For the better part of 2018, Dan Small has been on a mission.

Small, a key member of the team who established Insite as North America’s first sanctioned supervised-injection facility, wants the federal government to establish a royal commission to investigate the root causes of Canada’s overdose epidemic and government actions and inactions that led us to where the crisis stands today.

More than 4,000 people in Canada died of a drug overdose in 2017, some 1,450 of them in B.C. alone. It’s expected that both numbers will be higher this year.

“We need a complex, thoughtful, accountable set of recommendations that can flow out of this tragedy to inform an action plan that gives us a systematic approach to dangerous drug use,” Small, a medical anthropologist, adjunct professor at UBC, and former manager for Insite's operator, the Portland Hotel Society, told the Straight.

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. In a telephone interview, Small said he believes the opioid epidemic has killed enough people to justify a similar response.

But he’s grown skeptical its victims will get a royal commission. Small explained that Ottawa has appeared disingenuous in its dealings with him on the matter.

In May 2018, Small took his first step with the idea and wrote a letter to Prime Minister Justin Trudeau. The Prime Minister’s Office (PMO) responded, acknowledging his concerns and instructing Small to take his suggestion to Health Canada.

Small followed the PMO’s advice and wrote a second letter, this time to Health Minister Ginette Petitpas Taylor. A representative for her office responded last July. This time, Small was instructed to take his request to the office of the Governor General.

So Small did. He wrote a third letter, to Governor General Julie Payette. Her office responded on October 22.

“While I appreciate your concerns,” Antoine Morin wrote on the Governor General’s behalf, “please note that, as the apolitical and non-partisan representative of Her Majesty The Queen, the Governor General does not intervene in matters that are the responsibility of public or elected officials.

“I understand from your correspondence that you have already been in contact with the Prime Minister and the Minister Health, which were the appropriate steps to take,” it continues.

Small said this is the reply he expected all along.

“I had a sense of this because of the way politics works, but I wanted to be diligent and fair and follow that around,” he explained.

“So they sent me on a wild goose chase. And here I am, back, and now I want an honest answer,” Small continued. “I want an honest answer that says, ‘No, we’re not doing a royal commission’, or ‘Yes, we’re doing one’.

“Every day, every week, every month, every year, we lose more and more people,” he added. “It’s been about seven months since I’ve been writing to the prime minister. And in those seven months, how many people have died?”

The answer to Small’s question is an estimated 2,600 people, according to the Straight’s calculations based on Health Canada statistics.

Despite the runaround, Small said he will continue pursuing his goal and will now follow the suggestion of the Governor General’s office. He’s writing a fourth letter, this one addressed to the same office where he sent his first letter: the Prime Minister’s Office.

“Now is the time for reflective and clear accountability for the institutional, structural, systemic obstacles that allowed the opioid crisis to spiral out of control, cost so many lives, when clear, evidence-based, population health interventions could have saved lives,” Small said.

If a royal commission is eventually established to investigate the causes of Canada's opioid epidemic, it will likely focus on the years that former prime minister Stephen Harper and the Conservative party held power in Ottawa.

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 office. 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 Trudeau and the Liberals.

Statistics show that the epidemic of overdose deaths that last year claimed 1,458 lives in B.C. began on Harper's watch.

Speaking to the Straight in June, Small argued it was not a coincidence that overdose deaths rose under Harper's leadership; rather, it was a direct result of the former Conservative government's policies related to addiction and drug use, Small maintained.

"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," he explained. "It represented a decade of structural violence toward a marginalized group of people."