The brutal stabbing last month of a 58-year-old city employee in Nanaimo, B.C., made national headlines. The man was stabbed multiple times with a syringe after he asked two men who were using drugs in a public park washroom to leave.

The worker sustained multiple injuries to his face and abdomen and was hospitalized. As of Jan. 7, the RCMP were still investigating the suspects.

The incident comes on the heels of other violent attacks in the province that have been linked to mental health and substance use disorders.

On Dec. 4, Vancouver police fatally shot a man armed with a knife inside a 7-Eleven after he attacked two staff members while attempting to steal cigarettes. Earlier that day, the man had allegedly stolen alcohol from a nearby restaurant.

Three months earlier, on Sept. 4, a 34-year-old man with a history of assault and mental health problems randomly attacked two men in downtown Vancouver, leaving one dead and another with a severed hand.

These incidents have sparked growing calls from politicians, police and residents for governments to expand involuntary care and strengthen health-care interventions and law enforcement strategies.

“What is Premier Eby, the provincial and federal government going to do?” the volunteer community group Nanaimo Area Public Safety Association said in a Dec. 11 public statement.

“British Columbians are well past being fed-up with lip-service.”

‘Extremely complex needs’

On Jan. 5, B.C.’s newly reelected premier, David Eby, announced the province will open two involuntary care sites this spring. One will be located at the Surrey Pretrial Centre in Surrey, and the other at the Alouette Correctional Facility in Maple Ridge, a city northeast of Vancouver.

Eby said his aim is to address the cases of severe addiction, brain injury and mental illness that have contributed to violent incidents and public safety concerns.

Involuntary care allows authorities to mandate treatment for individuals with severe mental health or substance use disorders without their consent.

Amy Rosa, a BC Ministry of Health public affairs officer, confirmed to Canadian Affairs that the NDP government remains committed to expanding both voluntary and involuntary care as a solution to the rise in violent attacks.

“We’re grappling with a growing group of people with extremely complex needs — people with severe mental health and addictions issues, coupled with brain injuries from repeated overdoses,” Rosa said.

As part of its commitment to expanding involuntary care, the province plans to establish more secure facilities and mental health units within correctional centres and create 400 new mental health beds.

In response to follow-up questions, Rosa told Canadian Affairs that the province plans to introduce legal changes in the next legislative session “to provide clarity and ensure that people can receive care when they are unable to seek it themselves.” She noted these changes will be made in consultation with First Nations to ensure culturally safe treatment programs.

“The care provided at these facilities will be dignified, safe and respectful,” she said.

Maffeo Sutton Park, where on Dec. 10, 2024, a Nanaimo city worker was stabbed multiple times with a syringe; Sept. 1, 2024. [Photo credit: Alexandra Keeler]

‘Health-led approach’

Nanaimo Mayor Leonard Krog says involuntary care is necessary to prevent violent incidents such as the syringe stabbing in the city’s park.

“Without secure involuntary care, supportive housing, and a full continuum of care from detox to housing, treatment and follow-up, little will change,” he said.

Elenore Sturko, BC Conservative MLA for Surrey-Cloverdale, agrees that early intervention for mental health and substance use disorders is important. She supports laws that facilitate interventions outside of the criminal justice system.

“Psychosis and brain damage are things that need to be diagnosed by medical professionals,” said Sturko, who served as an officer in the RCMP for 13 years.

Sturko says although these diagnoses need to be given by medical professionals, first responders are trained to recognize signs.

“Police can be trained, and first responders are trained, to recognize the signs of those conditions. But whether or not these are regular parts of the assessment that are given to people who are arrested, I actually do not know that,” she said.

Staff Sergeant Kris Clark, a RCMP media relations officer, told Canadian Affairs in an emailed statement that officers receive crisis intervention and de-escalation training but are not mental health professionals.

