Opinion: After ten years of the toxic drug crisis, B.C. must build on what works

Given the scale of public investment in mental health, substance use, and supportive housing, we should expect a system that continuously learns and improves, writes Keir Macdonald. Above: Coast Mental Health's Rivers Reach supportive housing facility in Maple Ridge, which opened in 2025, includes on-site health and recovery supports. Photo by Tetiana Slyviak /Coast Mental Health

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Ten years into the toxic drug crisis, the danger is no longer that we lack evidence about what works. It is that we are prepared to ignore it.

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Recent decisions to close supervised consumption services in Ontario and differing approaches emerging in other provinces signal a notable change in direction. As B.C. passes the 10-year mark of its declaration of a public health emergency, the question is no longer whether change is coming. It is whether that change will build on what we have learned — or undo it.

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Since 2016, more than 18,000 people have lost their lives in B.C. from toxic drug poisonings and more than 55,000 people across Canada. These are not abstract statistics. They represent parents, siblings, co-workers, neighbours and friends.

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Ten years into this crisis, the situation looks vastly different. The drug supply has changed dramatically with the rise of fentanyl and benzodiazepine contamination. Modes of consumption have shifted, with smoking and inhalation becoming increasingly common.

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One reality has remained stubbornly consistent over the past decade: most deaths occur indoors, often in private residences, including supportive housing, single-room occupancy buildings, and private homes in every neighbourhood. People are using alone, privately. Despite years of innovation, this remains one of the hardest parts of the crisis to address.

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At the same time, the policy conversation is becoming increasingly polarized.

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In Ontario, publicly funded supervised consumption sites are being closed — despite little data being shared to justify the closure, but considerable evidence that these services save lives. When major policy shifts occur without clear evidence, it is hard to see how they will improve outcomes.

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In Alberta, a recovery-oriented model has been credited with significant reductions in overdose deaths. While encouraging, it is difficult to attribute these gains to any single policy or approach. The reported reductions nonetheless point to the importance of treatment, stabilization, and recovery-oriented services.

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This debate should not be framed as a choice between harm reduction and recovery. What is needed is a complete system grounded in evidence — one where prevention also matters, because the most effective response is one that stops people from reaching crisis in the first place.

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All of us need different supports at different points in our lives. The same is true for people with mental illness and substance use challenges.

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I have seen incredible growth and transformation in services for people struggling with mental health and addiction needs over the past decade. We have witnessed innovation, integrated models, and programs increasingly informed by evidence and lived experience. Service providers have adapted to a changing crisis, often in real time.