The toxic drug crisis: a devastating public health emergency reaches its eighth year



The 14th of April, 2024, marked eight years since British Columbia (BC) declared a public health emergency due to increased drug poisonings. Since then, more than 14,000 people have died due to toxic substances.

The First Nations Health Authority (FNHA) recognizes this somber anniversary as one that has disproportionately taken the lives of many First Nations people. These are beloved family members, friends, and community members.

“Our people have experienced all forms of harmful intergenerational impacts due to colonization. For example, children were horrifically abused in residential schools, d​ay schools and foster care. As adults, some self-medicate to deal with unfathomable memories of traumatic lived experiences. Seen in this light, it makes sense. The heartbreaking truth is that toxic drugs are creating devastating losses for our families and communities. I believe the best way to address this crisis is through harm reduction.  We must respect people's choices.  If they decide to live life with substance use as part of it, we must work alongside them in a way that they can make choices that result in them using safely. We must remember that colonization has shut all kinds of doors for our people; let us be the ones that keep the doors open today". 

-Cree Elder Emily Henry

First Nations people make up just over three per cent of the population of BC but 17.7 per cent of toxic drug deaths in the first six months of 2023. As of November 2023, 2,052 First Nations people have died from toxic drug poisoning since this public health emergency was declared in April 2016.

“It's painful to talk about these numbers because they're not just numbers, they're people, people who are loved and people who had futures ahead of them," said Dr. Nel Wieman, Chief Medical Officer for FNHA.

The life expectancy of First Nations people in BC has been greatly reduced by the dual impacts of the COVID-19 pandemic and the toxic drug public health emergency. Between 2015 and 2021, life expectancy for First Nations people decreased by 7.1 years.

“People should feel the loss – how whole communities are gutted with a loss of love and understanding. Communities look different than even a year ago."

-First Nations community member

Given these devastating numbers, response efforts have intensified:

In 2023, BC decriminalized the possession of up to 2.5 grams of some illicit drugs for personal use, as a move to destigmatize people who use substances (PWUS) and emphasize substance use as a health issue, not a criminal one. At the same time, it must be noted that decriminalization does not change the toxicity of the drug supply.

People with lived and living experience, also known as Peers, state that stigma remains one of the most significant barriers to addressing substance use. Peers have been organizing and creating networks to use their voices to reduce stigma across the province over the last several years. In all regions of BC, peers are harm-reduction champions that support PWUS and educate others who may place blame on the person rather than the toxic unregulated drug supply for the public health emergency.

“The more we marginalize, stigmatize, and criminalize people who use substances, the worse it's going to get. Substance use is not a criminal problem. We need to lead with our hearts, not our heads."

-First Nations Peer

As the unregulated drug supply continues to become more toxic, it is important to support harm-reduction efforts and endorse other options: courageous conversations about substance use, various forms of treatment models and compassionate care are integral to hold up members of communities that need our support. It has also been found that access to prescribed pharmaceutical alternatives (formerly prescribed safer supply) can help people who use substances rely less on the toxic street supply, which in turn, reduces the risk of death.

“People love you; people care about you; you are not alone."

-First Nations Peer

The FNHA emphasizes that all paths lead to wellness; this model holds up areas of strength, areas for growth, and specific priorities to support a person while also using a community-centered approach to healing.

While preventing toxic drug poisonings and reducing health and social harms is the goal of harm reduction, connection and culture are at the heart of First Nations-driven harm reduction. Connecting with people who use substances, supporting them without judgement, and offering unconditional love are all good steps we can take to ensure individuals and communities have safe options.

“Connections to community and Elders are critical. Connections are important. Ceremony is important. Feeling love and support is important. For our youth, for our Elders, for everyone."

-First Nations Peer

As we work toward an end to the public health emergency, the FNHA continues to follow the Framework for Action that was implemented as a response to the toxic drug emergency for First Nations people:

  • Prevent people who experience drug poisoning from dying,
  • Keep people safer when using substances,
  • Create an accessible range of treatment options, and
  • Support people on their healing journey.

“If you have anything to give and share, give until it hurts. And when you need it, the same will be done for you. It's going to be harder before it gets better. We have to give more."

-First Nations Peer

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