On January 31, British Columbia ended its historic—if insufficient—drug decriminalization pilot. For three years, the province had allowed people to possess up to 2.5 grams of unregulated opioids, methamphetamine, cocaine and MDMA without facing charges. Now, drug-user communities are figuring out what comes next.

Vancouver is hosting seven FIFA World Cup matches this summer, and harm reduction workers are bracing for something like the 2010 Olympics when police forcibly removed people living in public spaces, trashing tents and harm reduction supplies. A clean image for TV.

Krieg points out the absurdity of street sweeps targeting people who use drugs “without there actually being any money being put toward opening more treatment centers” or other necessary supports.

“It seems like they’re going back to when I first started with VANDU,” said Samona Marsh, the group’s secretary and a member of its police oversight project, as well as vice president of Coalition of Peers Dismantling the Drug War. “Nobody would say [sterile] needles are harm reduction.”

Teasing and bright, with three decades of lived experience, Marsh holds your gaze. She calls it like it is, ribbing some of the flaws in medical safer supply programs. (“I don’t want to take a pill when I’m sick—why the hell would I want to take a pill to get high?”) 

The decrim pilot had been fraught, but it was progress. Yet in January, BC officials including Health Minister Josie Osborne and Premier David Eby justified its end by simply saying it wasn’t working.

“Not working for who?” said Marsh, sitting cross-legged on the floor. “It was working for us.”

“It was a shocker to most people in the room.”

Amid rising political backlash, BC began gutting the decrim pilot shortly after it began. In 2024 it recriminalized drug use in all public spaces; consumption was effectively restricted to private indoor spaces, leaving unhoused people at heightened risk for criminalization. The 2.5-gram threshold left people vulnerable to distribution charges. And all along, the pilot continued to rely on police.

Though a widely publicized 2025 study suggested that the decrim pilot facilitated diversion of safer supply medications, Lisa Lapointe, who had recently retired as the province’s longest-running chief coroner, said it did so by misrepresenting the data. “We know that the crisis started under a criminalization program,” she told the Canadian Press. “We know that the number of deaths grew exponentially under the criminalization program .. [the study] doesn’t indicate that decriminalization is not working.”

Just weeks before the province ended the decrim pilot, BC’s Office of the Human Rights Commissioner called for a “human rights-based approach” to the overdose crisis, stating that emerging evidence suggested the pilot was in fact working as intended and that curtailing it “was based on unsubstantiated public perception that street disorder increased under decriminalization,” despite no evidence of that.

“This is the highest level of the [provincial government] making decisions that aren’t based in evidence,” Blake Edwards, a student nurse and long-time DTES outreach worker, told Filter. “I do take it personally, as a frontline worker for this long and seeing the entire evolution of this crisis. I’ve lost so many clients over the years. And I’ve lost so many friends.”

From the start, he said, what’s now being called a failed social experiment never prioritized the people who were actually dying. Drug user-led community groups have been denied the resources they need since “the forever emergency,” as Edwards described it, was first declared a BC public health crisis in 2016.

“It was a shocker to most people in the room,” said Pivot Legal Society lawyer Caitlin Shane, recalling a Surrey Union of Drug Users meeting in January the pilot’s demise was relayed to members, some of whom don’t have regular internet access. “It’s a decision that’s going to directly impact people’s lives … all of these types of political interventions are going to drive reliance on the unregulated market.”

Shane leads the drug policy reform campaign at Pivot, a DTES-based nonprofit focused on poverty and human rights. She describes how BC’s current drug policy reflects a right-wing turn among Eby and the BC New Democratic Party. They’ve made it clear, she said, that they don’t consider people who use drugs worthy of evidence-based supports.

Eby used to be a lawyer at Pivot, she added with a laugh.

Downstairs, photographs memorialize community members lost to the drug war.

Back at VANDU, Marsh notes that fewer glass pipes are being distributed for safer smoking; they are added to a To-Do list. As in the western United States, many people who use opioids in the DTES have shifted from injection to inhalation as they try to reduce the harms of a rapidly changing drug supply. But in recent months glass pipes have come under fire once again as harm-reduction opponents push Canadian drug policy to the right. Saskatchewan already ended pipe distribution in 2024, and prohibited the distribution of educational resources on safer smoking.

