“[The toxic drug supply crisis] is the leading cause of death for people between 19 and 59 in this province,” BC Human Rights Commissioner Kasari Govender told Filter. “The fact is that this toxic drug crisis won’t be solved without an approach that focuses on safer supply and harm reduction.”

Under international human rights law and Canadian constitutional law, governments have an obligation to protect the right to life and security and promote the health of individuals in their jurisdictions, which, the statement noted, includes “removing life threatening risks to individuals in consumer products.”

“We’re asking for harm reduction to be funded and to be supported.”

In the position statement, the commissioner wrote that Section 7 of the Canadian Charter of Rights and Freedoms—the right to life, liberty and security of the person—is “engaged when government policy contributes to preventable death, such as by denying access to harm reduction services,” and that inadequately addressing underlying factors such as trauma and mental health conditions “over the course of decades, is a failing of provincial and federal social policy to uphold rights.”

Although the position statement does not include a formal set of recommendations for the province, Govender told Filter that her office is “calling for increased access to safe supply … We’re asking for harm reduction to be funded and to be supported. We’re also asking for involuntary treatment to be treated with a variety of safeguards in place.”

Safe Supply, Diversion and Rollback

In March 2020, BC became the first jurisdiction in Canada to provide free prescribed pharmaceutical-grade opioids (primarily hydromorphone and morphine) to individuals deemed at high risk of overdose. The program became permanent in July 2021, and expanded to include injectable fentanyl.

Initiatives like BC’s, in addition to 10 similar pilot projects implemented by Health Canada, were demonstrably effective at decreasing risk of overdose death, though many critics also pointed to the limited access to these programs.

The BC human rights commissioner’s position statement is just the latest in a slew of testimony from provincial officials calling for bolder interventions.

In recent years, the province has largely ignored appeals, and stalled or rolled back policies that focused on harm reduction efforts like prescribed alternatives.

Lisa LaPointe, BC’s chief coroner at the time, along with a Death Review Panel of substance use specialists, regional health leaders, researchers, a police chief, BC’s representative for children and youth, and a peer clinical adviser, called for the expansion of non-medical safe supply options in their 2023 report.

In 2023 and 2024, BC Provincial Health Officer Dr. Bonnie Henry likewise echoed calls for a broader range of substances and access models to be included, including non-prescriber based options.

But in recent years, the province has largely ignored appeals from officials and numerous peer-led organizations, and stalled or rolled back policies that focused on harm reduction efforts like prescribed alternatives.

In February 2025, the province overhauled its safe supply program to require witnessed dosing for all new clients, effectively ending the take-home model for prescribed alternatives and significantly limiting access.

It claimed this was an effort to reduce drug diversion and “hold bad actors accountable for putting people and communities at risk,” according to a BC government news release.

But Govender emphasized that while some concerns around diversion may be justified, they should not supplant the demonstrated benefits of a robust safer supply program. “[Diversion] is about [pharmacies] abusing the law and the programs that were available to them. We should be addressing that problem, not taking away the entire system,” she said. “It’s a classic ‘throwing the baby out with the bath water’ situation.”

“The ultimate effect of [diversion] is to have safer drugs on the market, so ultimately that still probably did save some lives.”

In 2025, leaked information claimed a number of pharmacies (60 out of 1,400) were involved in diverting prescription opioids. The commissioner’s position statement noted that “as a result, the Ministry of Health quickly backtracked on their efforts,” and that “notably, there is no evidence to suggest that [diversion was] inherent in the safer supply program rather than a problem of illegal action taken by individuals within an otherwise legitimate public health effort.”

The political damage was done, however, and perhaps this was always likely. In 2024, BC’s Auditor General report had found that “there were no strategies to address major implementation barriers” of safe supply, and as a result, “the provincial government could not adequately communicate the effectiveness of programs and therefore was more susceptible to political critiques about the risks … such as diversion.”

Govender told Filter that “the ultimate effect of [diversion] is to have safer drugs on the market, so ultimately that still probably did save some lives … diversion is a far easier issue to tackle than the toxic drug crisis itself.” 

Involuntary Drug Treatment

A key component of the commissioner’s statement notes that while the province has been backtracking on safe supply and harm reduction-oriented policies, it has been simultaneously boosting its investment in involuntary drug treatment.

There is currently limited evidence to support the use of involuntary treatment for substance use disorder alone. Other evidence has associated involuntary treatment with increased overdose risk, and some experts deem the practice inherently unethical.

Govender said that “involuntary treatment shouldn’t exist only for substance use disorders … The science is really problematic on this.”

BC’s Mental Health Act has always allowed for the involuntary treatment for mental health disorders under certain conditions. But in September 2024, the governing BC New Democratic Party announced plans to expand the infrastructure used to detain people with substance use disorders and co-occurring conditions who could be certified under the Act.

Govender said that “involuntary treatment shouldn’t exist only for substance use disorders … The science is really problematic on this.”

On November 24 the province announced that it would be proposing what some experts have called a very “technical” and “confusing” change to the act.

The move came in the midst of an ongoing Charter challenge to BC’s Mental Health Act, and if passed the change would not impact eligibility criteria for involuntary treatment. It would, however, provide additional protections for health care workers engaged in it, should they face legal action. It will also “help clarify the purpose of the act, which is to provide treatment to those who require it,” according to a BC government news release.

