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Addictions

Harm reduction projects in Nelson are fraying the city’s social fabric, residents say

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News release from Break The Needle

Public disorder and open drug use raise concerns in picturesque mountain-rimmed town.

“Just the other night, we had an intruder in our yard,” Kirsten Stolee recounted, her voice unsteady. Her two daughters often watch television with their windows open. “He easily could have gotten inside,” she said.

Stolee lives in Nelson, a picturesque, mountain-rimmed town in BC’s Southern Interior that is struggling with rising public disorder. Some residents, herself included, say that local harm reduction initiatives – which appear to be operating without adequate accountability and safety measures – are responsible for the decay.

Near Stolee’s house, one can find the Stepping Stones emergency shelter alongside the former Nelson Friendship Outreach Clubhouse, which used to provide support services for individuals struggling with mental health issues before being abandoned late last year.

When the clubhouse still operated, supporters claimed that it provided clients with a space to socialize and partake in “art, gardening, cooking and summer camp” – but critics countered that it was a drop-in centre for drug users. After the provincial government announced plans to open a supervised inhalation site at the clubhouse early last year, local residents protested and had the project, and eventually the clubhouse itself, shut down.

Although Stolee supports harm reduction in principle, she opposed the opening of the inhalation site on safety grounds. The incidents near her home were concerning: an assault just outside her window, a drug-addled individual stabbing a pole with scissors, people carrying weapons on the street in front of the site. When her daughter’s phone was stolen, it was eventually recovered from a man at the clubhouse.

Although the clubhouse is closed, Stepping Stones continues to operate and has been similarly chaotic. Stolee watched a suspected drug dealer attack one of the residents there, and learned that another resident had made an inappropriate comment to her daughter.

She has also observed fire hazards near local homeless encampments, including a burning electrical panel and abandoned fires, and says that local drug users “play with fires” on sidewalks and streets. She finds these incidents concerning, as BC and Alberta have recently been ravaged by large wildfires and Nelson’s downtown is filled with historic wooden architecture.

Calling the police seemed unhelpful. In one case, officers dismissed her concerns about a man who was carrying large rocks, considering him non-threatening. However, the man was later arrested for assault and for using these types of rocks to break into a gas station.

Gavin Halford, a representative of Interior Health, the provincial agency which oversees most of the region’s harm reduction programs, stated that his organization “does not tolerate or condone any form of criminal activity, including trespassing.” He claimed that Interior Health has taken “a number of steps to increase security at the Clubhouse,” including increased signage, lighting, video surveillance and on-site security services.

However, the acquisition of 24/7 security services was facilitated by Stolee’s partner, after Interior Health told him that no such options were available. The partner also alleges that he was told by local police officers that Interior Health asked them not to enforce the “No Trespassing” signs around the clubhouse.

Stolee’s family has since invested $1,000 into security upgrades such as video surveillance and fencing. “We have baseball bats and pepper spray by our front door and a bat under the bed,” she said, noting that she wrote a letter to BC Premier David Eby detailing their experiences, which received no reply.

Kari Kroker, another neighbour of Stepping Stones, said that downtown Nelson has experienced a noticeable decline as open drug use and trafficking have proliferated, including sales to youth. “The alley behind my house has become a place of screaming and chaos,” she said, expressing frustration at how some drug users have told local children that using drugs is a form of “play.”

“I’m all in favour of putting more money into this situation, but I think we’re going the cheap way,” said Kroker. “I don’t see the province doing much to solve this. I don’t see rehab and supports for people. We need rehab. Where are the facilities to support people?” She believes that the town’s social fabric is fraying and that “harmony has been completely undermined.”

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Tanya Finley, owner of Finley’s Bar and Grill and Sage Wine Bar, is an outspoken critic of provincial harm reduction policies and a leading figure in N2, the local residents’ association. She says that human feces, drug dealing, broken windows and home invasions are daily issues in her community: “Our eighty-year-old neighbour, who had just had surgery, had a brick thrown through her window.”

Finley says that her activism has had personal and professional costs and that, after she wrote a newspaper article advocating that homeless individuals be relocated to more suitable locations, a harm reduction advocate urged for a boycott of her business on social media. This led to a decline in sales and caused some of her employees to worry about their job security.

N2 was formed earlier this year after the province attempted to open the aforementioned supervised inhalation site. Local residents believed that the location of the site was unsuitably close to several youth facilities and that health authorities had, in contravention to Health Canada guidelines, failed to adequately consult the community.

“We were lied to deliberately and continuously,” said Kroker. “We found out later that this had been in the works for almost a year.”