Downstairs, photographs memorialize community members lost to the drug war. People who lived and fought for dignity and self-determination, who saw night shifts become unions, friends become comrades and street-smarts become drug policy. 

“My mom’s there,” Marsh said. “I don’t know where my dad’s picture is though.”

She gets frustrated over drug use being medicalized and harm reduction being co-opted by institutions, producing what she calls “Swiss cheese research” overly fixated on trauma, as if there could be no other acceptable reason to use drugs. Can’t it ever just be a choice?

“Like Tracey Morrison, I’m going to die down here,” she said quietly, recalling the  beloved DTES housing and drug-policy activist, who died in 2017. 

“Once again, just another junkie dead.”

Image of Vancouver’s Downtown Eastside by GoToVan via Flickr/Creative Commons 2.0

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Today, his harm reduction work is with his community in Vancouver’s Downtown Eastside (DTES) as progressive drug policies are dismantled, taking vital HIV resources down with them.

In the 1990s, Ransom joined the Vancouver Area Network of Drug Users (VANDU) after longtime activist Hugh Lampkin found him in an alley and roped him into volunteering by the Carnegie Community Centre. The DTES was the site of “arguably the worst AIDS epidemic in the developed world.” Ransom lost his mother and aunts to overdose.

“It was getting really bad down here for a while,” he told Filter. “It was actually quite scary.”

He recalled how hospital workers would treat HIV patients as “lower-class,” refusing to approach them or talk to them.

Ransom would go to nearby Surrey to bring “a box of syringes” to people who didn’t have the means to come downtown. “We’d trade three dirty ones for a clean one,” he said. The “night shift,” as it was called back then, is a little more formal now, known as the Surrey Union of Drug Users. 

Ransom, who is Ojibwe-Cree and has strands of punchy green hair dangling over his eyes, bristles with energy. In addition to VANDU, he’s active with the Eastside Illicit Drinkers Group for Education, the P.O.W.E.R. police oversight project, and WAHRS, the oldest Indigenous harm reduction society in Canada. He spends his days bringing people sterile syringes, safer smoking kits and hand warmers, and twice-weekly sandwiches. Or looking for those who “go missing.” 

Many people still only have “bits and pieces” of information about HIV and hepatitis C, Ransom said, despite there being pop-up clinics in the neighborhood. “We do need to get more awareness out there. A lot of people tend to stay away from it.” They’ve been focused on overdose, just keeping themselves and their friends alive.

Since British Columbia declared the overdose crisis a public health emergency in 2016, more than 17,500 people in the province have died of overdose. But amid escalating political backlash, on January 14 BC shuttered its historic pilot that for the past three years had decriminalized possession of small quantities of opioids, cocaine, methamphetamine and MDMA. Now, recriminalization is bringing back barriers to health care, including potential for HIV and hepatitis C prevention. 

“It’s like they purposely want us to crash and burn,” Ransom said. 

“Accessing safer supply supported their adherence to HIV medications,” said Ivsins. “It’s a really important relationship.”

HIV transmission surged during the COVID-19 pandemic, as people were cut off from harm reduction resources. In 2023 Canada recorded 2,434 new diagnoses—35 percent more than in 2022, and the country’s largest annual increase in a decade. Transmission appeared to drop in 2024, with 1,826 new diagnoses. But this still means thousands more people who need accessible treatment. 

Andrew Ivsins, a researcher with the BC Centre on Substance Use and an assistant professor of social medicine at the University of British Columbia, has studied the impact of the province’s safer supply programs on participants with HIV. 

“Accessing safer supply supported their adherence to HIV medications,” he told Filter. “It’s a really important relationship that we found, where this innovation in harm reduction has more widespread impacts on people’s health and wellbeing.”

For antiretroviral therapies (ART) like the medications that treat HIV, adherence is critical. Bundling ART together with safer supply like pharmaceutical diacetylmorphine (heroin) or fentanyl can make that possible for people who have structural barriers working against them, Ivsins said, “like being without housing or always losing their belongings.” 

