By Adam Zivo

[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]

Some Canadian public-health researchers have argued that the nation’s drug dealers, far from being a public scourge, are central to the cause of “harm reduction,” and that drug criminalization makes it harder for them to provide this much-needed “mutual aid.” Incredibly, these ideas have gained traction among Canada’s policymakers, and some have even been put into practice.

Gillian Kolla, an influential harm-reduction activist and researcher, spearheaded the push to whitewash drug trafficking in Canada. Over the past decade, she has advocated for many of the country’s failed laissez-faire drug policies. In her 2020 doctoral dissertation, she described her hands-on research into Toronto’s “harm reduction satellite sites”—government-funded programs that paid drug users to provide services out of their homes.

The sites Kolla studied were operated by the nonprofit South Riverdale Community Health Centre (SRCHC) in Toronto. Addicts participating in the programs received $250 per month in exchange for distributing naloxone and clean paraphernalia (needles and crack pipes, for example), as well as for reversing overdoses and educating acquaintances on safer consumption practices. At the time of Kolla’s research (2016–2017), the SRCHC was operating nine satellite sites, which reportedly distributed about 1,500 needles and syringes per month.

Canada permits supervised consumption sites—facilities where people can use drugs under staff oversight—to operate so long as they receive an official exemption via the federal Controlled Drugs and Substances Act. As the sites Kolla observed did not receive exemptions, they were certainly illegal. Kolla herself acknowledged this in her dissertation, writing that she, with the approval of the University of Toronto, never recorded real names or locations in her field notes, in case law enforcement subpoenaed her research data.

Even so, the program seems to have enjoyed the blessing of Toronto’s public health officials and police. The satellite sites received local funding from 2010 onward, after a decade of operating on a volunteer basis, apparently with special protection from law enforcement. In her dissertation, Kolla described how SRCHC staff trained police officers to leave their sites alone, and how satellite-site workers received special ID badges and plaques to ward off arrest.

Kolla made it clear that many of these workers were not just addicts but dealers, too, and that tolerance of drug trafficking was a “key feature” of the satellite sites. She even described, in detail, how she observed one of the site workers packaging and selling heroin alongside crackpipes and needles.

In her dissertation, Kolla advocated expanding this permissive approach. She claimed that traffickers practice harm reduction by procuring high-quality drugs for their customers and avoiding selling doses that are too strong.

“Negative framings of drug selling as predatory and inherently lacking in care make it difficult to perceive the wide variety of acts of mutual aid and care that surround drug buying and selling as practices of care,” she wrote.

In truth, dealers routinely sell customers tainted or overly potent drugs. Anyone who works in the addiction field can testify that this is a major reason that overdose deaths are so common.

Ultimately, Kolla argued that “real harm reduction” should involve drug traffickers, and that criminalization creates “tremendous barriers” to this goal.

The same year she published her dissertation, Kolla cowrote a paper in the Harm Reduction Journal with her Ph.D. supervisor at the Dalla Lana School of Public Health. The article affirmed the view that drug traffickers are essential to the harm-reduction movement. Around this time, the SRCHC collaborated with the Toronto-based Parkdale Queen West Community Health Centre— the only other organization running such sites—to produce guidelines on how to replicate and scale up the experiment.

Thankfully, despite its local adoption, this idea did not catch on at the national level. It was among the few areas in the early 2020s where Canada did not fully descend into addiction-enabling madness. Yet, like-minded researchers still echo Kolla’s work.

In 2024, for example, a group of American harm-reduction advocates published a paper in Drug and Alcohol Dependence Reports that concluded, based on just six interviews with drug traffickers in Indianapolis, that dealers are “uniquely positioned” to provide harm-reduction services, partly because they are motivated by “the moral imperative to provide mutual aid.” Among other things, the authors argued that drug criminalization is harmful because it removes dealers from their social networks and prevents them from enacting “community-based practices of ethics and care.”

It’s instructive to review what ultimately happened with the originators of this movement—Kolla and the SRCHC. Having failed to whitewash drug trafficking, Kolla moved on to advocating for “safer supply”—an experimental strategy that provides addicts with free recreational drugs to dissuade use of riskier street substances. The Canadian government funded and expanded safer supply, thanks in large part to Kolla’s academic work. It abandoned the experiment after news broke that addicts resell their safer supply on the black market to buy illicit fentanyl, flooding communities with diverted opioids and fueling addiction.

The SRCHC was similarly discredited after a young mother, Karolina Huebner-Makurat, was shot and killed near the organization’s supervised consumption site in 2023. Subsequent media reports revealed that the organization had effectively ignored community complaints about public safety, and that staff had welcomed, and even supported, drug traffickers. One of the SRCHC’s harm-reduction workers was eventually convicted of helping Huebner-Makurat’s shooter evade capture by hiding him from the police in an Airbnb apartment and lying to the police.

There is no need for policymakers to repeat these mistakes, or to embrace its dysfunctional, activist-driven drug ideologies. Let this be another case study of why harm-reduction policies should be treated with extreme skepticism.

[This article was originally published in The Hub and has been syndicated with permission]

When it comes to addressing the national overdose crisis, the Canadian public seems ideologically split: some groups prioritize recovery and abstinence, while others lean heavily into “harm reduction” and destigmatization. In most cases, we would defer to the experts—but they are similarly divided here.

This factionalism was evident at the Canadian Society of Addiction Medicine’s (CSAM) annual scientific conference this year, which is the country’s largest gathering of addiction medicine practitioners (e.g., physicians, nurses, psychiatrists). Throughout the event, speakers alluded to the field’s disunity and the need to bridge political gaps through collaborative, not adversarial, dialogue.

This was a major shift from previous conferences, which largely ignored the long-brewing battles among addiction experts, and reflected a wider societal rethink of the harm reduction movement, which was politically hegemonic until very recently.

Recovery-oriented care versus harm reductionism

For decades, most Canadian addiction experts focused on shepherding patients towards recovery and encouraging drug abstinence. However, in the 2000s, this began to shift with the rise of harm reductionism, which took a more tolerant view of drug use.

On the surface, harm reductionists advocated for pragmatically minimizing the negative consequences of risky use—for example, through needle exchanges and supervised consumption sites. Additionally, though, many of them also claimed that drug consumption is not inherently wrong or shameful, and that associated harms are primarily caused not by drugs themselves but by the stigmatization and criminalization of their use. In their view, if all hard drugs were legalized and destigmatized, then they would eventually become as banal as alcohol and tobacco.

The harm reductionists gained significant traction in the 2010s thanks to the popularization of street fentanyl. The drug’s incredible potency caused an explosion of deaths and left users with formidable opioid tolerances that rendered traditional addiction medications, such as methadone, less effective. Amid this crisis, policymakers embraced harm reduction out of an immediate need to make drug use slightly less lethal. This typically meant supervising consumption, providing sterile drug paraphernalia, and offering “cleaner” substances for addicts to use.

Many abstinence-oriented addiction experts supported some aspects of harm reduction. They valued interventions that could demonstrably save lives without significant tradeoffs, and saw them as both transitional and as part of a larger public health toolkit. Distributing clean needles and Naloxone, an overdose-reversal medication, proved particularly popular. “People can’t recover if they’re dead,” went a popular mantra from the time.

Saving lives or enabling addiction?

However, many of these addiction experts were also uncomfortable with the broader political ideologies animating the movement and did not believe that drug use should be normalized. Many felt that some experimental harm reduction interventions in Canada were either conceptually flawed or that their implementation had deviated from what had originally been promised.

Some argued, not unreasonably, that the country’s supervised consumption sites are being mismanaged and failing to connect vulnerable addicts to recovery-oriented care. Most of their ire, however, was directed at “safer supply”—a novel strategy wherein addicts are given free drugs, predominantly hydromorphone (a heroin-strength opioid), without any real supervision.

While safer supply was meant to dissuade recipients from using riskier street drugs, addiction physicians widely reported that patients were selling their free hydromorphone to buy stronger illicit fentanyl, thereby flooding communities with diverted opioids and exacerbating the addiction crisis. They also noted that the “evidence base” behind safer supply was exceptionally poor and would not meet normal health-care standards.

Yet, critics of safer supply, and harm reduction radicalism more broadly, were often afraid to voice their opinions. The harm reductionists were institutionally and culturally dominant in the late 2010s and early 2020s, and opponents often faced activist harassment, aggressive gaslighting, and professional marginalization. A culture of self-censorship formed, giving both the public and influential policymakers a false impression of scientific consensus where none actually existed.

The resurgence in recovery-oriented strategies

Things changed in the mid-2020s. British Columbia’s failed drug decriminalization experiment eroded public trust in harm reductionism, and the scandalous failures of safer supply—and supervised consumption sites, too—were widely publicized in the national media.¹

Whereas harm reductionism was once so powerful that opponents were dismissed as anti-scientific, there is now a resurgent interest in alternative, recovery-oriented strategies.

These cultural shifts have fuelled a more fractious, but intellectually honest, national debate about how to tackle the overdose crisis. This has ruptured the institutional dominance enjoyed by harm reductionists in the addiction medicine world and allowed their previously silenced opponents to speak up.

When I first attended CSAM’s annual scientific conference two years ago, recovery-oriented critics of radical harm reductionism were not given any platforms, with the exception of one minor presentation on safer supply diversion. Their beliefs seemed clandestine and iconoclastic, despite seemingly having wide buy-in from the addiction medicine community.

While vigorous criticism of harm reductionism was not a major feature of this year’s conference, there was open recognition that legitimate opposition to the movement existed. One major presentation, given by Dr. Didier Jutras-Aswad, explicitly cited safer supply and involuntary treatment as two foci of contention, and encouraged harm reductionists and recovery-oriented experts to grab coffee with one another so that they might foster some sense of mutual understanding.²

Is this change enough?

While CSAM should be commended for encouraging cross-ideological dialogue, its efforts, in this respect, were also superficial and vague. They chose to play it safe, and much was left unsaid and unexplored.

Two addiction medicine doctors I spoke with at the conference—both of whom were critics of safer supply and asked for anonymity—were nonplussed. “You can feel the tension in the air,” said one, who likened the conference to an awkward family dinner where everyone has tacitly agreed to ignore a recent feud. “Reconciliation requires truth,” said the other.

One could also argue that the organization has taken an inconsistent approach to encouraging respectful dialogue. When recovery-oriented experts were being bullied for their views a few years ago, they were largely left on their own. Now that their side is ascendant, and harm reductionists are politically vulnerable, mutual respect is in fashion again.

When I asked to interview the organization about navigating dissension, they sent a short, unspecific statement that emphasized “evidence-based practices” and the “benefits of exploring a variety of viewpoints, and the need to constantly challenge or re-evaluate our own positions based on the available science.”

But one cannot simply appeal to “evidence-based practices” when research is contentious and vulnerable to ideological meddling or misrepresentation.

Compared to other medical disciplines, addiction medicine is highly political. Grappling with larger, non-empirical questions about the role of drug use in society has always necessitated taking a philosophical stance on social norms, and this has been especially true since harm reductionists began emphasizing the structural forces that shape and fuel drug use.

Until Canada’s addiction medicine community facilitates a more robust and open conversation about the politicization of research, and the divided—and inescapably political—nature of their work, the national debate on the overdose crisis will be shambolic. This will have negative downstream impacts on policymaking and, ultimately, people’s lives.

Come learn more about how “safer supply” is flooding Ontario with opioids, and why regulatory reform is urgently needed.

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By Adam Zivo

[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]

Over the past decade, North America embraced two disastrous public health movements: pediatric gender medicine and “harm reduction” for drug use. Though seemingly unrelated, these movements are actually ideological siblings. Both were profoundly shaped by extremist LGBTQ activism, and both have produced grievous harms by prioritizing ideology over high-quality scientific evidence.

While harm reductionists are known today for championing interventions that supposedly minimize the negative effects of drug consumption, their movement has always been connected to radical “queer” activism. This alliance began during the 1980s AIDS crisis, when some LGBTQ activists, hoping to reduce HIV infections, partnered with addicts and drug-reform advocates to run underground needle exchanges.

In the early 2000s, after the North American AIDS epidemic was brought under control, many HIV organizations maintained their relevance (and funding) by pivoting to addiction issues. Despite having no background in addiction medicine, their experience with drug users in the context of infectious diseases helped them position themselves as domain experts.

These organizations tended to conceptualize addiction as an incurable infection—akin to AIDS or Hepatitis C—and as a permanent disability. They were heavily staffed by progressives who, influenced by radical theory, saw addicts as a persecuted minority group. According to them, drug use itself was not the real problem—only society’s “moralizing” norms.

These factors drove many HIV organizations to lobby aggressively for harm reduction at the expense of recovery-oriented care. Their efforts proved highly successful in Canada, where I am based, as HIV researchers were a driving force behind the implementation of supervised consumption sites and “safer supply” (free, government-supplied recreational drugs for addicts).

From the 2010s onward, the association between harm reductionism and queer radicalism only strengthened, thanks to the popularization of “intersectional” social justice activism that emphasized overlapping forms of societal oppression. Progressive advocates demanded that “marginalized” groups, including drug addicts and the LGBTQ community, show enthusiastic solidarity with one another.

These two activist camps sometimes worked on the same issues. For example, the gay community is struggling with a silent epidemic of “chemsex” (a dangerous combination of drugs and anonymous sex), which harm reductionists and queer theorists collaboratively whitewash as a “life-affirming cultural practice” that fosters “belonging.”

