Innovations in harm reduction can't curb 'catastrophic' overdose crisis, say experts

In the final days of his tenure as B.C.'s provincial health officer, Perry Kendall says the harm reduction policies that are part of his legacy save lives — but are not enough to turn the tide on overdoses from illicit drugs.

B.C. leads in new approaches to drug abuse, but the body count is still rising

An injection kit is shown at a supervised drug injection facility in Vancouver. (Jonathan Hayward/Canadian Press)

In the waning days of his tenure as B.C.'s provincial health officer, Perry Kendall said the harm reduction policies that form his legacy have saved lives — but have not done enough to curb the devastating numbers of people in B.C. who have died of overdoses from illicit drugs.

Harm reduction is a strategy aimed at reducing the negative consequences of drug use.

B.C. is home to some of the most progressive policies surrounding harm reduction — from a clinic that distributes prescription grade heroin, to opioid vending machines, to supervised injection sites.

But it's also facing one of the worst overdoses crises in the country.

More than 1,400 people died of an illicit drug overdose in the province in 2017, making it "the most tragic year ever," according to the chief coroner.

Back in 2002, Vancouver's municipal election was called "Canada's first drug election" after drug policy and the Downtown Eastside became a focal point of the electoral race. 9:20

Donald MacPherson, director of the Canadian Drug Policy Coalition, said that B.C.'s leadership in harm reduction is a direct result of the dire situation.

"The envelope is being pushed because of the desperate situation and no one really knows what to do, because we've never seeing anything like this before," he said.

"But if we had another public policy that had failed as dramatically as our drug policy over the past few years, we'd say this is a catastrophic failure."

A complex history

Kendall said he was introduced to the concept of harm reduction in the 1970s when he was practicing medicine in Glasgow, Scotland.

Emergency physicians noticed that on Friday nights patients would come in covered in cuts after getting into pub fights. In the bars most notorious for fighting, they replaced the glasses with automotive safety glass.

"People still got drunk and fought," said Kendall. "But they didn't get facial lacerations."

Kendall's work on harm reduction continued when he came to Canada, and became part an informal network of activists, officials and medical professionals who banded together first during the HIV crisis and then the heroin overdose crisis.

Vancouver's 2002 municipal election was fought in part over different approaches to drug policy, as explained in a CBC documentary for the National.

So why, more than 15 years later, have innovative policies failed to prevent deaths?

Stigma, toxicity of drug supply remain deadly 

Kendall said that harm reduction is an emergency response — but fails to address the toxicity of the drug supply, or reframe the way drug use is approached.

"We haven't been able to control the illicit drug supply, or keep fentanyl out of it, or change drug policy so that we can decriminalize personal use and treat it as health problem rather than law enforcement problem," he said.

Both Kendall and MacPherson say it's virtually impossible to imagine a scenario where harm reduction services are scaled up to the point that everyone could have access — and argue that decriminalization is the only long term approach that will save lives.

"If it was toxic food, the government would replace the food, if it was toxic water, they'd truck in water," said MacPherson.

"Unfortunately, for drug policy, a lot of people have to die before we get the courage to think of new more radical approaches."