Since the province declared opioid overdoses and deaths a public health emergency seven years ago, at least 11,807 people in the province have died.
Since Canada announced a new drugs and substances strategy focused on harm reduction, roughly 34,455 Canadians have lost their lives to an opioid overdose.
Since 2016, when both events occurred, the governments of British Columbia and Canada have committed more than $2 billion combined toward addressing the toxic drug crises that have intensified within their respective borders.
The number of deaths, and the dollars intended to prevent them, have only increased.
BIV and Glacier Media reviewed government budgets, records, announcements and commitments in an effort to account for how much money has been directed toward the opioid crisis at municipal (City of Vancouver), provincial and federal levels.
The reporting that follows examines funds that specifically target this issue. Without a doubt, there are government resources dedicated to areas such as health care, mental health and addictions, law enforcement, the judicial system and community supports that directly and indirectly address this crisis as well. Breaking out the value of those investments was beyond the scope of this project.
Canada: Policy reform a critical complement to hundreds of millions in annual targeted funding
In December 2016, Canada’s then-minister of health announced that the country’s National Anti-drug Strategy would be replaced with the Canadian Drugs and Substances Strategy. More than a name change, the new program’s goal was to reinstate harm reduction as a core pillar of Canada’s drug strategy, alongside prevention, treatment and enforcement.
One of the overarching reasons for the change was to better position Canada to deal with its growing opioid crisis.
Though the crisis pre-dates 2016, and federal funds were being directed towards substance-use treatment before that time, it wasn’t until Canada’s 2017 budget that federal funds were directed specifically to the opioid crisis. They included $110 million for the updated Canadian Drugs and Substances Strategy, as well as $16 million for opioid-related public health emergencies in B.C. and Alberta.
Federal funds have been specifically dedicated to addressing the crisis every year since, with funding nearly doubling to $231 million in 2018.
Ottawa claims to have spent $800 million on combating Canada’s opioid crisis. From 2017 to 2022, there were $654 million in expense line items that specifically mention opioids, although other funding could have been included in other expense categories. In 2023, the federal government proposed its largest annual opioid crisis expenditure to date: $359 million, bringing the total amount specifically spent on the crisis to more than $1 billion.
The money mostly funds community organizations that deliver opioid and other drug and substance-related programs. This includes opioid agonist therapy services (which help treat addiction and manage symptoms of withdrawal), safer supply programs, awareness and access to naloxone, reduced stigma and support for families and other harm-reduction initiatives. In Ottawa’s 2018 budget, a one-time sum of $150 million was allocated to an Emergency Treatment Fund to help provinces improve access to opioid treatment services.
The government has also made indirect investments to address the opioid crisis including $650 million in 2022 for community-based wellness programs, and $4.5 million to support people with chronic pain, as many instances of opioid addiction start with a prescription to alleviate pain.
Currently, the Government of Canada’s website identifies $134.2 million in funding for active projects to combat the opioid crisis, along with an additional $93.8 million for programs that address the use of substances, which could include opioids. British Columbia is currently benefiting from one-third of all funding for active programs combatting either opioids or multiple other substances – a total of $74.1 million, more than half of which ($39.8 million) is directed specifically to opioids.
The most expensive active program in B.C. is the Safer Alternative for Emergency Response for Vancouver Coastal Health, at just under $5 million. The project aims to deliver a safe supply program, prescribing pharmaceutical-grade opioids to people most at risk of overdose. Another $4.8 million was provided to Simon Fraser University’s Canadian Drug Policy Coalition with the goal of implementing harm-reduction systems and increasing national awareness.
While targeted federal investment on this issue has undeniably increased, the question as to its impact and effectiveness is difficult to determine.
Opioid deaths in Canada have continued to climb in the years following Ottawa’s renewed focus on the opioid crisis.
From 2016 to September 2022, 34,455 Canadians died of an opioid overdose. The number of deaths per day more than doubled in 2021 to 21 from 10 in 2019. In 2022, this figure fell slightly to 20 deaths per day, with 87 per cent of those occurring in B.C., Alberta and Ontario.
Opioid poisoning hospitalizations have fallen somewhat, starting at 13 in 2019, peaking at 17 in 2021 and falling to 14 in 2022. Emergency medical services responses to opioid-related calls followed a similar trend, registering roughly 17,400 responses in 2019, peaking at roughly 30,600 in 2021 and falling to 28,200 in 2022.
When this data was released, a joint statement from the co-chairs of the Canada’s special advisory committee on the epidemic of opioid overdoses highlighted how Canada had previously shown global leadership in its approach to the crisis, with supervised consumption sites, safer supply initiatives and community-based prevention models.
By comparison, from 2017 to 2020, the U.S. federal government dedicated $20.7 billion towards programs through various agencies to combat its opioid epidemic, which took 91,799 lives in 2020 – the most-recent year for which data is available, according to the Centers for Disease Control and Prevention. The same year, Canada spent $454 million (2.1 per cent the United States’ commitment) on a crisis that killed 4,395 people in Canada (4.7 per cent of the U.S. total), according to the Canadian Centre on Substance Use and Addiction.