For the most part, though, the alliance has been characterized by shared tones and tactics—and bad epistemology. Both groups deploy politicized, low-quality research produced by ideologically driven activist-researchers. The “evidence-base” for pediatric gender medicine, for example, consists of a large number of methodologically weak studies. These often use small, non-representative samples to justify specious claims about positive outcomes. Similarly, harm reduction researchers regularly conduct semi-structured interviews with small groups of drug users. Ignoring obvious limitations, they treat this testimony as objective evidence that pro-drug policies work or are desirable.

Gender clinicians and harm reductionists are also averse to politically inconvenient data. Gender clinicians have failed to track long-term patient outcomes for medically transitioned children. In some cases, they have shunned detransitioners and excluded them from their research. Harm reductionists have conspicuously ignored the input of former addicts, who generally oppose laissez-faire drug policies, and of non-addict community members who live near harm-reduction sites.

Both fields have inflated the benefits of their interventions while concealing grievous harms. Many vulnerable children, whose gender dysphoria otherwise might have resolved naturally, were chemically castrated and given unnecessary surgeries. In parallel, supervised consumption sites and “safer supply” entrenched addiction, normalized public drug use, flooded communities with opioids, and worsened public disorder—all without saving lives.

In both domains, some experts warned about poor research practices and unmeasured harms but were silenced by activists and ideologically captured institutions. In 2015, one of Canada’s leading sexologists, Kenneth Zucker, was fired from the gender clinic he had led for decades because he opposed automatically affirming young trans-identifying patients. Analogously, dozens of Canadian health-care professionals have told me that they feared publicly criticizing aspects of the harm-reduction movement. They thought doing so could invite activist harassment while jeopardizing their jobs and grants.

By bullying critics into silence, radical activists manufactured false consensus around their projects. The harm reductionists insist, against the evidence, that safer supply saves lives. Their idea of “evidence-based policymaking” amounts to giving addicts whatever they ask for. “The science is settled!” shout the supporters of pediatric gender medicine, though several systematic reviews proved it was not.

Both movements have faced a backlash in recent years. Jurisdictions throughout the world are, thankfully, curtailing irreversible medical procedures for gender-confused youth and shifting toward a psychotherapy-based “wait and see” approach. Drug decriminalization and safer supply are mostly dead in North America and have been increasingly disavowed by once-supportive political leaders.

Harm reductionists and queer activists are trying to salvage their broken experiments, occasionally by drawing explicit parallels between their twin movements. A 2025 paper published in the International Journal of Drug Policy, for example, asserts that “efforts to control, repress, and punish drug use and queer and trans existence are rising as right-wing extremism becomes increasingly mainstream.” As such, there is an urgent need to “cultivate shared solidarity and action . . . whether by attending protests, contacting elected officials, or vocally defending these groups in hostile spaces.”

How should critics respond? They should agree with their opponents that these two radical movements are linked—and emphasize that this is, in fact, a bad thing. Large swathes of the public understand that chemically and surgically altering vulnerable children is harmful, and that addicts shouldn’t be allowed to commandeer public spaces. Helping more people grasp why these phenomena arose concurrently could help consolidate public support for reform and facilitate a return to more restrained policies.

[This editorial was originally published by Canadian Affairs and has been republished with permission]

This week, Canada’s largest public transit system, the Toronto Transit Commission, announced it would be stationing crisis worker teams directly on subway platforms to improve public safety.

Last week, Canada’s largest library, the Toronto Public Library, announced it would be increasing the number of branches that offer crisis and social support services. This builds on a 2023 pilot project between the library and Toronto’s Gerstein Crisis Centre to service people experiencing mental health, substance abuse and other issues.

The move “only made sense,” Amanda French, the manager of social development at Toronto Public Library, told CBC.

Does it, though?

Over the past decade, public institutions — our libraries, parks, transit systems, hospitals and city centres — have steadily increased the resources they devote to servicing the homeless, mentally ill and drug addicted. In many cases, this has come at the expense of serving the groups these spaces were intended to serve.

For some communities, it is all becoming too much.

Recently, some cities have taken the extraordinary step of calling states of emergency over the public disorder in their communities. This September, both Barrie, Ont. and Smithers, B.C. did so, citing the public disorder caused by open drug use, encampments, theft and violence.

In June, Williams Lake, B.C., did the same. It was planning to “bring in an 11 p.m. curfew and was exploring involuntary detention when the province directed an expert task force to enter the city,” The Globe and Mail reported last week.

These cries for help — which Canadian Affairs has also reported on in Toronto, Ottawa and Nanaimo — must be taken seriously. The solution cannot simply be more of the same — to further expand public institutions’ crisis services while neglecting their core purposes and clientele.

Canada must make public order a priority again.

Without public order, Canadians will increasingly cease to patronize the public institutions that make communities welcoming and vibrant. Businesses will increasingly close up shop in city centres. This will accelerate community decline, creating a vicious downward spiral.

We do not pretend to have the answers for how best to restore public order while also addressing the very real needs of individuals struggling with homelessness, mental illness and addiction.

But we can offer a few observations.

First, Canadians must be willing to critically examine our policies.

Harm-reduction policies — which correlate with the rise of public disorder — should be at the top of the list.

The aim of these policies is to reduce the harms associated with drug use, such as overdose or infection. They were intended to be introduced alongside investments in other social supports, such as recovery.

But unlike Portugal, which prioritized treatment alongside harm reduction, Canada failed to make these investments. For this and other reasons, many experts now say our harm-reduction policies are not working.

“Many of my addiction medicine colleagues have stopped prescribing ‘safe supply’ hydromorphone to their patients because of the high rates of diversion … and lack of efficacy in stabilizing the substance use disorder (sometimes worsening it),” Dr. Launette Rieb, a clinical associate professor at the University of British Columbia and addiction medicine specialist recently told Canadian Affairs.

Yet, despite such damning claims, some Canadians remain closed to the possibility that these policies may need to change. Worse, some foster a climate that penalizes dissent.

“Many doctors who initially supported ‘safe supply’ no longer provide it but do not wish to talk about it publicly for fear of reprisals,” Rieb said.

Second, Canadians must look abroad — well beyond the United States — for policy alternatives.

As The Globe and Mail reported in August, Canada and the U.S. have been far harder hit by the drug crisis than European countries.

The article points to a host of potential factors, spanning everything from doctors’ prescribing practices to drug trade flows to drug laws and enforcement.

For example, unlike Canada, most of Europe has not legalized cannabis, the article says. European countries also enforce their drug laws more rigorously.

“According to the UN, Europe arrests, prosecutes and convicts people for drug-related offences at a much higher rate than that of the Americas,” it says.

Addiction treatment rates also vary.

“According to the latest data from the UN, 28 per cent of people with drug use disorders in Europe received treatment. In contrast, only 9 per cent of those with drug use disorders in the Americas received treatment.”

And then there is harm reduction. No other country went “whole hog” on harm reduction the way Canada did, one professor told The Globe.

If we want public order, we should look to the countries that are orderly and identify what makes them different — in a good way.

There is no shame in copying good policies. There should be shame in sticking with failed ones due to ideology.

By Adam Zivo

[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]

Progressive “harm reduction” advocates have insisted for decades that active users should take a central role in crafting drug policy. While this belief is profoundly reckless—akin to letting drunk drivers set traffic laws—it is now entrenched in many left-leaning jurisdictions. The harms and absurdities of the position cannot be understated.

While the harm-reduction movement is best known for championing public-health interventions that supposedly minimize the negative effects of drug use, it also has a “social justice” component. In this context, harm reduction tries to redefine addicts as a persecuted minority and illicit drug use as a human right.

This campaign traces its roots to the 1980s and early 1990s, when “queer” activists, desperate to reduce the spread of HIV, began operating underground needle exchanges to curb infections among drug users. These exchanges and similar efforts allowed some more extreme LGBTQ groups to form close bonds with addicts and drug-reform advocates. Together, they normalized the concept of harm reduction, such that, within a few years, needle exchanges would become officially sanctioned public-health interventions.

The alliance between these more radical gay rights advocates and harm-reduction proponents proved enduring. Drug addiction remained linked to HIV, and both groups shared a deep hostility to the police, capitalism, and society’s “moralizing” forces.

In the 1990s, harm-reduction proponents imitated the LGBTQ community’s advocacy tactics. They realized that addicts would have greater political capital if they were considered a persecuted minority group, which could legitimize their demands for extensive accommodations and legal protections under human rights laws. Harm reductionists thus argued that addiction was a kind of disability, and that, like the disabled, active users were victims of social exclusion who should be given a leading role in crafting drug policy.

These arguments were not entirely specious. Addiction can reasonably be considered a mental and physical disability because illicit drugs hijack users’ brains and bodies. But being disabled doesn’t necessarily mean that one is part of a persecuted group, much less that one should be given control over public policy.

More fundamentally, advocates were wrong to argue that the stigma associated with drug addiction was senseless persecution. In fact, it was a reasonable response to anti-social behavior. Drug addiction severely impairs a person’s judgement, often making him a threat to himself and others. Someone who is constantly high and must rob others to fuel his habit is a self-evident danger to society.

Despite these obvious pitfalls, portraying drug addicts as a persecuted minority group became increasingly popular in the 2000s, thanks to several North American AIDS organizations that pivoted to addiction work after the HIV epidemic subsided.

In 2005, the Canadian HIV/AIDS Legal Network published a report titled “Nothing about us without us.” (The nonprofit joined other groups in publishing an international version in 2008.) The 2005 report included a “manifesto” written by Canadian drug users, who complained that they were “among the most vilified and demonized groups in society” and demanded that policymakers respect their “expertise and professionalism in addressing drug use.”

The international report argued that addiction qualified as a disability under international human rights treaties, and called on governments to “enact anti-discrimination or protective laws to reduce human rights violations based on dependence to drugs.” It further advised that drug users be heavily involved in addiction-related policy and decision-making bodies; that addict-led organizations be established and amply funded; and that “community-based organizations . . . increase involvement of people who use drugs at all levels of the organization.”

While the international report suggested that addicts could serve as effective policymakers, it also presented them as incapable of basic professionalism. In a list of “do’s and don’ts,” the authors counseled potential employers to pay addicts in cash and not to pass judgment if the money were spent on drugs. They also encouraged policymakers to hold meetings “in a low-key setting or in a setting where users already hang out,” and to avoid scheduling meetings at “9 a.m., or on welfare cheque issue day.” In cases where addicts must travel for policy-related work, the report recommended policymakers provide “access to sterile injecting equipment” and “advice from a local person who uses drugs.”

The international report further asserted that if an organization’s employees—even those who are former drug users—were bothered by the presence of addicts, then management should refer those employees to counselling at the organization’s expense. “Under no circumstances should [drug addicts] be reprimanded, singled out or made to feel responsible in any way for the triggering responses of others,” stressed the authors.

Reflecting the document’s general hostility to recovery, the international report emphasized that former drug addicts “can never replace involvement of active users” in public policy work, because people in recovery “may be somewhat disconnected from the community they seek to represent, may have other priorities than active users, may sometimes even have different and conflicting agenda, and may find it difficult to be around people who currently use drugs.”

The messaging in these reports proved highly influential throughout the 2000s and 2010s. In Canada, federal and provincial human rights legislation expanded to protect active addicts on the basis of disability. Reformers in the United States mirrored Canadian activists’ appeals to addicts’ “lived experience,” albeit with less success. For now, American anti-discrimination protections only extend to people who have a history of addiction but who are not actively using drugs.

The harm reduction movement reached its zenith in the early 2020s, after the Covid-19 pandemic swept the world and instigated a global spike in addiction. During this period, North American drug-reform activists again promoted the importance of treating addicts like public-health experts.

Canada was at the forefront of this push. For example, the Canadian Association of People Who Use Drugs released its “Hear Us, See Us, Respect Us” report in 2021, which recommended that organizations “deliberately choose to normalize the culture of drug use” and pay addicts $25-50 per hour. The authors stressed that employers should pay addicts “under the table” in cash to avoid jeopardizing access to government benefits.

These ideas had a profound impact on Canadian drug policy. Throughout the country, public health officials pushed for radical pro-drug experiments, including giving away free heroin-strength opioids without supervision, simply because addicts told researchers that doing so would be helpful. In 2024, British Columbia’s top doctor even called for the legalization of all illicit drugs (“non-medical safer supply”) primarily on the basis of addict testimonials, with almost no other supporting evidence.

For Canadian policymakers, deferring to the “lived experiences” and “leadership” of drug users meant giving addicts almost everything they asked for. The results were predictably disastrous: crime, public disorder, overdoses, and program fraud skyrocketed. Things have been less dire in the United States, where the harm reduction movement is much weaker. But Americans should be vigilant and ensure that this ideology does not flower in their own backyard.

By Adam Zivo

[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]

Ever since Portugal enacted drug decriminalization in 2001, reformers have argued that North America should follow suit. The Portuguese saw precipitous declines in overdoses and blood-borne infections, they argued, so why not adopt their approach?

But when Oregon and British Columbia decriminalized drugs in the early 2020s, the results were so catastrophic that both jurisdictions quickly reversed course. Why? The reason is simple: American and Canadian policymakers failed to grasp what led to the Portuguese model’s initial success.

Contrary to popular belief, Portugal does not allow consequence-free drug use. While the country treats the possession of illicit drugs for personal use as an administrative offense, it nonetheless summons apprehended drug users to “dissuasion” commissions composed of doctors, social workers, and lawyers. These commissions assess a drug user’s health, consumption habits, and socioeconomic circumstances before using arbitrator-like powers to impose appropriate sanctions.

