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4 years ago, the Canadian province of British Columbia gave addicts legal access to fentanyl and other opioids, hoping to reduce hospitalizations and deaths. Safer Opioid Supply program included lenient rules to encourage users to join. Doctors could write prescriptions even for people at high risk of overdose. Addicts did not have to enter treatment or even agree to counseling to participate. Canada’s national health insurance program even paid for the drugs.

The results have been catastrophic. Published in JAMA Internal Medicine, Canadian researchers found opioid overdose hospitalizations and deaths have soared in British Columbia since 2020. The rise occurred both in absolute numbers and compared to other Canadian provinces that did not legalize opioid prescriptions. The researchers first compared British Columbia to two small nearby provinces. But they found similar results when they checked bigger provinces too, including Ontario, Canada’s largest. By 2022, deaths in British Columbia had risen roughly 100%. The 7,200 opioid overdose deaths British Columbia suffered from 2021 through 2023 are thus suffered the equivalent of about 475,000 deaths in the US. And the figure does not include overdoses from cocaine or other drugs like Valium. Put another way, people in British Columbia are dying from opioid overdose at roughly double the rate in the US, where overdoses are rightly viewed as a national emergency. If British Columbia were a state, it would have the 2nd-highest rate of opioid overdose deaths, behind only West Virginia.

For drug advocates, the answer to the failures of “harm reduction” is always more of the same. About 12 months ago, British Columbia fully decriminalized the possession and use of heroin, cocaine, and fentanyl. But with death rates continuing to rise, advocates argued last fall addicts be allowed to receive drugs without a prescription - a proposal that essentially would end any restrictions on state-funded drug use.

What no one in the harm reduction community will admit is that societies can control drug use. They can’t eliminate it entirely, but they can make it more or less acceptable by highlighting its harms and making users legally responsible, thanks to stigmatization, increased taxes, and police enforcement. How many deaths will it take for the harm reducers to admit the truth?

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