Donald MacPherson is the executive director of the Canadian Drug Policy Coalition, a recipient of the Lifetime Achievement Award by the BC Centre on Substance Use, and author of the “four pillars” drug strategy. Scott Bernstein is the director of policy for the Canadian Drug Policy Coalition.

It was another International Overdose Awareness Day on Saturday but it’s not clear whether awareness is causing real change. While the death toll continues to devastate individuals, families and communities with no end in sight, policies stagnate – with the latter fuelling the former. Between 2016 and 2018, 11,577 people died from opioid-related overdoses, the vast majority of them a result of poisoning by the toxic drug supply plaguing the illegal drug market. First responders are fatigued with grief. Frontline workers spend much of their time administering naloxone – the life-saving medication that brings people back from the edge of death. But those who can’t access harm-reduction services are still dying.

The piercing sound of sirens is commonplace in Canadian cities as 911-overdose calls become shockingly routine. Grief never does.

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This is a bleak preamble to the reality that a tipping point may be near – a point when Canadians come to understand that our current drug-policy framework in Canada stands in the way of provinces and local health authorities mounting robust public-health responses to the devastating overdose crisis. Recent calls for action from health authorities in Canada – Vancouver Coastal Health, Toronto Public Health and Montreal Public Health – demonstrate a rapidly changing discourse on what might actually work to stem the tide of deaths from overdoses in Canada.

These authorities’ chief medical-health officers reviewed the evidence and concluded that current policies are not only creating much of the harm caused to people who use drugs, they are a catastrophic failure when it comes to responding to the problem: A toxic supply of illegal drugs killing thousands of Canadians. In short, our drug policies are making things worse, not better. These findings prove that criminalizing and stigmatizing the very people at risk of overdose is not an evidence-informed public-health response.

In a 2018 report, Toronto Public Health said: “The evidence on the health and social harms of our current criminalization approach to illegal drugs as well as that of alternative approaches such as decriminalization and legal regulation strongly support the need to shift to a public health approach to drugs in Canada.” Montreal Public Health’s Mylène Drouin also responded in support of Toronto’s calls for a rethink of our approach. This July, Vancouver Coastal Health called not only for decriminalization of drugs for possession for personal use but also for legal regulation of currently illegal drugs in an effort to deliver a safe supply of drugs to people at risk of overdose. “We know that what drives deaths most is the toxicity of the illegal drug supply, and unless we can replace that with a regulated alternative, we’re going to continue to see deaths,” chief medical health officer Patricia Daly said.

Public health leaders in Canada realize that moving toward a legally regulated supply of drugs to replace the toxic and deadly criminally controlled supply, with all its negative impacts on public safety, is in the best interests of the public health and safety goals of Canadians. While many have called for change before, it has taken the depth of the human tragedy currently unfolding to drive home the urgency of moving from recommendations to action. And the work has just begun.

Given the dire situation across Canada, there is need for clear-headed, innovative and fast action supported by evidence to change our approach. In drug policy, as in the discourse on climate change, the coming federal election will pit science against politics with the lives of so many Canadians on the line. We sincerely hope that the evidence speaks for itself and politicians of all stripes will support our public health leaders to begin to turn the corner on the overdose crisis. Death from drug overdose is preventable – but only if we are willing to make policy changes that can save lives. Next year, when we mark International Overdose Awareness Day, let us not feel the same sense of despair.

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