Substance Use News, January 2023


Substance Use News provides a monthly collection of news and resources on the social, medical and political responses to the toxic drug supply crisis. Info for People Who Use Substances: get the latest alerts, and tips on how to stay safe from Toward the Heart. Visit our Substance Use and Harm Reduction page for more resources. 


BC Coroners Report

BC Coroners Service Report: Illicit Drug Toxicity Deaths in BC. January 1, 2012 – December 31, 2022 

This report summarizes all unintentional illicit drug toxicity deaths in British Columbia (accidental and undetermined) that occurred between January 1, 2012, and December 31, 2022, inclusive.
A review of completed cases from 2019-22 indicates that the top four detected drugs relevant to illicit drug toxicity deaths were fentanyl (86%), cocaine (45%), methamphetamine/amphetamine (42%), and other opioids (22%). There is no indication that prescribed safe supply is contributing to illicit drug deaths.


Toxic-drug supply claims nearly 2,300 lives in 2022: BC Coroners Service

“The reality is that these deaths are preventable,” BC chief coroner Lisa Lapointe said. “Toxicology data confirms that the drug supply in British Columbia is increasingly volatile and life-threatening. The Standing Committee on Health and two BC Coroners Service death review panels are in agreement that we must rapidly increase access to a safer supply of substances, while at the same time, building out a robust system of evidence-based care. Those dying are our family members, neighbours, friends and colleagues. Urgent action is required to reduce the significant risks that tens of thousands of British Columbians are currently facing.”


As BC marks another 2,272 toxic drug deaths, addictions doctor tells families: ‘I am so sorry’

“To the families of the 45 individuals who have passed away in the last week alone … to their friends and their colleagues and their communities and loved ones: my heart goes out to you and I’m so sorry that we’re continuing to fail,” said addiction medicine specialist Dr. Paxton Bach during an emotional news conference Tuesday. “I hope that we can sit with that grief and that outrage. I hope that every citizen of the province reflects on this report and feels that outrage and uses that to drive the advocacy that is needed to generate change.”


Decriminalization begins in BC as coroners service releases overdose death data

Dean Wilson, who started working as a peer facilitator at the B.C. Centre on Substance Use in 2017 as a heroin user, saiddecriminalization is a welcome change to prevent drug users’ interactions with poice.
However, he said it needs to be accompanied with a bold plan to provide more people with a broad range of saferalternatives to toxic street drugs, which profiteers often cut or contaminate with the powerful opioid fentanyl. “They’ll cut their cocaine for five minutes, then they’ll cut their fentanyl on the same scale and all of a sudden there’sfentanyl on the cocaine. And when somebody who’s never done opioids at all gets the one (hit) that had a little bit offentanyl, they’re dead,” Wilson said.


BC Counts Down to Decriminalization

Starting January 31, 2023, adults over 18 years old in BC will not be subject to criminal charges for the personal possession of small amounts of certain illegal drugs. Health Canada has granted an exemption from the Controlled Drugs and Substances Act to the Province of BC. until January 31, 2026. Visit BC Government site to learn more.

Drug Decriminalization in British Columbia – Know Your Rights

To ensure people in BC know when they are and are not protected by BC’s decriminalization policy, Pivot Legal Society has created a printable Know Your Rights Card with friends at the Vancouver Area Network of Drug Users (VANDU). If you’re a person who uses drugs (or a drug user-led group), feel free to contact Pivot Legal for some hardcopy cards.


As Decriminalization Begins in British Columbia, Activists Watch Warily

Now that BC’s decriminalization model has taken effect, the Vancouver Area Network of Drug Users (VANDU) is among those planning to watch closely how it plays out in practice. A VANDU board member told Filter that the low threshold—considering how people go out to buy larger amounts to get a price break, or to limit the number of purchases they make—could result in people being criminalized more than before, if police increasingly target people who exceed the limit.


