Rather than investing in prevention strategies and expanding access to treatment and recovery services, British Columbia, Canada, chose to enact radical harm reduction policies—policies that are now being linked to a significant worsening of the opioid crisis.
In March 2020, British Columbia launched its safer opioid supply policy, allowing physicians and nurse practitioners to prescribe pharmaceutical-grade opioids to individuals at risk of overdose. Then, in January 2023, the province implemented a decriminalization policy, removing criminal penalties for possession of small quantities (up to 2.5g) of drugs including opioids, cocaine, methamphetamine, and MDMA.
The result? A public health disaster.
Hospitalizations due to opioid poisoning increased by 33% (93 additional hospitalizations) following the rollout of the safer supply program. After decriminalization was added, these hospitalizations rose another 58% (164 more hospitalizations), relative to the pre-policy period.
The safer opioid supply guidelines allowed prescribers to offer powerful opioids such as up to 14 hydromorphone tablets per day and two oral morphine (80 to 240 mg) capsules per day, with the option of supervised ingestion at the prescriber’s discretion. While advocates argue that these policies shield people from contaminated street drugs, a critical question remains: Who is tracking where these powerful drugs end up—and what’s being done to move people into treatment and recovery?
The evidence is troubling. Diversion is happening. Only about 3% of opioid users have accessed these so-called safer opioids. This means the vast majority of high-dose prescriptions may be going unused by intended recipients—fueling black market activity and increasing the risk of exposure for opioid-naïve individuals, especially youth. Rather than reduce harm, these diverted drugs may be driving overdose and addiction deeper into communities.
Decriminalization only exacerbates the issue by removing legal consequences, making it harder for law enforcement to respond and opening the door for increased public use, street-level trafficking, and easier circulation of diverted substances.
As for opioid-related deaths, there were increases during the safer supply period, although these findings lost statistical significance after deeper analysis. Nonetheless, the trend raises serious concerns, especially given the surge in hospitalizations.
The authors also noted rising reports of public drug use, which contributed to the government’s decision to recriminalize drug use in public spaces—a walk-back of the initial policy.
These policies may have been introduced with good intentions, but the outcomes are clear: they are not working. By prioritizing access to drugs over prevention, treatment, and accountability, British Columbia has intensified the crisis it sought to solve.
As other jurisdictions consider similar approaches, British Columbia’s experience should serve as a warning—not a model.
Reference: https://doi.org/10.1001/jamahealthforum.2025.0101
