The Decibel - A year of drug decriminalization in B.C.

Episode Date: February 8, 2024

It’s been a year since B.C. got permission to decriminalize possessing small amounts of some street drugs. At the time, B.C.’s Minister of Mental Health and Addictions said this would “break down the stigma that stops people from accessing life-saving support and services.”But since then, B.C. recorded its highest-ever number of deaths from illicit drugs in 2023. And in response to public outcry, the provincial government has sought to limit drug use in more public areas like beaches and playgrounds.Andrea Woo is a staff reporter at The Globe’s Vancouver bureau, and she’s won a National Newspaper Award for her coverage of the toxic drug crisis. She’ll tell us what we know about how decriminalization works in B.C., and if anyone thinks it’s working out.Questions? Comments? Ideas? E-mail us at [e-mail]

It's been one year since the B.C. government decriminalized certain types of drugs, like heroin and cocaine. Decriminalization was put in place to help address the toxic drug crisis in B.C. More than 2,500 people died just last year. But the policy has also spurred complaints from the public, and some people are asking for decriminalization to be reversed. Andrea Wu is a Globe reporter in Vancouver. She won a National Newspaper Award for her sustained coverage of the toxic drug crisis. She's here to explain what effect decriminalization has had one year in, the politics around it, and what else we could be doing to stop overdose deaths. I'm Maina Karaman-Wilms, and this is The Decibel from The Globe and Mail. Andrea, thank you so much for being here.

Thank you for having me. So BC is one year into decriminalization, and I know you've been covering this for a long time, Andrea. So I think we should maybe just start by taking a step back. Can you just tell us what was the push behind decriminalization in the first place? Sure. So the backdrop to this is that BC is now in its eighth year into a public health emergency due to soaring drug deaths. It's in this context that a lot of people started saying we need to do things differently from how we were doing them before. And that's how we've started to open the door to things like decrim and safer supply and some of the more changes that are considered a lot more radical than what

we might have considered before. Yeah. And when we say decriminalization in this context, what are we actually talking about? What exactly does it mean here? So decriminalization under the current three-year pilot in BC means that for people who have less than two and a half grams of certain drugs, the drugs most commonly associated with overdose deaths, you will not face any criminal penalties. Police will not seize your drugs. It's different from legalization, and I think that's important to point out. These drugs are still completely unregulated. It's illegal to manufacture them, to transport them, to sell them, etc. How does BC plan to measure success here? So that is a very good question because the evaluation of the success of decriminalization hinges on what the stated goals are. And that sounds obvious, but we've heard many different rationales for it. So if we say the goal is to save lives, drug deaths have gone up almost every year for the last

decade. We had a record number of deaths last year, 2,511 people died. And, you know, D-Crim hasn't made a dent in that. Some have pointed out that without addressing the cause of the increase in deaths, and that's the highly toxic illicit drug supply, that those numbers won't change. If we say the goal is to lessen the stigma associated with drug use so that people feel comfortable seeking help, and that's a line that government has said often, BC government says that about 4,200 adults

accessed bed-based treatment and recovery services in 2022-23, and that's up from 3,700 the year before. Can we attribute that to decrim? We can't really say. Others say if we accept that addiction is a health issue, then it makes no sense to impose criminal penalties on people who are grappling with a substance use disorder. And so that is the reason for decriminalization. So BC government says in the first six months compared to the previous four year average, there's been a 76% decrease in possession related offenses and a 97% decrease in possession-related offenses, and a 97% decrease in drug seizures under the two and a half gram threshold. So if you're a vulnerable woman with an addiction and you

didn't have your drug seized, you didn't end up going out and doing sex work to obtain more drugs, desperately trying to avoid withdrawal, is that a success? I mean, if you're a kid in your 20s struggling with drug use and you were not arrested and charged and you didn't get a criminal record and it didn't affect your ability to get a job or housing, is that a success? Probably, but that's very hard to measure. Okay. So it sounds like, yeah, there's a lot of different aspects of this we could look at to kind of assess the success or not. I just want to be clear, though, has the province actually set out a clear measure of success for this program? of decriminalization underway. The province is doing their own. And then there's a separate one, federally funded, based out of Ontario with Ontario researchers. And I don't yet know when we will be seeing the results of that. One thing that you mentioned, Andrea,

and one thing that I would imagine a lot of people might look to if we're talking about what success in this program looks like is reducing the number of deaths, the number of overdose deaths. And so after a year of decriminalization, you said that those numbers actually haven't gone down. They have gone up. It set a record last year in 2023. Do we have any idea of why? What is driving the deaths is our increasingly volatile illicit drug supply. Back in 2012, we had less than 5% of deaths that had fentanyl detected in them. And today it's about 85% every year. So the drugs are significantly stronger. There aren't a lot of second and third chances now. There are other drugs like benzodiazepines

and animal dewormers and tranquilizers being cut into the drugs now that's really messing with people. And it's also worth noting that the toxic drug crisis is not a BC problem. It's widespread across North America. It's continually driven up deaths in many states and provinces. Alberta, for example, places a big emphasis on treatment, not a big fan of harm reduction measures like supervised consumption, no decrim. Alberta is also on record to have its worst year for drug deaths. So January to October, I believe it was, they had almost 1,700 drug deaths. I believe it was nearly 40% more than the same period the previous year. And that's not to suggest that one model is better than the other, but rather to show how widespread and intractable of a problem this is.