“It is unclear what the recent amendments to the MHA will mean in practice,” Govender said. “The government has been clear that deemed consent—which is currently before the courts in a constitutional challenge—remains in the law. But the result is definitely still to be determined.”

“Our investments should be going towards voluntary treatments … Not only does that respect rights to agency, but it is also more effective.”

Earlier in 2025, BC announced the opening of 18 involuntary beds at the Alouette Homes and 10 at the Surrey Pretrial Centre, where participants were being housed in the solitary confinement unit. While the government touted adding 760 new voluntary treatment beds since 2017, a recent news release also stated that “work is underway to open an additional 100 involuntary care beds in Surrey and Prince George facilities.”

“Our investments should be going towards voluntary treatments,” Govender said. “We need to properly fund voluntary services so that people have places to go when they choose to go. Not only does that respect their rights to agency, but it is also more effective.”

The commissioner’s position statement notes that “until these services actually meet demand, using evidence of the tragic harms of the toxic drug crisis to support violating people’s liberty rights not only lacks credibility, but also seriously undermines human rights protections.”

No significant changes have been made to BC’s Mental Health Act as yet, but Govender noted that Dr. Daniel Vigo, the scientific advisor to BC Premier David Eby, released guidance to psychiatrists on the use of involuntary treatment in March 2025.

“We don’t know yet the impact of that and whether that’s increased …  our use of involuntary treatment, but that’s certainly presented as a possibility because there’s just been so much focus on involuntary approaches,” Govender said. 

The Commissioner’s Powers

Govender was appointed as BC’s first independent human rights commissioner in September 2019. After serving her first five-year term, she was unanimously reappointed for a second term by the BC legislature in May 2024. The release of a position statement, though sure to generate attention, falls on the softer end of her powers.

Govender has the ability to use formal measures such as inquiries and official reports, which unlike position statements generally include recommendations. She also has legal powers to obtain information.

Although she does not have the ability to mandate recommendations, she explained, she can “require [that] those I make recommendations to report back to me on how well they’re doing in implementing the recommendation.”

“Part of the goal of this statement for our office is to have a jumping-off point … so that we can [then] make [formal] recommendations.”

Based on a recent report, the province and private entities to which she has issued recommendations fully or partially implement them about 59 per cent of the time.

“Part of the goal of this statement for our office is to have a jumping-off point … so that we can [then] make [formal] recommendations,” Govender said.

She also has the power to act as intervenor in cases before the BC Supreme Court. When asked if she intended to be an intervenor in the DULF constitutional challenge or any other upcoming court cases regarding the overdose crisis, she declined to comment.

However, she suggested that this position statement is only the beginning for her office, which is set to host a December 10 discussion with Govender, former Chief Coroner Lapointe and the Canadian Mental Health Association’s Jonny Morris.

Govender’s many past roles at human rights-oriented nonprofits include a spell on the board of Pivot Legal Society, which advocates for drug policy reform; as BC human rights commissioner, she could do so with substantial influence. While this is the first time that her office has addressed the toxic drug supply crisis head on, it has previously released letters on issues relating to poverty and housing, and inquiries into policing, as well as initiatives around equitable health care access.

“I’m not sure yet what our next steps will be,” Govender said of the commission’s drug policy involvement, “but this certainly is one of the focuses of our work going forward.”

Photograph of an April 2025 rally to mark the ninth anniversary of the BC government declaring the overdose crisis a public health emergency, by Dustin Godfrey

The post BC Human Rights Commissioner Slams Overdose Inaction as “Violation” appeared first on Filter.

The majority decision was reached on October 24 in the case, R. v Wilson. In September 2020, Paul Wilson pulled over his truck in rural Saskatchewan to report the overdose of a woman, Cheryl Delorme, on the side of the road. After an ambulance had stabilized Delorme, Constable Heidi Jo Marshall of the Royal Canadian Mounted Police arrived on the scene and arrested Wilson, Delorme and two others.

Following the arrest, Wilson’s truck was searched and according to court submissions from prosecutors, weapons, ammunition, drugs and “drug-trafficking tools” were found by police.

“It sounds very simple, but there’s been a lot of debate about whether or not someone can be arrested because the legislation says you can’t be charged or convicted,” DJ Larkin, executive director of the Canadian Drug Policy Coalition (CDPC), told Filter of the decision. “Supreme Court judgments apply nationally, so now the most important thing is to get the message out so people understand they should be safe from arrest for simple possession [when] saving a life.”

“Even though someone can’t be charged or convicted, some police were still arresting people based on suspicion of simple possession,” they added.

Larkin explained that though Wilson was charged with possession with the purpose of trafficking and other firearm-related charges, the issue, “is that it all started with arresting him because he was at the scene of an overdose, which according to police was sufficient to give them suspicion that he was in possession of drugs for personal use.”

Larkin said the interveners argued there were three core principles that the court needed to employ in its analysis.

Larkin and the CDPC were among a host of interveners in the case, alongside the Association des intervenants en dépendance du Québec and Harm Reduction Nurses Association.

