazine and medetomidine, are making things worse, said Bach.
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Likewise, fentanyl test kits, available at supervised consumption sites and overdose prevention sites since 2016, and for take home since 2020, are not adequate for the complexity of the synthetic drugs, said Bach.
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Treatment
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Access to mental health and addiction treatment has expanded in the province in the past 10 years.
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Bach points to the road to recovery program, a rapid-access treatment program launched by Providence Health Care that offers detox and long-term care beds, as another step in the right direction.
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Since 2017, the B.C. government says it has introduced more than 800 new treatment and recovery beds, bringing the total number of beds to 3,785.
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Dr. Julian Somers, an SFU professor of health sciences who is an addiction specialist, said the kind of treatment beds matters as much as the number.
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“The treatment programs we have are relatively siloed, and there are no standards across treatment programs in B.C.”
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Expanded access to opioid agonist treatment, involving medications like Suboxone or methadone, has expanded dramatically in the last 10 years, but medication-based programs are not adequate on their own, said Somers.
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“We need effective addiction treatment that focuses on the psychological and social changes that make it possible to … have a meaningful recovery.”
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Somers cites social isolation and poverty as key drivers in the addiction crisis, and said poor British Columbians need the same access to recovery programs that are available to those with access to privately funded options.
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“We need a single standard of treatment. If you are a poor person in B.C. we act as though the psychological and social aspects of your treatment doesn’t exist, and we give you the one thing you need separation from: drugs.”
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Developing effective treatment programs has taken too long, said McBain.
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“There are a lot of aspirational things the government says that we don’t see happening,” McBain said. “We still have four or five people dying every day from a preventable cause.”
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