These sanctions depend on the nature of the offense. In less severe cases, users receive warnings, small fines, or compulsory drug education. Severe or repeat offenders, however, can be banned from visiting certain places or people, or even have their property confiscated. Offenders who fail to comply are subject to wage garnishment.

Throughout the process, users are strongly encouraged to seek voluntary drug treatment, with most penalties waived if they accept. In the first few years after decriminalization, Portugal made significant investments into its national addiction and mental-health infrastructure (e.g., methadone clinics) to ensure that it had sufficient capacity to absorb these patients.

This form of decriminalization is far less radical than its North American proponents assume. In effect, Portugal created an alternative justice system that coercively diverts addicts into rehab instead of jail. That users are not criminally charged does not mean they are not held accountable. Further, the country still criminalizes the public consumption and trafficking of illicit drugs.

At first, Portugal’s decriminalization experiment was a clear success. During the 2000s, drug-related HIV infections halved, non-criminal drug seizures surged 500 percent, and the number of addicts in treatment rose by two-thirds. While the data are conflicting on whether overall drug use increased or decreased, it is widely accepted that decriminalization did not, at first, lead to a tidal wave of new addiction cases.

Then things changed. The 2008 global financial crisis destabilized the Portuguese economy and prompted austerity measures that slashed public drug-treatment capacity. Wait times for state-funded rehab ballooned, sometimes reaching a year. Police stopped citing addicts for possession, or even public consumption, believing that the country’s dissuasion commissions had grown dysfunctional. Worse, to cut costs, the government outsourced many of its addiction services to ideological nonprofits that prioritized “harm reduction” services (e.g., distributing clean crack pipes, operating “safe consumption” sites) over nudging users into rehab. These factors gradually transformed the Portuguese system from one focused on recovery to one that enables and normalizes addiction.

This shift accelerated after the Covid-19 pandemic. As crime and public disorder rose, more discarded drug paraphernalia littered the streets. The national overdose rate reached a 12-year high in 2023, and that year, the police chief of the country’s second-largest city told the Washington Post that, anecdotally, the drug problem seemed comparable to what it was before decriminalization. Amid the chaos, some community leaders demanded reform, sparking a debate that continues today.

In North America, however, progressive policymakers seem entirely unaware of these developments and the role that treatment and coercion played in Portugal’s initial success.

In late 2020, Oregon embarked on its own drug decriminalization experiment, known as Measure 110. Though proponents cited Portugal’s success, unlike the European nation, Oregon failed to establish any substantive coercive mechanisms to divert addicts into treatment. The state merely gave drug users a choice between paying a $100 ticket or calling a health hotline. Because the state imposed no penalty for failing to follow through with either option, drug possession effectively became a consequence-free behavior. Police data from 2022, for example, found that 81 percent of ticketed individuals simply ignored their fines.

Additionally, the state failed to invest in treatment capacity and actually defunded existing drug-use-prevention programs to finance Measure 110’s unused support systems, such as the health hotline.

The results were disastrous. Overdose deaths spiked almost 50 percent between 2021 and 2023. Crime and public drug use became so rampant in Portland that state leaders declared a 90-day fentanyl emergency in early 2024. Facing withering public backlash, Oregon ended its decriminalization experiment in the spring of 2024 after almost four years of failure.

The same story played out in British Columbia, which launched a three-year decriminalization pilot project in January 2023. British Columbia, like Oregon, declined to establish dissuasion commissions. Instead, because Canadian policymakers assumed that “destigmatizing” treatment would lead more addicts to pursue it, their new system employed no coercive tools. Drug users caught with fewer than 2.5 grams of illicit substances were simply given a card with local health and social service contacts.

This approach, too, proved calamitous. Open drug use and public disorder exploded throughout the province. Parents complained about the proliferation of discarded syringes on their children’s playgrounds. The public was further scandalized by the discovery that addicts were permitted to smoke fentanyl and meth openly in hospitals, including in shared patient rooms. A 2025 study published in JAMA Health Forum, which compared British Columbia with several other Canadian provinces, found that the decriminalization pilot was associated with a spike in opioid hospitalizations.

The province’s progressive government mostly recriminalized drugs in early 2024, cutting the pilot short by two years. Their motivations were seemingly political, with polling data showing burgeoning support for their conservative rivals.

The lessons here are straightforward. Portugal’s decriminalization worked initially because it did not remove consequences for drug users. It imposed a robust system of non-criminal sanctions to control addicts’ behavior and coerce them into well-funded, highly accessible treatment facilities.

Done right, decriminalization should result in the normalization of rehabilitation—not of drug use. Portugal discovered this 20 years ago and then slowly lost the plot. North American policymakers, on the other hand, never understood the story to begin with.

By Alexandra Keeler | 5-minute read

Senator Patrick Brazeau may be best remembered for facing off with then Liberal MP Justin Trudeau in a 2012 charity boxing match — or perhaps for the series of scandals that followed, including assault and cocaine possession charges and being suspended from the Senate for improper housing expenses.

But Brazeau, who was reinstated to the Senate in 2016, says he would like to be remembered for making the public more aware of alcohol’s health risks.

“We just need to look at alcohol for what it is,” Brazeau told Canadian Affairs in an interview. “It is a poison [that] causes a lot of negative impacts to individuals, families and society as a whole.”

Since 2022, Brazeau has been fighting to require alcoholic drinks in Canada to include cancer warning labels.

“To reduce the number of loved ones being taken before their time, it is absolutely essential to provide this information directly and plainly to consumers,” Brazeau said in June 2023, during a second reading of a bill he introduced to require alcohol warning labels.

For Brazeau, the fight is personal. Brazeau battled colon cancer while managing substance use issues.

“[I] battled colon cancer … and at that time, I wasn’t aware [of the cancer risks],” said Brazeau in an interview with Canadian Affairs.

“I was in the 75 per cent category that was not aware that alcohol consumption caused seven fatal, known cancers.”

‘No concerns whatsoever’

Alcohol is a Group 1 carcinogen, putting it in the same category as tobacco and asbestos, according to the WHO’s International Agency for Research on Cancer. It is linked to multiple fatal cancers and significant public health harms.

At least 47 WHO member states mandate some form of health or safety warning on alcohol containers. In Canada, there are no federal requirements for health warning labels on alcoholic beverages — as exist for cannabis or cigarettes.

“Since we had cancer warning labels on tobacco packaging, smoking in the last 20 years has gone down almost 25 per cent — which is quite significant,” said Brazeau.

Some experts have told Canadian Affairs that Canadian governments are hesitant to act, partly due to their own financial dependence on alcohol revenues.

The alcohol industry has also been very effective at downplaying alcohol’s health risks and lobbying against warning labels. In some cases, they have even threatened legal action against governments that tried to implement them.

“The biggest pushback is from one of the most powerful lobby organizations in the world — the alcohol lobby,” said Brazeau. “Their only real concern is profits.

“They have no concerns whatsoever about the health and wellbeing of Canadians.”

The industry group Spirits Canada told Canadian Affairs that cancer is a complex disease with “multiple contributing factors which are difficult to convey effectively in a warning label.”

“The spirits industry is highly regulated and will always commit to following all laws and regulations that govern labelling,” Via Dulay, director of communications and public affairs for Spirits Canada, told Canadian Affairs in an email.

She added that Canada already has “an integrated network of policies” to inform consumers that “alcohol is a unique product which warrants careful attention.”

Spirits Canada said it supports Health Canada’s low-risk drinking guidelines, but referred to the 2011 version still posted on the Health Canada website, which recommends no more than 10 drinks per week for women and 15 for men.

While Health Canada mandated and funded the creation of 2023 drinking guidelines — which say no amount of alcohol is risk-free and risks rise significantly with more than two drinks per week — it has not replaced the 2011 guidelines on its website.

Bill S-202

In an effort to force Ottawa to act, Brazeau first introduced a private member’s bill that would require better alcohol labelling in 2022. That bill failed to pass before Parliament was prorogued in March. But when Parliament resumed this May, Brazeau reintroduced it.

Bill S-202 would require alcoholic drinks with more than 1.1 per cent alcohol by volume (ABV) to include labels.

These labels would have to warn of alcohol’s health risks, define a standard alcoholic drink, state how many standard drinks are in a package and indicate the recommended limit of standard drinks.

Bill S-202 recognizes the “direct causal link between alcohol consumption and the development of fatal cancers,” the bill reads.

Brazeau says he does not expect change overnight. But by introducing Bill S-202, he hopes to lay the groundwork for a healthier, better-informed public.

Many public health experts hope to see this happen.

Tim Stockwell, a senior scientist at the Canadian Institute for Substance Use Research and professor at the University of Victoria, described cancer warning labels on alcohol as “a perfect place to start telling the truth about alcohol.”

A 2023 Health Canada survey showed 75 per cent of people think a health warning label would make them reconsider the harms caused by drinking.

“Most people in Canada agree that alcohol labels should display or provide standard drink information, guidance on health risks and health warnings and should not be exempt from displaying the health information we receive for other regulated products like cannabis or tobacco,” a spokesperson from the Canadian Centre on Substance Use and Addiction told Canadian Affairs in an email.

‘Plant the seeds’

In addition to cancer warnings, experts say labels should also display other important information.

“If I buy a can of peas, I know how many calories there are, and I know the ingredients, and I know the serving size, and I know how many servings there are per container,” said Timothy Naimi, director of the Canadian Institute for Substance Use Research and a professor at the University of Victoria.

“[When] I buy a bottle of vodka and it just says 40 per cent ABV — I don’t know what the serving size is, I don’t know how many Canadian standard drinks there are per container.”

Peter Butt, a clinical professor at the University of Saskatchewan and co-author of Canada’s low-risk drinking guidelines, said it is hypocritical for the alcohol industry to resist warning labels.

Alcohol producers that make non-alcoholic products — such as Corona Cero, a non-alcoholic beer enhanced with Vitamin D and only 60 calories per bottle — were willing to include nutritional labels when it meant gaining access to grocery store shelves.

“They whinge about the problems with labeling, but there was absolutely no hesitation whatsoever when they could get product recognition in grocery stores,” he said.

“So a warning label [is possible, and] if anything, easier, because it’s less complicated [than nutrition information] — you see some of this hypocrisy.”

Brazeau’s bill passed second reading in the Senate in June 2023. It still needs to be studied by a Senate committee — something Brazeau hopes will happen this fall — and pass third reading in the Senate. It would then need to also be passed in the House of Commons.

The vast majority of private member’s bills never become law. But private member’s bills often help to make the public aware of issues.

“This is a bill to plant the seeds so that people could have better health information,” said Brazeau.

“It just takes time, but it needs to start somewhere.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 5-minute read

David Gillis was just nine years old the first time he got drunk. Raised in bars and strip clubs, he regularly served as a bartender at his parents’ parties. By 16, he was in rehab.

“Alcohol was always the drug that I went to, but opiates were what always brought me to my knees,” he told Canadian Affairs.

It wasn’t until he was in his 40s that Gillis finally broke the cycle of recovery and relapse.

After a stint in rehab, he landed a job at a community centre in Victoria, B.C., where he could be open about his past. There, he launched a job-skills program to help others in recovery transition back into the workforce.

The centre is one of several organizations in B.C. and Alberta that recognize work can be key to people’s recovery journeys — and have created or adapted jobs to support people on that journey.

“[Recovery success] is not just about getting work, it’s about getting the right kind of work with the right culture, with the right mindset,” said Paul Latour, manager of the landscaping business Your Place Victoria, which exclusively employs people in recovery.

“If you go into a bad culture or an environment that’s negative … none of those things are really good for people that are just really trying to anchor in the recovery element in their lives.”

Work works

A 2015 study of people who inject drugs in Vancouver found that employment can help prevent relapse and has a “stabilizing effect.” An earlier, 2010 study in Vancouver found the same.

But people in recovery often face logistical, emotional and physical challenges to rejoining the workforce.

Gaps in work history, a lack of professional references and criminal records can make it difficult to get a job offer.

And those that do can struggle in their new workplaces. Doug Mackenzie, who operates two B.C.-based social enterprises for people in recovery, says trades and restaurant jobs are easy to access, but high-risk.

“Everybody in the trade industry … they’re just used to working hard and drinking and smoking dope,” he said. “In the restaurant industry, a lot of them seem to drink and smoke dope.”

Gillis, who now mentors others in recovery through a Vancouver Island Health Authority program, says kitchens at restaurants and bars can be toxic. The typical work schedule is “anti-social” and alcohol is often close at hand, which can quickly lead to relapse.

Many people in recovery are also managing medication side effects or withdrawal symptoms. This can make workplaces such as kitchens physically overwhelming due to the heat.

Gillis says the physical and mental toll of withdrawal — combined with the effort of staying sober — can also make it hard to absorb new information in a new job.

And trust can be an issue. “Taking direction is difficult sometimes because [people in recovery] have trust issues, and you [as an employer] have to build that trust,” he said.

Options

Edmonton-based Adam Johnston was forced onto a path to recovery after being charged with drug trafficking in 2023.

Facing five years in prison, Johnston — who has struggled with a heroin and fentanyl addiction — was accepted into Alberta’s Drug Treatment Court, a 12- to 24-month program that provides addiction treatment as an alternative to incarceration.

“We get a chance to just change our lives around instead of going to jail,” said Johnston, who is 43.

First launched in 2005, the program is individualized to each participant’s needs, the government’s website says.

“In the initial phases of the program, we aren’t allowed to work,” said Johnston, who entered the program after first spending 15 months in recovery. “They do a lot of work just on you yourself, so we take a bunch of … courses on boundaries, self care — they rehabilitate you from the ground up.”

