Addictions
‘Harm Reduction’ is killing B.C.’s addicts. There’s got to be a better way
From the Frontier Centre for Public Policy
B.C. recently decriminalized the possession of small amounts of illicit drugs. The resulting explosion of addicts using drugs in public spaces, including parks and playgrounds, recently led the province’s NDP government to attempt to backtrack on this policy
Fuelled by the deadly manufactured opioid fentanyl, Canada’s national drug overdose rate stood at 19.3 people per 100,000 in 2022, a shockingly high number when compared to the European Union’s rate of just 1.8. But national statistics hide considerable geographic variation. British Columbia and Alberta together account for only a quarter of Canada’s population yet nearly half of all opioid deaths. B.C.’s 2022 death rate of 45.2/100,000 is more than double the national average, with Alberta close behind at 33.3/100,00.
In response to the drug crisis, Canada’s two western-most provinces have taken markedly divergent approaches, and in doing so have created a natural experiment with national implications.
B.C. has emphasized harm reduction, which seeks to eliminate the damaging effects of illicit drugs without actually removing them from the equation. The strategy focuses on creating access to clean drugs and includes such measures as “safe” injection sites, needle exchange programs, crack-pipe giveaways and even drug-dispensing vending machines. The approach goes so far as to distribute drugs like heroin and cocaine free of charge in the hope addicts will no longer be tempted by potentially tainted street drugs and may eventually seek help.
But safe-supply policies create many unexpected consequences. A National Post investigation found, for example, that government-supplied hydromorphone pills handed out to addicts in Vancouver are often re-sold on the street to other addicts. The sellers then use the money to purchase a street drug that provides a better high — namely, fentanyl.
Doubling down on safe supply, B.C. recently decriminalized the possession of small amounts of illicit drugs. The resulting explosion of addicts using drugs in public spaces, including parks and playgrounds, recently led the province’s NDP government to attempt to backtrack on this policy — though for now that effort has been stymied by the courts.
According to Vancouver city councillor Brian Montague, “The stats tell us that harm reduction isn’t working.” In an interview, he calls decriminalization “a disaster” and proposes a policy shift that recognizes the connection between mental illness and addiction. The province, he says, needs “massive numbers of beds in treatment facilities that deal with both addictions and long-term mental health problems (plus) access to free counselling and housing.”
In fact, Montague’s wish is coming true — one province east, in Alberta. Since the United Conservative Party was elected in 2019, Alberta has been transforming its drug addiction policy away from harm reduction and towards publicly-funded treatment and recovery efforts.
Instead of offering safe-injection sites and free drugs, Alberta is building a network of 10 therapeutic communities across the province where patients can stay for up to a year, receiving therapy and medical treatment and developing skills that will enable them to build a life outside the drug culture. All for free. The province’s first two new recovery centres opened last year in Lethbridge and Red Deer. There are currently over 29,000 addiction treatment spaces in the province.
This treatment-based strategy is in large part the work of Marshall Smith, current chief of staff to Alberta’s premier and a former addict himself, whose life story is a testament to the importance of treatment and recovery.
The sharply contrasting policies of B.C. and Alberta allow a comparison of what works and what doesn’t. A first, tentative report card on this natural experiment was produced last year in a study from Stanford University’s network on addiction policy (SNAP). Noting “a lack of policy innovation in B.C.,” where harm reduction has become the dominant policy approach, the report argues that in fact “Alberta is currently experiencing a reduction in key addiction-related harms.” But it concludes that “Canada overall, and B.C. in particular, is not yet showing the progress that the public and those impacted by drug addiction deserve.”
The report is admittedly an early analysis of these two contrasting approaches. Most of Alberta’s recovery homes are still under construction, and B.C.’s decriminalization policy is only a year old. And since the report was published, opioid death rates have inched higher in both provinces.
Still, the early returns do seem to favour Alberta’s approach. That should be regarded as good news. Society certainly has an obligation to try to help drug users. But that duty must involve more than offering addicts free drugs. Addicted people need treatment so they can kick their potentially deadly habit and go on to live healthy, meaningful lives. Dignity comes from a life of purpose and self-control, not a government-funded fix.
Susan Martinuk is a senior fellow at the Frontier Centre for Public Policy and author of the 2021 book Patients at Risk: Exposing Canada’s Health Care Crisis. A longer version of this article recently appeared at C2CJournal.ca.