California, a state with roughly the same population as Canada, has spent around the same amount as Canada, at approximately $1 billion.
Federal investments, particularly in developing a safe drug supply, are a critical and important intervention, said Kora DeBeck, research scientist with the BC Centre on Substance Use. But while big budget allocations towards opioid treatment may be politically saleable, they are not as effective as lower-cost policy changes, such as drug deregulation, decriminalization or legalization, said DeBeck, who added criminalizing drug users bears significant costs, and does little to prevent drug use or public health-related harms.
Federal funding for various programs that address the opioid crisis have helped, DeBeck said, but the overall level of funding remains insufficient for the scale and scope of the crisis.
“We know that investments in those areas are not enough and that people aren't getting the services that they need,” she said.
The driver of deaths, DeDeck added, is a toxic drug supply. She said the the best way to tackle that issue is to remove the supply-side of the equation from the hands of the black market.
“We can't spend our way out of this, we can't treat our way out of this,” she said. “We need policy reform.”
B.C.: Billions spent on mental health and addictions, along with a decriminalization model and safe supply project that haven’t reduced deaths
The government of B.C. has invested almost $2 billion of direct, indirect and targeted funding into the province’s toxic drug crisis since 2014, according to an audit by Glacier Media.
However, experts say these investments have not done enough to lower the number of overdose deaths.
B.C. declared a public health emergency in April 2016, following a 30-per-cent increase in illicit drug overdose deaths between 2014 and 2015. The announcement marked the first time a provincial health officer exercised emergency powers under the Public Health Act, and the first time a Canadian province took this kind of action regarding a toxic drug crisis, according to the B.C. government.
“The declaration in 2016 was really met with very little in terms of concrete investment and overdose prevention, and even more so in terms of addressing the upstream policies that caused the toxic drug crisis,” said Nicole Luongo, B.C. systems change coordinator for the Canadian Drug Policy Coalition.
There have been approximately 17,369 suspected illicit drug overdose deaths in B.C. since 1996, according to data from the BC Coroners Service (BCCS). Of this total, 596 deaths have so far occurred in 2023, and 2,314 occurred in 2022 – the highest yearly total ever recorded in the province.
“If your success is measured by overdose deaths, we still have a complete disaster on our hands. It is an ongoing crisis that has been going on for years now,” said Mark Haden, a professor at the University of British Columbia’s School of Population and Public Health.
Following the declaration, the province created the BC Centre on Substance Use (BCCSU), which provides treatment and research for the toxic drug crisis, as well as the Joint Task Force on Overdose Response, intended to provide leadership from experts and give advice to the province.
Since Budget 2017 and through to the current fiscal plan, the B.C. government has committed more than $1.1 billion in targeted investments that address the overdose emergency, according to the BC United Caucus. More broadly, the Ministry of Mental Health and Addictions estimates that the province spends approximately $3.3 billion annually on mental health and substance use-related service delivery.
But many issues remain, such as ensuring access to B.C.’s safe drug supply, integrating treatment and harm reduction, and the framing of addiction and mental health, according to those who spoke to Glacier Media.
In B.C., mental health and substance-use resources have been fully integrated at the provincial level for roughly the past decade, according to Haden and the Canadian Centre of Substance Use and Addiction. The result, Haden said, is less funding for addictions and the dismantling of addiction services.
“There used to be intact addiction services programs that included detox, residential treatment centres, outpatient counselling, it was provincial. Then it was taken over by mental health and all of the addictions leadership left, and it was basically run by people that weren't interested in addiction services and then we had the crisis,” Haden said.
While the experts who spoke to Glacier Media say they understand the need to look at both mental health and addictions, the assumption that addiction is also mental illness “dilutes the possibility of targeted policy responses,” said Luongo.
The Ministry of Mental Health and Addictions was created in 2017 to lead B.C.’s response to the toxic drug crisis and build a coordinated approach to mental health and addictions, according to the province.
“This is a supply chain issue, so we need to address the supply. Then you have the government coming out and saying we're investing in addiction and mental health services, which is good. I'm not saying that's not something we should be doing. That is a solution to a different problem and those problems are routinely conflated. That then both limits public imagination and limits the actual policy options available,” said Luongo.
Fentanyl – a potent synthetic opioid drug – and variations of it accounted for 86 per cent of unregulated drug overdose deaths in 2022, according to BCCS.
British Columbians have been accessing prescribed safe supply since March 2020, when the province introduced the first phase of the program, according to the B.C. government. From March 2020 to November 2022, roughly 11,670 people were prescribed safe supply medications.
“People are still accessing their drugs through the criminal system. So, when we stop doing that and we allow people to access their drugs through a health system, then we can actually manage this. The only reason why people are dying is because people don't know what they're injecting,” said Haden.
Beyond safe supply, B.C. has also invested in treatment and harm-reduction strategies.