Larkin said the interveners argued there were three core principles that the court needed to employ in its analysis. The first being that any public health-related legislation, especially the Controlled Drugs and Substances Act, has to be interpreted through the lens of reducing harm. “You have to interpret this legislation to prevent injury, reduce harm and save lives—and [the court] said that very clearly.”

“Second, we argued that you need to make it simple,” Larkin said. “No one who is trying to call 911 while saving a life should need a law degree to understand what their risk is.”

Third, assumptions regarding the benefit to public safety during arrests and drug seizures during overdose response needed to be tested, Larkin said. “The courts said that essentially we need to prioritize the significant public health benefit of encouraging people to call 911 over the remote possibility of a public safety benefit of arresting and searching someone.”

The arguments that law enforcement made in R. v Wilson relied heavily on this supposed possibility, Larkin said. “That’s based on the hypothesis that if you seize someone’s drugs, making drugs less available somehow has a safety benefit. There’s considerable academic research indicating that the opposite is true.”

Several studies and government reports have found that drug seizures are associated with increased risk of overdose, prevent people from accessing life-saving services or calling emergency services during overdoses, and increase harm to people who use drugs.

“The last argument [made by law enforcement and federal prosecutors] was that it would overly limit officers’ ability to do investigations for their own safety,” Larkin said. But if someone pulls a knife out, say, at the scene of a medical emergency, officers always have the power to arrest someone on the basis that they reasonably believe that their safety is in danger. “That hasn’t changed.”

“We need to be able to send a really clear message to young people … otherwise they might be too scared to call.”

To Larkin, this decision is particularly important for youth. “We need to be able to send a really clear message to young people who have a friend who might be using [drugs] for the first time … they need to know immediately that they’re not going to get in trouble because otherwise they might be too scared to call.”

They added that for those who have historically been more likely to have negative interactions with law enforcement—people who lack housing, Indigenous, Black and other racialized people—it signals that police in these instances are expected to provide a medical response, not a punitive one.

Corey Ranger, a British Columbia nurse and president of the Harm Reduction Nurses Association, said it’s incredibly important that communities know that they have legal protection if they stay at the scene of an overdose.

“It’s not just about fatal overdoses,” he told Filter, “but it’s about the visible and irreparable harm that’s happening to people when they’re not getting timely rescue breathing, naloxone administration or someone to stay with them to monitor for secondary overdose.”

A recent study showed that people who experience toxic drug events are 19.5 times more likely to have encephalopathy or an acquired brain injury than the general population. “What we know now is that because of the unpredictability of the drug supply that is now also saturated with benzodiazepines, animal tranquilizers and fentanyl, the risk for hypoxic and toxic brain injury has gone up so high in British Columbia,” Ranger said.

Harm reduction proponents have “a lot of work ahead of us to prevent this very harmful, regressive policy backslide that’s happening across the entire country.”

But he noted that while the Supreme Court of Canada decision is “extremely positive,” harm reduction proponents also have, “a lot of work ahead of us to prevent this very harmful, regressive policy backslide that’s happening across the entire country.”

Municipalities, provinces and even the federal government have backtracked significantly in recent years on progressive drug policies. For instance, Bill C-2, the Stronger Borders Act, is a largely interdiction-focused bill that expands police powers and border security measures—ostensibly aimed at reducing the trafficking of fentanyl across borders, following pressure from the Trump administration. This, Ranger said, will only increase the volatility of the drug market.

Several provinces have either considered or already moved to expand involuntary drug treatment legislation. Involuntary treatment as an intervention has limited evidence to support its effectiveness at encouraging abstinence among people who use drugs. Several studies have pointed to links between involuntary drug treatment and increased risk of overdose.

Prescription-based safe supply programs in British Columbia have also been significantly curbed in the past year. And Toronto has closed down overdose prevention sites, while prohibiting the distribution of safe supply and other harm reduction supplies at its new provincially-funded health centers. The provincial government of Saskatchewan, meanwhile, has not only restricted syringe service programs, but released legislation in the spring that would classify fentanyl, methamphetamine and hypodermic needles as “street weapons.”

“Politicians need to do better, and this court case is really, really clear on that.”

“Nothing is being done from an evidence-based standpoint across all levels of government,” Ranger said.

Asked what has been driving the shift away from harm reduction-oriented policies, Larkin and Ranger agree that much of what we’re seeing is a result of misinformation and politicized ideological shifts. 

“People who are getting clicks and likes online and [we have] a reactive government that is responding to the moral panic to avoid getting voted out … so we have policymakers with extremely liberal backgrounds doing extremely conservative things to retain their position of power,” Ranger said.

“The only thing we can do to fix this is really advocate that our policymakers … start being more truthful with us,” Larkin added. “Poltical messaging influences public opinion and then public opinion influences policy. And that is why we’re seeing steps away from evidence-based policy.”

How significant, then, is the new Supreme Court ruling in this national context?

“It has to be a win,” Larkin said. “Having the Supreme Court without caveat, without limitations, say, ‘You will not get arrested for drug possession, please call 911,’ is really important … Politicians need to do better, and this court case is really, really clear on that.”

Photograph of Supreme Court of Canada by Jamie McCaffrey via Wikimedia Commons/Creative Commons 2.0

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The study, published in the Lancet in May, contributes to a growing body of research showing how safe opioid supply (SOS) reduces harms. However, it is the first of its kind to directly compare the benefits of SOS with those of conventional medications for opioid use disorder, also known as opioid agonist therapies (OAT).

