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British Columbia is at the centre of Canada’s toxic drug crisis. More than 18,000 people have died of drug poisoning since the province declared a public health emergency in April 2016. In 2024, B.C. coroners office reported that unregulated drugs were the leading cause of death for British Columbians under 60, killing more people than homicides, suicides, accidents and natural disease combined. While the numbers have declined since their 2023 peak, the emergency continues. 

Public safety, crime and visible “street disorder” have become central themes in conversations about mental health and substance use. As the provincial election approaches, these concerns are shaping how parties talk about the crisis and the policies they propose. 

Mental health and substance use are policy issues, not individual failures. They are shaped by whether people have stable housing, enough income, quality care and meaningful connections to their communities. In the last 10 years the province has invested in harm reduction and early interventions, it has also expanded its reliance on involuntary treatment and turned toward criminalization. 

A health system that only intervenes once someone reaches crisis will always be playing catch-up. With the election weeks away, the public should know what B.C. has built, where it is falling short and what the next government should do differently. 

A decade of harm reduction saved lives 

Researchers, policy experts and people with lived experience have been instrumental in pushing harm reduction policies forward. Harm reduction policies aim to keep people who use substances alive and safe, without requiring them to stop using first in order to access support programs. Since 2017, the province has committed more than $3.15 billion to mental health and substance use (MHSU) care. 

B.C. has more supervised consumption and overdose prevention sites than any other province. It has also directed $50 million toward naloxone (overdose reversal medicine), distributed through community sites and pharmacies across the province. Take home naloxone kits have averted nearly 40,000 deaths since 2019. These measures keep people alive, but they do not change the drug supply itself, which remains toxic and unpredictable. 

The most promising investments bring care into communities before a crisis becomes a police or hospital matter. In 2024, community crisis response teams answered more than 5,000 calls and referred just 1.3 per cent to police. The province has also expanded early intervention programs, integrated child and youth teams and Indigenous-led recovery services. 

Some of this progress rests on federal funding. Bilateral agreements worth $82 million a year have been a stable funding source for these crucial services, but are set to expire at the end of March 2027. The next government should secure their renewal and preserve dedicated MHSU funding outside general health transfers. 

Public health gives way to public order 

B.C. is backing away from public health approaches. 

Harm reduction services are closing. The Thomus Donaghy site, the only public overdose prevention site in Vancouver’s city centre, closed after logging more than 149,000 visits and responding to 480 overdoses since 2021. Vancouver Coastal Health planned a replacement site for Helmcken Street, but Mayor Ken Sim opposed the relocation, citing concerns about public disorder and impacts on nearby businesses. In August 2026, the provincial government caved and cancelled it.

The end of B.C.’s decriminalization pilot reflects a similar shift. In 2023, B.C. decriminalized personal possession of small amounts of certain illicit drugs. Researchers and advocates argue that criminalization increases stigma, prevents people from asking for help and entrenches risky drug use.

Portugal decriminalized drug use in 2001 and paired it with substantial investment in health and social services, including outreach and harm reduction. In the years that followed, rates of drug-related deaths, HIV infections and problematic drug use fell. Portugal’s experience shows that decriminalization, paired with wraparound services, can reduce drug related harms and improve public safety.

B.C.’s policies did not get the same investment or coordination. Critics judged both harm reduction and decriminalization by whether the policies could quickly reduce visible street disorder, though each is just one part of a broader public health response. When that disorder persisted, these policies became easier to discredit and abandon, despite their role in preventing deaths and connecting people to care. 

The provincial government substantially narrowed the pilot in 2024 when it amended the policy’s scope to only allow private residences and designated health care sites—prohibiting possession in nearly all other public spaces. The province then phased out this limited program entirely in January 2026.

Despite its limitations, early research found that Indigenous youth felt more able to access harm reduction services under the pilot. B.C. should try decriminalization in earnest, within a broader expanded system of care.

Coercion in place of care

The most troubling part of B.C.’s record is its growing reliance on involuntary care. 

In 2025, B.C. had 270 publicly funded detox beds across the province—only 57 have been added since 2017. Access to psychiatric services also varies widely, with reported wait times ranging from one day to more than a year depending on location and urgency. The availability of timely, voluntary services remains a challenge across the province.

Geography compounds the issue. Northern Health, which covers roughly the entire northern half of B.C. territory, has the highest toxic drug death rate of any health authority, at 58 per 100,000 people. Residents in rural and remote communities can travel hundreds of kilometres for services that should be available closer to home.

Meanwhile, B.C. has the highest rate of involuntary hospitalization in Canada. Between 2016 and 2021, physicians admitted more than 20,000 people a year under the Mental Health Act. Budget 2026 allocated $131 million to specialized and intensive treatment, including involuntary treatment. This was the budget’s only net new investment in adult MHSU services.

The Canadian Mental Health Association (CMHA) describes involuntary treatment as one of the most expensive ways to address the MHSU crisis. When people cannot get support early, costs shift to hospitals, police and the justice system. CMHA cites provincial estimates that MHSU related harms cost the B.C. economy $6.6 billion a year. 

Researchers have also called into question the safety and efficacy of this approach, pointing to limited evidence that involuntary treatment improves outcomes. A physician usually decides whether someone can be detained under the Mental Health Act. This leaves room for racial and gender bias and overrides people’s ability to make decisions about their lives, including decisions about treatment and risk. There is also a higher possibility of overdose and death after release for people who use substances. 

In B.C., people leaving treatment return to some of the least affordable living conditions in Canada. Average rent in the province runs about $2000 a month for a one bedroom apartment. Those who land in unstable housing or poverty risk falling back on the same ways of coping. 

First Nations people make up 3.4 per cent of B.C.’s population but accounted for 15.8 per cent of toxic drug-related deaths in 2025. For many Indigenous communities, the legacy of colonialism and residential schools has contributed to intergenerational trauma. The emphasis on involuntary treatment ignores these social determinants of health and well-being. 

Priorities for the next government

Recent policy has focused heavily on responses to visible street disorder and people experiencing acute mental health and substance use challenges. Yet children and youth, trades workers, single mothers, seniors on fixed incomes and others who need MHSU services get far less attention. 

CMHA polling found that 77 per cent of British Columbians want governments to make mental health services more affordable and accessible through public funding. 

The next government should broaden access to MHSU services such as counselling and psychotherapy while also addressing the social and economic conditions that shape public health. 

A balanced approach to the issue would include:

  • Investing in poverty reduction and affordable and non-market housing. 
  • Protecting overdose prevention and supervised consumption sites, alongside community-led crisis response. 
  • Expanding drug checking and evidence-informed safer supply programs to reduce exposure to the toxic unregulated drug supply. 
  • Providing stable, multiyear funding for voluntary, prevention oriented and Indigenous-led services.
  • Reporting publicly on spending, service quality and outcomes, backed by independent review and minimum wait time standards. 

B.C.’s response cannot begin and end with treatment beds, police and involuntary hospitalization. The next government must fund services that reach people before they are in crisis and strengthen the social and economic supports that make recovery possible. 

It’s time B.C. stopped scapegoating harm reduction, decriminalization and the people who rely on these services, and took responsibility for building a broader system of care that addresses the crisis at its roots. 

About the author

Rachel Pettigrew

Rachel Pettigrew (she/they) is a research assistant at the Canadian Centre for Policy Alternatives. Drawing on a degree in sociology and a Master of Social Work, their work combines policy research and advocacy to advance the interests of workers, communities and the environment amid political, economic and technological change.