This article originally appeared in the Province.
By Blair Gibbs and Keith Humphreys, May 4, 2023
In 2020 and 2021, a deadly health crisis caused a loss of about 450,000 years of life in Canada, five times the years of life stolen by COVID. The crisis is drug addiction and, like COVID, it will not be rolled back until the country devotes new thinking and resources to its resolution.
Because the outcomes of the punitive “war on drugs” approach have been disappointing, it is common to imagine that the opposite approach would yield better results.
In 2000, Vancouver launched a new public health-focused strategy to address drug addiction, which ever since has increasingly emphasized harm reduction, including supervised drug consumption sites, heroin clinics, community distribution of powerful opioids, and decriminalization.
However, deaths kept rising every year and in 2016 the province declared a public health emergency — and five years later, deaths had more than doubled again. So, despite noble intentions and a substantial resource investment, B.C.’s overdose death rate is now as high as the worst affected parts of the U.S.If this was any other area of policy — educational attainment, or crime, or cancer survival rates — this level of deterioration would be cause for a huge public reckoning and a major rethink of our approach. Who is responsible? What was promised that simply hasn’t been delivered?
As death rates have climbed, the crime, disorder and wider social impact of the addiction crisis have started to get federal attention. But drug policy seems stuck in a polarized debate between a war on drugs versus complete laxness about their availability and harms. We need a “third way.”
Everyone working in this field wants to improve life chances and save people from premature death, but Canada needs a new approach because we are clearly not winning this battle with the tactics adopted to date. Policies in places like B.C. could be fuelling the drug addiction crisis, not mitigating it.
If an exclusively “harm reduction” approach was the necessary pivot away from a “war on drugs,” then why has a more liberalized approach not managed to save more lives? It can’t be compassionate if it doesn’t work.
The toxic supply of fentanyl is a key driver of the crisis. This public health threat is intrinsically hard to combat; fentanyl is cheap to manufacture, easy to smuggle, potent in very small quantities, hard to interdict and very simple to cut with other drugs.
No jurisdiction has all the answers, but the time has come to recognize the limits of an exclusively harm reduction approach, as well as the right place for smart enforcement, including court-ordered sobriety, and adequate investment in recovery.
We should not be defeatist. Not everyone with an opioid addiction will end up overdosing, and not everyone with a chronic addiction is destined to stay addicted. Recovery is possible and policies should provide viable pathways for drug users to enter treatment and pursue recovery. Pressuring addicted individuals to undergo treatment is controversial, but positive incentives alone may not be working.
Addiction is treatable and more focus on evidence-based treatment options, including new licensed drugs like Sublocade, could help reduce demand for dangerous illicit drugs. Purpose-built recovery communities could provide the sustainable conditions to allow some users to transition to a drug-free life over time.
A third way on addiction policy is possible, but that needs a new debate where we are honest about what success looks like, take a non-ideological approach to the problem, and leverage the right level of government to play its part.
British Columbia remains the epicentre of this drug addiction crisis. Unfortunately, it is no longer where pioneering policy is making any meaningful difference. No one wants a return to an ’80s style crackdown, but we must be prepared to move beyond policies that have not delivered the turnaround we have all been promised repeatedly for over 20 years.
Today’s depressing goal — albeit one that has still not been met — of keeping a slightly higher share of desperate people from dying cannot be the peak of our ambitions.
Blair Gibbs is a policy consultant and former advisor to the UK prime minister. Keith Humphreys is a professor of Psychiatry at Stanford University and served as senior drug policy advisor in U.S. President Obama’s White House. They recently authored a new Report for the Stanford Network on Addiction Policy and participated at a Macdonald-Laurier Institute panel event.