Early efforts to address public safety concerns were undermined by accusations of NIMBYism and inadequate responses from government authorities. After N2 was formed and took collective action – such as letters to officials and media engagement – officials began to take these concerns more seriously and temporarily halted the opening of the inhalation site.

Polly Sutherland from ANKORS, a local harm reduction organization, acknowledged friction with the community but said that deteriorating public safety is largely due to limited resources. “We need more staff hours… We have the expertise and compassion for these individuals. Just give us the resources to do our jobs, and we will get it done,” she said.

She said that high rents have worsened homelessness and dereliction, and that mobile services could mitigate the concentration of public disorder in certain areas.

Nelson’s Mayor, Janice Morrison, who has had 35 years of experience working in healthcare, emphasized that municipal authority over healthcare is limited and argued for improved communication with provincial and federal agencies, which she believed needed to provide more funding.

“I think ANKORS is totally correct in that they need more staff hours and more resources,” she said, while stressing the importance of funding existing roles, such as community safety officers and outreach workers. “Drug addiction is a health issue, not a crime,” she said.

Morrison also criticized Interior Health for its inadequate community consultation regarding the placement of harm reduction sites. “They’ve had a hard go of it in their area,” the mayor said, referring to these sites’ neighbours.

Despite public safety challenges, Morrison noted that Nelson has made progress with operating several safe injection sites and would soon be adding 28 supportive housing beds. She remained committed to finding solutions despite persistent funding difficulties. “I’m ready to hear the solutions, and to support anyone with viable ideas,” she said.

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2025 Federal Election

Study links B.C.’s drug policies to more overdoses, but researchers urge caution

Published on

By Alexandra Keeler

A study links B.C.’s safer supply and decriminalization to more opioid hospitalizations, but experts note its limitations

A new study says B.C.’s safer supply and decriminalization policies may have failed to reduce overdoses. Furthermore, the very policies designed to help drug users may have actually increased hospitalizations.

“Neither the safer opioid supply policy nor the decriminalization of drug possession appeared to mitigate the opioid crisis, and both were associated with an increase in opioid overdose hospitalizations,” the study says.

The study has sparked debate, with some pointing to it as proof that B.C.’s drug policies failed. Others have questioned the study’s methodology and conclusions.

“The question we want to know the answer to [but cannot] is how many opioid hospitalizations would have occurred had the policy not have been implemented,” said Michael Wallace, a biostatistician and associate professor at the University of Waterloo.

“We can never come up with truly definitive conclusions in cases such as this, no matter what data we have, short of being able to magically duplicate B.C.”

Jumping to conclusions

B.C.’s controversial safer supply policies provide drug users with prescription opioids as an alternative to toxic street drugs. Its decriminalization policy permitted drug users to possess otherwise illegal substances for personal use.

The peer-reviewed study was led by health economist Hai Nguyen and conducted by researchers from Memorial University in Newfoundland, the University of Manitoba and Weill Cornell Medicine, a medical school in New York City. It was published in the medical journal JAMA Health Forum on March 21.

The researchers used a statistical method to create a “synthetic” comparison group, since there is no ideal control group. The researchers then compared B.C. to other provinces to assess the impact of certain drug policies.

Examining data from 2016 to 2023, the study links B.C.’s safer supply policies to a 33 per cent rise in opioid hospitalizations.

The study says the province’s decriminalization policies further drove up hospitalizations by 58 per cent.

“Neither the safer supply policy nor the subsequent decriminalization of drug possession appeared to alleviate the opioid crisis,” the study concludes. “Instead, both were associated with an increase in opioid overdose hospitalizations.”

The B.C. government rolled back decriminalization in April 2024 in response to widespread concerns over public drug use. This February, the province also officially acknowledged that diversion of safer supply drugs does occur.

The study did not conclusively determine whether the increase in hospital visits was due to diverted safer supply opioids, the toxic illicit supply, or other factors.

“There was insufficient evidence to conclusively attribute an increase in opioid overdose deaths to these policy changes,” the study says.

Nguyen’s team had published an earlier, 2024 study in JAMA Internal Medicine that also linked safer supply to increased hospitalizations. However, it failed to control for key confounders such as employment rates and naloxone access. Their 2025 study better accounts for these variables using the synthetic comparison group method.

The study’s authors did not respond to Canadian Affairs’ requests for comment.

 

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Correlation vs. causation

Chris Perlman, a health data and addiction expert at the University of Waterloo, says more studies are needed.

He believes the findings are weak, as they show correlation but not causation.

“The study provides a small signal that the rates of hospitalization have changed, but I wouldn’t conclude that it can be solely attributed to the safer supply and decrim[inalization] policy decisions,” said Perlman.