Johnston recently started job hunting. Although he has not yet heard back from any companies, he is hopeful, due to the program’s strong reputation with employers.

“[P]eople in the program have been able to have employers look at them in a good light because of being in the drug treatment program, rather than just any other person in recovery coming off the street,” he said.

In Victoria, Latour’s landscaping business Your Place Victoria intentionally employs people transitioning out of addiction.

“My job is not to run a landscape company,” he said. “My job is to create an ecosystem of companies that give options for people in recovery.”

Latour designed outdoor, team-based jobs to reduce isolation, and created a gradual path from part-time to full-time work. What matters most, he says, is not the type of work, but whether it takes account of a person’s recovery needs.

“Having a hard day and having [someone] who understands where you’re coming from … to be able to lean on or have that conversation or ask for help is so much easier than any other environment,” he said.

Latour hires based on “strength of recovery,” not credentials. He looks for openness, vulnerability and a willingness to seek help.

Also in B.C., Doug Mackenzie operates two social enterprises — Options Exterior Cleaning in Kelowna and Options Salad and Subs Meal Prep in Duncan — that provide structured, recovery-informed employment. Staff meet weekly with employees to talk through challenges in their work and recovery.

“Now that you’re working, you’ve limited your time, so you might not be able to get to those [addiction] support groups during the day, and you’re too tired at night, so [we] do a weekly check in,” he said.

“That way [we can address anything] before it gets too far.”

Unmasking

In 2023, Levi Timmermans, director of project delivery with BC Transit, helped create a partnership between the public transport agency and New Roads Therapeutic Center to provide people in recovery with meaningful work.

Their first collaboration involved environmental restoration around a new handyDART facility in Victoria — a hub for the door-to-door transit service for people with disabilities. Participants cleared invasive species, landscaped and rebuilt a fish-bearing creek.

Timmermans says any initial apprehensions he and his colleagues may have had disappeared as they got to know the individuals at New Roads and saw the positive impact of their work.

“It almost brought tears to my eyes when I was there, just seeing these people rebuilding their lives and how fragile they are … and you can actually do something productive and build self-esteem in these people.”

Building self-esteem can be critical, since many people in recovery have internalized a sense of shame due to stigma, says Gillis.

“[When you make any mistake, you think] ‘I can’t do this because I’m a f*cking addict’,” Gillis said. “And it’s like, no, you can’t do that because you’re not in an open, welcome environment that’s safe for you to make mistakes and learn.”

Timmermans believes the individuals in New Roads benefitted from teamwork, being connected to nature and being involved in projects with a purpose.

“They were part of something a little bit bigger than themselves,” he said about their work, which included clearing invasive species, landscaping and reconstructing a fish-bearing creek.

“It was pretty special, honestly.”

Individuals from New Roads have continued to be hired for ongoing maintenance work, and have since secured other contracts in the community, says Timmermans. He encourages businesses to collaborate with their communities, including local recovery programs.

“Don’t be fearful,” he says. “Let those relationships create opportunities.”

Gillis says collaboration and transparency needs to go both ways, and establishing real relationships means taking off the mask.

“If you have to go into a world where you can’t talk about the things you’ve been through, I can’t see that working,” said Gillis.

“You’re taking off the mask in recovery because you want to be authentic and real in yourself. If you walk into a world where you have to put a mask back on, you might as well just go use again.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 4-minute read

A new study suggests a powerful group of scientists is distorting how the public understands alcohol’s health risks.

The study, published July 9 in the peer-reviewed journal Addiction, analyzed nearly 300 critiques by the International Scientific Forum on Alcohol Research (ISFAR) — a self-described independent group of scientists that publishes critiques of new alcohol studies.

It found ISFAR was far more likely to praise research showing alcohol’s health benefits and to criticize studies highlighting harm, regardless of study quality.

Public health experts say the study is further evidence of how alcohol’s health risks are deliberately downplayed or distorted.

“[Alcohol’s] benefits are exaggerated and the risks are underestimated,” said Tim Stockwell, a senior scientist at the Canadian Institute for Substance Use Research (CISUR).

“There’s been a bias towards the idea that, like a panacea, [alcohol will] stop cognitive decline, or there’s ‘evidence’ it will reduce likelihood of getting a common cold or becoming deaf or having a hip fracture — there’s lots of false associations in the literature that people are looking at.”

Alcohol’s health impact

Alcohol-related harms are rising sharply across Canada.

Between April 2020 and December 2022, alcohol-attributable deaths in Canada rose nearly 18 per cent, and hospitalizations climbed more than eight per cent.

Alcohol is now the leading cause of substance-related harm in every province and territory except the Maritimes, where it trails only tobacco.

Alcohol contributes to seven types of cancer, including breast and colon cancer, and is a major risk factor for heart disease, stroke and mental illness.

“[Alcohol] is a modifiable risk factor,” said Peter Butt, a clinical professor in the University of Saskatchewan’s Department of Family Medicine and a co-author of Canada’s low-risk drinking guidelines.

And yet, many Canadians still see moderate drinking as harmless — or even healthy.

Moderate drinking myth

For decades, some studies suggested light or moderate drinkers lived longer than people who abstained, and that moderate drinking was beneficial to heart health.

But Stockwell says these studies’ methodologies are flawed. The so-called abstainers often include people who quit drinking for health reasons, and were thus already sick.

“A lot of the current abstainers have given up [their drinking] for health reasons, so they’re self-selected to be an unhealthy group,” said Stockwell.

“Conversely, the people who are drinkers, many of them are robust and well enough to carry on drinking, so it’s a very biased comparison.”

When researchers adjust for this error, he says, any protective effects vanish. What remains is a clear link: the more you drink, the higher your risk — even at relatively low levels of consumption.

This scientific shift is what led Canada to overhaul its alcohol guidance in 2023, warning that no amount of alcohol is without risk. The new national guidelines recommend no more than two drinks a week — a sharp contrast to the prior threshold of ten to fifteen drinks.

“It wasn’t an edict,” said Butt. “We didn’t say you shouldn’t drink more than two standard drinks a week.

“We said you should reduce the amount that you drink … [and] any reduction is good.”

Misinformation

Not everyone has welcomed the new guidance.

Public health experts say misinformation and industry influence continue to cloud the conversation around alcohol’s risks — with ISFAR playing a central role.

“[ISFAR is] a group that’s industry funded — the scientists deny that they’re industry funded, but clearly they are,” said Butt. “They tend to reference each other’s research, but none of it can be placed in peer-reviewed journals because they’re compromised.

“It’s this tainted, biased research that the industry uses to attack the publicly funded research.”

The Addiction study concluded that ISFAR’s critiques consistently promoted alcohol’s supposed health benefits while downplaying or dismissing harms, regardless of a study’s quality.

“These patterns provide a valuable resource for industry actors to shape public perception, downplay risk and influence policy — using strategies that closely resemble those historically employed by the tobacco industry,” reads the study.

In a statement to Canadian Affairs, ISFAR denied its scientists are influenced by industry.

“ISFAR, as an organization, has no ties to the alcohol industry,” said Creina Stockley, ISFAR’s co-director, in a written response to Canadian Affairs. “Some members have conducted work as scientists funded partly or entirely by the industry or have worked for institutions financed by the alcohol sector.”

Stockley worked for more than two decades at the Australian Wine Research Institute and has held paid consultancies with Alcohol Beverages Australia and Wine in Moderation, groups that represent alcohol manufacturers and sellers.

ISFAR’s other co-director, Henk Hendriks, has received fees from beer companies Carlsberg and Heineken and the International Alliance for Responsible Drinking — a coalition backed by alcohol behemoths Anheuser‑Busch InBev, Bacardi, Diageo and others.

ISFAR’s board chair, R. Curtis Ellison, led a Boston University institute that received unrestricted donations from Diageo, Brown-Forman and the New York Wine & Grape Foundation.

Despite these industry ties, ISFAR says its critiques are not biased.

“All that matters to ISFAR is the merit of the scientific arguments and the scientific integrity of the conclusions,” said Stockley.

Fighting with facts

In response to widespread confusion about alcohol’s health risks, public health researchers are working to make accurate information broadly accessible.

Earlier this year, the Canadian Institute for Substance Use Research launched the Know Alcohol app — a mobile tool that helps people understand their personal risk and how it changes with different levels of drinking.

“Tough to change your genes, but when it comes to alcohol, you can reduce the amount,” said Butt, of the University of Saskatchewan. “And that has an immediate reduction in your risk if there’s a family history of breast or colon or mouth, throat, esophageal cancer and liver cancer.”

Researchers also stress that the goal is not prohibition or moral panic, but transparency and informed choice.

“We’re not trying to say ‘don’t ever drink again,’” said Butt. “[We’re saying] here’s the information — make decisions for yourself.”

Butt believes there are a wide range of benefits to drinking less — and that the conversation should focus on empowerment, not shame.

“It’s not losing your life because you’re reducing alcohol, but rather improving it.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 4-minute read

As Canada weighs expanding alcohol access, the World Health Organization is urging countries to do the opposite.

In a report released July 2, the WHO called for a 50 per cent global increase in taxes on alcohol, tobacco and sugary drinks by 2035. The goal is to reduce chronic disease and generate $1 trillion in public revenue over the next decade.

In Canada, health policy experts are also urging reforms such as minimum unit pricing and higher taxes for alcohol.

They say alcohol is wrongly seen as a profit centre by governments, when its costs in fact outweigh the revenue it generates.

“The most misunderstood thing [about alcohol], at least in North America, is the fact that alcohol is costing taxpayers and governments money, not bringing in revenue,” said Timothy Naimi, director of the Canadian Institute for Substance Use Research and a professor at the University of Victoria.

“Taxpayers are subsidizing the production of alcohol and people who drink heavily.”

Profit and loss

Earlier this spring, a report from the Canadian Centre on Substance Use and Addiction showed the country is drinking too much — and paying for it.

Canadians who drink consume, on average, more than 13 standard drinks a week, far beyond the recommended low-risk threshold of one to two drinks a week.

A 2024 study found total federal and provincial government revenue from alcohol was $13.3 billion between 2007 and 2020, while total social costs were nearly $20 billion. Governments generate revenue from alcohol through taxes, markups, licensing fees and government-run liquor stores.

“Alcohol results in considerable public costs for health care, criminal justice, and economic loss of production,” the study says.

“It’s not really providing revenue … because the secondhand costs are not really being fully recouped,” said Naimi.

Health care and lost productivity are the largest factors contributing to the social costs, according to the study.

Some critics argue that lost productivity should not be considered. Economists have pointed out that productivity losses are difficult to reliably quantify.

“This assumes society is ‘owed’ some net contribution from each person,” a commenter posted in the popular online discussion forum Reddit. “That would be like saying video game producers owe everyone because people choose to play games instead of contribut[ing] more to society.”

Others take a different view.

“Productivity losses have wide-ranging impacts on the economy and the well-being of people in Canada, which are squarely within the realm of government responsibility,” a spokesperson for the Canadian Centre on Substance Use and Addiction told Canadian Affairs in an email.

They say alcohol-related productivity losses include lost value of work due to premature deaths, disability and absenteeism. These losses hurt overall GDP, shrink income tax revenues and strain public services like health care.

“Framing productivity as outside the scope of public policy overlooks both the economic evidence and the moral imperative to create environments that support healthy, sustainable livelihoods,” the spokesperson said.

Red right hand

Tim Stockwell, a scientist at the Canadian Institute for Substance Use Research and a psychology professor at the University of Victoria, says governments either are not aware of alcohol’s true costs or do not see the political benefits of addressing them.

“[T]here is not much political gain in rendering our most popular recreational drug less available or more expensive,” he said.

Naimi says that it is like the government’s left hand does not know what its right hand is doing, since finance departments do not track health and social costs.

“Alcohol policies run out of departments of treasury or finance, so they only see the revenues,” said Naimi. “But they’re not the ones that are spending on all these other things that are caused by alcohol on the other side of the government.”

Jayadeep Patra, a scientist with the Centre for Addiction and Mental Health, says Canada needs to better predict the long-term costs of alcohol. Canada needs “smarter forecasting tools that combine data from health care, justice, and the workplace,” he said.

“Right now, most budgeting is short-term, but we need models that look 10, 20, or 30 years ahead — especially since alcohol-related harm often builds up slowly over time.”

Sin tax

Naimi says minimum unit pricing, which sets a floor price per drink, is a highly effective policy because it targets the cheapest alcohol, which is disproportionately consumed by the heaviest drinkers. Already in place in some provinces, minimum unit pricing reduces harmful consumption without significantly hurting revenue.

Alcohol consumption only drops slightly as prices rise, Naimi says. “If I raise the price 10 per cent, I’m only going to reduce consumption by seven per cent,” he said.

“If you do the math, when you raise taxes, you raise revenue.”

Experts say taxes — which raise prices across all products — are also a key tool to reduce alcohol-related harm.

“The primary objective of alcohol taxation policy is to reduce the affordability of alcoholic beverages in order to lower consumption — both overall and among heavy drinkers,” Guillermo Sandoval, an economist with the WHO, told Canadian Affairs in an email.

“Alcohol demand is relatively inelastic — meaning that consumption falls, but by a smaller proportion than the price increase.”

The Canadian Centre on Substance Use and Addiction recommends taxing all alcoholic beverages based on ethanol content and indexing rates to inflation.

Industry groups like Beer Canada and Spirits Canada and the Canadian Taxpayers Federation call automatic alcohol tax hikes “undemocratic” and unpopular with the public.

But Naimi argues most people prefer so-called “sin taxes” over property or income taxes.