A B.C. pharmacy scam investigation has led the provincial government to return to a witnessed consumption model for safer supply
More than 60 pharmacies across B.C. are alleged to have participated in a kickback scheme linked to safer supply drugs, according to a provincial report released Feb. 19.
On Feb. 5, the BC Conservatives leaked a report that showed the findings of an internal investigation by the B.C. Ministry of Health. That investigation showed dozens of pharmacies were filling prescriptions patients did not require in order to overbill the government. These safer supply drugs were then diverted onto the black market.
After the report was leaked, the province committed to ending take-home safer supply models, which allow users to take hydromorphone pills home in bottles. Instead, it will require drug users to consume prescribed opioids in a witnessed program, under the oversight of a medical professional.
Gregory Sword, whose 14-year-old daughter Kamilah died in August 2022 after taking a hydromorphone pill that had been diverted from B.C.’s safer supply program, expressed outrage over the report’s findings.
“This is so frustrating to hear that [pharmacies] were making money off this program and causing more drugs [to flood] the street,” Sword told Canadian Affairs on Feb. 20.
The investigation found that pharmacies exploited B.C.’s Frequency of Dispensing policy to maximize billings. To take advantage of dispensing fees, pharmacies incentivized 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. Pharmacies earned up to $11,000 per patient a year.
“I’m positive that [the B.C. government has] known this for a long time and only made this decision when the public became aware and the scrutiny was high,” said Elenore Sturko, Conservative MLA for Surrey-Cloverdale, who released the leaked report in a statement on Feb. 5.
“As much as I am really disappointed in how long it’s taken for this decision to be made, I am also happy that this has happened,” she said.
The health ministry said it is investigating the implicated pharmacies. Those that are confirmed to have been involved could have their licenses suspended, be referred to law enforcement or become ineligible to participate in PharmaCare, the provincial program that helps residents cover the costs of prescription drugs.
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Witnessed dosing
The leaked report says that “a significant portion of the opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients.” It also says “prescribed alternatives are trafficked provincially, nationally and internationally.”
Critics of the safer supply program say it enables addiction, while supporters say it reduces overdoses.
Sword, Kamilah’s father, is suing the provincial and federal governments, arguing B.C.’s safer supply program made it possible for youth such as his daughter to access drugs.
Madison, Kamilah’s best friend, also became addicted to opioids dispensed through safer supply programs. Madison was just 15 when she first encountered “dillies” — hydromorphone pills dispensed through safer supply, but widely available on the streets. She developed a tolerance that led her to fentanyl.
“I do know for sure that some pharmacies and doctors were aware of the diversion,” Madison’s mother Beth told Canadian Affairs on Feb. 20.
“When I first realized what my daughter was taking and how she was getting it, I phoned the pharmacy and the doctor on the label of the pill bottle to inform them that the patient was selling their hydromorphone,” Beth said.
Masha Krupp, an Ottawa mother who has a son enrolled in a safer supply program, has said the safer supply program in her city is similarly flawed. Canadian Affairs previously reported on this program, which is run by Recovery Care’s Ottawa-based harm reduction clinics.
“I read about the B.C. pharmacy scheme and wasn’t surprised,” Krupp told Canadian Affairs on Feb. 20. Krupp lost a daughter to methadone toxicity while she was in an addiction treatment program at Recovery Care.
“Three years [after starting safer supply], my son is still using fentanyl, crack cocaine and methadone, despite being with Dr. [Charles] Breau and with Recovery Care for over three years,” Krupp testified before the House of Commons Standing Committee on Health on Oct. 22, 2024.
Krupp has been vocal about the dangers of dispensing large quantities of opioids without proper oversight, arguing many patients sell their prescriptions to buy stronger street drugs.
“You can’t give addicts 28 pills and say, ‘Oh here you go,’” she said in her testimony. “They sell for three dollars a pop on the street.”
Krupp has also advocated for witnessed consumption of safer supply medications, arguing supervised dosing would prevent diversion and ensure proper oversight of pharmacies.
“I had talked about witnessed dosing for safe supply when I appeared before the parliamentary health committee last October,” she told Canadian Affairs this week.
“I’m grateful that finally … this decision has been made to return to a witness program,” said Sturko, the B.C. MLA.
In 2020, B.C. implemented a witnessed consumption model to ensure safer supply opioids were consumed as prescribed and to reduce diversion. In 2021, the province switched to take-home models. Its stated aim was to expand access, save lives and ease pressure on health-care facilities during the pandemic.