In Canada, medications for opioid use disorder (MOUD) and safer supply exist on a spectrum, with a broader range of options than the three MOUD approved in the United States—albeit still very limited —relative to what people actually need. Methadone, buprenorphine and slow-release oral morphine (Kadian) are examples of opioid agonist therapy, as MOUD is known in Canada. Hydromorphone (Dilaudid) tablets and other pharmaceutical opioids are “prescribed alternative,” or safer supply.

During the pandemic Health Canada loosened some of the restrictions around these medications, encouraging providers to grant more take-homes and allowing some patients to receive deliveries rather than requiring them to travel to a pharmacy—sometimes multiple times a day—for supervised dosing. So pharmacies could blister-pack someone’s antiretroviral HIV medication with their other prescriptions, and these packs could be dropped off at, for example, the front desk of the patient’s single-room occupancy building. 

In 2025, by which time the political tide had turned against harm reduction, BC mandated that all dosing of prescribed alternatives be witnessed by a health care professional. 

If no one is home, the medication is simply taken back. 

“For folks who are unhoused or not really stabilized in their drug use at all, that daily delivery from a pharmacist is lifesaving,” Blake Edwards, a student nurse and long-time DTES outreach worker, told Filter. He said it’s also cost-effective for pharmacies, as the ones “that are handling those medications aren’t getting any financial incentive to do so.”

Now, people are more likely to miss doses. If no one is home, the medication is simply taken back. 

Canada has been the only G7 country where HIV/AIDS prevalence is rising. The defunding of PEPFAR (the US President’s Emergency Plan for AIDS Relief) and the backbone of global HIV/AIDS research reached Vancouver as well—with funding cuts impacting research at the University of British Columbia on HIV treatment for women. The HIV Legal Network emphasized Canadian drug policy as a key federal election issue. Yet policies remain unaligned.

In addition to the decriminalization of drugs, Canada has moved away from decriminalization of HIV. Non-disclosure can still be prosecuted as “aggravated sexual assault,” even in cases with no risk of transmission. Though in recent years prosecutors have been directed away from such cases, more than 200 people have faced HIV-related charges since the AIDS epidemic. The federal government was expected to address this, but in 2024 abandoned the plan to do so.

Image (cropped) via Washington State Health Care Authority

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“DULF emphasized material action over symbolic performance,” Nyx said. “And we should serve as a reminder that direct aid and grounded organizing often achieve more than idealistic posturing or policy wish-testing.”

British Columbia first declared the opioid-involved overdose crisis a public health emergency in April 2016. In 2020, faced with the province’s inaction, DULF began distributing pure heroin, cocaine and methamphetamine to 52 pre-screened members of its compassion club in Vancouver’s Downtown Eastside. The neighborhood has been disproportionately impacted by the crisis, and from the beginning its residents have responded with strong grassroots harm reduction organizing.

In August 2021, DULF applied for an exemption from Section 56 of the Controlled Drugs and Substances Act (CDSA), requesting access to a CDSA-licensed pharmaceutical supplier and authorization to distribute the supply through its compassion club. Despite unanimous support from Vancouver’s city council, Health Canada denied the request.

DULF had also submitted a separate application for exemption as a drug-checking site and overdose prevention center (OPC)—which Health Canada did authorize.

In March 2023, Nyx and DULF cofounder Jeremy Kalicum requested a judicial review to contest Health Canada’s decision to deny them authorization for distribution, which remains pending. Health Canada could grant DULF the exemption retroactively, but has not yet issued a response.

But overdose deaths continued to rise, and so DULF continued to distribute a safe supply of drugs.

Then, in October 2023, Nyx and Kalicum were arrested. Eventually both were charged with three counts of possession for the purpose of trafficking, which carry life sentences as the maximum penalties. The Montreal event was one of eight stops on a national tour to raise money for DULF’s legal aid fund. 

DULF’s trial is set to take place between October 6 and January 30, 2026. 

