It’s been 10 years since British Columbia’s provincial health officer declared the toxic drug crisis to be a public health emergency, and the data are sobering. In Canada overall, a total of 55,032 apparent opioid toxicity deaths and 51,563 opioid-related poisoning hospitalizations were reported between January 2016 and September 2025.

Preliminary data from the province suggest that the number of unregulated drug deaths in February 2026 alone equated to about 4.1 deaths per day. Deaths among individuals aged 30-59 years accounted for 69% of the total, and 78% of decedents were male. The highest numbers of unregulated drug deaths in the first 2 months of 2026 were in the Fraser Health and Vancouver Coastal Health authorities (62 and 74 deaths, respectively), representing 51% of all such deaths.

“It’s a somber anniversary,” Paxton Bach, MD, clinical assistant professor of social medicine at the University of British Columbia in Vancouver, told Medscape News Canada. “Back in 2016, when this crisis was first declared, I don’t think any of us ever anticipated that so little progress would have been made in 10 years. I don’t think we can celebrate anything as successes or progress, considering that we’re still seeing so many people from every corner of the province and every demographic status losing their lives to the ongoing crisis. We are failing.”

Bach is also a general internist and addiction medicine physician at St. Paul’s Hospital in Vancouver and co-medical director for the British Columbia Centre on Substance Use.

Multiple Strategies Attempted?

Statements from government leaders on the 10th anniversary seemed to support the position that various strategies should be used to resolve the crisis. Josie Osborne, Minister of Health, said that “the toxic drug crisis is complex and has no single solution.”

Bonnie Henry, provincial health officer, added, “Evidence shows that harm reduction and overdose prevention services, including overdose prevention sites, drug checking, and access to alternatives to unregulated drugs, are saving lives. Now more than ever, it is essential that we continue to enable access to these services….Prevention and early intervention, harm reduction, medication-assisted treatment, and other evidence-based treatment and recovery services and social supports must be available when people need and are ready for them.”

But government actions seemed to diverge from that position. On January 31, 2026, a 3-year pilot of decriminalization intended to make it easier for patients struggling with addiction to ask for help was terminated. At that point, Osborne told reporters at a news conference that the pilot program “hasn’t delivered the results that we hoped for” but did not elaborate.

Other provinces ended funding for supervised drug consumption sites, as well. Toronto Public Health reported in 2025 that the closure of five supervised consumption sites “will reduce access to an evidence-based clinical healthcare service, leading to an anticipated increase in preventable fatal and nonfatal overdoses.”

“One misconception among the public is that we’ve tried harm reduction and it hasn’t worked,” Kora DeBeck, PhD, distinguished professor of substance use and drug policy at Simon Fraser University in Vancouver, told Medscape News Canada. “But when we look at what our drug policies have been, we see that we’ve consistently been in a criminalized, prohibition-based context regarding substance use, and that has been our primary response to substance use throughout the last decade.” 

“We’ve had harm reduction and treatment and various things working on the margins of what is still an incredibly criminalized, stigmatized, overarching framework,” she said. “Yes, we’ve tinkered with harm reduction and decriminalization, but we haven’t had a fulsome public health approach to the overdose crisis.”

Regarding the decriminalization effort, DeBeck said, “There was public drug use before, during, and after decriminalization. The public was seeing more suffering on the street because we have an increasing housing crisis and people have nowhere else to go. We have a drug supply contaminated with fentanyl, as well as with benzodiazepines and heavy tranquilizers.”

The contaminated supply adversely affected people who were using drugs on the street and was highly visible. “The public was seeing that and equating it with decriminalization,” she said, rather than the social determinants of health that often lead to abuse.

Safe Supply Cut Short

DeBeck believes that safe supply, also called prescribed alternatives, is an “innovative approach with a lot of promise.” Safe supply involves substituting a drug with known content and purity for toxic drugs such as fentanyl laced with benzodiazepines and tranquilizers. But the recently discontinued pilot projects were resource-intensive. Some allowed users to take the substituted drug home, whereas others required use to be witnessed, and all required a physician willing to prescribe and monitor the patients.

“Another challenge was that the main medication provided was hydromorphone, which is a much less potent opiate than fentanyl,” DeBeck said. “Many folks reported that hydromorphone wasn’t even strong enough to manage their withdrawal symptoms, and they ended up selling the pills to get money to buy fentanyl. So there was a mismatch between what people wanted and needed and what they were given. There were a lot of concerns about diversion because people didn’t want easily accessible drugs in the community.”

There are many models of regulated alternatives, DeBeck said, “but we have not put energy into revising our models to meet people where they’re at and move them away from the toxic drug supply. It’s not that these programs haven’t worked or aren’t working; it’s that we haven’t really done them.”

Four Pillars Strategy

“It’s discouraging to see approaches such as harm reduction and treatment positioned as if they’re in opposition to one another,” Bach asserted. He noted that Vancouver put forth the four pillars approach to drug policy 25 years ago. The approach combines prevention, treatment, harm reduction, and enforcement, and many initiatives support more than one pillar.

“That paradigm is as applicable today as it was then,” he said. “It recognizes that the singular investment in any one of them without paying attention to the others is not providing that continuum that we all know is required. It is destined to fail or not serve certain populations. And none of them are available and accessible at the scale that’s required across Canada to make a meaningful difference in the rates of overdose deaths.

“There’s a persistent sense that ‘this problem doesn’t apply to me,’ but that perception is demonstrably false,” he added. “1 in 3 of us knows somebody who’s died of an overdose. We need to recognize the role we play in the ongoing crisis and take whatever steps we can to try and reduce the number of deaths that are continuing.”

Urgency Required

The crisis requires an urgent, coordinated, and overarching response that “continues to be lacking,” said Bach. He compared it with what he called the diametrically opposite response to the COVID pandemic, when he was on the front lines treating patients with the virus in a hospital.

The appropriateness of many aspects of the COVID response has been debated in retrospect, he acknowledged. “But the one thing we can’t criticize is how, remarkably everyone — officials in federal, provincial, and municipal governments — responded to the crisis because it was felt to be so important.

“We changed overnight the way that we practiced medicine, conducted research, and interacted with one another as a society,” he said. “That is the type of response that is needed for the current public health crisis.”

What’s missing, he explained, is an overarching plan that reduces demand for street drugs by addressing issues such as mental health, poverty, homelessness, trauma, access to primary care, and chronic pain management. “These issues are challenging on their own but also feed directly into the reasons why people continue to use substances and continue to be at risk of overdose death.”

Instead, DeBeck added, “What I see is a movement toward more policing, more criminalization, and things like involuntary treatment.” She also has observed “magical thinking around addiction treatment — ie, that we just need more of it, and the problem will be fixed. We’re just turning away and pretending that it’ll somehow go away, but it’s not going to go away.”

Public nervousness about drug use tends to encourage easy solutions such as policing and addiction treatment, she said. “The more we can engage the public about the complexities of drug policy and get them to recognize the limitations of policing and the classic, abstinence-oriented addiction treatment, the more support there will be. This [effort] could give politicians confidence that they’re not going to get backlash around using evidence-based approaches for public health.”

Bach and DeBeck declared having no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDEdge, The Lancet (where she was a contributing editor), and Reuters Health.