I do want to ask you about the response from people in BC to decriminalization. So it's been in effect for a year now. Do we know how British Columbians are feeling about decriminalization now? There has been considerable frustration and concern from the public and from municipalities about street disorder, including public drug use, which some blame on decriminalization. Some policing stakeholders have said that they no longer have the tools to move people along when residents or business owners report problematic drug use. On that, Lisa LaPointe, she is the outgoing chief coroner here in BC. She said that when we're talking about street disorder and public drug use, it's also worth remembering the impact the pandemic has had on our communities, the housing crisis here, the cost of living, and the fact that homelessness has gone up by a lot. The most recent homeless count showed that it's gone up by one third in the lower mainland compared to the previous count from, I think, two or three years before. So Ms. LaPointe's point is, you know, is there more crime and drug use or is it now visible

to a degree that we were not used to? Yeah. So it sounds like people in BC and different communities do have legitimate concerns here, though. I guess, how has the province responded to that? The BC government recently introduced legislation seeking to expand the number of places where drug use would, again, be criminalized. So this would be near building entrances, bus stops, parks, beaches, sports fields, and that would add on to the existing legislation that prohibits it from playgrounds, splash pads, elementary schools, etc. essentially saying that by forcing drug users into the shadows, especially given the dire lack of housing and legal supervised consumption spaces in BC, that it would cause irreparable harm to people at risk of injury or death amid a public health crisis. So while it's clearly not ideal

for people to be using drugs in public spaces, it's safer than the alternative, which could mean death for them. So the province is now appealing that. They're arguing that the judgment was premature, that it was overly broad and not firmly grounded in the evidence, and that the judge failed to respect the government's legislative authority. And of course, Andrea, all of this is playing out in an election year in the province. So I guess I just wonder, how is this issue playing out politically in that way? Yeah, so our next provincial election is currently scheduled for October, with some thinking that it may be called sooner than that. lately. And there has been an apparent effort by the province to seem responsive to the concerns of British Columbians. So I think this is very much an effort to say, hey, we hear that you guys are very worried about this, and here's what we're going to do. Andrea, I think you've spoken to drug users and advocates about decriminalization. Can you just briefly tell me, I guess, what have you

heard from them? If you ask advocates about this, I think they would say that, you know, the criticism that we often hear from them is that what's being done you sort of walk it back and then you include all these places where people are not allowed to use drugs in public places. So technically, BC has decriminalized possession, and yet what is the effect on the ground? Safer Supply is another example of that. You open the door to this quite radical intervention, and yet less than 4% of people diagnosed with an opioid use disorder can actually access these medications and overdose deaths aren't coming down and it's being seen as a failure. We'll be back in a moment. So Andrea, we've talked a lot about decriminalization.

Let's talk a little bit more about safer supply, because this is something that we tend to hear about. But maybe we can just lay it out. How exactly does it work in BC? People have some feelings about safer supply. These are pharmaceutical alternatives to the illicit drug supply. And the BC government is actually trying to call it that, to refer to it as that rather than safer supply, acknowledging that there's no drug that's inherently safe and they moved from safe to safer and they want to scrap that altogether. It's an intervention that is predicated on the idea that if someone is at high risk of overdose

and death from toxic illicit drugs, that a clinician can prescribe a regulated substance instead to either sever or lessen that person's dependence on the street supply, thereby reducing their risk of overdose and death. The most commonly prescribed drug under the program is called hydromorphone. It's an opioid medication that's commonly used to treat moderate to severe pain. So like dental pain, post-surgery pain, cancer pain, etc. And do we have any idea if this is effective in reducing the number of people who actually die from an overdose? So last month, there was the first population level evaluation of safer supply programs in BC, and that was published in the British Medical Journal. The research looked at anonymized data

from just under 6,000 people with either opioid or stimulant use disorder who had filled a prescription as part of BC's safer supply programs between March 2020 and August 2021. And their health outcomes were compared to a control group. And what they found was that people at risk of opioid overdoses who were prescribed at least a one-day supply of a pharmaceutical alternative were 61% less likely to die from any cause the following week. And those who were prescribed a four-day supply were 91% less likely to die from any cause the following week. The researchers were describing it as the strongest evidence thus far. Yeah. I mean, when you're talking about numbers like 61%, that seems like a pretty significant change there. So that seems positive. Of course, there has been a lot of criticism of