He also noted the rise in hospitalizations doesn’t necessarily mean more overdoses. Rather, more people may be reaching hospitals in time for treatment.

“Given that the [overdose] rate may have gone down, I wonder if we’re simply seeing an effect where more persons survive an overdose and actually receive treatment in hospital where they would have died in the pre-policy time period,” he said.

The Nguyen study acknowledges this possibility.

“The observed increase in opioid hospitalizations, without a corresponding increase in opioid deaths, may reflect greater willingness to seek medical assistance because decriminalization could reduce the stigma associated with drug use,” it says.

“However, it is also possible that reduced stigma and removal of criminal penalties facilitated the diversion of safer opioids, contributing to increased hospitalizations.”

Karen Urbanoski, an associate professor in the Public Health and Social Policy department at the University of Victoria, is more critical.

“The [study’s] findings do not warrant the conclusion that these policies are causally associated with increased hospitalization or overdose,” said Urbanoski, who also holds the Canada Research Chair in Substance Use, Addictions and Health Services.

Her team published a study in November 2023 that measured safer supply’s impact on mortality and acute care visits. It found safer supply opioids did reduce overdose deaths.

Critics, however, raised concerns that her study misrepresented its underlying data and showed no statistically significant reduction in deaths after accounting for confounding factors.

The Nguyen study differs from Urbanoski’s. While Urbanoski’s team focused on individual-level outcomes, the Nguyen study analyzed broader, population-level effects, including diversion.

Wallace, the biostatistician, agrees more individual-level data could strengthen analysis, but does not believe it undermines the study’s conclusions. Wallace thinks the researchers did their best with the available data they had.

“We do not have a ‘copy’ of B.C. where the policies weren’t implemented to compare with,” said Wallace.

B.C.’s overdose rate of 775 per 100,000 is well above the national average of 533.

Elenore Sturko, a Conservative MLA for Surrey-Cloverdale, has been a vocal critic of B.C.’s decriminalization and safer supply policies.

“If the government doesn’t want to believe this study, well then I invite them to do a similar study,” she told reporters on March 27.

“Show us the evidence that they have failed to show us since 2020,” she added, referring to the year B.C. implemented safer supply.


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.

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Addictions

Addiction experts demand witnessed dosing guidelines after pharmacy scam exposed

Published on

By Alexandra Keeler 

The move follows explosive revelations that more than 60 B.C. pharmacies were allegedly participating in a scheme to overbill the government under its safer supply program. The scheme involved pharmacies incentivizing clients to fill prescriptions they did not require by offering them cash or rewards. Some of those clients then sold the drugs on the black market.

An addiction medicine advocacy group is urging B.C. to promptly issue new guidelines for witnessed dosing of drugs dispensed under the province’s controversial safer supply program.

In a March 24 letter to B.C.’s health minister, Addiction Medicine Canada criticized the BC Centre on Substance Use for dragging its feet on delivering the guidelines and downplaying the harms of prescription opioids.

The centre, a government-funded research hub, was tasked by the B.C. government with developing the guidelines after B.C. pledged in February to return to witnessed dosing. The government’s promise followed revelations that many B.C. pharmacies were exploiting rules permitting patients to take safer supply opioids home with them, leading to abuse of the program.

“I think this is just a delay,” said Dr. Jenny Melamed, a Surrey-based family physician and addiction specialist who signed the Addiction Medicine Canada letter. But she urged the centre to act promptly to release new guidelines.

“We’re doing harm and we cannot just leave people where they are.”

Addiction Medicine Canada’s letter also includes recommendations for moving clients off addictive opioids altogether.

“We should go back to evidence-based medicine, where we have medications that work for people in addiction,” said Melamed.

‘Best for patients’

On Feb. 19, the B.C. government said it would return to a witnessed dosing model. This model — which had been in place prior to the pandemic — will require safer supply participants to take prescribed opioids under the supervision of health-care professionals.

The move follows explosive revelations that more than 60 B.C. pharmacies were allegedly participating in a scheme to overbill the government under its safer supply program. The scheme involved pharmacies incentivizing clients to fill prescriptions they did not require by offering them cash or rewards. Some of those clients then sold the drugs on the black market.

In its Feb. 19 announcement, the province said new participants in the safer supply program would immediately be subject to the witnessed dosing requirement. For existing clients of the program, new guidelines would be forthcoming.

“The Ministry will work with the BC Centre on Substance Use to rapidly develop clinical guidelines to support prescribers that also takes into account what’s best for patients and their safety,” Kendra Wong, a spokesperson for B.C.’s health ministry, told Canadian Affairs in an emailed statement on Feb. 27.