“All police officers in BC are mandated to undergo crisis intervention and de-escalation training and must recertify every three years,” he said. Additional online courses help officers recognize signs of “mental, emotional or psychological crisis, as well as other altered states of consciousness,” he said.

“It’s important to understand however that police officers are not medical/mental health professionals.”

Clark also referred Canadian Affairs to the BC Association of Chiefs of Police’s Nov. 28 statement. The statement says the association has changed its stance on decriminalization, which refers to policies that remove criminal penalties for illicit drug use.

“Based on evidence and ongoing evaluation, we no longer view decriminalization as a primary mechanism for addressing the systemic challenges associated with substance use,” says the statement. The association represents senior police leaders across the province.

Instead, the association is calling for greater investment in health services, enhanced programs to redirect individuals from the justice system to treatment services, and collaboration with government and community partners.

Vancouver Coastal Health’s Pender Community Health Centre in East Hastings, Vancouver, B.C., Aug. 31, 2024. [Photo credit: Alexandra Keeler]

‘Life or limb’

Police services are not the only agencies grappling with mental health and substance use disorders.

The City of Vancouver told Canadian Affairs it has expanded programs like the Indigenous Crisis Response Team, which offers non-police crisis services for Indigenous adults, and Car 87/88, which pairs a police officer with a psychiatric nurse to respond to mental health crises.

Vancouver Coastal Health, the city’s health authority, adjusted its hiring plan in 2023 to recruit 55 mental health workers, up from 35. And the city has funded 175 new officers in the Vancouver Police Department, a seven per cent increase in the force’s size.

The city has also indicated it supports involuntary care.

In September, Vancouver Mayor Ken Sim was one of 11 B.C. mayors who issued a statement calling on the federal government to provide legal and financial support for provinces to implement involuntary care.

On Oct. 10, Conservative Party Leader Pierre Poilievre said a Conservative government would support mandatory involuntary treatment for minors and prisoners deemed incapable of making decisions.

The following day, Federal Minister of Mental Health and Addictions Ya’ara Saks said in a news conference that provinces must first ensure they have adequate addiction and mental health services in place before discussions about involuntary care can proceed.

“Before we contemplate voluntary or involuntary treatment, I would like to see provinces and territories ensuring that they actually have treatment access scaled to need,” she said.

Some health-care providers have also expressed reservations about involuntary care.

In September, the Canadian Mental Health Association, a national organization that advocates for mental health awareness, issued a news release expressing concerns about involuntary care.

The association highlighted gaps in the current involuntary care system, including challenges in accessing voluntary care, reports of inadequate treatment for those undergoing involuntary care and an increased risk of death from drug poisoning upon release.

“Involuntary care must be a last resort, not a sweeping solution,” its release says.

“We must focus on prevention and early intervention, addressing the root causes of mental health and addiction crises before they escalate into violent incidents.”

Sturko agrees with focusing on early intervention, but emphasized the need for such interventions to be timely.

“We should not have to wait for someone to commit a criminal act in order for them to have court-imposed interventions … We need to be able to act before somebody loses their life or limb.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler

On Christmas Eve, during his final year of high school, Justin Schneider’s friend handed him his first bowl of weed.

Schneider says he remembers it being an especially stressful evening and thinking, ‘Oh my God, they were lying to us about this.’

“Here I was this ‘good kid,’ staying away from alcohol and drugs, but this stuff is the best thing I’ve ever had,” he said. “But that reaction was brought on because it was the first time I’d ever taken any type of medication for anxiety.”

At first, Schneider used cannabis to cope with generalized anxiety, depression and insomnia. By his late twenties, he had become a heavy user.

In 2018, after more than 20 years of daily cannabis use, he was finally able to overcome his cannabis dependency with the help of a psychiatrist and addictions counselor.

Canadians’ relationship with cannabis has shifted dramatically since it was first legalized for non-medical use in 2018, a new survey shows.