It’s the ‘Eve of Decriminalization’ for Drug Possession in BC

“There is a lot of uncertainty on this ‘eve of decriminalization,’” said Amber Streukens, a Nelson-based organizer with the Rural Empowered Drug User Network and harm reduction worker for ANKORS West (AIDS Network Kootenay Outreach and Support Society, which serves communities including Nelson, Trail, Castlegar and Kaslo). “The measure is lacking in a lot of ways and what’s going to happen feels unknowable.”


BC takes action to save lives, build new connections of care with drug decriminalization

Statement from BC’s Ministry of Mental Health and Addictions: The Province is taking a critical step to end the shame and stigma that prevents people with substance-use challenges from reaching out for life-saving help as B.C.’s decriminalization of people who use drugs comes into effect on Tuesday, Jan. 31, 2023. “We know criminalization drives people to use alone. Given the increasingly toxic drug supply, using alone can be fatal,” said Jennifer Whiteside, B.C.’s Minister of Mental Health and Addictions. “Decriminalizing people who use drugs breaks down the fear and shame associated with substance use and ensures they feel safer reaching out for life-saving supports. This is a vital step to get more people connected to the services and supports as the Province continues to add them at an unprecedented rate.”


It’s Time for Drug Decriminalization – Done Right – Now

From HIV Legal Network: This week, we are watching with great interest as the possession of some drugs in small amounts will finally be decriminalized in the Province of British Columbia. While in theory a positive step forward in the quest to end an escalating drug poisoning crisis that is driven by bad drug policy, we remain deeply concerned that this “decriminalization” model neglects the lived realities of those most at risk for drug poisoning and will continue to criminalize many people who use drugs in the province.


Police given 45-minute training video and infographics as decriminalization set to begin in BC

A day before possession of small amounts of certain illicit drugs is temporarily decriminalized, about a third of B.C.’s frontline police officers have completed the first phase of training on how to implement the new rules. During a technical briefing Monday, reporters learned the province has developed a 45-minute recorded presentation on the decriminalization pilot project as part of the first phase of training for the province’s more than 9,000 officers on the streets.


BC Decrim Threshold Was Set for Police, Not People Who Use Drugs

British Columbia is about to become the first Canadian province to decriminalize personal possession of some state-banned drugs—a move that media and government officials are widely touting as progressive. As drug users who work in frontline harm reduction, we do not share this view. the threshold of personal possession at a cumulative 2.5 grams, which doesn’t reflect true buy-in from the people it purports to serve.


BC’s ‘necessary step forward’ in drug decriminalization

“Decriminalization is not a controversial idea in the current era,” says Paxton Bach, a general internist and addiction medicine physician, co-medical director for the British Columbia Centre on Substance Use (BCCSU) and Assistant Professor in the Department of Medicine at the University of British Columbia. “The members of the public might be surprised by that, but there is remarkable agreement among stakeholders that this is a necessary step forward.” Advocate Guy Fellicella says that even though the selected 2.5-gram threshold is different from what the community wants, it is nevertheless an improvement.


Why Does BC’s Decriminalization Exclude Benzodiazepines?

Benzodiazepines had been noticeable in the supply since around 2019, but drug-checking data and coroners reports show that since 2020 they’ve become a much more prominent feature—particularly in the supply of “down,” or drugs sold as state-banned opioids. “Benzodope” has become ubiquitous. Yet on January 31, a BC pilot will decriminalize possession of small amounts of four drugs: meth, cocaine, opioids and MDMA. No benzos.


Brother of overdose victim plans to open brick-and-mortar store selling hard drugs in Vancouver

A three-year pilot project approved by Health Canada will decriminalize the possession of up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA in the province starting Jan. 31 for British Columbians age 18 and older. Jerry Martin says he plans to open a brick-and-mortar store in Vancouver’s Downtown Eastside, but BC’s Ministry of Mental Health and Addictions says the decriminalization of people who use drugs is not the same as legalization. “Mr. Martin’s project is not within the scope of decriminalization,” the ministry said in an email statement. “The selling (or trafficking) of controlled substances remains illegal.”


