A pioneer of Vancouver’s harm-reduction movement has called for a federal investigation into Canada’s opioid epidemic and drug-overdose deaths.

“The barriers that have prevented harm reduction service innovations are not scientific, medical or epidemiological,” reads a letter addressed to Prime Minister Justin Trudeau and dated May 15, 2018. “The barriers are implicit and explicit values, the bedrock of our culture and institutions, regarding addiction and drug use.

"As such, in the public interest, I ask that you establish a royal commission to examine the variables that have accounted for the dramatic overdose tragedy.”

The letter was written by Dan Small, a medical anthropologist who previously worked for the Portland Hostel Society, where he played a key role in establishing North America’s first supervised-injection facility, Insite.

“Should an Inquiry or Commission not be struck, then it will, in my view, provide a further illustration of systemic violence towards a population of people that has been failed repeatedly when the circumstances that took their lives were entirely amenable to efficacious intervention,” the letter continues.

“In order to understand why medical, scientific and legal findings have not been enough to move forward substantively on supervised injection until the advent of an astronomical overdose epidemic, we need to investigate the underlying structural cultural forces that have been at play.”

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.

In a telephone interview, Small, who today is an adjunct professor at UBC, said he suspects a royal commission would find that some of the blame for Canada’s overdose crisis lies with the former Conservative government of Stephen Harper.

“One of the most startling examples of the need for an inquiry, and evidence of a structural intervention, is the response from the federal government under the Conservatives to essentially, structurally, hamper the creation of supervised-injection services across the country,” Small told the Straight. “When they did that, that was specifically done to structurally make it complicated, to put barriers in place, for the development of supervised-injections services across the country. Those kinds of things need to be looked at carefully.”

Small suggested a royal commission could serve as a truth-and-reconciliation process for victims of the war on drugs.

“How did we allow this type of dramatic, astonishing tragedy to happen?” Small asked.

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.

In the letter to Trudeau, Small describes a lost opportunity. He recounts how the Harper administration opposed Insite, challenging its existence all the way to the Supreme Court of Canada. Insite eventually won, in 2011, Small notes, 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 operating for only 18 hours per day. For well over a decade, the project didn’t move forward in terms of capacity and still doesn’t operate consistently for 24 hours per day.

“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. Were this any other group, the failure of societal institutions to address the preventable deaths would be a source of public outcry.”