Guy Felicella, a peer clinical adviser at BCCSU, said that harm-reduction strategies need to be married with treatment and recovery policies, in addition to being delivered in a timely manner.
“We have both harm reduction and recovery. The challenge has always been with accessing both in a timely manner.… Recovery centres need to work better with the harm-reduction services as a hand off to let people know that if you ever feel like using you can go to this place, they'll help you so you don't have to die. Because this is the reality that we're in,” he said.
“You can fund everything. But if the policy doesn't allow the money to flow and hit the people, then what good is the money?”
In 2023, Health Canada granted B.C. an exemption from the Controlled Drugs and Substances Act, allowing individuals to carry small amounts of illicit drugs for personal use. Haden described this decriminalization as a move that shows that the province sees the crisis as a health issue rather than a criminal one.
He pointed to Oregon and Portugal as two other examples of decriminalization. B.C. more closely resembles Oregon in that the province has implemented a decriminalization model but has not seen a subsequent decrease in its number of overdose deaths.
“Portugal decriminalized drugs, but they had the police play a role of referral to treatment that was quite insistent, it wasn't required, but it was a very clear vehicle into treatment centres through police referrals,” he said, adding that this is the best model for decriminalization, but one that does not exist in B.C. or Oregon.
Vancouver: New VPD and VCH spending nearly matches crisis-related investments over previous seven years combined
Since 2016 and up until 2023, the City of Vancouver has put at least $25.65 million into directly addressing its opioid overdose crisis. The funding has been focused on three major areas:
- a three-person medic unit, which accounts for a majority of the funding ($2.05-2.43 million);
- opioid crisis response investment in the City of Vancouver staff and Vancouver Police Department (VPD); and
- the micro street-cleaning grants in the city’s Downtown Eastside.
In response to the costs of the crisis, the City of Vancouver introduced a 0.5-per-cent property tax increase in December 2016 to enhance funding support for first responders, front-line workers and shelters by approximately $3.5 million per year. The figure was built into the city’s base budget and continues to be allocated toward overdose response.
In 2020, funding for the VPD under the opioid crisis response budget was increased to $160,000 from $60,000 and continued until 2023. The funding for the Downtown Eastside cleaning grants rose to $590,000 in 2019 from $200,000 in 2018. It was further increased to $890,000 annually over the 2020-23 period.
Some achievements have been noticed and recognized by experts. One important step, they say, has been the city's partnership with Vancouver Coastal Health to set up and operate 12 overdose prevention sites in Vancouver.
“While a significant number of people continue to die, even more would have if we had not taken certain steps. The BC Centre for Disease Control found that 60 per cent of deaths were averted during the opioid crisis at early stages based around three specific interventions: The Take Home Naloxone program, overdose prevention sites and the opioid agonist treatment,” said Benjamin Perrin, a law professor at the University of British Columbia and author of Overdose: Heartbreak and Hope in Canada’s Opioid Crisis.
Another achievement has been the decriminalization of the simple possession of illicit drugs in Vancouver – something the city has been asking Ottawa for since November 2020. In May 2022, the federal government granted a three-year exemption to criminal penalties for people who possess a small amount of certain illicit substances for personal use in B.C.
“That’s another crucial thing because we know that by criminalizing people who use drugs, that increases the stigma. So that's another area under the previous city government where we saw some leadership,” said Perrin.
But despite some important milestones and ongoing investment, the overdose death rates in Vancouver have increased, counteracting progress in reducing deaths in 2019. There were over 400 overdose deaths in Vancouver in 2020, with an average of six deaths per week reported by the VPD, and an average of approximately 100 calls per week that were responded to by Vancouver Fire Rescue Services. And the situation has worsened since – 161 people died of an overdose in Vancouver in the first half of 2022, based on VPD and coroner reports, or an average of eight to nine deaths per week.
Perrin said homelessness, substance use and mental health are nuanced, public health and social issues, and investments ought to be directed to health and social services, and not toward hiring more police officers.
The city’s 2023 budget includes initial funding of $13.8 million to support the hiring of additional VPD officers, and to support the expansion of initiatives between the VPD and Vancouver Coastal Health. The latter was also awarded a grant of $8.1 million to enhance those initiatives. This new funding – at $21.9 million – nearly matches the $25.65 million the city had invested in opioid crisis-related initiatives over seven years, from 2016 to 2022.
Perrin said he would like to see the city work with Vancouver Coastal Health and the province to provide rapid access to evidence-based treatment.
“The city council has a role in not only allocating its funding towards things that will support the opiate crisis response, and also in being an advocate to the provincial government to say, look, this is what we see in our community."
This article is part of an in-depth, provincewide journalistic effort by Glacier Media to examine the scope, costs and toll of the opioid and toxic drug crisis in British Columbia – a public health emergency that has taken at least 11,807 lives since 2016.
If you or someone you know is in an emergency, call 911. If you need help with substance abuse, call the B.C. government's alcohol and drug information and referral service at 1-800-663-1441. It's available 24 hours a day.