BC’s drug decriminalization pilot excludes young users — and that will marginalize them, experts fear

While advocates for drug users say decriminalization alone won’t stop thousands of people dying from a tainted drug supply, others say it is a step in the right direction when it comes to treatment. But some say the fact it excludes youth could further marginalize drug users under the age of 18 — especially given that there are no youth-oriented harm reduction spaces in the province.


UBC lab develops new, portable drug-checking device ahead of limited decriminalization

A lab at the University of British Columbia is working on new drug-checking technology, including a device they say can identify lower concentrations of drug components. Sara Guzman, a graduate student working at UBC’s Hein Lab, is helping test a new, portable version of high-performance liquid chromatography instruments, or HPLCs, which she says can identify drug concentrations below five per cent. The Hein Lab says it plans to eventually provide the service for free to drug-checking sites and distributors working with clinics. It aims to have the device ready for use by the end of April this year.


Former Vancouver mayor defends BC’s approach to drug decriminalization

Kennedy Stewart has been a prominent supporter of decriminalization both during his tenure as mayor of Vancouver and now in his new role as director of the Centre for Public Policy Research at Simon Fraser University. Under Stewart’s leadership, city council passed a motion in November 2020 to decriminalize the simple possession of illicit drugs in Vancouver by seeking an exemption from Health Canada under the Controlled Drugs and Substance Act. That eventually morphed into a province-wide application that was accepted by Ottawa, though at a lower threshold than the 4.5 grams B.C. asked for. As of Jan. 31, people aged 18 and older will now be able to possess up to a cumulative 2.5 grams of opioids, cocaine, methamphetamine and MDMA within the province.


In the News

Animal tranquillizer xylazine is now in Canada’s street drug supply. Here’s what to know

Xylazine, a sedative and analgesic normally used in veterinary medicine to sedate large animals such as cattle or horses, has been wreaking havoc in parts of the US, notably in Philadelphia, where it was found in 90 per cent of dope samples tested in the city in 2021. The Canadian Community Epidemiology Network on Drug Use (CCENDU) issued an alert last July identifying the emerging presence of xylazine in a small number of opioid samples tested in BC, Manitoba, Ontario, Quebec and Nova Scotia. Since then, its presence in Canada has grown, according to drug test samples and coroner’s reports in BC and Ontario.


BC toxic drug crisis: Fewer 911 calls as deaths continue

BC Emergency Health Services saw a slight decline in 911 calls for overdose and drug toxicity last year, but some areas saw a dramatic increase, and the death rate doesn’t appear to be slowing down.


Why this Saskatchewan drug outreach centre doesn’t require abstinence to access its services

Advocates say that harm reduction aims to meet people where they’re at. That can mean supporting someone to continue using drugs in a supervised way amid rising overdose-related deaths. “When we force people or manipulate them to seek abstinence as a part of engaging in support services, we’re just creating a cycle for them of disappointment and a lot of difficulty ahead,” said Kayla DeMong, the executive director of Prairie Harm Reduction.


Alberta’s Dangerously Out-of-Touch Approach to Substance Use

Alberta is a prime example of how policy shifts away from public health approaches have tangible effects for the well-being of people who use drugs. Our research with marginalized drug users in Lethbridge, Alberta, demonstrates that the closure of supervised consumption sites can increase drug-related harms and negatively impact the safety and welfare of people who use drugs.


Rural Saskatchewan lacking support for drug users, says woman in recovery

“If I didn’t have a ride to Regina detox or St. Joseph’s treatment centre then I wouldn’t have been able to go, and for the people here who don’t have rides where do they go?” Brooke Jasper said. “They don’t go anywhere. There’s nothing. There’s no detoxes there’s no treatment centres.” Drugs, on the other hand, are readily available in these smaller centres, according to Jasper.


