Addictions
No, drug prohibition is not ‘white supremacy’

From Break The Needle
British Columbia’s top doctor released a report arguing that the legalization of all drugs combats “racism” and “colonialism.” That’s historically illiterate.
The notion that drug prohibition is inherently racist has become exceedingly popular within the harm reduction world and, by extension, inside many public health institutions and graduate programs. Yet anyone with even a cursory knowledge of history can see that this is absurd. Societies from all across the world have long understood the dangers of addictive substances and supported efforts to criminalize them—so why is this being ignored?
Though the “prohibition is racist” movement usually flies under the public’s radar, it was thrust into the limelight earlier this month when B.C.’s top doctor, Bonnie Henry, released a report calling for the legalization of all drugs. Not only did Henry recommend that dangerous substances—including meth, cocaine and fentanyl—be sold in stores much like alcohol and cannabis, her team asserted that prohibitionist policies are “based on a history of racism, white supremacy, paternalism, colonialism, classism and human rights violations.”
One would hope such sweeping declarations would have been backed with fulsome arguments and historical references, but that didn’t happen here.
Instead, the report simply emphasized how Canada’s original drug laws, dating back to the late 19th and early 20th centuries, were motivated by racist animus against Chinese immigrants. As opium was popular among these immigrants, the drug was believed to pose a special moral threat to white society and was among the first substances to be harshly policed. This, in turn, gave the state a new legal tool to harass Chinese Canadians and, in some cases, deport them.
After briefly explaining this point, Henry’s report concluded that, “Over time, the moral panic associated with drug use expanded to target many more groups of people, including Indigenous people, Black people, women, people of colour, and people of lower socioeconomic status.” This extrapolation was presented as a self-evident fact, without any evidence or citations to explain or substantiate it.
Henry’s recommendations were immediately rejected by the provincial government and savagely ridiculed in the media. Yet the views articulated in her report, shocking as they may have been to many, were not actually exceptional. They only rehashed the dominant beliefs of the harm reduction world—beliefs have also, over the past decade or so, permeated deeply into Canada’s public health bureaucracies.
Henry’s report may be dead in the water, but the underlying ideas which animated it are still very much alive and will, in all likelihood, continue to influence Canadian policymakers within the cloistered hallways of the civil service. This is a shame, because it is difficult to overstate how strange these kinds of beliefs are.
To argue that drug prohibition is broadly based on a history of racism, mostly because it was misused for racist purposes a century ago, is kindergarten-level reasoning. There are ample examples of non-European societies, past and present, embracing criminalization. This is glaringly obvious and, in many cases, common knowledge.
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Non-Western drug prohibition throughout the ages
Perhaps one of the greatest examples of non-European drug prohibition is Sharia law, which has banned the consumption of mind-altering substances since the 7th century. One wonders how harm reduction activists can claim, with a straight face, that prohibition is rooted in “colonialism” and “white supremacy” when Islam’s religious and legal texts supported it centuries before global European empires emerged.
Since harm reduction scholars are so concerned about Chinese experiences, it would be instructive to look toward China itself, where prohibition is also popular.
In the late 18th century, the British began exporting large quantities of opium to the Qing Empire (China), which quickly fomented a wave of addiction and social disorder. Soon after, Qing officials embarked on a multi-decade campaign to criminalize the drug. “Opium is a poison, undermining our good customs and morality. Its use is prohibited by law,” wrote the Daoguang Emperor in an edict issued in 1810.
By the mid-19th century, the Qing worried that, without drastic action, China would be left bereft of money and productive men—so they banned all sales of opium and destroyed any supply of it they could find, including European wares. This angered the British, who profited handsomely off the opium trade, and led them to victoriously wage war against the Qing—not once, but twice—to forcibly stop prohibition.
Narcotics thus continued to flow through the veins of China’s body politic, wreaking havoc for generations. Since then, Chinese nationalists have bitterly remembered the Opium Wars as a colonial crime which marked the beginning of China’s “century of humiliation.”
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The 98th Regiment of Foot at the attack on Chin-Kiang-Foo (Zhenjiang), 21 July 1842, resulting in the defeat of the Manchu government. Watercolour by military illustrator Richard Simkin (1840–1926).
This raises an important question: how exactly can anyone square this history with the ideological framework of the harm reduction movement? Were the Qing embodying some mystical form of white supremacy? Perhaps we should be grateful that the British sent their anti-racist warships to decolonize China’s drug laws.
Even today, the legacy of the Opium Wars continues to inform Chinese attitudes towards drugs—both within China itself (where strict prohibitionism is the norm) and in the diaspora.