Nyx and Kalicum have filed a constitutional challenge with the BC Supreme Court, which may ultimately go to the Supreme Court of Canada. DULF’s legal approach invokes Sections 7 and 15 of the Canadian Charter of Rights and Freedoms. They argue that not providing a safe supply to people at risk of overdose infringes upon Section 7, which guarantees life, liberty and security, and Section 15, which guarantees equality under the law and protection from discrimination.

DULF is leaning on the medical recognition of substance use disorder to support the necessity of access to safe supply, when the unregulated street supply that people currently have access to is killing them.

At least 52,544 people across Canada died of opioid-involved overdose between January 2016 and December 2024. Fentanyl was involved in 74 percent of those deaths. In 2024, the country saw an average of 20 people each day die of opioid-involved overdose. In BC, First Nations people died of overdose at 6.7 times the rate of other residents, despite a decrease in overdose deaths overall. The fatality rate among First Nations women was 11.6 times higher than that of non-First Nations women in the province.

Québec, meanwhile, recorded its highest opioid overdose mortality rate since 2017, with 67 percent of the deaths involving fentanyl.

“We couldn’t have done this program anywhere but Vancouver,” said Nyx. “Because of how dug-in the harm reduction infrastructure is and because of how much democratic organizing is done.”

“Since we’ve closed down, three people have died,” Nyx said. “One person is currently in prison.”

DULF used an extensive screening process for eligibility in its compassion club. Around 30 of the compassion club members regularly used DULF’s safe supply, which Nyx and Kalicum sourced from the dark web. The contents were then confirmed through forensic drug-checking services provided by the University of British Columbia. No one in the compassion club died while using DULF’s safe supply. Three members entered abstinence-based recovery.

The drugs themselves were purchased entirely with money from crowdfunding campaigns. But the drug-checking and other operational costs of the OPC were covered through a CA$200,000 contract with the Vancouver Coastal Health Authority, which was originally supposed to be in effect from October 2022 through March 2024. The health authority ended the contract shortly before Nyx and Kalicum were arrested in October 2023.

“Since we’ve closed down, three people have died. One person is currently in prison,” Nyx said. “The ramifications of just cutting everyone off this program were extremely severe.” 

Nyx, a former renters’ rights campaigner, drew a parallel between treating dopesickness and treating alcohol withdrawal through the managed alcohol pilot programs that have operated with government support across Canada. Participants in these programs receive doses of alcohol at regular intervals, and set personal goals around use and reduction. 

She also spoke about DULF’s forthcoming research on hospitalization rates as well as drug pricing and demand in the Downtown Eastside, and called for more studies in the same vein. 

“It’s the volatility in this drug supply that is killing people,” Nyx said.

In January 2023, BC decriminalized small quantities of opioids, cocaine, methamphetamine and MDMA. It essentially ended that policy in May 2024, amid political backlash and a shift away from harm reduction by governments across Canada.

In February, former Prime Minister Justin Trudeau launched the Canada-United States Joint Strike Force aimed in large part at fentanyl trafficking, with an investment of $200 million. Kevin Brosseau has been appointed commissioner of Canada’s Fight Against Fentanyl, a title widely referred to as “fentanyl czar.” The US has long had a “drug czar,” at the helm of its Office of National Drug Control Policy, but for Canada such a position is new. 

The Canadian Liberal government elected in April campaign on a platform that promised stronger crackdowns as part of a $1.3 billion border-security plan. The government committed to listing transnational drug-trafficking organizations as terrorist entities under the Criminal Code. Its strategy for fentanyl interdiction parallels what the US had become familiar with under the administration of former president Joe Biden. 

But harsher enforcement has never decreased the drug supply, only made it more dangerous.

Fentanyl purity in the unregulated supply might be 5 percent one day and 50 percent the next. Overdose is made more complex and dangerous by other adulterants, particularly benzodiazepines like etilozam and bromazolam.

“It’s the volatility in this drug supply that is killing people,” Nyx said. 

Top image of safe supply distribution via Drug User Liberation Front. Inset graphic via Montreal Ask A Punk.

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