What to know about Canada’s toxic drug crisis and supervised drug-use sites

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Opioids are the leading cause of fatal overdoses in Canada, and since 2016 more than 40,000 deaths have been linked to the drugs.

Provinces have been dealing with the opioid crisis in a variety of ways, from focusing on treatment and recovery to considering decriminalization.

Here’s a brief rundown of how we got here and an explanation of some common terms used in stories about substance use and the toxic drug crisis.

The opioid crisis in Canada so far

The number of people exposed to opioids has increased dramatically since the late 1990s, when the drugs became more readily available and legal formulations were prescribed regularly for pain. People became dependent and turned to the illegal drug supply – which, in turn, was contaminated with more potent opioids such as fentanyl.

From 2010 to 2015, Canada experienced an increase in sales of “diverted or illegally produced” opioids, according to the federal government. Then, 2016 saw a sudden jump in overdose deaths, it reported, and they have “been high ever since.” As one physician wrote in The Globe this summer, when he first began working in addiction medicine, “people used heroin. This has been replaced by a cocktail of fentanyl mixed with other substances.”

During the COVID-19 pandemic, reduced access to health care and social services – as well as an increasingly toxic drug supply – worsened the overdose crisis. People became more likely to use alone, and safety measures such as staying indoors led to a decrease in patients seeking overdose prevention services, The Globe reported back in 2020. Opioid-related deaths across the country nearly doubled during the pandemic, with the majority in British Columbia, Alberta and Ontario. More than 15,000 people died of “apparent opioid toxicity” in the two years ending in March 2022, a 91-per-cent increase from the 7,906 deaths that occurred in the two prior years, Globe reporter Andrea Woo wrote.

What’s happening in Ontario

The opioid crisis killed more than 2,500 people in Ontario in 2023. After a passerby was fatally shot outside a supervised drug-use site in Toronto that year, the province launched a review of such programs.

In August 2024, the Ontario government announced that it intends to shut down nearly half of the supervised drug-use sites it funds – plus prevent existing ones from moving and new ones from opening. In November, Premier Doug Ford’s government tabled its Safer Streets, Stronger Communities Act, which bans what the province calls consumption and treatment services within 200 metres of schools and childcare centres. Ten of the province’s 23 sites will have to close by the end of March.

What’s happening in British Columbia

British Columbia’s three-year decriminalization pilot project began on Jan. 31, 2023, in an attempt to respond to an opioid and toxic street drug crisis that has killed more than 14,000 people since 2016. Health Canada granted the province a legal exemption that allowed people to carry 2.5 grams of illegal drugs for use in sanctioned public spaces without being criminally charged. This past spring, Premier David Eby announced B.C. would roll back parts of the project, and would allow police officers to arrest people using drugs in public.

Before the fall B.C. vote, Mr. Eby announced that his government would introduce a plan to provide involuntary care for people with concurrent addiction, mental illness and acquired brain injuries, as well as legislation to compel youth to receive care if they are unable to seek it themselves. He was re-elected in October.

Despite the recent changes, B.C. is continuing to focus on harm reduction measures. In August it launched a confidential and free help line to provide same-day access to opioid treatment, which can include prescriptions for medications such as Suboxone and methadone to prevent withdrawal symptoms and reduce overdose risks.

What’s happening in Alberta

Alberta has been taking a recovery-oriented approach to the toxic drug crisis. It provides free treatment in public addiction centres and same-day access to addiction medicines through a toll-free number, and it has increased the number of treatment beds. In May, opioid-related deaths dropped 55 per cent from the same time last year, the province reported. But critics say a lack of data makes it difficult to properly assess the effectiveness of this type of policy approach.

Opinion: Supervised drug consumption sites may have earned political and public wrath, but they are more helpful than harmful

Common terms to know

Harm reduction refers to a myriad of ways to reach people who might not be ready to give up substances. Examples include teaching them safer ways to use and the signs of an overdose, or ensuring basic needs such as food and shelter are met. According to the Canadian Mental Health Association, the philosophy around harm reduction acknowledges that substance use is inevitable and that it is necessary to take steps to minimize harm.

Supervised drug-use sites are places where people can use drugs in a sterile environment under the watch of trained staff. These services are seen as an evidence-based intervention that reduce health care costs, prevent blood-borne illnesses from spreading and reduce overdose deaths.

Safer supply programs are interventions where medical professionals prescribe controlled substances as an alternative to illicit drugs.

Needle-exchange programs provide sterile, single-use needles and syringes to help prevent disease transmission and reduce health risks.

Decriminalization is a policy that abolishes criminal penalties for using and possessing small amounts of illicit substances for personal use.

Treatment for substance use can include group therapy, in-patient treatment, day programs, prescription medication, 12-step groups and detox.

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With files by Laura Stone, Ian Bailey, Kelly Grant, Andrea Woo, Mike Hager