Addictions
Nanaimo syringe stabbing reignites calls for involuntary care
Safe needle disposal box at Deverill Square Gyro 2 Park in Nanaimo, B.C., Sept. 5, 2024. [Photo credit: Alexandra Keeler]
By Alexandra Keeler
Some politicians, police and community groups argue involuntary care is key to addressing severe addiction and mental health issues
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.”
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‘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.
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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.
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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.
Our content is always free – but if you want to help us commission more high-quality journalism, consider getting a voluntary paid subscription.
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.
Our content is always free – but if you want to help us commission more high-quality journalism, consider getting a voluntary paid subscription.
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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