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Addictions

BC NDP, Conservatives’ drug policies converge in close election

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10 minute read

From Break The Needle 

By Alexandra Keeler

The BC NDP and Conservatives have both pledged to introduce involuntary care for addicts as they contend for voter support on unpopular issue

Gregory Sword has been advocating for British Columbia to permit involuntary care of individuals struggling with addiction ever since losing his 14-year-old daughter to an overdose two years ago.

Now, he looks likely to get his wish — regardless of which party wins the provincial election on Oct. 19.

On Sept. 15, NDP Premier David Eby announced plans to expand involuntary care for “people with addiction challenges, brain injuries, and mental-health issues.” The announcement follows a similar pledge by BC Conservative Leader John Rustad, who on Sept. 11 promised to introduce involuntary care for adults and minors.

The move suggests the BC NDP may be recalibrating its drug policies in response to polling data and competitive pressure from the BC Conservative Party, which has seen its electoral prospects bolstered by the collapse of the centre-right BC United Party.

The BC Conservatives and BC NDP are tied in the polls, at 44 and 43 per cent respectively, according to an Aug. 30 Angus Reid survey. More than two-thirds of respondents said they thought the province was on the “wrong track” in dealing with the opioid crisis. A Sept. 5 Angus Reid poll had similar findings, with 74 per cent of respondents rating the NDP’s handling of the drug crisis as “poor” or “very poor.”

‘A new phase’

B.C. saw a six per cent drop in opioid-related deaths in early 2024 compared to 2023. But the province continues to account for 32 per cent of all drug-related deaths in Canada, despite having just 13 per cent of its population.

In Sunday’s announcement, Eby referred to the introduction of involuntary care as “the beginning of a new phase of our response to the addiction crisis … We are taking action to get them the care they need to keep them safe, and in doing so, keep our communities safe, too.”

Rustad criticized the announcement, citing policy inconsistency. “For years, the NDP ignored the calls for involuntary care, leaving families helpless and those suffering on the streets,” he said in a media release.

“Now, after our party clearly outlined a plan to bring compassion and accountability to addiction treatment, Eby is suddenly pretending to be on board.”

However, Eby first proposed introducing involuntary care in August 2022 during his leadership race. The NDP’s move also partially follows a recommendation of Dr. Daniel Vigo, B.C.’s first chief scientific adviser for psychiatry, who was appointed to that role in June 2024.

Sword, who tried to get his daughter help, believes B.C.’s youth treatment framework — which currently requires minors to consent to addictions treatment — ultimately contributed to his daughter’s death.

“This is how screwed up B.C. is: If I harm my child, beat my child, get my child drugs — she can be taken away from me and get the help that she needs,” he told Canadian Affairs in August. “But if she’s doing it to herself, it’s okay.”

Bold harm-reduction measures

The “new phase” in the NDP’s response to the drug crisis reflects a shift from a prior focus on bold harm-reduction measures — some of which have been followed by reversals.

Since taking office in 2017, the NDP has doubled the number of supervised consumption sites in B.C., from three to six (five are currently operational). And it has expanded the number of overdose prevention sites — which generally offer fewer services than supervised consumption sites — from 20 to 44.

In 2020, the NDP government introduced prescribed alternative supply programs — previously known as “safer supply” — which enable users to receive prescribed opioids as an alternative to illicit street drugs.

In January 2023, the province began a three-year, trial decriminalization project that permitted British Columbians to possess small amounts of otherwise illicit drugs such as heroin, fentanyl, and methamphetamine. B.C. was the first — and so far only — province to decriminalize hard drugs.

But in April, the province partially reversed course, obtaining Ottawa’s approval to recriminalize the use of hard drugs in public spaces.

In October 2023, Provincial Health Officer Dr. Bonnie Henry ordered that vending machines be installed outside hospital emergency departments on Vancouver Island to dispense free drug consumption supplies. On Sept. 12, Eby ordered a review of this initiative, leading to a suspension of the machines until the review is complete.

The BC NDP party did not respond to multiple requests for comment for this story by press time.

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Conservative alternatives

The BC Conservatives have positioned themselves as champions of “common sense” solutions to the drug crisis. In response to requests for comment for this story, the BC Conservatives referred Canadian Affairs to its Sept. 15 media release.

Rustad has said that safe supply programs and decriminalization have been policy failures. The party’s platform pledges to “end heroin hand-outs” and to “reverse decriminalization of hard drugs.” Rustad has also criticized harm-reduction vending machines, accusing Eby of “encouraging the proliferation of hard drug use across the province.”

“I know that they [BC Conservatives] are very much on board for more recovery models versus drug decriminalization,” said William Yoachim, a Nanaimo city council member and member of the Snuneymuxw First Nation. Yoachim says he is cautiously optimistic there could be a significant policy change under a new government.

“My only concern with what a Conservative government’s approach would be is their leader. I’m not sure how committed he would be towards the Indigenous recovery.”

The BC Conservatives have said they would develop a new public health strategy focused on addressing “the root causes of drug addiction that prioritizes treatment and not free drugs.”

They have also proposed stricter penalties for drug smuggling and enhanced border security.

Before suspending its electoral campaign, the BC United Party had pledged to introduce free, accessible mental health and addiction services and longer treatment stays. It had also advocated for people with lived experience of addiction, homelessness and mental illness to be involved in designing recovery-oriented housing.

It remains unclear whether the BC Conservatives — which now includes some former BC United candidates — will adopt any of these policies.

Sarah Blyth, a frontline harm-reduction worker with the Vancouver Overdose Prevention Society, says she is frustrated by how polarizing the issue of drug policy has become.

“People are becoming really dogmatic on either side of it,” she said. “We should be looking at each other to see what unique, creative approaches we’re taking … and figure out what’s working where, and do our best.”

Blyth says she plans to keep her head down through this election. “Let them fight it out.”

“Let this be over, and then let’s get back to work.”


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.

Subscribe to Break The Needle. Our content is always free – but if you want to help us commission more high-quality journalism, consider getting a voluntary paid subscription.

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.

Our content is always free – but if you want to help us commission more high-quality journalism,

consider getting a voluntary paid subscription.

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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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