Particularly since the start of the COVID-19 pandemic, there have been several federally-funded SOS programs operating in Ontario. Outside of these programs, some physicians have also chosen to prescribe SOS to their patients. The first SOS program in the province—and the first formal program in Canada—launched in 2016 at London InterCommunity Health Centre. SOS, as the researchers note, “typically involves prescribing short-acting opioids (eg, hydromorphone) to individuals at high risk of overdose for take-home, unsupervised use.”

In contrast, medications like methadone and buprenorphine are long-acting opioids that work to prevent withdrawal symptoms and reduce cravings and risk of overdose without typically causing the person to get high. Available in Canada since the 1960s, these medications can also—unlike in the United States—be picked up from pharmacies with a prescription. Supported by much evidence, they’re considered gold-standard treatments for opioid use disorder.

“We found that for both groups there were significant improvements across all the outcomes that we looked at.”

“One of the gaps that we had identified was that studies hadn’t typically compared safer supply to alternative options like OATs,” lead author Dr. Tara Gomes, of the Ontario Drug Policy Research Network, told Filter. “We found that for both [groups] there were significant improvements across all the outcomes that we looked at … [including] reduced opiate toxicities, all-cause emergency department visits, admissions to hospital, new infections … and deaths [from opioid toxicity].”

After comparing over 900 SOS recipients with over 25,000 methadone recipients in a population-based matched cohort study, the researchers narrowed their sample size to 856 people from each group who met the eligibility criteria. They then assessed the health of these groups, based on several clinical outcomes, for a year following treatment initiation.

The two groups were kept as similar as possible in terms of socioeconomic demographics, which parts of the province people lived in, and numbers of prior overdoses and health-care interactions.

“[We found that] people who were receiving safer supply were [relative to most methadone recipients] quite complex in terms of high rates of [past] overdoses and health-care interactions and diagnoses [like HIV and hepatitis C] in the years before they started safer supply,” Gomes said. “For our study, to have a reliable comparison, we needed … to be sure we were comparing apples to apples in terms of the types of people who were starting these programs.”

Gomes said she did not find the fact that SOS contributed to overall improved health outcomes surprising. But one finding in particular stood out to her and her team: The group prescribed SOS had much higher retention rates than the group on methadone.

The researchers found that overall health improvements “were more pronounced among methadone recipients.” However, “Importantly, the benefits of methadone over SOS on clinical outcomes were largely removed after accounting for higher rates of discontinuation among methadone recipients.”

For people commencing SOS, the median time to discontinuation was 268 days—compared with 103 days for those on methadone.

The one exception was with “opioid toxicity” (overdose), for which rates among methadone recipients remained slightly better after adjustment. That’s significant. But people’s differing needs and the better retention rate for SOS means that both options “have important, complementary roles in addressing Canada’s ongoing drug toxicity crisis,” the researchers concluded.

For people commencing SOS, the median time to discontinuation was 268 days, or almost nine months—compared with 103 days, or just over three months, for those on methadone.

“This is likely reflecting that, for people who are very [medically] complex, who may have tried OATs … frequently in the past, who are highly reliant on the unregulated drug supply and have developed a high tolerance to that supply, methadone is not working particularly well right now,” Gomes said.

Although methadone has been the medical standard for decades, Gomes said that clinical guidance documents seem to recognize this evolving issue, and now allow for greater flexibility, suggesting that higher doses of methadone be prescribed for certain patients.

But she added that methadone alone may not be the most effective tool for everyone. Due to the potency of the fentanyl-dominated unregulated opioid market in Canada, “there is this recognition that people are just simply not able to stay on methadone as long anymore, it’s likely contributing to their withdrawal and people are having to go back to the unregulated drug supply…”

“In contrast, these safer supply programs really try to be designed to meet people where they’re at,” she continued, “and to recognize that people still might use the unregulated drug supply but that they can still have access to a regulated form of an opioid.”

Despite its demonstrated benefits, many people on safe supply face losing access to treatment in Ontario and nationwide.

Many of the SOS recipients surveyed in this study were pooled from community health centers and programs that largely received funding through federal Substance Use and Addiction Program (SUAP) grants.

The temporary funding for the majority of these programs expired in March and thus far, has not been renewed. Without this funding or any additional provincial support, Gomes said that many of the most vulnerable people will lose access to treatment options that work for them.

“Safer supply programs are in a position right now where they’re trying to adapt and determine if they continue to prescribe safer supply in some way to their patients or if they try to transition those patients to [OAT],” Gomes said. SOS recipients who aren’t interested in OAT are “simply losing access to services.”

“The longer we keep people engaged in treatments, the more likely they are to—number one—stay alive. Number two, they’re also getting all those other health concerns addressed.”

Dr. Andrea Sereda, who leads the SOS program at London InterCommunity Health Centre and was not involved in the new research, said that, particularly for highly medically complex groups, keeping safer supply options and the longer retention time associated with them is vital.

“The longer we keep people engaged in treatments, the more likely they are to—number one—stay alive,” she told Filter. “Number two, knowing they’re more complex, [SOS recipients] are also getting all those other health concerns addressed… instead of just receiving treatment for opioid use disorder, they’re also getting their HIV and hepatitis C addressed, and that’s really important to people.”