“In public opinion polls, when you match up alcohol taxes or cigarette taxes in comparison to paying more property or income taxes, taxpayers overwhelmingly would prefer to pay higher sin taxes compared to higher property or income taxes,” he said.

Patra suggests using some of the revenue to fund addiction treatment or hospitals.

Stockwell says stronger public messaging on alcohol’s health harms could shift public opinion. “People have assumed the health risk only applies at high levels,” he said.

“When people realize [alcohol causes cancer] their support for governments taking stronger action to increase price and reduce availability increases.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 5-minute read

More and more cannabis users are ending up in emergency rooms suffering from severe, repeated bouts of vomiting — a condition known as cannabis hyperemesis syndrome.

A new study found that emergency visits for cannabis hyperemesis syndrome increased 13-fold over eight years, accounting for more than 8,000 of the nearly 13,000 cannabis-related ER visits in that period.

Experts say the mounting health risks associated with cannabis use are due to rising THC levels in cannabis products. They urge stronger regulation, better labeling and more research — using Quebec’s approach as a potential model.

“I don’t think we have the perfect model in Quebec — there’s pros and cons,” said Dr. Didier Jutras-Aswad, a clinical scientist at the Centre hospitalier de l’Université de Montréal (CHUM) and a professor in the Department of Psychiatry and Addiction at Université de Montréal.

“But overall, the process of … progressively implementing changes, not wanting to be the first one in line to put all this new product on the market, I think is probably, in terms of public health, more prudent.”

THC levels

Tetrahydrocannabinol (THC) is the primary psychoactive compound in cannabis and what causes the “high.” It is one of more than 100 cannabinoids, or chemical compounds, naturally found in the cannabis plant.

Delta‑9‑THC is the most common and well-studied form, though other forms of THC exist and are less understood.

Federal drug laws place strict limits on delta-9-THC levels. They cap delta-9-THC at 10 milligrams per piece for edibles, and 1,000 milligrams per container for extracts and topicals. Dried cannabis flower and pre-rolled joints have no THC cap, but must disclose the THC level on their labels.

Other intoxicating cannabinoids — like delta-8-THC — are not regulated the same way. Some producers use these other cannabinoids to get around delta-9 limits to make their products more potent.

In 2023, Health Canada issued guidance warning against this practice, noting it could lead to inspections and regulatory action. Its guidance is not legally binding.

“Good weed”

Dr. Oyedeji Ayonrinde, a professor of psychiatry and psychology at Queen’s University, says “good weed” used to mean a product did not contain pesticides or contaminants. Now, it often means a product is high-THC — reinforcing the risky idea that stronger is better.

“We would say, Oh, man, that guy’s got good weed,’ because it’s 30 per cent [THC],” he said.

Today, THC levels average about 25 per cent — up from about four per cent in the 1960s. But some products go as high as 80 or 90 per cent THC.

“That’s ‘the good stuff,’” said Ayonrinde, referring to how consumers view products with these elevated levels of THC.

“One of the major [health] risk factors is the use of cannabis with higher than 10 per cent THC,” said Dr. Daniel Myran, a physician and Canada Research Chair at the University of Ottawa.

Myran led three Canadian studies this year linking heavy cannabis use to health risks such as schizophrenia, dementia and early death.

Chris Blair, a Canadian originally from Jamaica, says the cannabis he once smoked — natural, Jamaican, homegrown weed known as “sess” — was much milder than what is available through Ontario dispensaries today.

“We grew it, it was natural … the regular Mary Jane sess,” he said. “And then times changed … the sess was pushed to almost become the hydro[ponic] type of thing."

Hydroponic growing methods produce more potent cannabis with higher THC levels. Blair says he could no longer go back to Jamaican sess, because he had built up a tolerance to it.

“Unfortunately, going back to sess was not the same, because it wasn’t the same high or same strength,” he said.

“Back when [I was] smoking [Jamaican sess] … I’d finished that spliff and we were ready to go hang out, we’re ready to party.

“Nowadays, after you smoke you’re mashed and you’re not doing anything.”

Greening out

Ayonrinde says higher THC levels can alter how the brain’s dopamine receptors work, which may induce paranoia.

“Being out of touch with reality, auditory hallucinogens, delusional thoughts, disorganized thinking — that’s part of the mechanism pathway for the development of a severe and enduring mental illness [like] schizophrenia,” he said.

High THC can also worsen anxiety, disrupt sleep, affect mood and trigger psychosis, he says. Other experts cited risks including cannabis use disorder, mental health issues, and dizziness or nausea — sometimes referred to as “greening out.”

Young people, whose brains are still developing until age 25, are most vulnerable to these harmful effects, Ayonrinde says.

During adolescence, the brain undergoes intense growth. “Think of the brain like a construction site,” he said. Frequent, high-dose THC use during this critical period can disrupt dopamine systems and increase the risk of building scaffolding for serious mental health conditions.

While some literature suggests that cannabidiol (CBD) — another major cannabinoid in most cannabis products — may act as a calming, non-psychoactive counterbalance to THC, Ayonrinde says this is only true at extremely high doses, around 6,000 mg.

Standard measurement

Experts say the diversity of cannabis products on the market is part of the challenge.

“When people say, ‘Weed helps me with my trauma,’ an example I often give is: cannabis is just like saying ‘dog’,” said Ayonrinde.

“What breed? Is it a chihuahua or a rottweiler or a great dane? Because without knowing exactly the THC, CBD … what are you talking about?

“There’s no single cannabis.”

Cannabis products lack clear dosage guidelines, and Ayonrinde says marketing messages push consumers to opt for high potency options.

Ruth Ross, a professor of pharmacology and toxicology at the University of Toronto, would like Canada to adopt a standard unit of measurement for THC levels, so consumers could easily understand what one unit means.

“Say a unit was one milligram; they could multiply that up — it’s easy math,” she said.

Myran agrees. “The way we sell alcohol in this country is not set up so that you pay the same amount for a litre of wine as you do for a litre of vodka,” said Myran.

“You have a minimum price per unit of ethanol … and there’s a really compelling reason to price cannabis according to its THC content … [to] financially discourage people from always moving to the highest potency THC products.”

Ross says there is also a need for more current cannabis research. Most cannabis research evaluates the effects of cannabis products with much lower THC levels than those seen on the market today. Long-term health effects can take decades to appear — similar to tobacco.

“Some of [the health harms] might emerge over many, many years, and we don’t know what those will be until data comes in,” she said.

Quebec’s approach

Ross points to Quebec as a unique model in cannabis regulation. It is the only province that caps THC potency and tightly controls how cannabis can be marketed. For example, edibles resembling candy or desserts are prohibited.

Jutras-Aswad, of the Université de Montréal, says overly strict rules can drive some consumers — especially those younger than the province’s legal age of 21 — to the black market.

Still, he says Quebec’s model offers benefits, including greater control over sales and a public health approach focused on harm reduction rather than profit.

Under Quebec’s Cannabis Regulation Act, the Société québécoise du cannabis (SQDC) is the only authorized cannabis retailer in the province.

SQDC employees are trained to offer science-based information, connect consumers with support services and promote safer use.

Researchers in Ontario are now studying how Quebec’s stricter THC limits may be affecting cannabis-related harms compared to other provinces.

“That’s going to be a really interesting within-Canada experiment,” said Ross.

Myran recommends adopting Quebec’s 30 per cent THC caps nationwide.

He also recommends better product labelling requirements and a pricing model that sets a minimum price per unit of THC — to discourage the purchase of high-potency products.

In a 2023 op-ed, Ross argued provinces should fund cannabis research to guide policy and public health.

In it, she notes that Quebec reinvested all $95 million of its 2022 revenue from cannabis sales into prevention and research. By contrast, Ontario set aside just 0.1% of its $170 million in cannabis revenue for a Social Impact Fund that has no clear public health focus.

“Canada can do so much better. We have world experts in cannabis research from coast-to-coast, and we are uniquely positioned to have high-quality, well-funded research on its medical use and potential harms,” she wrote.

“Five years from now, will we be dealing with major public health challenges that could have been avoided?”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 4-minute read

Participation in B.C.’s safer supply program — which offers prescription opioids to people who use drugs — has dropped by nearly 25 per cent over the past two years, according to recent government data.

The B.C. Ministry of Health says updated prescribing guidelines and tighter program oversight are behind the decline.

But addiction experts say the story is more complicated.

“Many of my addiction medicine colleagues have stopped prescribing ‘safe supply’ hydromorphone to their patients because of the high rates of diversion … and lack of efficacy in stabilizing the substance use disorder (sometimes worsening it),” said Dr. Launette Rieb, a clinical associate professor at the University of British Columbia and addiction medicine specialist.

“Many doctors who initially supported ‘safe supply’ no longer provide it but do not wish to talk about it publicly for fear of reprisals,” she said in her email.

Missing data

B.C. has had safer supply programs in place province-wide since 2021.

Participation in its program peaked at nearly 5,200 individuals in March 2023, and then declined to fewer than 3,900 individuals by December 2024. This is the most recent data publicly available, according to B.C.’s health ministry.

In an emailed statement, the ministry attributed the decline to updated clinical guidance and more restrictive prescribing practices “aimed at strengthening the integrity and safety of the program.”

In February, the province updated its safer supply prescribing guidelines to require most patients of the program to consume prescription opioids under the supervision of health-care professionals — a practice known as “witnessed dosing.”

The B.C. government has not released any data on how many patients have been transitioned to witnessed dosing.

The ministry did not address Canadian Affairs’ questions about whether patients are being cut off involuntarily from the program, whether fewer physicians are prescribing or whether barriers to accessing safer supply have increased.

‘Dependence, tolerance, addiction’

Some experts say the decline in safer supply participation is due to physicians being influenced by their peers and public controversy over the program.

Dr. Karen Urbanoski, an associate professor in the Public Health and Social Policy department at the University of Victoria, says peer influence plays a significant role in prescribing practices.

A 2024 study found the uptake of prescribed safer supply in B.C. was closely tied to prescribers’ professional networks.

“These peer influences are apparent for both the uptake of [safer supply] prescribing and its discontinuation — they are likely playing a role here,” Urbanoski said in an email to Canadian Affairs.

Urbanoski also points to the broader environment — including negative media coverage and uncertainty about program funding — as factors behind the decline.

“Media discourse and general politicization of [safer supply] has likely had a ‘cooling effect’ on prescribing,” she said.

Dr. Leonara Regenstreif, a primary care physician and founding member of Addiction Medicine Canada, says many physicians embraced safer supply without fully grasping its clinical risks. Addiction Medicine Canada is an advocacy group representing 23 addiction specialists across Canada.

Regenstreif says physicians too young to have practiced during the peak of OxyContin prescribing were often enthusiastic prescribers of safer supply in the program’s early days. OxyContin is a prescription opioid that helped spark North America’s addiction crisis.

“In my experience, the MD colleagues who have embraced [safer supply] prescribing most zealously … never experienced the trap of writing scripts without knowing what was ahead — dependence, tolerance, addiction, consequences,” her emailed statement says.

Now, many of these physicians are looking for an “exit ramp,” Regenstreif says, as concerns over safer supply diversion and its treatment benefits grow.

Reib, of the UBC, says some of her colleagues in addictions medicine fear speaking out about their concerns with the program.

“Some of my colleagues have had their lives threatened by their patients who have become financially dependent on selling their [hydromorphone],” said Rieb.

The College of Physicians and Surgeons of B.C., which represents physicians in the province, referred Canadian Affairs’ questions about declining program participation to the health ministry and the BC Centre on Substance Use. The centre was unable to provide comment by press time.

Public backlash

The decline in B.C.’s safer supply participation unfolds amid mounting scrutiny of the program and its effectiveness.

Rieb says that the program’s framing — as free, safe and widely available — may run counter to longstanding public health strategies aimed at reducing drug use through pricing and harm awareness.

“Drivers of public use of substances are availability, cost, and perception of harm,” she said. “[Safe supply] is being promoted as safe, free and available for the asking.”

There have been reports of youth gaining access to diverted safer supply opioids and developing addictions to fentanyl as a result. Last September, B.C. father Gregory Sword testified before the House of Commons that his teenage daughter died after accessing diverted safer supply opioids.

B.C.’s recent decision to overhaul its prescribing guidelines followed revelations of a widespread scam by dozens of B.C. pharmacists to exploit the safer supply program to maximize profits.

Experts also note that Canada still lacks the evidence needed to assess the long-term health outcomes of people in safer supply programs. There is currently no research in Canada tracking these long-term health outcomes.

“There is a lack of research to date on retention on [safer supply],” said Urbanoksi.

Rieb agrees. “There are many methodological problems with the recent studies that conclude [the] benefit of pharmaceutical alternatives (‘safe supply’),” she said.

“We need long term studies that look at risks/harms as well as potential benefits.”

Regenstreif says the recent drop in participation may have an unintended upside — encouraging more people with substance use disorders to try what she sees as a more effective treatment: opioid agonist therapy, or OAT. This therapy uses medications like methadone or buprenorphine to reduce withdrawal symptoms and cravings.

“If fewer people are accessing [safer supply] tablets … more people with [opioid use disorder] might accept proper OAT treatment,” she said.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 4-minute read

Since 2020, Canada has been piloting a new strategy to prevent youth from using drugs and alcohol.

The strategy is based on a highly successful model pioneered in Iceland in the 1990s — one that helped cut Iceland’s youth substance use from among Europe’s highest to the lowest.

But in Canada, the effectiveness of the Icelandic model remains unproven — and some experts say Canada needs a strategy that is better targeted to Canada’s unique culture.