The 2024 Canadian Cannabis Survey, released by Health Canada Dec. 6, reveals cannabis use has become increasingly normalized, driven by broader legal access and growing social acceptance. It also suggests legalization has achieved many of policymakers’ key goals.

But Schneider and others warn cannabis is not without its risks, and say better public education is required to address some of cannabis’ lesser known risks.

‘Some sketchy guy’

Health Canada’s annual survey, which collected responses from more than 1,600 Canadians aged 16 and older, reveals a thriving legal cannabis market in Canada.

The number of users purchasing cannabis through legal channels has nearly doubled since legalization, rising from 37 per cent in 2019 to 72 per cent today.

“I imagine if I was just starting out [with cannabis] now, I wouldn’t ever have to interact with some sketchy guy, and that would have been easier growing up,” said Jesse Cohen, a 34-year-old daily cannabis user from Montreal.

Cohen uses cannabis to unwind after work or while performing menial tasks at home. Today, he picks up his supply from a sleek, well-lit government-regulated dispensary. He feels this interaction is safer than buying it on the black market.

Cohen says he has also seen the quality and variety of products on the market improve — accompanied by an increase in price.

In the survey, just over one-quarter of all respondents said they used cannabis for non-medical purposes in the past year, up from 22 per cent in 2018. Among youth, that number was 41 per cent.

The number of youth using cannabis has remained stable since 2018, a finding that challenges some critics’ claims that legalization would lead to higher rates of youth consumption.

“For youth, I do think that the whole legalization de-stigmatized and took the risk out of it — it wasn’t a taboo subject or a taboo activity anymore — so there wasn’t the same draw,” said Ian Culbert, executive director of the Canadian Public Health Association, a non-profit that promotes public health.

“Let’s face it, youth experiment, and if it’s something your grandmother is doing, you don’t necessarily want to be doing it too.”

Another positive trend, Culbert says, is that cannabis users now seem to be better informed about the risks of driving while high.

Only 18 per cent of people who had used cannabis in the past year reported getting behind the wheel after cannabis use, down from 27 per cent in 2018.

Culbert interviewed cannabis users when cannabis was legalized. At that time, many said they thought their driving abilities improved when under the influence of cannabis.

“Of course, that’s just not the truth … They felt that their video game experience was so much better when they were consuming, therefore why wouldn’t driving a car be better?” Culbert said.

“I think [because of] education efforts, and the fact that police across the country have put in programs to identify and prosecute people who are driving impaired, that message has gotten through, and people are now equating it to drinking alcohol and driving.”

Public health campaigns also seem to have raised awareness of cannabis’ risks to physical health. Successive Health Canada cannabis surveys have shown a growing understanding of cannabis’ effects on lung health and youth brain development.

Schneider believes public health campaigns now need to focus more on the mental health risks associated with heavy cannabis use.

“I think there’s a responsibility to say that, for a small proportion of people, it can be very psychologically addictive and very, very risky to mental health.”

According to Health Canada, regular cannabis users can experience psychological and mild physical dependence, with withdrawal symptoms that include irritability, anxiety, upset stomach and disturbed sleep.

“You don’t actually have anxiety,” said Schneider about his own withdrawal symptoms. “But your brain creates it anyway, driving you to use cannabis to relieve it.”

Research also shows frequent use of high-THC cannabis is linked to an increased risk of psychosis, a mental condition marked by a disconnection from reality. Individuals with mental disorders or a family history of schizophrenia are at particular risk.

In the survey, only 70 per cent of respondents said they had enough reliable information to make informed decisions about cannabis use. And the number of respondents saying they have not seen any education campaigns or public health messages about cannabis has increased, from 24 per cent in 2019 to 50 per cent today.

Culbert says the revenue that the government generates from cannabis creates a disincentive for it to issue strong health warnings.

“There’s no coherence in our regulatory and legal frameworks with respect to health harms and the level of regulation,” he said.

“Governments are addicted to their sin taxes,” he said.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.