safer supply, though, including from politicians. Pierre Polyev, the federal conservative leader, has talked about this quite a bit. This is a deliberate policy by woke, liberal and NDP governments to provide taxpayer funded drugs, flood our streets with easy access to these poisons. So Andrea, what have health experts said to that? Like, are those concerns legitimate? So there are, I would say, two big criticisms in the public discourse and Mr. Polyev's comments there sort of touch on both of them. The first one is that it feels very counterintuitive to be giving, quote, free drugs to addicts, which is how it's been described often, that we should treat people instead. And that it's one of those things that sounds very common

sense. And of course, we would rather treat people and have them not be addicted than be giving them drugs and feeding a habit. I think the main point there is that this is not either or. Safer supply is not treatment. It is essentially a harm reduction intervention to try to keep people alive as we try to direct people towards treatment, as we try to make the situation less horrible. It's estimated that there are 225,000 people who use illicit drugs in BC. Of those, more than 100,000 are diagnosed with an opioid use disorder. At any given time, whether there's a drug crisis or not, only a small fraction of people are ready or able to access treatment. Even if everyone wanted treatment, prescribing pharmaceutical alternatives is not

intended to be the panacea to this. But I think there's a recognition that it can stabilize people. It can lessen their risk of death in the face of an acute toxic drug crisis. And so the second piece, diversion, that is a real concern. And when we say diversion, we mean like reselling drugs essentially is what you're saying? Yeah. So drugs that even pharmaceutical drugs that end up with people to whom they were not prescribed. So since safer supply programs started in British Columbia in 2020, again, the most commonly prescribed medication is hydromorphone. It's comparable in strength to heroin. Heroin is something that hasn't been on our streets really for many years now. It's been completely replaced with fentanyl, which is significantly stronger. And so if you are someone who was addicted to heroin and you have ended up

being addicted to fentanyl, hydromorphone is not going to do very much for you. But this is what we have felt comfortable prescribing to date. And so we hear often, and I've heard directly from people who are part of the program, that if it's not meeting their needs, they will either sell it to get something stronger, like maybe fentanyl to meet their needs, or they'll give it to someone else who cannot access prescribed safer supply. And another big piece of that is that when we talk about people who are diverting these drugs, they're almost, I think, maybe always people who are living in poverty. So I've talked to one addiction physician who prescribes safer supply. And he's like, you know, I have patients who make $80,000. Like they're not the ones who

are diverting their safer supply. It's people who can't eat, like people who are out on the streets. And maybe I need 40, 50 bucks more than I need these tablets right now. There was another doctor that I talked to who was talking about this. And she said, I wish I could just prescribe money instead. It seems to be what they really need. And there have been calls to expand the Safer Supply Program in BC as well. So, I mean, is that something that people are looking at? Yeah, so there have been two reports recently regarding the expansion of Safer Supply. One is from Provin provincial health officer Bonnie Henry. Some of the

recommendations that she had were to expand the types of medications that would be available so that they do meet the needs of people. So there's less of an incentive to sell it or to give it away. The expert panel from the coroner service and Dr. Bonnie Henry, they pointed out the extreme pressures on our healthcare system already. More than a million people don't even have family doctors. To expect individual clinicians to essentially be gatekeepers to a safer drug supply is probably not very realistic. So what Dr. Bonnie Henry has recommended before is potentially something like making these substances available at multidisciplinary clinics. So there's still doctor oversight, but not one-to-one prescribing or making them available at health authority

overdose prevention sites. Or a more controversial model would be Compassion Club. So similar to what we did with weed before legalization, where members would pay money and buy these safer substances. Okay. So Andrea, you've been covering this for a while now. So from your reporting and the people that you've been talking to, I mean, is there anything else that we could or that we should be doing here to confront the toxic drug crisis? People agree on a lot more than one might think based on the public discourse. who have been very loud with their concerns about this agree that regulated opioid medications play a very important tool in responding to people with opioid use disorders, that it's effective in connecting people to healthcare, that it does stabilize people, that it can be used to titrate people to traditional medications like methadone.

I think there's a lot of agreement that our substance use treatment system is inadequate. And I think the most important thing that we could do on an issue that is as emotionally and politically charged as this is to turn the volume down and have a really thoughtful discussion because people agree on a lot more than people might think. Andrea, thank you so much for being here today. I appreciate the opportunity. Thank you. That's it for today. I'mika ram and wilms kasha mahailovich produced this episode our producers are madeline white cheryl sutherland and rachel levy mclaughlin david crosby edits

the show adrian chung is our senior producer and angela pachenza is our executive editor thanks so much for listening and i'll talk to you tomorrow