"Every Death a Policy Failure": The Other Public Health Crisis

  • Matthew Bonn

    Canada has been in the worst public health crisis it’s ever seen, years before the COVID-19 pandemic emerged.1 This is the “other” public health crisis, overshadowed by the pandemic and ignored by the general public: a crisis that has left families devastated and looking for answers. A crisis that has been used for political gain, yet left abandoned when real changes were possible. This is a public health crisis that has personally impacted me: I’ve been forced to procure toxic and poisonous drugs and to be criminalized for using them, even though I don’t drink or consume legal substances. If you know what I’m describing, then I apologize because you’ve likely been impacted by it too. This is Canada’s worst public health crisis, far more stigmatized and discriminated against than any others.  

    Here is an inside look at Canada's overdose crisis.  

    From January 2016 to March 2022, there have been 30,843 opioid-related deaths, referred to here as overdose deaths. Since the onset of the COVID-19 pandemic, there was a 91% increase in these deaths. In reality this is a drug poisoning crisis that has claimed the lives of over thirty thousand Canadians, yet very little policy action has been taken.2 Even though the majority of these deaths have been in the west of Canada, causing disastrous and catastrophic harm to provinces such as British Columbia and Alberta,3,4 Ontario5 has also endured lasting and significant harms because of the overdose crisis. What about all the other provinces? What have they experienced? As a Canadian living on the east coast, I can say that every province has been impacted by this crisis, and nearly everyone has experienced some sort of loss due to the contamination of our drug supply.   

    The government of Canada has created an interactive epidemiological map to display and track these deaths—but what have they done to effect positive change to start saving the lives of some of the most marginalized and discriminated-against citizens?  

    While political parties continue to drag their heels on implementing demands for policy changes such as decriminalization and safe supply, multiple Canadians die from a toxic unregulated drug each day. Every time someone dies from poisonous drugs, a family is broken to pieces. In response, unique non-governmental organizations such as Moms Stop the Harm have organized to fight for a wide-level system change, to once and for all end Canada’s overdose crisis. Moms Stop the Harm is defined as a “network of Canadian families impacted by substance-use-related harms and deaths.” They “advocate for the change of failed drug policies, provide peer support to grieving families, and assist those with loved ones who use or have used substances.” Sadly enough, during this crisis, they have had an increasing number of new members signing up to change a failed system.  

    Will politicians listen to these grieving mothers? I hope so.  

    If they don’t listen to family members, will they listen to people who use drugs? Will politicians continue to be able to look into the eyes of—not only mothers grieving the loss of loved ones—but also some of the most dedicated, passionate, and resilient citizens who are set on ending the overdose crisis? 

    The Canadian Association of People who Use Drugs (CAPUD) has been around a little bit longer than Moms Stop the Harm, but the two organizations have led the fight together for progressive Canadian drug policy over the last few horrific years. CAPUD, which I’m a part of, is defined on their website as a national organization composed entirely of people who use or used drugs, including board members and staff.6 They empower people who use drugs currently deemed illegal to survive and thrive with their human rights respected and their voices heard. They envision a world where drugs are legally regulated and the people who use them are not criminalized. CAPUD is structured to have diverse representation from people most directly impacted by the overdose crisis: the organization’s board includes members from all over Canada, and the staff are located in Dartmouth, Nova Scotia. As an organization of people who use illegal drugs and have witnessed their communities die, CAPUD’s coast-to-coast scope shows just how many people are impacted by this crisis. These are some of the most brave and courageous advocates, fighting for long-term policy change by admitting that the substances they choose to use are criminalized.  

    If it wasn’t for organizations like CAPUD or Moms Stop the Harm, our drug policies in Canada would be as archaic as when drug prohibition started. We may not have the progressive policies advocates are demanding, but some positive change has taken place. Canadian law has mechanisms to “exempt” drugs from the Controlled Drugs and Substances Act, such as Health Canada’s exemption bureau. When an organization applies to run an overdose prevention site7 or a supervised consumption site,8 they apply directly to the federal government for an exemption, which permits drugs that are procured on the unregulated market to be consumed safely and with others present at a standalone brick-and-mortar site. To this day, there hasn’t been a recorded overdose death in one of these facilities.9 Frontline staff are trained to respond to overdoses with rescue breathing or naloxone. Naloxone has been an extremely effective tool in the fight against the overdose crisis, as it reverses opioid overdoses when responded to in a timely manner.  

    There isn't one silver bullet in the fight against the overdose crisis, but there are long-term policy changes that need to be implemented to allow us a realistic chance against the unregulated toxic drug supply. These include structural policy changes such as implementing patient-centred safe supply,10 and decriminalizing everyone who uses drugs. 

