An entire election cycle has long come and gone since a Vancouver harm-reduction pioneer began lobbying the Prime Minister’s Office for a formal review of the opioid epidemic. And finally, after 22 months of correspondence, it appears Ottawa has shut the door on the idea.
“At this time, the Government of Canada is not considering establishing a Royal Commission to investigate the variables that have contributed to Canada’s current opioid overdose crisis,” reads a January 27, 2020, letter signed by Jennifer Novak, executive director of Health Canada’s Opioid Response Team.
Dan Small, a co-founder of North America’s first sanctioned supervised-injection facility, Insite, told the Straight that he’s come to believe it’s a question to which no one in power wants an answer.
“The government is afraid of what it might find,” he said in a telephone interview. “There is some culpability and, in any case, hard accountability associated with a dramatic lack of action.”
Small said he wanted the federal government to establish a royal commission—a research body appointed by a prime minister’s cabinet to conduct a comprehensive and impartial investigation of a specific problem—because a better understanding of the roots of the crisis could lead to more effective solutions. But he conceded it increasingly looks unlikely that will ever happen.
“The barriers are not epidemiological, they’re not medical, they’re not scientific,” Small said. “They are cultural. They are about people’s implicit and explicit values about drug users.”
Small’s first piece of correspondence with Ottawa on the subject of a royal commission is dated May 15, 2018.
During the year that followed, Small was repeatedly referred to one government office and then another.
Finally, on January 27, Small received Novak’s straightforward answer.
“I regret that our response to your request for a Royal Commission could not be positive at this time,” it reads.
“I would like to assure you, however, that the Government of Canada shares your view that the current overdose situation is deeply tragic,” the letter continues. “We further agree with you that structural factors, including the institutional, societal and cultural variables that you mention in your blog post, are key drivers of this crisis. In view of these factors, the federal government is committed to taking a public health-focused approach to drug policy.”
If a royal commission ever is established to investigate the causes of Canada's opioid epidemic, it would likely focus on the years that former prime minister Stephen Harper and the Conservative party held power.
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 Justin Trudeau and the Liberals.
In 2019, there were 823 illicit-drug overdose deaths in B.C. during the first 10 months of the year. That’s down from 1,542 fatal overdoses in 2018 but miles about the overdose numbers that characterized the Conservative party’s first several years in office.
The statistics show that the epidemic began on Harper's watch.
Small, a medical anthropologist and adjunct professor at UBC, noted that the Conservative government went to great lengths to stifle harm-reduction efforts, famously taking Insite all the way to the Supreme Court of Canada.
Today’s Liberal government is in favour of supervised injection and has allowed for many new drug-consumption sites to open across Canada. But the former government’s playbook remains in use in other jurisdictions, Small said.
“That’s what’s happening in Alberta, that’s what’s happening in Ontario, with Jason Kenny and with Doug Ford," he explained. "We are allowing elected officials to arbitrarily withhold permits and funding associated with harm reduction....This is structural violence.”
Despite fatal overdoses rising in Alberta and Ontario, those governments have placed supervised-injection programs under reviews with dubious parameters and frozen or diminished funding for such initiatives.
Across Canada, there were 3,024 opioid-related deaths in 2016, according to Health Canada. The following year, there were 4,133 and then 4,614 in 2018. We don't know how many people died in years previous because Canada's federal government did not begin counting fatal overdoses until after the Conservatives were voted out of office.
Small noted that in 2011, the Supreme Court of Canada ruled that Harper’s health minister of the day, Tony Clement, could not arbitrarily withhold federal approval of a supervised-injection facility if doing so put people in harm’s way.
“Yet today we are allowing this to happen [in Alberta and Ontario],” Small said.
"It comes down to this issue of undervaluing the personhood and the citizenship and the humanity of a group of people [drug users] who are historically perceived as having earned their illness," he added, "that they deserved what they got."