“The [Icelandic Prevention Model] was originally developed to address alcohol and tobacco use in Iceland in the 1990s,” Leslie Buckley, chief of addictions at the Centre for Addiction and Mental Health (CAMH), told Canadian Affairs in an email.

“It was not designed with opioids or mental health in mind and doesn’t appear to incorporate trauma-informed practices,” she said.

The Icelandic model

The Icelandic Prevention Model aims to deter youth substance use by treating “society as the patient.”

The model is implemented through entire communities by a range of organizations, including town councils, schools, health providers, youth organizations and parent groups.

Its aim is to strengthen the social conditions that affect youth substance use, such as peer pressure, parental influence, extracurriculars and community ties. For example, parents are encouraged to have their children at home in the evenings.

In Iceland, the strategy has yielded impressive results.

Between 1998 and 2013, the share of 15-16-year-olds who reported getting drunk in the past 30 days fell from 42 per cent to five per cent. Daily smoking dropped from 23 per cent to one per cent, and lifetime cannabis use fell from 17 per cent to six per cent.

Given its success, the model has been broadly adopted in countries around the world, and is today used on five continents.

But its founders stress that the model must always be adapted to a country’s own culture.

“We don’t tell people what to do, but we provide this framework, and always it has to be culturally adapted,” said Jon Sigfusson, chairman of Planet Youth, the organization that created the Icelandic Prevention Model.

“What works in Iceland doesn’t work in Canada or anywhere else.”

In an email to Canadian Affairs, Planet Youth emphasized the importance of understanding the unique dynamics of the community in which the strategy is being rolled out.

“The key strategies include building a strong coalition that works in the community for the community, using survey data that looks into risk and protective factors and specific community challenges, guiding decision-making based on data,” the Planet Youth team told Canadian Affairs in an email.

‘The entire community’

In Canada, the Icelandic Prevention Model was first piloted in 2020 among Grade 10 students in Lanark County, Ont.

Today, it is being piloted in seven communities across the country, including in Cape Breton, N.S., Mississauga, Ont., and the Grand Erie region of Ontario.

Canada’s adoption of the Icelandic Prevention Model marks a major shift from Canada’s pre-2020 approach to substance use prevention. That approach relied on short-term, targeted education campaigns to help youth recognize and resist peer pressure.

“The ‘just say no to drugs’ approach does not work and has been proven ineffective time and time again,” said Sefin Stefura, project manager of the Icelandic Prevention Model in Cape Breton.

Buckley, of CAMH, says the Icelandic Prevention Model’s focus on the entire community is one of its strengths.

“One positive aspect of the Icelandic Model is that it involves an entire community — and bringing people together to work on a common goal,” she said in her email.

At the same time, experts caution that the Icelandic Prevention Model — which was first implemented in the 1990s — was not designed to address the complex challenges Canadian youth face today.

The model needs rigorous evaluation in Canada due to its “different population, different sociocultural landscape, and differing substance[s],” Buckley said.

“We cannot highlight enough the importance of evaluation in the early pilots,” she said.

A recent consultation by the Canadian Centre on Substance Use and Addiction found that Canadian youth want mental health support, peer-led education and non-judgmental tools for coping with stress and trauma.

“Youth often start using substances for social reasons — to fit in and socialize more effortlessly — but often continue because they are using it to cope with stress, mental health challenges or pain,” the report says.

Cape Breton, one of the cities currently piloting the Icelandic Prevention Model, is adapting its strategy to ensure all research and interventions put mental health, accessibility and lived experience at the forefront, says project manager Stefura.

Stefura says the community also plans to create a youth congress to co-lead decisions with schools and municipal leaders.

“There is really no way to separate [trauma and mental health] from primary prevention,” she said.

In Ontario’s Grand Erie region, health promoters Lina Hassen and Josh Daley say they view the Icelandic Prevention Model as a valuable framework — but only when part of a larger approach.

“We don’t pretend or believe that this is a silver bullet,” said Daley. “We know it’s a complex issue, so it’s going to have a complex solution, and we think this is complementary to what’s going on.”

“We have a local drug and alcohol strategy,” Hassen added.

“We are recognizing the need to embed mental health components — such as training for schools and community leaders on trauma-informed care — and aligning the model with local mental health resources.”

Dagmar Morgan-Sinclair, the executive director of the team implementing the Icelandic Prevention Model in Mississauga, says the model complements, but should not replace, other targeted substance use prevention programs.

In Canada, one such program is PreVenture. PreVenture is an evidence-based Canadian program used primarily in schools and universities that helps youth identify and mitigate behavioural traits that can correlate with substance use disorders.

“Our strategy is a ‘yes, and’ to some of these individualized-focused programs,” said Morgan-Sinclair. “This is something that works in tandem.”

Buckley agrees that the Icelandic Prevention Model’s broad, community-based approach should be paired with targeted programs like PreVenture, which have been proven to work in the Canadian context.

“Health Canada says the [Icelandic] program allows for local adaptation — but most of the funded communities are in smaller or rural areas, and don’t include places with the highest rates of youth drug use like Vancouver or Toronto,” she said.

Canada’s efforts to reduce youth substance use have, so far, been modest. Health Canada, for example, committed just $20 million to the Icelandic Prevention Model over five years, while the opioid crisis is estimated to cost the country about $40 billion a year.

“We have not invested in primary prevention as much as we should,” said Buckley.

“We need to consider, invest in and test these upstream prevention practices in Canada,” Buckley said.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 4-minute read

Canada’s financial institutions could face criminal liability for facilitating transactions tied to cartel-linked drug sales, according to a new report by journalist David Clement.

Clement argues Canada’s recent designation of seven transnational criminal organizations as terrorist entities may implicate banks, credit card companies and Interac under the Criminal Code, due to their role in processing payments for illegal drug sales.

“In Canada, collaborating with a listed terrorist organization is a serious offence under the Criminal Code,” writes Clement in the report.

“It should cause them — the banks and Interac — to take action,” Clement told Canadian Affairs in an interview.

Legal experts say the Criminal Code permits the prosecution of institutions that facilitate terrorism. But the burden of proof is high and the likelihood of charges being laid is low.

“Theoretically, there’s no impediment to [prosecuting financial institutions],” said Anil Kapoor, a criminal and national security lawyer.

“The real question is how you acquire the evidence, and … does the evidence add up to knowingly [facilitating illegal transactions]?”

Terrorist organizations

In February, Canada expanded its list of designated terrorist organizations to include seven criminal organizations, most of them powerful drug cartels.

The list includes five Mexican cartels, such as the Cártel de Sinaloa and Cartel de Jalisco Nueva Generación (CJNG), El Salvador’s La Mara Salvatrucha (MS‑13) and Venezuela’s Tren de Aragua.

This designation brings anti-terrorism laws into play for groups previously targeted mainly for drug trafficking. This allows law enforcement to pursue broader charges with harsher penalties and lower thresholds for prosecution.

Clement’s report, published by the advocacy group Consumer Choice Center, warns that banks, credit card companies and Interac could face legal risks for facilitating transactions with online drug vendors linked to these cartels.

However, Clement stops short of identifying any specific institutions as having committed wrongdoing.

Bankrolling cartels

Clement says financial institutions should be required to act on publicly available information about how to purchase illicit substances.

“If I buy from Moon Haus and I buy cocaine, what bank is that deposit going to?” said Clement. Moon Haus is an online Canadian vendor that openly sells illicit psychedelic drugs and accepts payment via e‑Transfer.

A vendor like Moon Haus is not a designated terrorist organization, but its connections to cartel-supplied products could leave financial institutions legally exposed, says Clement.

“A compliance officer at a bank could likely just search for [a Moon Haus] email and see if it’s linked to any of their deposit accounts,” he said.

Legal experts agree that the Criminal Code permits financial institutions to be charged with facilitating terrorism. But the challenge would be proving intent.

There needs to be a deliberate understanding or intention to facilitate terrorist-related transactions for it to be considered “knowingly” aiding terrorism, says Kapoor, who sits on the board of the Canadian Civil Liberties Association and previously served on the Prime Minister’s Advisory Council on National Security.

Jessica Davis, president of Canadian security consultancy Insight Threat Intelligence, says the bar is very high for prosecuting financial institutions for terrorist financing in Canada.

“You’re much more likely to get things like really large fines for [financial institutions] just not doing enough due diligence and not reporting enough,” said Davis, who was formerly a senior analyst with the Canadian Security Intelligence Service.

“Then [law enforcement would] have to meet a very high bar to convince a prosecutor that this was a good use of their time. And in my experience, it’s hard enough to get prosecutors to pursue terrorist financing charges.”

Davis says Canada has seen only three terrorist financing convictions — and none of them targeted financial institutions that facilitated the transactions.

By contrast, the U.S. has aggressively pursued financial institutions linked to cartel crimes. In October 2024, the U.S. Department of Justice slapped TD Bank, Canada’s second-largest bank, with a $3 billion US fine for failing to stop cartel-linked money laundering.

The department highlighted “long-term, pervasive, and systemic deficiencies” in TD’s transaction monitoring. It said TD had knowingly underfunded its U.S. anti-money laundering program, enabling over $670 million in cartel-linked laundering.

“By making its services convenient for criminals, it became one,” said Attorney General Merrick Garland, at a press conference at the time. Deputy Attorney General Lisa Monaco called the case a “lesson” for bank compliance officials nationwide.

‘Choked out’

Kapoor and Davis say Canada currently lacks the legal framework to hold banks accountable in the way U.S. agencies do.

“We don’t have the statutory infrastructure to hold our banks responsible in the same way,” said Kapoor.

Still, Kapoor says there are ways for Canadian institutions to disrupt cartel operations by cutting off their financial channels. “If they’re choked out of the equation and won’t assist people, then cartels really can’t operate,” he said.

Kapoor says Canadian banks, credit card companies and postal services could de-platform or report suspicious transactions to FINTRAC, Canada’s financial intelligence unit. This could then lead to investigations by law enforcement.

“Banks [are] in the business of essentially getting people to deposit money in their institutions so they can turn around and lend it out — that’s how they make their money,” said Kapoor.

“But at the same time, they don’t want to run afoul of any regulations.”

‘Tougher approach’

According to FINTRAC, businesses and financial institutions subject to the Proceeds of Crime (Money Laundering) and Terrorist Financing Act are required to report to law enforcement about suspicious transactions, listed persons or properties.

“Following the listing of seven transnational criminal organizations as terrorist entities under the Criminal Code in February 2025, FINTRAC called on businesses to update their processes and ensure the submission of listed person or entity property reports,” a spokesperson told Canadian Affairs in an emailed statement.

Last fiscal year, FINTRAC generated more than 400 financial intelligence disclosures related to terrorist financing and threats to Canada’s security, which were shared with law enforcement and national security partners, the spokesperson said.

The Canadian Bankers Association, which represents more than 60 domestic and foreign banks operating in Canada, told Canadian Affairs its members dedicate “significant resources” to anti-money laundering and anti-terrorist financing programs.

It cited its work on Project Guardian as one example. That project uses financial intelligence and suspicious transaction reports to thwart fentanyl-related money laundering networks.

Interac told Canadian Affairs it carefully monitors its e-Transfer network for risks and threats, and alerts the financial institutions on both ends of the transaction about any issues.

Visa Canada told Canadian Affairs it enforces “robust compliance requirements” for financial institutions and merchants, but declined to provide further detail. Mastercard, BMO, RBC, TD and Scotiabank did not respond to requests for comment.

Davis says she hopes to see Canada take a tougher approach to holding financial institutions accountable.

“I would love to personally see more prosecutions for criminal non-compliance,” she said.

“Then, once there is a reasonable case law on that, I think that then we might be able to see something brought against financial institutions in the right circumstances for knowingly facilitating.”

“At a certain point in time, they cannot deny it anymore.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 4-minute read

A new study that compares safer supply with a traditional approach to addiction treatment has ignited debate among addiction experts.

The study, published in The Lancet Public Health in April, examined health outcomes for people receiving safer supply and compared them to a similar group of people receiving methadone, a drug used to reduce drug cravings and withdrawal symptoms.

It concluded that safer supply programs significantly improved participants’ health outcomes. Safer supply provides people at high risk of overdose with prescription opioids as a safer alternative to toxic street drugs.

But critics question the study’s conclusions. They note that many safer supply participants had access to more support services and that the majority also received methadone. These factors make it difficult to identify which treatment drove the positive results.

“The study did not compare [safer supply] to methadone, but rather the initiation of both with several other unaccounted variables,” wrote psychiatrists Dr. Robert Tanguaya and Dr. Nickie Mathew in a formal critique also published in The Lancet.

Findings

The peer-reviewed study is the first in Canada to compare the health outcomes for people receiving safer supply with those receiving methadone through a program known as opioid agonist therapy. Opioid agonist therapy, or OAT, is widely used to treat opioid use disorder.

The study, which was led by teams at Unity Health Toronto, ICES, the University of Toronto and the Ontario Network of People Who Use Drugs, followed about 1,700 Ontarians who started treatment between 2016 and 2021. Half were receiving prescribed hydromorphone through Ontario’s safer supply programs; the other half were receiving methadone through an OAT program.

Participants were tracked for up to one year. Both groups saw improvements, including fewer overdoses, emergency room visits, hospital stays and new infections.

“The findings suggest [safer supply] programmes play an important, complementary role to traditional opioid agonist treatment in expanding the options available to support people who use drugs,” the study says.

However, when compared against each other, the safer supply group had higher rates of overdose, ER visits and hospital admissions than those on methadone.