The expiry of SUAP funding comes at a time when political backlash against harm reduction is arguably at an all-time high.

British Columbia has rolled back many of its more progressive drug policies over the last few years, including restricting safer supply dispensing and requiring that all patients now be witnessed by a pharmacist when taking medication.

Alberta recently announced its plan to expand involuntary drug treatment legislation, and in Ontario, the provincial government is in the process of expanding its Homelessness and Addiction Recovery Treatment (HART) Hub model at the expense of its supervised consumption sites, many of which are being forced to shut down. The HART Hubs are explicitly barred from providing any “drug consumption services,” sterile syringes or safe supply.

“Right now it feels as if political parties are really under the sway of public opinion, and that’s not the best way to provide correct therapies and treatments to human beings,” Sereda said. “We’re in a time where evidence-based medicine isn’t being treated with the level of respect [considering the] level of expertise that is involved in it.”

For Sereda, safe supply should not be considered specialty care, when it should be just one of many tools, alongside methadone and buprenorphine, available to help people.

“Clinicians should be able to make decisions based on the research and based on what is best for their patients,” she said, “without fear of political or public backlash for doing what is best for the person in front of them.”

Photograph (cropped) by Mike Mozart via Flickr/Creative Commons 2.0

The post Safe Supply Mirrors Methadone Outcomes, With Better Retention appeared first on Filter.

By tracking the influx of fentanyl into Oregon’s unregulated drug market, the authors of the study—which was published September 5 in the Journal of the American Medical Association (JAMA)—were able to account for the increase in overdose deaths that coincided with the adoption of Measure 110.

“I think this study has a role in the post-mortem for Measure 110,” Michael Zoorob, the study lead and a consultant at Rhode Island Hospital, told Filter. “A lot of people wrongly attribute the increase in overdose death rates that occurred in Oregon in recent years to Measure 110, but that’s not consistent with the evidence.”

Oregon voters approved Measure 110 in 2020. It decriminalized the possession of small amounts of all banned drugs, and greatly boosted funding for treatment, harm reduction and other social supports. It took effect on February 1, 2021, and was the first measure of its kind in the United States.

On March 1, 2024, following public and political backlash, Oregon legislators approved House Bill 4002, which recriminalized drug possession. That took effect on September 1, making low-level possession a misdemeanor punishable by up to 180 days in jail.

A press release from the Drug Policy Alliance called HB 4002 “a return to the failed approach of law and enforcement and the criminal legal system as the primary response to people struggling with substance use disorders, instead of health and service providers.”

A Closer Look at Measure 110 and Overdose Mortality

The JAMA study demonstrated what Dr. Zoorob said may already seem “obvious” to many advocates: A shifting drug supply, principally the growing prevalence of fentanyl, drove the increase in Oregon’s overdose deaths in the relevant period.

In contrast, the authors concluded, “no association between M110 and fatal overdose rates was observed.”

This was the first study to examine the circumstances around Measure 110 in this way.

“In a lot of studies, we do account for the arrival of fentanyl when we are speaking with participants in smaller-scale qualitative studies,”  Saba Rouhani, assistant professor of epidemiology at the NYU School of Global Public Health, told Filter. “But we haven’t been systematically accounting for the fact that fentanyl hit these different states at different times.”

Dr. Rouhani, who was not involved in the new study, said that its methodology was highly rigorous. “They adopted one core technique and replicated it with four different causal inference models; they were even able to replicate the findings of contradictory studies that have come out.”

The research group used drug seizure data from the National Forensic Laboratory Information System to first model the spread of fentanyl across the US geographically. “The first finding is the East to West pattern that people have talked about,” Zoorob said.

“The change point in Oregon where we see fentanyl enter the market is roughly the same as when Measure 110 takes effect.”

The group used a statistical procedure called change point analysis, which looks at the point in time that you see a dramatic change in the level of a variable, in this case, fentanyl in the drug supply.

“The change point in Oregon where we see fentanyl enter the market is roughly the same as when Measure 110 takes effect,” Zoorob said. A chart in the study illustrates how, by the time Oregon reached this point in early 2021, more than 40 other states had previously done so.

Next, the researchers used a regression model to quantify how much of the changes in drug overdose death rates between states over time were attributable to fentanyl exposure. “We show that fentanyl exposure explains more than half of that variation, which is crazy,” Zoorob said.

Third, Zoorob’s team was able to replicate the findings of an earlier study, published in the Journal of Health Economics, which had found that decriminalization accounted for a 23 per cent increase in overdose deaths in the state.

When they controlled for fentanyl, the effect of decriminalization was nullified.

“If you ignore the transition of the drug supply, we find a statistically significant effect with Measure 110 contributing to overdose,” Zoorob explained. “But what’s really happening here is that there’s this confounding variable: fentanyl exposure. If we adjust for that, the effect of Measure 110, or drug decriminalization, shrinks to zero.” 

Evaluations of Measure 110

A recent Drug Policy Alliance report states that decriminalization in Oregon was designed to reduce the harms of drug criminalization, and that under Measure 110 there was substantial progress toward this goal. Advocates didn’t claim that decriminalization in itself, as opposed to legal regulation, would make the drug supply much safer.