    A safe and regulated supply of one's drug of choice informs the consumer of its quality and quantity, reducing the unintentional harms caused by contamination. This concept was coined by CAPUD, which defines safe supply as a legal and regulated supply of drugs with mind- or body-altering properties that have traditionally only been accessible through the illegal unregulated drug market. This concept has been ramped up in practice across the country, including appearing in peer-reviewed studies coming out of British Columbia, Ontario, and Nova Scotia.11,12,13 While Health Canada’s Substance Use and Addictions Program14 has funded multiple safe-supply programs, healthcare practitioners and providers have increased medical safe-supply prescribing practices since the COVID-19 pandemic.  

    Safe supply is an intervention; it is not the solution. People who use illegal and unregulated drugs are still at risk of the structural and social harms experienced by the criminalization of drug use. Safe supply should be scaled up and several models need to be implemented such as injectable opioid agonist therapy and compassion clubs.15,16 People who use drugs are not homogeneous—they come from diverse backgrounds and use drugs in different ways.  

    Advocates calling for a safe supply, for the most part, have also been demanding decriminalization of drug use. While some political parties support this, our federal government in power still wants more data and research. Therefore, they granted British Columbia a temporary exemption17 under the Controlled Drugs and Substances Act, subsection 56.1, the same section that allows overdose prevention sites and supervised consumption sites to operate. This exemption was put together quickly, and has fundamental flaws, such as a threshold amount of 2.5 grams. Additionally, benzodiazepines are not included in the exemption (despite the radical shift in the drug supply in British Columbia that has been saturated with novel psychoactive benzodiazepines18 such as etizolam and flurazepam), and it is only offered in a three-year time slot. This exemption should be granted for at least five-year intervals with options to renew, and offered to any provinces willing to decriminalize drug use, since it is federal drug laws that criminalize people.  

    It’s not just people who use drugs and their family members whose voices we need to hear. If Canada is ever to fully implement safe supply and drug decriminalization, we need every stakeholder at the table demanding the human rights of every citizen be upheld, regardless if they use currently criminalized drugs, to reinforce the idea that which drugs are criminalized and which aren’t is arbitrary. Sometimes this calls for the general public to support people who use drugs and their families at the local drug policy rally. Sometimes it means taking the lead through other forms of advocacy, such as letter writing to politicians or journalism in national or local media. You never know who you may reach by writing your truths in the opinion section of your local newspaper. There are also media outlets dedicated to shifting drug policy, such as Filter, an online publication 19 based in New York that amplifies the voices of people who use drugs and work in drug policy all over the world. Filter was launched in 2018 and their mission is to advocate through journalism for rational and compassionate approaches to drug use, drug policy, and human rights. Publications like Filter have a sustainable and lasting impact by highlighting what’s happening with the war on drugs in other regions and jurisdictions.  

    Through Filter I have met people around the world doing the same work that I do, fighting chaotic drug laws. If I’m not writing a piece for Filter, then I’m reading someone else's or commenting for an up-and-coming drug policy journalist. This is one of many ways people can get involved in changing the narrative on drug use.  

    People have altered their state of mind since the beginning of time, and we’re not going to stop! The criminalization of drug use has not slowed human drug consumption. Every death caused by a toxic unregulated drug devastates families and loved ones. The overwhelming amount of grief and trauma experienced by this community needs to be considered, and we need to do everything we can to support this marginalized population.  

    I have experienced the structural and consistent harms of the toxic drug supply. I have overdosed multiple times from not only fentanyl, but also the new wave of the drug supply that has seen an increase of tranquilizers and benzodiazepines. Just because I like altering my state of mind and shutting it off once in a while doesn’t mean I want to die. I need a regulated drug market, just like how the rest of society has the luxury of buying alcohol of known quality, quantity, and purity. I also need to know that I’m not being criminalized for a drug that I decide to use or not. It’s my body; it’s my choice.  

    I use drugs, but that’s just one part of my identity! I’m a researcher, an advocate, and a journalist. I have seen the power of what advocacy can do and I’m convinced that this overdose crisis isn’t going to end until long-term drug policy measures such as safe supply and decriminalization are implemented and in place for everyone who uses drugs in Canada.  

    I won’t stop advocating until we have a comprehensive regulated drug market.  

    I won’t stop advocating until all drugs consumed are not criminalized anymore.  

    We need to empower the voices of people fighting for this cause. Too much harm and havoc has already been caused by the toxic drug supply and the criminalization of drug use. 



    Matthew Bonn is the program manager with the Canadian Association of People Who Use Drugs. He’s also a board member of the International Network of Health and Hepatitis in Substance Users and a knowledge translator for the Dr. Peter Centre. His writing has appeared in The Conversation, CATIE, Doctors Nova Scotia, Policy Options, and The Coast. Matthew was on the 64th Canadian Delegation to the Commission on Narcotic Drugs. He is a current drug user and formerly incarcerated person.

    See Connections ⤴

    1↑2↑3↑4↑5↑6↑7↑8↑9↑10↑11↑12↑13↑14↑15↑16↑17↑18↑19↑