Still, the authors conclude that safer supply can complement methadone, especially for people who do not respond well to traditional options like OAT.

Confounders

In their May 27 critique in The Lancet Public Health, psychiatrists Tanguay and Mathew say the study fails to isolate the effects of safer supply.

“It is unclear from this study whether the benefits attributed to [safer supply] initiation came from the prescribed … hydromorphone or not,” they wrote.

One concern is that most safer supply participants were also on methadone — a highly dose-dependent medication — and the study did not account for how much of each drug they received.

Dr. Leonara Regenstreif, a primary care physician who specializes in substance use disorders, raised a similar point in an email to Canadian Affairs.

She noted that 84 per cent of safer supply participants in the study were already on methadone when they began receiving hydromorphone.

“It would take a lot of fudging to be able to say [safer supply] was responsible for an outcome, when that group was actually receiving two drugs,” she said.

The main study’s authors did not respond to requests for comment. Instead, they directed Canadian Affairs to their May 27 response to Tanguay and Mathew’s critique, also published in The Lancet.

Wraparound care

Critics also say that improved outcomes among safer supply participants may be due to the extensive additional health care they received while on safer supply.

This additional care was evidenced in study participants’ medication costs.

In the year after treatment began, median medication costs for safer supply patients rose by more than $13,000 per person. By comparison, costs for those on methadone rose by about $1,600.

Glen McGee, a statistics professor at the University of Waterloo, says this suggests safer supply participants may have received broader care, including treatment for other conditions like HIV or hepatitis C.

“This could suggest treatment [of the safer supply group] involved more thorough care in addition to [safer supply], which could also account for some of the improved outcomes,” he said.

In their response to Tanguay and Mathew’s critique, the main study’s authors said the additional care is not a flaw — it reflects how Ontario’s safer supply model is designed.

“Embedding hydromorphone prescriptions within other health and social services that address the complex needs of people at high risk of drug-related harms is a deliberate and defining feature,” they wrote.

McGee suggests the challenge of isolating the impact of broader care makes it difficult to draw broad conclusions about safer supply’s role in patients’ health outcomes.

“The analyses in the main paper seem reasonable, but the conclusions are perhaps too strong,” said McGee. “We don’t necessarily know if [safer supply] alone would be as effective.”

Overdose risk

Critics also focused on safer supply participants having a higher risk of overdose than those in opioid agonist therapy.

Although safer supply patients were more likely to stay in treatment than methadone patients, overdose rates remained higher for safer supply patients — even after adjusting for people who dropped out from the methadone group.

The study authors say this is likely because safer supply patients started at higher risk and many continued using street drugs early in treatment.

“The smaller decline among [safer supply] recipients might reflect higher baseline risk and greater ongoing exposure to the unregulated drug supply early in treatment,” they wrote.

They also noted that very few people died in either group, showing that treatment — whether safer supply or methadone — offers protection.

However, Regenstreif urges caution.

“If you peel away the stats language, underneath it all you have a cohort with higher risks of opioid toxicity and other hazards of ongoing drug use,” said Regenstreif.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 5-minute read

In May, shortly after Parliament resumed, Quebec Senator Patrick Brazeau introduced Bill S-202, a private member’s bill to require nearly all alcoholic beverages to carry health warning labels.

“As a former alcohol consumer, I was once in the 75 per cent of Canadians who are not aware that there is a causal link between alcohol consumption and seven cancers,” Brazeau told the House of Commons on June 3.

“I personally battled colon cancer several years ago, so much so that when I received treatment, I felt I was being killed inside.”

Brazeau is something of an outlier in government. Public health experts say Canadian governments are not doing enough to address alcohol’s known health risks — and that the alcohol industry is a big part of the problem.

“We’ve known about the carcinogenic effects of alcohol since the 80s,” said Peter Butt, a University of Saskatchewan researcher and co-chair of Canada’s latest drinking guidelines. “But there are no warning labels, so the consumer is given false confidence.

“Some of this falls at the doorstep of the government, because they regulate the labeling.”

Alcohol harms

Today, the World Health Organization warns that alcohol harms nearly every system in the body.

The International Agency for Research on Cancer classifies alcohol as a cause of six cancers.

Chronic alcohol use raises the risks of liver and heart disease, brain damage, mental health issues, injuries and fetal alcohol spectrum disorders.

In Canada, the federal government oversees labeling and public health messaging rules, while the provinces control liquor sales and drinking ages.

In January 2023, Health Canada released updated national alcohol guidelines in response to the growing evidence of alcohol-related harms. This new guidance marked a major departure from its 2011 recommendations, which had suggested women not exceed 10 drinks per week and men not exceed 15.

The new guidelines have a sober message: no amount of alcohol is risk-free, and risk rises significantly with more than two drinks a week.

“We didn’t say you shouldn’t drink more than two standard drinks a week. We said you should reduce the amount that you drink,” said Butt, who co-chaired the team that updated the guidelines.

“The consumer had a right to know.”

Mixed messages

Aside from tightening its guidelines, Canadian governments have done little to better protect the public.

Public health experts say one major flashpoint has been warning labels. In general, drinks with greater than 0.5 per cent alcohol content are exempt from standard food and beverage labeling requirements.

“Even bottled water or non-alcoholic beer has to have the nutrition facts because it doesn’t have enough alcohol in it to get the exemption,” said Adam Sherk, a research scientist at the Canadian Centre for Substance Use and Addiction who also advised on Canada’s updated alcohol guidelines.

The Canadian Cancer Society has been advocating for labels on alcohol products since 2017. The Canadian Institute for Substance Use Research has done the same since 2023. But Health Canada has not initiated any regulatory process to mandate warning labels for alcohol products.

Some research indicates such labels could reduce sales.

A 2020 study by the Yukon government and the Canadian Institute for Substance Use Research tested how warning labels affect consumer behaviour. It found labels did increase awareness and reduce sales.

Yukon pulled its label requirements after the alcohol industry threatened to sue the government.

Convenient

Labelling is just one of many measures governments could take to reduce alcohol-related harm.

In addition to labels, the Canadian Alcohol Policy Evaluation project recommends minimum unit pricing, marketing and advertising controls, and public education campaigns. No province or territory has fully implemented all of these measures.

“[T]he Canadian federal government has not adopted or only partially adopted many evidence based alcohol policies,” the project’s report reads.

Meanwhile, some provinces are moving in the opposite direction.

Nova Scotia is considering expanding retail options. In April, Quebec rejected a recommendation to lower its blood alcohol limit for drivers, despite repeated coroner warnings.

Ontario has gone the furthest.

The province plans to invest $175 million over five years to grow its alcohol sector. It has begun permitting alcohol sales in convenience stores for the first time — with up to 8,500 new retailers expected to carry alcohol by 2026. It has also scrapped previous limits on pack sizes and discount pricing.

In April 2024, the province’s chief medical officer, Dr. Kieran Moore, recommended raising the legal drinking age from 19 to 21. Premier Doug Ford rejected the idea, arguing that if 18-year-olds can enlist in the military, they should be allowed to drink.

“We believe in treating people like adults,” he told media at the time.

In late June, the province also approved alcohol consumption on so-called “pedal pubs” — large, multi-person bicycles equipped with a U-shaped bar, often used for tours or bachelor parties.

“There’s never been such a large increase in availability all at once,” said Sherk, calling Ontario’s expansion “unprecedented.”

False profits

Tim Stockwell, a University of Victoria professor and former director of the Canadian Institute for Substance Use Research, says corporate influence helps explain why governments are failing to address alcohol’s health risks.

“Evidence for harms from alcohol has been with us for decades and has only strengthened,” said Stockwell. “Commercial vested interests have always dominated the policy sphere.”

Federal lobbying records show Beer Canada has routinely targeted Health Canada and more than two dozen federal agencies to influence policy on labeling, taxation and public health messaging. This includes closed-door meetings with MPs and senior officials from the Department of Finance and Agriculture Canada.

Beer Canada did not respond to multiple requests for comment by press time. Spirits Canada and Molson Coors Beverage Company also did not respond to multiple requests for comment.

Butt, of the University of Saskatchewan, says the money governments generate from alcohol sales creates a conflict with their public health mandate.

Federal and provincial governments generate revenue from alcohol through a range of mechanisms, including excise taxes, provincial markups, sales taxes and licensing fees. In some provinces, governments also earn profits from government-run liquor stores.

“[Governments] look at it from a lost revenue perspective, rather than from a public health perspective,” said Butt.

Ian Culbert, of Public Health Canada, puts it more bluntly. “Governments have a substance sales issue, as opposed to a substance use issue,” he said. “But it’s short-term gain for long-term pain.”

“Public Health wants to reduce consumption, because all consumption contributes to harm,” said Stockwell, of the Canadian Institute for Substance Use Research. “Commerce wants to … expand the consumption.”

A familiar playbook

Every expert interviewed for this story said the alcohol industry is following the tobacco industry’s playbook.

“They’re using the same sort of rear-guard action policies: denial, heavy government lobbying, government revenue,” said Butt.

“I don’t trust either the industry nor the government to do the right thing based upon past action. I think it’s important that consumers are educated.”

Adam Sherk agrees. “If I was [the industry], I would also be scared about consumers knowing this link [to cancer] better,” he said.

“The strategy is to obfuscate the link — point to studies that might be older or found no link, or put a lot of things in the water so it seems less clear than it is.”

But alcohol, experts say, is harder to regulate than tobacco. “Nobody liked to be in an airplane with smokers eating dinner next to smokers, so it was really easy to demonize smoking,” said Culbert.

“Alcohol is so ingrained in everything: we drink when we’re happy, we drink when we’re sad, we drink when we’re bored — we drink.”

Still, the normalization does not make the risks any less real. “There’s a mortality rate attached to this,” said Butt.

“And that’s the thing that is tragic — this is a modifiable risk factor.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 5-minute read

In mid-May, Alberta appointed Rick Wilson as the province’s new minister of mental health and addiction.

Wilson, who represents the Maskwacîs-Wetaskiwin riding south of Edmonton, was Alberta’s longest serving minister of Indigenous relations, serving from 2019 to this year.

Now, Wilson is tasked with accelerating the implementation of the Alberta Model, a recovery-oriented system of care that prioritizes addiction prevention, early intervention and treatment over harm reduction.

Canadian Affairs spoke with Wilson about his priorities in the new role, how his prior work with Indigenous communities shapes his perspective and what lies ahead for mental health and addiction care in Alberta.

AK: I understand you’ve been tasked with advancing the Alberta Recovery Model. What aspects of the model require the most focus in the term ahead?

RW: My goal is going to be to keep the momentum going. [We need to] get all the recovery communities opened up, keep expanding our supports, like CASA Classrooms [classroom-based mental health programs], and just keep filling the gaps for better information.

AK: Why was your predecessor, Dan Williams, shuffled out of the post?

It was a cascading event. Our speaker took a job in Washington, so we voted for a new speaker, Rick McIver. That left a hole in Municipal Affairs, [where Dan was moved]. I’d been bugging Premier Smith for more help with addictions and mental health. She said, ‘Go fix it then, I’ll put you there.’

AK: Do you have personal experience with mental health or addiction struggles?

RW: Do you want the whole sad story here?

I used to raise a lot of cattle and had one really rank bull that was terrorizing the farm. One morning I tried to get him up, and it didn’t end well — he got me down, fractured several vertebrae in my neck and back, and collapsed my lungs. I don’t know how I survived, but somehow I did.

For a year, I couldn’t walk. I was in so much pain I didn’t even know who I was. I would literally pray for one second of relief. Whatever the doctor gives you, you’ll take it — Oxytocin to Percocet; you name it, I was on it. My wife said she’d give me a pill and an hour later, I’d be begging her for more. This went on for close to a year.

I finally had what’s called laser spinal surgery. I was one of the very lucky ones. I went into it in a wheelchair, but I came out walking, and the pain was gone.

About a week later, I told my wife, ‘I think I’m full of infection — I’m burning up with fever, I’m sweating, and I think they’ve nicked a nerve. I feel like I got a giant hole in me.’ She looked at me like I was crazy.

We went to the doctor. He said I was completely healed and asked, ‘What do they have you on?’ Then he said, ‘You just quit taking everything?’ I told him, ‘Yeah, there’s no more pain, so I just quit.’

He said, ‘Well, you’re in withdrawal.’

Once I knew what it was, I was able to tough it out, but it’s not a pleasant experience. I don’t think people are really trying to get high — you just don’t want to feel that alone. I literally felt like there was a hole right through me, like I was just empty inside. So I have a lot of empathy for people that are in addiction.

RW: When I was in Indigenous Relations, half my time was spent around addiction issues. It’s horrible. Out on the First Nations, there’s hardly a chief who hasn’t lost a son or somebody close to them. That’s all I did — go to funerals, one after another.

What I learned was you really just have to listen — and that’s one thing the government isn’t good at.

AK: What learnings from that role are you bringing to your new portfolio, and how do you see them benefiting your work in mental health and addiction?

RW: I want to put an Indigenous lens on the whole thing. I think that’s the piece we’re missing. What I found most successful was to use their culture. Get the elders involved. They have the sweats, smudges and language. To take somebody’s language away is devastating.

You hear a lot about reconciliation, but I took it for real. My good friend Willie Littlechild said, ‘Minister, I want to see some reconcili-action.’ He said I could use that — so I do, a lot.

AK: Can Indigenous recovery models work more broadly for non-Indigenous Albertans?

RW: I’ve really seen it work with non-Indigenous folks as well. But everybody’s going to be different. For some people, maybe Christianity is the way to go. And for some people, it’s Alcoholics Anonymous.

