One aspect of Canada's opioid epidemic that seldom receives attention is that it began on the watch of former Conservative prime minister Stephen Harper.

In British Columbia, the first province hit by the crisis, there were roughly 200 fatal overdoses each year during the first half of Harper's time in power.

Then, nearing the end of his term as prime minister, in 2013, there were 333 fatal overdoses in B.C. Then 368 in 2014 and then 522 in 2015, the year that Harper was defeated by Justin Trudeau.

A pioneer of Vancouver’s harm-reduction movement wants a light shone on those years.

Dan Small, a former manager of the Portland Hotel Society and cofounder of North America's first supervised-injection facility, Insite, told the Straight that he's fighting for a formal investigation that would explore the causes of Canada's opioid epidemic.

"The view that they [the Conservatives] put forward, which was very persecutory towards opioid users, has had a long-reaching influence across the country and into communities," Small said in a telephone interview. "It represented a decade of structural violence toward a marginalized group of people.

"If this were any other group [but drug users], would we have allowed this institutional, structural violence to occur for a decade, resulting in thousands of deaths?"

Late yesterday (June 4), Small created an online petition that "calls on the Right Honourable Prime Minister Trudeau and Health Minister Ginette Petitpas Taylor to establish a Royal Commission examining the circumstances, including government actions and inactions, leading up to and accounting for Canada’s opioid overdose epidemic."

The petition follows a letter that Small sent to the Prime Minister's Office wherein he outlined a case for the appointment of a royal commission.

Small, a medical anthropologist and adjunct professor at UBC, recounted how the Harper administration opposed Insite, challenging its existence all the way to the Supreme Court of Canada. Insite eventually won, in 2011, but sanctioned supervised-injection services were not expanded beyond Insite until the winter of 2016.

“On the dawn of the Supreme Court decision in favour of Insite in 2011, Canada was poised, in my view, for a paradigm shift in the realm of drug policy,” Small wrote. “Despite the decision in favour of Insite and its establishment as a key part of the standard of care, supervised injection services remained isolated to a single program in Vancouver.

“It took the tragedy of an astonishing overdose epidemic in order to bring about significant government or institutional action to substantively address the dangers of illicit drug use," he continued in the letter. "Were this any other group, the failure of societal institutions to address the preventable deaths would be a source of public outcry.”

A royal commission is a research body appointed by a government’s cabinet to “carry out full and impartial investigations of specific national problems”, according to Library and Archives Canada. In the past, royal commissions were convened to investigate the contamination of the country’s blood-donor and distribution systems, for example, and the status and relations of Canada’s Indigenous peoples.

While B.C. has kept reliable statistics on illicit-drug overdose deaths since the early 1990s, Canada only began counting fatal overdoses at the federal level after Harper and the former Conservative administration were voted out of power in 2015.

At least 5,869 people in Canada died of an opioid overdose between January 2016 and September 2017, according to the federal government. In B.C. alone, there were 1,448 illicit-drug overdose deaths in 2017, up from 991 in 2016 and 522 in 2015.

Small suggested that a federal investigation into overdose deaths could save lives.

"Through a royal commission, you look to the past but you also look to the future in terms of putting an action plan in place to prevent this from happening again," he said.

"I think this is an opportunity for the prime minister, for Justin Trudeau, to define himself relative to the astonishing, poignant, tragic structural violence that was perpetrated on opioid users in this country over 10 years."