Under Measure 110, the state saw a reduction in drug possession-related arrests and pumped hundreds of millions of dollars into treatment. The report notes that decriminalization also saved Oregon nearly $40 million in criminal-legal system costs and caused a significant increase in the number of people accessing substance use disorder treatment and other services.

However, a state audit released January 2023 was critical of Measure 110, flagging a number of deficiencies in its implementation. One issue it highlighted was that the citizens’ panel overseeing new treatment funding was slow in delivering the money, and the health authority had not provided the panel with adequate support.

“The fact that the money and resources to really focus on health outcomes came later didn’t do the public impression of this policy any favors.”

Lawmakers also declined to fund the $50,000 police training intended to smooth the new ticketing system designed to get people into treatment—an issue that would later be flagged in several other reports, though many advocates have said the involvement of law enforcement was unlikely to encourage people to feel safe in accessing treatment.

“The policy was actually a two part policy,” as Rouhani noted of Measure 110’s decriminalization and funding elements. “The second part took longer to implement. The fact that the money and resources to really focus on improving health outcomes came later didn’t do the public impression of this policy any favors.”

The majority of the funds to expand services were not disbursed by the Oregon Health Authority until after August 2022, 18 months after the law took effect.

Proponents of decriminalization have accused Oregon’s politicians of scapegoating widespread public issues on Measure 110, further harming public perception of the law.

As noted in the Drug Policy Alliance report, external factors like increased evictions and homelessness—in part due to COVID-19 eviction protections lifting in June 2021, and increased economic insecurity during the pandemic—all exacerbated Oregon’s housing crisis. From 2020 to 2022, the report notes, the state’s unhoused population grew by 23 percent.

“Recriminalization went through,” Rouhani said, “but I think it’s important for the historical record to be really rigorous in how we evaluate and reflect on what happened with this policy.” 

The Future of Decriminalization Research

Rouhani believes that we aren’t likely to see—nor be able to measure—the positive health outcomes from policy changes like decriminalization until they are in effect longer-term.

“Given that these policies are now being repealed, it really limits our ability to see the impacts that decriminalization could have on fostering supportive trajectories of care for people who use drugs,” she said. “But we know that arresting people who use drugs is largely ineffective at deterring future use or crime, and increases risks of a cascade of negative health outcomes.”

Criminalization and arrests are associated with a higher risk of overdose, create barriers to employment and housing, and disproportionately impact people of color and other marginalized populations. “We would expect that [removing criminalization] would in turn, translate to positive health outcomes longer-term,” Rouhani said.

When it comes to future research, Rouhani said that Zoorob’s study can not only shed light on what happened with Measure 110, but also has implications for how researchers do “outcomes research writ large” in the context of such a volatile drug market.

“If it happens to coincide with changes in drug supply, people will potentially misattribute changes in public health outcomes to a certain policy.”

Zoorob feels it is beyond the scope of this paper to suggest whether or not other states should take up decriminalization. But he said that he hopes it can help with the analysis of other drug policy decisions, and that he would like to see more studies of individual health outcomes amid drug policy reforms.

“I think we need to have some humility about how much we can learn from one intervention in a single state over a short period of time, or from a single study,” Zoorob added.

“But the key takeaway is that Measure 110 did not cause this increase in overdose deaths,” he emphasized of his latest research. “We’re likely going to have this problem whenever we debate public policy. If it happens to coincide with changes in drug supply, people will potentially misattribute changes in public health outcomes to a certain policy, when really it comes down to these broader macro issues.”

Photograph (cropped) by Neon Tommy via Flickr/Creative Commons 2.0

The Influence Foundation, which operates Filter, previously received a restricted grant from the Drug Policy Alliance. Filter‘s Editorial Independence Policy applies.

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Vancouver Downtown Eastside outreach worker Siobhan Fox is among them. “DULF had really gone above and beyond and had taken a risk by doing the compassion club. They’d effectively saved lives and now are being punished,” she told Filter. “When they put the call out [for donations for their legal fees] I finally felt like, ‘Okay, this is our chance as a community to step up and support them like they have supported others through their actions.’”

For Fox, the legal backlash the group is facing is unwarranted, particularly as more evidence has emerged demonstrating the efficacy of DULF’s compassion club model. ”Even [British Columbia Premier David Eby] has said, ‘They’re great people, doing great work and saving lives—but they broke the law.’ But sometimes, laws have to be broken for the greater good. There’s many laws over the course of history that haven’t been moral or ethical.”

DULF first began distributing small quantities of tested, labeled drugs to known Downtown Eastside community members in early 2020. It began largely as a demonstration, to show policymakers how to stop rising deaths associated with the adulterated street supply. But two years later, it had become an operational, low-barrier compassion club, offering a predictable supply of drugs to 47 members.

In August 2021, DULF sought a Section 56 exemption to Canada’s Controlled Drugs and Substances Act (CDSA), which would have offered the compassion club similar legal protections to those currently afforded to supervised injection sites. Although the application was endorsed by Vancouver City Council, Vancouver Coastal Health and numerous policy experts, it was denied by Health Canada nearly a year later. DULF is currently challenging this decision in a judicial review.