Researchers consider how to ‘denormalize’ drinking culture ahead of new alcohol guide

Catherine Paradis, interim co-chair of the CCSA’s updated guidance project, said the recommendation for Canadians to consider reducing their alcohol intake is “not an easy ask” for those who enjoy drinking regularly, so policy changes will need to be made to highlight the risks. “A particularly effective one could be the mandatory labelling of all alcoholic beverages with the number of standard drinks, Canada’s guidance on alcohol, and health warnings,” Paradis said, adding that would involve the federal and/or provincial governments.


It’s time to put cancer warning labels on alcohol, experts say

The pressure on the government to put cancer warning labels on alcohol containers is growing, as experts say the majority of Canadians don’t know the risks that come with consuming even moderate amounts. Based on its findings, the Canadian Centre on Substance Use and Addiction (CCSA) is now calling for health warning labels that include the cancer risk on alcohol containers, and labels that inform people of how many standard drinks are in every container.


How to Take Canada’s New Drinking Guidelines Seriously

However you may encounter it, alcohol is so commonplace that few realize how harmful it can be. And most don’t know where the line crosses from moderate to excess. According to the World Health Organization, alcohol consumption is “a causal factor in more than 200 diseases, injuries and other health conditions.” It is associated with the risk of chronic diseases like heart disease, high blood pressure, stroke and digestive issues, as well as several types of cancers including mouth and throat cancer, stomach cancer and in women, breast cancer.


Association of sex work and social-structural factors with non-fatal overdose among women who use drugs in Vancouver, Canada

Women who use drugs (WWUD) and engage in sex work experience disproportionate sex- and drug-related harms, such as HIV, however comparatively little is known about their overdose risk. Therefore, we examined the association between sex work and overdose and secondarily explored the association of social-structural factors, such as policing and gendered violence, with overdose.



Advocacy and Education

Sexual and emotional intimacy key to syringe sharing among women who inject drugs in Philadelphia

Published in AIDS and Behavior, a recent study among women who inject drugs in Philadelphia set out to determine how the women’s relationships influenced syringe sharing. Women were more likely to use syringes after someone they had an intimate or close relationship with, including sex partners, people who helped them inject, and those providing emotional support.


Victoria SAFER Initiative

SAFER is a flexible, community-based model of safe supply that is grounded in harm reduction policy and practice and utilizes a social justice lens. The SAFER program is run by a multidisciplinary staff team (e.g., support workers, systems navigators, nurses, physicians) and provides support and referrals to other community services. The program offers safe supply (e.g., opioids, stimulants) in a variety of formats (e.g., tablets, patches, liquid). AVI Health & Community Services (AVI) launched SAFER in July 2020 during the COVID-19 pandemic with funding from Health Canada’s Substance Use and Addictions Program (SUAP).


Does sexuality matter? A cross-sectional study of drug use, social injecting, and access to injection-specific care among men who inject drugs in Melbourne, Australia

Gay, bisexual and other men who have sex with men (GBMSM) are overrepresented in cohorts of people who inject drugs. GBMSM’s substance use is usually explored in the context of its contribution to sexual risk. We examined drug use practices, connectedness to other people who inject drugs, peer-to-peer injecting, and access to care among men who inject drugs in Melbourne, Australia. Researchers aim to describe similarities and differences in these parameters for GBMSM and other men.


North Carolina pharmacists’ willingness to sell fentanyl test strips: a survey study

Although fentanyl test strips (FTS) can accurately determine the presence of fentanyl in unregulated substances, access to FTS remains limited. This study aimed to examine North Carolina community pharmacists’ attitudes and willingness to engage in various behaviors related to FTS sales and distribution.


Visit the BC Centre for Disease Control’s Unregulated Drug Poisoning Emergency Dashboard for provincial data from different sources.

Visit the BC Centre on Substance Use for information on evidence-based approaches to substance use and addiction.

Visit the National Safer Supply Community of Practice (NSS-CoP), whose goal is to scale up safer supply programs across Canada.


Questions? Feedback? Get in touch. Janet Madsen, Capacity Building  and Digital Communications Coordinator, [email protected]



Focus image by Andrew, Flickr (Creative Commons)