“You’re really fighting against a group of people … working within the bureaucracy of [the B.C. NDP] government … who have been making efforts to work towards the legalization of drugs and, in doing that, have looked only for opportunities to bolster their arguments for their position, instead of examining their approach in a balanced way,” said Sturko.
“These are foreseeable outcomes when you do not put proper safeguards in place and when you completely ignore all indications of negative impacts.”
Sword also believes some drug policies fail to prioritize the safety of vulnerable individuals.
“Greed is the ultimate evil in society and this just proves it,” he said. “We don’t care about these drugs getting into the wrong hands as long as I get my money.”
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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The leaked audit shows from 2022 to 2024, a staggering 22,418,000 doses of opioids were prescribed by doctors and pharmacists to approximately 5,000 clients in B.C., including fentanyl patches.
A confidential investigation by British Columbia’s Ministry of Health, Financial Operations and Audit Branch has uncovered explosive allegations of fraud, abuse, and organized crime infiltration within PharmaCare’s prescribed opioid alternatives program. Internal audit findings, obtained by The Bureau, suggest that millions of taxpayer dollars are being diverted into illicit drug trafficking networks rather than serving harm reduction efforts.
The leaked documents include photographs from vehicle searches that show collections of fentanyl patches and Dilaudid (hydromorphone) apparently packaged for resale after being stolen from the taxpayer-funded “safer supply” program. This program expanded dramatically following a federal law change implemented by Prime Minister Justin Trudeau’s government in 2020, which broadened circumstances in which pharmacy staff could dispense opioids, according to the document’s evidence.
“Prior to March 17, 2020, only pharmacists in BC were permitted to deliver [addiction therapy treatment] drugs,” the audit says.
B.C.’s safer supply program was launched in March 2020 as a response to the opioid overdose crisis, declared in 2016. It allows people with opioid-use disorder to receive prescribed drugs to be used on-site or taken away for later use.
The Special Investigations Unit and PharmaCare Audit Intelligence team identified a disturbing link between doctors, pharmacists, assisted living residences, and organized crime, where prescription opioids meant to replace illicit drugs are instead being diverted, sold, and trafficked at scale.
“A significant portion of the opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients,” the document states.
It suggests that financial incentives have created a business model for organized crime, asserting that “prescribed alternatives (safe supply opioids) are trafficked provincially, nationally, and internationally,” and that “proceeds of fraud” are being used to pay incentives to doctors, pharmacists, and intermediaries.
BC Conservative critic Elenore Sturko, a former RCMP officer, began raising concerns about the program two years ago after hearing anecdotes about prescribed opioids being trafficked. She asserts that the program is a failure in public policy and insists that Provincial Health Officer Dr. Bonnie Henry be dismissed for having “denied and downplayed” problems as they emerged. Sturko also argues that B.C. must change its drug policy in light of U.S. President Donald Trump’s stance linking the trafficking of fentanyl and other opioids to potential trade sanctions against Canada.
The document shows that PharmaCare’s dispensing fee loophole has incentivized pharmacies to maximize billings per patient, with some locations charging up to $11,000 per patient per year—compared to just $120 in normal cases.
Perhaps most alarming is the deep infiltration of B.C.’s safer supply program by criminal networks. The Ministry of Health report lists “Gang Members/Organized Crime” as key players in the prescription drug pipeline, which includes “Doctors, pharmacies, and assisted living residences.”
This revelation confirms long-standing fears that B.C.’s “safe supply” policy—originally designed to prevent deaths from contaminated street drugs—is instead sometimes supplying criminal organizations with pharmaceutical-grade opioids.
The leaked audit shows from 2022 to 2024, a staggering 22,418,000 doses of opioids were prescribed by doctors and pharmacists to approximately 5,000 clients in B.C., including fentanyl patches.
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Beyond organized crime’s direct involvement, pharmacies themselves have exploited regulatory gaps to generate massive profits from PharmaCare’s policies:
- Pharmacies offer kickbacks to doctors, housing staff, and medical professionals to steer patients toward specific locations.
- Financial incentives fuel fraud, with multiple investigations identifying 60+ pharmacies offering incentives to clients.
- Non-health professionals, including housing staff, are witnessing OAT (opioid agonist treatment) dosing, violating patient safety protocols.
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