Fox couldn’t wait. She put out a call for “artists, creators and makers” who could donate items or services for a silent auction.

When Nyx and Kalicum were arrested in October 2023, a group of community members moved to form the DULF Solidarity Committee. Shortly after charges were laid against the two on May 31, DULF put out a call for help fundraising for legal fees, and a subcommittee was formed to help facilitate and promote such efforts.

But Fox said she couldn’t wait a month for the fundraising committee’s first scheduled meeting. Just two days after DULF’s public request, she put out a call through friends and social media for “artists, creators and makers” who could donate items or services for a silent auction. She said the response was overwhelming.

The July event drew just shy of 50 individual donations of items—from singing lessons, to autographed children’s books, to handmade clothing and jewelry. A full-day tattooing session with local artist Makato Chi raised over $4,500.

In total, the event earned $10,345. For Fox, the success of the auction and the diverse reach of those involved underscores how personal DULF’s work is to so many people. “This isn’t just a Downtown Eastside issue, it’s an everybody issue.”

Individuals and organizations from across North America, and even as far away as Dublin, Ireland, have been finding their own ways to fundraise.

Just over the past several weeks, benefit concerts, auctions, family-friendly barbecues, raffles, and sales of everything from T-shirts to ceramics to hot sauce have all contributed to the cause.

At publication time, over $109,000 had been raised for DULF’s legal defense fund. That’s more than two-thirds of the group’s initial $150,000 goal—though a recent Instagram post suggests more may eventually be needed, as DULF plans to “challenge the constitutionality of the CDSA as applied to the compassion club.”

“This is all part of a wider battle. We have to be able to pick each other up in these seriously dangerous situations of state violence.”

Soma Snakeoil, a nonprofit co-founder and professional dominatrix, responded to the call from Los Angeles. Snakeoil is the executive director of the Sidewalk Project—run by people with lived and living experience, and dealing with housing, medical case management and other advocacy work for clients living in Skid Row and other marginalized areas in the city.

Snakeoil and her team at what she described as “probably the most radical harm reduction program in Los Angeles” have admired DULF’s work from afar. The Vancouver group is “one of the most important organizations in the world right now,” she told Filter.

Inspired by DULF’s work, she contributed her dominatrix services, a BDSM session that earned $400, to Fox’s silent auction.

“There are people throughout the world doing safe supply programs underground, but DULF is out there on fucking Vice,” Snakeoil said. “They’re not being quiet about their process or how they’re doing this. I just really look up to their courage to be that public and open about this cause.”

She believes it’s more important now than ever that international harm reduction communities stand up for DULF. When the group is “so visible, it’s easy to come for them,” she said. “But this is all part of a wider battle. We have to be able to pick each other up in these seriously dangerous situations of state violence.”

Snakeoil highlighted San Francisco Mayor London Breed, who recently passed a program making it easier to bus people experiencing homelessness out of the city. “It’s wild, because she’s saying the quiet part out loud. That’s sort of the temperature of the world in most places right now… Everyone’s out there fighting their own battles, but we need to have more solidarity on the international stage.”

Despite political attitudes shifting against harm reduction even in many reputedly progressive cities, DULF Solidarity Eastcoast member Campbell McClintock said that he’s heartened to see “tendrils” of North American communities banding together in support of DULF.

McClintock, who lives in Nova Scotia, has worked in housing support and outreach for the last four years. He was drawn to DULF’s cause because he sees the need for an accessible safe supply. “Being in a community like Kjipuktuk [Halifax], I know so many people who would benefit from this type of access,” he told Filter. “People have to jump through so many hoops to get either medication through a doctor that still doesn’t suit their needs, or turn to a potentially fatal illicit street supply.”

DULF Solidarity Eastcoast was founded in July by Montreal-based artist and library archivist Lucy Pauker, and their friend, Chavel Rappos. The core of the group is made up of about 10 members, connected mainly through the “anarchist, artist and punk music scenes” and mostly living in Halifax and Montreal.

The group has so far put on a barbecue and benefit concert in each city, together with online raffles. It’s so far raised over $9,000. It’s currently planning a third event, a rave and raffle in Halifax, for September 28.

“DULF really illustrates the power of doing something from the ground up. It’s seeing what the needs are of the people around you—and making something happen.”

“I don’t think any of us live in an area that is untouched by [the toxic drug supply crisis],” Pauker said, adding that they were pleasantly surprised to receive raffle donations from restaurant gift cards to massages, haircuts and zines.

“It’s been so heartening to see such a super-wide range of supporters,” Pauker said. “Often when you’re doing this kind of organizing it can be like pulling teeth, but we’ve had a really diverse group [wanting to get involved].”

Even though Pauker and McClintock live thousands of miles from Vancouver, they agree that if DULF’s legal battles go favorably, it could eventually help people far beyond BC.

“To me, DULF really illustrates the power of doing something from the ground up,” McClintock said. “It’s the power of not waiting on some big money funder to do something they approve of. It’s seeing what the needs are of the people around you—and making something happen.”

Top image is a screenshot of the silent auction organized by Siobhan Fox. Inset photograph of 2022 Vancouver rally for action on the overdose crisis by Maddi Dellplain.

Correction, August 20: This article has been edited to correct the date of September’s DULF Solidarity Eastcoast event in Halifax.