In San Francisco, America’s petri dish for drug liberalization, it is Chinese-Americans who are leading a public backlash against progressive policies and calling for greater prohibition. Similarly, Chinese-Canadians were instrumental to Vancouver’s political pivot during the 2022 municipal elections, wherein the centrist ABC party swept the city council and the mayor’s office. Just this spring, Chinese-Canadian protestors in Richmond, the most ethnically Chinese city in North America , thwarted the launch of a new supervised consumption site, only to have a white progressive woman shout “Go back to Hong Kong” at them. No doubt another anti-racist activist.
When I interviewed almost a dozen Chinese-Canadian small business owners and workers in Vancouver’s historical Chinatown last summer, their support for prohibition was clear—and the legacy of the Opium Wars was invoked several times. Many other ethnic groups are processing similar historical traumas, and facing similar erasure. Do harm reduction activists forget, for example, that early European colonists devastated North American Indigenous communities by plying them with alcohol?
Indigenous leaders did not respond to that crisis by calling for more booze. On the contrary, they pushed for prohibition. Illustratively, when Treaties No. 6 and 7 were negotiated during the 1870s, Indigenous representatives asked for the “exclusion of fire water” from Saskatchewan, and that “no intoxicating liquor be allowed to be introduced or sold” on reserves. Even today, dozens of “dry” Indigenous reserves throughout Canada continue to ban alcohol and drugs to whatever extent they can.
When I interviewed over a dozen Indigenous elders and community members in Calgary last summer, their opposition to drug liberalization was clear—some went so far as to condemn decriminalization and “safer supply” programs as “pharmaceutical colonialism.” Ronnie Chickite, chief of the We Wai Kai Nation in British Columbia, told me this spring that his entire band council was “entirely against” decriminalization and that provincial officials had allegedly ignored them.
Building upon these interviews, two senior contacts in the Ontario government confirmed to me earlier this year that Indigenous leaders across the province seem to commonly hold prohibitionist beliefs. Who would have thought that Indigenous people could be such raging white supremacists?
Surveying the world today, it is clear that drug prohibition is actually strongest in non-European states—particularly East Asian and Middle Eastern ones—while liberalization is actually more popular in the West. It is telling that the harm reduction movement seems intent on ignoring this, or, alternatively, positioning non-white prohibitionism as a symptom of corrupting European influences. Both responses are, ironically, more than a little racist—how else can one describe the systematic erasure of non-European voices?
How is it that harm reduction advocates, who make such a theatre of their own “anti-racism,” cannot grasp that non-white communities have intellectual and cultural agency and do not simply let white people dictate their beliefs? In their obsessive disdain for European civilization, these advocates close their eyes to the rest of the world and inadvertently reproduce the same cultural narcissism that they ostensibly condemn—their calls for racial justice conceal a Eurocentric mindset sopping with paternalism.
How is this possible? How has this happened? A glimpse of an answer can be found in the “Acknowledgements” section of Henry’s report this month, where brief biographies of the report’s contributors were provided. Each contributor fixated on their ethnicity and, in many cases, proclaimed themselves as “third generation settlers” or “occupiers.” Unsurprisingly, almost everyone on the team was white. Though there were some Indigenous voices (who were seemingly relegated to working on exclusively Indigenous-related tasks, of course), not a single Asian, black or Middle-Eastern voice could be found.
The B.C. provincial health officer report’s contributors section:
So it seems that a bunch of white progressive bureaucrats produced a document that fixated on “colonialism” and “racism” while ignoring the actual beliefs of many, if not most, non-white communities. Nothing could encapsulate the harm reduction zeitgeist more perfectly: the privileging of empty gestures over real consultation, the self-indulgent self-flagellation of the white bourgeoisie, the patronizing assumption that minority communities have homogenous political beliefs that happen to align with progressive causes.
All of this would be comedic if lives weren’t at stake.
It should be clarified that there are many valid ways to criticize drug laws from a racial justice lens. Laws are just tools which we use to order society, and, like any tool, they can be abused—so it is fair to explore how some laws, in some contexts, have racist intentions or outcomes.
This is best illustrated by the wealth of scholarship criticizing American cannabis laws—in this case, critics have been able to concretely show that specific laws, in specific contexts, are being enforced unfairly and exacerbating inequities without producing justificatory social benefits.
Yet this mode of analysis, which focuses heavily on outcomes and concrete data, is an entirely different beast from the essentialist arguments recklessly flung around by the harm reduction movement. It makes sense to test measurable hypotheses about specific laws and their implementations. But to argue that drug prohibition is intrinsically “racist” is to succumb to ideological hallucination.
This essay originally appeared in The Hub and has been syndicated to Break The Needle through a co-publishing agreement.
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2025 Federal Election
Study links B.C.’s drug policies to more overdoses, but researchers urge caution

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.
Addictions
Addiction experts demand witnessed dosing guidelines after pharmacy scam exposed

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.
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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