I think [the common thread] is that hope. [When you’re addicted] you feel hopeless.

I felt empty, and you need something to replace that emptiness. The problem is, you turn to alcohol, you turn to drugs to fill that gap, and that’s not going to do it. It’s a very temporary fix that just pushes you deeper down the rabbit hole.

AK: Can you explain what a recovery community is, and how it fits into the province’s continuum of care?

RW: The way they used to do it, you’d throw someone in recovery for a couple of weeks [and expect] that should cure it, then out you go. Well, that doesn’t work.

[Now] it’s more of a holistic approach: you go into detox, and then from there, you go into rehab. Some people fall out of rehab, [but they go] back into detox, and eventually you start working your way around the circle.

Transitional housing is key. You can’t just send someone back into the community without support — they’ll relapse. After housing, the focus is on community reintegration, finding work, and family support. It’s like an Indigenous healing circle — a full circle to prevent falling back into addiction.

We’re working on 11 sites — one in Red Deer, Gunn, Lethbridge and Calgary opening this summer. Seven more are planned, including Edmonton, Grande Prairie and five with Indigenous communities.

AK: Some critics argue that the Alberta Model leans toward coercive care, and that the benefits of involuntary treatment may not outweigh the risks and costs. How will the Compassionate Intervention Act, which mandates addiction treatment, address those concerns?

RW: Compassionate care isn’t just for the individuals [with substance use disorders]. We have to be compassionate for them, but we also have to be compassionate for the people in their community that are impacted.

In my own riding in the Maskwacîs-Wetaskiwin — some people come in [to the hospital] three times in a day that have overdosed. To overdose several times a day — you’re doing brain damage when you’re at that point.

These people are in dire straits, and we have to intervene with them, because they’re not even capable of thinking for themselves [or] to go for voluntary treatment. We want to give the people that are addicted that opportunity to rebuild their lives. Right now, there’s just a lot of enabling going on.

This interview has been edited and condensed for clarity.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 4-minute read

Canada lacks long-term data on safer supply programs, despite funding these programs for years.

Safer supply programs dispense pharmaceutical opioids as a replacement for toxic street drugs.

There is a growing body of research on safer supply’s short-term health effects. But there are no Canadian studies that evaluate program participants’ health impacts beyond 18 months.

The absence of research into long-term data on safer supply means policymakers do not understand how safer supply affects participants’ health, substance use or social outcomes over time.

“Long-term data is important because it helps us understand not just short-term health outcomes like reduced overdoses, but also broader impacts on quality of life, stability and health care use,” said Farihah Ali, scientific lead at the Institute for Mental Health Policy Research at CAMH. The Centre for Addiction and Mental Health is one of Canada’s leading centres for addiction research and clinical care.

Pilot projects

Canada’s first safer supply programs were introduced in Ontario in 2016. Those programs were initially small in scope, intended for a small group of high-risk individuals.

In 2020, the federal government began funding safer supply pilot programs across the country. Provinces are responsible for the delivery and regulation of these programs.

B.C. introduced provincewide programs in 2021. Other provinces, such as Alberta, have restricted safer supply access to a very small number of clinics, and have generally shifted away from harm reduction models in favour of recovery-oriented approaches.

According to the Canadian Public Health Association, an advocacy organization, the original goal for safer supply was to reduce deaths and harms associated with the unregulated toxic drug supply. It was not meant to replace addiction treatment, but to rather act as a bridge to further care.

However, a 2023 report by researchers at McMaster University and Simon Fraser University noted safer supply “does not principally operate toward goals of treatment or recovery.” The report describes safer supply instead as an emergency intervention focused on stabilization and survival.

Evidence gaps

There is a small but growing body of short-term studies on the health effects of Canada’s safer supply programs. Most only track participants’ outcomes for up to 12 months.

Some of those studies suggest safer supply may reduce the immediate harms associated with drug use.

A 2024 study found a 91 per cent reduction in the risk of death among high-risk individuals receiving safer supply in B.C. Critics have raised concerns about the study’s methodology, sample size and confounding variables.

In contrast, a March study suggested B.C.’s safer supply and decriminalization policies may be associated with increased hospitalizations. These findings also sparked controversy, with experts debating how well the data isolate causal impacts.

And a comparative study released in April also showed some positive outcomes from safer supply. It too sparked significant expert debate.

‘Arms-length’

Of all the provinces, B.C. has implemented safer supply most broadly. The province’s health ministry did not directly respond when asked about the long-term goals of its safer supply program, or whether B.C. collects longitudinal data on program participants’ health outcomes.

“Evidence shows [safer supply] helps separate people from the unregulated drug supply, manage their substance use and withdrawal symptoms with regulated medications, and helps connect them to voluntary health and social supports,” a Ministry of Health spokesperson told Canadian Affairs in an email.

The ministry did not provide the evidence it referenced.

At the federal level, Health Canada confirmed that, to date, it has funded just two evaluations of safer supply programs, despite spending more than $100 million on safer supply since April 2023.

The first was a short-term study, funded by the federal government’s Substance Use and Addictions Program program. Conducted over four months, that study assessed 10 safer supply programs in Ontario, B.C., and New Brunswick. It documented initial impacts on participants’ lives and program delivery, primarily through qualitative methods such as interviews and surveys.

The second study is an ongoing, “arms-length evaluation” of 11 safer supply pilot programs funded by the Canadian Institutes of Health Research (CIHR), Canada’s federal health research agency.

When asked about long-term research on safer supply, Health Canada referred Canadian Affairs to a 2022 funding announcement about this multi-year evaluation. While the evaluation is being conducted over several years, it is unclear if it includes long-term tracking of patients’ outcomes.

Barriers and resistance

There are a number of factors that make it challenging to evaluate safer supply programs over long periods.

Ali, of CAMH, says unstable, short-term funding can disrupt long-term research.

“When programs are shut down or scaled back, we lose contact with participants and the ability to track outcomes over time,” she said.

Program participants can also be difficult to track over long periods, she says. Many struggle with housing insecurity, health instability and criminalization.

Frontline staff also face burnout and high turnover, she says, limiting support for such research activities.

Additionally, there are tradeoffs between the anonymity needed to encourage patients to access safer supply programs and the ability to collect detailed data.

“Ethical concerns — like not wanting to burden participants or risk their safety or confidentiality — require us to design studies that are trauma-informed and flexible, which adds complexity to long-term data collection,” Ali said.

Julian Somers, a clinical psychologist and professor at Simon Fraser University, says B.C.’s failure to conduct long-term evaluations of its safer supply programs is not just an oversight, but an act of negligence.

“B.C. has some of the best pharmaceutical data systems in the world,” Somers said, referring to PharmaCare and PharmaNet — databases that capture every prescription drug transaction in the province.

Somers says his team previously used PharmaNet data to examine prescribed opioids’ effects on health and social outcomes. In 2017, he proposed a long-term safer supply evaluation using these tools.

In 2017, he proposed a long-term evaluation of B.C.’s safer supply programs.

The province declined.

According to Ali, “Future research should explore how safer supply impacts people’s long-term health, stability and connection to care.”

“We also need to listen to people’s experiences, how safer supply affects their daily lives, their sense of dignity, and their relationships with care providers through qualitative mechanisms.”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

By Alexandra Keeler | 5-minute read

This February, B.C pledged to reintroduce witnessed dosing to its controversial safer supply program.

Safer supply programs provide prescription opioids to people who use drugs. Witnessed dosing requires patients to consume those prescribed opioids under the supervision of a health-care professional, rather than taking their drugs offsite.

The province said it was reintroducing witnessed dosing to “prevent the diversion of prescribed opioids and hold bad actors accountable.”

But experts are saying the government’s interim guidelines, released April 29, are fundamentally flawed.

“These guidelines — just as any guidelines for safer supply — do not align with addiction medicine best practices, period,” said Dr. Leonara Regenstreif, a primary care physician specializing in substance use disorders. Regenstreif is a founding member of Addiction Medicine Canada, an advocacy group that represents 23 addiction specialists.

Addiction physician Dr. Michael Lester, who is also a founding member of the group, goes further.

“Tweaking a treatment protocol that should not have been implemented in the first place without prior adequate study is not much of an advancement,” he said.

Witnessed dosing

Initially, B.C.’s safer supply program was generally administered through witnessed dosing. But in 2020, to facilitate access amidst pandemic restrictions, the province moved to “take-home dosing,” allowing patients to take their prescription opioids offsite.

After pandemic restrictions were lifted, the province did not initially return to witnessed dosing. Rather, it did so only recently, after a bombshell government report alleged more than 60 B.C. pharmacies were boosting sales by encouraging patients to fill unnecessary opioid prescriptions. This incentivized patients to sell their medications on the black market.

B.C.’s interim guidelines, developed by the BC Centre on Substance Use at the government’s request, now require all new safer supply patients to begin with witnessed dosing.

But for existing patients, the guidelines say prescribers have discretion to determine whether to require witnessed dosing. The guidelines define an existing patient as someone who was dispensed prescription opioids within the past 30 days.

The guidelines say exemptions to witnessed dosing are permitted under “extraordinary circumstances,” where witnessed dosing could destabilize the patient or where a prescriber uses “best clinical judgment” and determines diversion risk is “very low.”

Holes

Clinicians say the guidelines are deliberately vague.

Regenstreif described them as “wordy, deliberately confusing.” They enable prescribers to carry on as before, she says.

Lester agrees. Prescribers would be in compliance with these guidelines even if “none of their patients are transferred to witnessed dosing,” he said.

In his view, the guidelines will fail to meet their goal of curbing diversion.

And without witnessed dosing, diversion is nearly impossible to detect. “A patient can take one dose a day and sell seven — and this would be impossible to detect through urine testing,” Lester said.

He also says the guidelines do not remove the incentive for patients to sell their drugs to others. He cites estimates from Addiction Medicine Canada that clients can earn up to $20,000 annually by selling part of their prescribed supply.

“[Prescribed safer supply] can function as a form of basic income — except that the community is being flooded with addictive and dangerous opioids,” Lester said.

Regenstreif warns that patients who had been diverting may now receive unnecessarily high doses. “Now you’re going to give people a high dose of opioids who don’t take opioids,” she said.

She also says the guidelines leave out important details on adjusting doses for patients who do shift from take-home to witnessed dosing.

“If a doctor followed [the guidelines] to the word, and the patient followed it to the word, the patient would go into withdrawal,” she said.

The guidelines assume patients will swallow their pills under supervision, but many crush and inject them instead, Regenstreif says. Because swallowing is less potent, a higher dose may be needed.

“None of that is accounted for in this document,” she said.

Survival strategy

Some harm reduction advocates oppose a return to witnessed dosing, saying it will deter people from accessing a regulated drug supply.

Some also view diversion as a life-saving practice.

Diversion is “a harm reduction practice rooted in mutual aid,” says a 2022 document developed by the National Safer Supply Community of Practice, a group of clinicians and harm reduction advocates.

The group supports take-home dosing as part of a broader strategy to improve access to safer supply medications. In their document, they say barriers to accessing safer supply programs necessitate diversion among people who use drugs — and that the benefits of diversion outweigh the risks.

However, the risks — and harms — of diversion are mounting.

People can quickly develop a tolerance to “safer” opioids and then transition to more dangerous substances. Some B.C. teenagers have said the prescription opioid Dilaudid was a stepping stone to them using fentanyl. In some cases, diversion of these drugs has led to fatal overdoses.

More recently, a Nanaimo man was sentenced to prison for running a highly organized drug operation that trafficked diverted safer supply opioids. He exchanged fentanyl and other illicit drugs for prescription pills obtained from participants in B.C.’s safer supply program.

Recovery

Lester, of Addiction Medicine Canada, believes clinical discretion has gone too far. He says take-home dosing should be eliminated.

“Best practices in addiction medicine assume physicians prescribing is based on sound and thorough research, and ensuring that their prescribing does not cause harm to the broader community, as well as the patient,” he said.

“[Safer supply] for opioids fails in both these regards.”

He also says safer supply should only be offered as a short-term bridge to patients being started on proven treatments like buprenorphine or methadone, which help reduce drug cravings and manage withdrawal symptoms.

B.C.’s witnessed dosing guidelines say prescribers can discuss such treatment options with patients. However, the guidelines remain neutral on whether safer supply is intended as a transitional step toward longer-term treatment.

Regenstreif says this neutrality undermines care.

“[M]ost patients I’ve seen with opioid use disorder don’t want to have [this disorder],” she said. “They would rather be able to set goals and do other things.”

Oversight gaps

Currently, about 3,900 people in B.C. participate in the safer supply program — down from 5,200 in March 2023.

The B.C. government has not provided data on how many have been transitioned to witnessed dosing. Investigative journalist Rob Shaw recently reported that these data do not exist.

“The government … confirmed recently they don’t have any mechanism to track which ‘safe supply’ participants are witnessed and which [are] not,” said Elenore Sturko, a Conservative MLA for Surrey-Cloverdale, who has been a vocal critic of safer supply.

“Without a public report and accountability there can be no confidence.”

The BC Centre on Substance Use, which developed the interim guidelines, says it does not oversee policy decisions or data tracking. It referred Canadian Affairs’ questions to B.C.’s Ministry of Health, which has yet to clarify whether it will track and publish transition data. The ministry did not respond to requests for comment by deadline.

B.C. has also not indicated when or whether it will release final guidelines.

Regenstreif says the flawed guidelines mean many people may be misinformed, discouraged or unsupported when trying to reduce their drug use and recover.

“We’re not listening to people with lived experience of recovery,” she said.

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.