More than a month later, addiction specialists are still waiting.

 

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According to Addiction Medicine Canada’s letter, the BC Centre on Substance Use posed “fundamental questions” to the B.C. government, potentially causing the delay.

“We’re stuck in a place where the government publicly has said it’s told BCCSU to make guidance, and BCCSU has said it’s waiting for government to tell them what to do,” Melamed told Canadian Affairs.

This lag has frustrated addiction specialists, who argue the lack of clear guidance is impeding the transition to witnessed dosing and jeopardizing patient care. They warn that permitting take-home drugs leads to more diversion onto the streets, putting individuals at greater risk.

“Diversion of prescribed alternatives expands the number of people using opioids, and dying from hydromorphone and fentanyl use,” reads the letter, which was also co-signed by Dr. Robert Cooper and Dr. Michael Lester. The doctors are founding board members of Addiction Medicine Canada, a nonprofit that advises on addiction medicine and advocates for research-based treatment options.

“We have had people come in [to our clinic] and say they’ve accessed hydromorphone on the street and now they would like us to continue [prescribing] it,” Melamed told Canadian Affairs.

A spokesperson for the BC Centre on Substance Use declined to comment, referring Canadian Affairs to the Ministry of Health. The ministry was unable to provide comment by the publication deadline.

Big challenges

Under the witnessed dosing model, doctors, nurses and pharmacists will oversee consumption of opioids such as hydromorphone, methadone and morphine in clinics or pharmacies.

The shift back to witnessed dosing will place significant demands on pharmacists and patients. In April 2024, an estimated 4,400 people participated in B.C.’s safer supply program.

Chris Chiew, vice president of pharmacy and health-care innovation at the pharmacy chain London Drugs, told Canadian Affairs that the chain’s pharmacists will supervise consumption in semi-private booths.

Nathan Wong, a B.C.-based pharmacist who left the profession in 2024, fears witnessed dosing will overwhelm already overburdened pharmacists, creating new barriers to care.

“One of the biggest challenges of the retail pharmacy model is that there is a tension between making commercial profit, and being able to spend the necessary time with the patient to do a good and thorough job,” he said.

“Pharmacists often feel rushed to check prescriptions, and may not have the time to perform detailed patient counselling.”

Others say the return to witnessed dosing could create serious challenges for individuals who do not live close to health-care providers.

Shelley Singer, a resident of Cowichan Bay, B.C., on Vancouver Island, says it was difficult to make multiple, daily visits to a pharmacy each day when her daughter was placed on witnessed dosing years ago.

“It was ridiculous,” said Singer, whose local pharmacy is a 15-minute drive from her home. As a retiree, she was able to drive her daughter to the pharmacy twice a day for her doses. But she worries about patients who do not have that kind of support.

“I don’t believe witnessed supply is the way to go,” said Singer, who credits safer supply with saving her daughter’s life.

Melamed notes that not all safer supply medications require witnessed dosing.

“Methadone is under witness dosing because you start low and go slow, and then it’s based on a contingency management program,” she said. “When the urine shows evidence of no other drug, when the person is stable, [they can] take it at home.”

She also noted that Suboxone, a daily medication that prevents opioid highs, reduces cravings and alleviates withdrawal, does not require strict supervision.

Kendra Wong, of the B.C. health ministry, told Canadian Affairs that long-acting medications such as methadone and buprenorphine could be reintroduced to help reduce the strain on health-care professionals and patients.

“There are medications available through the [safer supply] program that have to be taken less often than others — some as far apart as every two to three days,” said Wong.

“Clinicians may choose to transition patients to those medications so that they have to come in less regularly.”

Such an approach would align with Addiction Medicine Canada’s recommendations to the ministry.

The group says it supports supervised dosing of hydromorphone as a short-term solution to prevent diversion. But Melamed said the long-term goal of any addiction treatment program should be to reduce users’ reliance on opioids.

The group recommends combining safer supply hydromorphone with opioid agonist therapies. These therapies use controlled medications to reduce withdrawal symptoms, cravings and some of the risks associated with addiction.

They also recommend limiting unsupervised hydromorphone to a maximum of five 8 mg tablets a day — down from the 30 tablets currently permitted with take-home supplies. And they recommend that doses be tapered over time.

“This protocol is being used with success by clinicians in B.C. and elsewhere,” the letter says.

“Please ensure that the administrative delay of the implementation of your new policy is not used to continue to harm the public.”


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.


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Launched a year ago Break The Needle provides news and analysis on addiction and crime in Canada.
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