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In August 2021, Vancouver-based groups the Drug User Liberation Front (DULF) and the Vancouver Area Network of Drug Users (VANDU), applied for a Section 56 exemption to the Controlled Drugs and Substances Act (CDSA). This would have allowed DULF to run a not-for-profit “compassion club”—to purchase, test and sell drugs at cost, in order to protect a small group of adults who use drugs from the adulterated street supply.

Nearly a year after filing, their exemption request was denied by Health Canada.

DULF went ahead with its volunteer-led program anyway, until it was forcibly halted by Vancouver police on October 25, 2023. Co-founders Eris Nyx and Jeremy Kalicum were arrested and released on certain conditions; the Crown has yet to press charges.

Days after the arrests, British Columbia’s chief coroner, Lisa Lapointe, recommended that the province establish and expand non-prescription safe supply programs to reduce deaths.

BC’s drug supply has only grown more dangerous over the last five years. Coroners Service data show 2,511 suspected deaths related to unregulated drugs in 2023, the highest number ever recorded.

“Given the magnitude of the current crisis, was it reasonable to turn down DULF without considering ways they could work with them?”

The judicial review will ask the court to determine if Canada’s decision to deny DULF’s exemption request was reasonable, DJ Larkin, a legal expert and executive director of the Canadian Drug Policy Coalition, explained to Filter.

“Canada is the only entity that has control over whether people can access regulated drugs of known potency,” she said. “Given the magnitude of the current crisis, was it reasonable to turn down DULF without considering ways they could work with them?”

What Could Happen With the Judicial Review?

There are three paths the court could take. One, the judge could side with Health Canada and the decision would remain unchanged. Two, the court could determine the government acted unreasonably and turn the decision back to Health Canada to re-evaluate. And three, the court could determine that the decision was unreasonable and order Health Canada to grant DULF the exemption.

DULF’s legal team is aiming for the third option. “This wasn’t just a policy decision that [Health Canada’s director general of controlled substances] had to make,” Tim Dickson, one of DULF’s lawyers, told Filter. “She failed to proportionately balance the Charter rights that drug users have to life, liberty and security against the other objectives in the CDSA.”

The upcoming judicial review resembles one held in 2011, over Insite. In 2003, the Vancouver facility had become the first sanctioned safe consumption site in North America, operating under a Section 56 exemption. When the Conservative federal government refused to renew Insite’s expired exemption, a judicial review process ultimately ordered a permanent exemption.

DULF’s case, however, has some extra complications.

DULF presently sources its drug supply off the dark web, and its original exemption request was denied partly for this reason. The group has repeatedly asked the government to help facilitate a pathway to a legal supplier.

“DULF was pleading with Health Canada to become more engaged in solving this problem, and they said, ‘That’s not what we do,’” Dickson said.

Though there’s no way to know for sure, Larkin predicted that the court is most likely to turn the decision back to Health Canada.

The court can’t order Health Canada to provide a legal supplier, so if granted the exemption, DULF would continue to operate using its current model. But Dickson stressed that it would be “contrary and irrational” to disallow the compassion club on these grounds.

“[Drugs used at] overdose prevention sites, and the small amount of drugs that have been decriminalized in BC, have all been illegally obtained,” he said. “Nonetheless, those measures have been approved because of the need to protect life. But the director general has refused to approve DULF’s life-saving compassion club just because, for now, the drugs would likewise need to be obtained from illegal sources.”

Though there’s no way to know for sure, Larkin predicted that the court is most likely to turn the decision back to Health Canada, which could come to a different conclusion. Depending on the outcome, she said, the government may also decide to appeal the court’s decision, which could even eventually land the case in the Supreme Court of Canada.

New Evidence for Compassion Club Efficacy

The judicial review comes on the heels of a novel study, released in February, on the outcomes of DULF’s compassion club.

The study assessed 47 participants over a 12-month period and found a 50 per cent reduction in non-fatal overdose rates.

“We know from research that one of the strongest predictors of deaths from an overdose event is having a history of non-fatal overdose,” co-author Thomas Kerr told Filter. “By providing people with a reliable, quality-tested, supply of drugs, their risk of overdose dramatically decreased.”

Kerr said these results are significant because they demonstrate the efficacy of lower-barrier alternatives that could fill many of the gaps in prescriber-based safer supply. Compassion club participants “are able to interact in a more normal consumer-like experience with people from their own community,” he said. “There’s more trust.”

“I hope that people see the real benefits of the work they did as they contemplate these questions.” 

Kerr added that the researchers had hoped to obtain even more data, but their work was cut short by the October police raids. “It doesn’t really help advance our response to the overdose crisis by simply shutting down novel initiatives.”

The court will be expected to make a judgment based on the information that was available at the time of the initial decision. But Larkin said that the study “could help determine the magnitude of the unreasonableness of (Canada’s) decision, given that it was a very effective program.”

Following the submissions phase on March 7 and 8, it could take weeks or months for the judge to make a decision.

“It was a courageous initiative on the part of a couple people who were trying to save the lives of their friends and community—and it worked,” Kerr said of the compassion club. “I hope that people see the real benefits of the work they did as they contemplate these questions.” 

Photograph of Sahilli Park, East Vancouver, in February by Maddi Dellplain

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