441-00803 (Health)

The toxic drug and overdose crisis is one of the most serious and unprecedented public health threats in Canada’s recent history, which is having devastating impacts on individuals, friends and families, and communities across the country. The Government recognizes that substance use is a health issue, and is committed to a public health approach to address the crisis.

The Government of Canada also recognizes that the crisis has only become more complex due to the ongoing COVID-19 pandemic. This had led to a more uncertain and toxic illegal drug supply, resulting in tragic increases in overdose-related deaths across the country, as well as reduced access to health and social services due to COVID-related health measures (such as social distancing requirements, isolation requirements, etc.) and staff shortages, such as life-saving harm reduction, pharmaceutical-grade alternatives and treatment services. Health Canada and the Public Health Agency of Canada have been working with provinces, territories, municipalities, Indigenous communities and other partners, including researchers, advocates and people with lived and living experience, to ensure that people who use drugs can continue to access the treatment, harm reduction and other services they need.

The Government of Canada remains fully committed to addressing the overdose crisis as a health issue and is working with partners across all provinces and territories to save lives. Provinces and territories have a range of tools and authorities to address the ongoing overdose crisis in their respective jurisdictions. For example, provinces and territories fund and deliver the majority of direct social and health interventions, such as naloxone distribution and supervised consumption sites, which are shown to effectively reduce overdoses deaths and harms. Provinces, territories and municipalities also have the power to declare a public health emergency in response to a significant increase in overdose-related deaths, as was the case for British Columbia in April 2016 and Alberta declaring a public health crisis in May 2017. More recently, Yukon declared a substance use health emergency in January 2022. The declaration of a provincial and territorial public health emergency allows a provincial and territorial government to access and exercise extraordinary powers to address a crisis.

The Emergencies Act is not an appropriate mechanism to address the ongoing overdose crisis, which requires a longer-term, sustained, and multi-jurisdictional effort to address the complex, interrelated health, social and economic factors driving opioid-related deaths and harms. At the federal level, we have taken action by: reducing legislative and regulatory barriers; developing new prescription guidelines and marketing restrictions; launching a public awareness campaign; improving the knowledge base; supporting treatment, safer supply and harm reduction initiatives across Canada; working with domestic and international partners to reduce the illegal drug supply; and, providing emergency funding to provinces and territories.

The Government of Canada recognizes that substance use is a public health issue, not an issue for the criminal justice system. We are committed to a public health approach to address the crisis. Canada’s approach to substance use issues is comprehensive, collaborative, and compassionate, guided by our federal drug strategy – the Canadian Drugs and Substances Strategy (CDSS). The CDSS takes a public health-focused approach and lays out our framework for evidence-based actions to reduce the harms associated with substance use in Canada.  In the context of the worsening overdose crisis, and taking steps to reduce harms and deaths related to substance use, the Government is placing particular focus on:

• ensuring that harm reduction services are available to Canadians who need them;
• working with stakeholders to reduce stigma directed at people who use drugs, which acts as a barrier to accessing critical health and social services and often leads to social isolation and further risk of harms;
• continuing to work with provinces and territories to improve access to evidence-based treatment options;
• continuing to address illegal production and trafficking, with a focus on organized drug crime; and,
• implementing additional surveillance and research activities that will further build the evidence base and allow us to pursue innovative solutions to this public health crisis.

Since 2017, the federal government has taken significant actions and made commitments of more than $800M to address the toxic drug and overdose crisis and substance use-related harms. Recent examples of key federal investments in this area include:

• Nearly $350M  to the Substance Use and Addictions Program (SUAP) between 2017-2022  in support of community-based organizations responding to substance use issues, including investments to help them provide direct services in a COVID-19 context and to scale-up key lifesaving measures and increase access to a safer drug supply as an alternative to the contaminated supply;
• $150 million through the one-time Emergency Treatment Fund to provinces and territories, which, when cost-matched with the provinces and territories, will result in an investment over $300 million to improve access to evidence-based treatment services;
• $45 million to develop national standards for mental health and substance use services, in collaboration with provinces and territories, health organizations and key stakeholders, to address long-standing challenges in the delivery of mental health and substance use services and supports across the country; and,
• $22.8 million in public education through national and targeted advertising, partnerships and experiential marketing on the risks of opioids, overdose awareness, harm reduction and stigma awareness and reduction.

Of note, under SUAP, more than $20 million has been allocated to fund Naloxone distribution, education and training. In addition, through SUAP, the Government of Canada is supporting policies and approaches for greater access to pharmaceutical-grade alternative to the toxic illegal drug supply – a practice often referred to as safer supply. As of September 2022, Health Canada has supported 28 safer supply pilot projects across Canada through the Substance Use and Addictions Program, representing total funding commitments of over $77.8 million. This includes supporting a range of service delivery projects in British Columbia, Manitoba, Ontario, Quebec and New Brunswick, research/knowledge transfer and exchange projects, and a National Safer Supply Community of Practice to help share knowledge amongst stakeholders.

Health Canada has supported the rapid expansion of supervised consumption services across Canada. Since January 2016, the number of federally approved supervised consumption sites (SCS) offering services grew from 1 to 39. Health Canada also proactively issued exemptions that allows provinces and territories to establish new temporary Urgent Public Health Need Sites – also known as overdose prevention sites – within existing supervised consumption sites, shelters or other temporary sites, as needed. Urgent Public Health Need Sites, unlike supervised consumption sites, are temporary locations that can be set up rapidly to address the overdose crisis. Both share the goal of reducing overdose deaths.

We have also made a number of regulatory changes at the federal level to help improve access to medications used in drug treatment and safer supply programs, including:

• issuing a class exemption (an exemption authorized to a group of people, such as pharmacists, to conduct specific activities with controlled substances) to make it easier for patients to access the medications they need;
• approving injectable hydromorphone as a treatment option for patients with severe opioid use disorder;
• approving injectable diacetylmorphine as a new treatment option for patients with severe opioid use disorder; as well facilitating the prescribing and dispensing of methadone and diacetylmorphine; and  
• authorizing nurses who provide health care services at a community health facility to conduct certain activities with controlled substances.

The Government recognizes that social determinants of health, such as poverty, discrimination, and trauma, can place individuals at an increased risk of substance use harms and that the approaches to reduce these harms require sustained efforts and supports from diverse systems. We continue to work closely across federal departments to ensure that federal actions on mental health and addictions, homelessness and housing, poverty, and reconciliation are coordinated and synergistic. We are also committed to engaging collaboratively with provinces and territories, First Nations, Inuit, and Métis communities, and other stakeholders to advance whole-of-society approaches to these issues.

In response to substance use harms and the opioid overdose crisis, the Government of Canada is regularly consulting with stakeholders and has convened several expert advisory groups, including people directly impacted by substance use. The Government regularly engages with people with lived and living experience (PWLLE) and organizations that represent them, including; regular bi-lateral meetings with key organizations, participation on projects teams, facilitating PWLLE engagement in government and ministerial events and meaningful consultations in order to better understand their perspectives of substance use and on-the- ground realities (e.g., roundtables, Knowledge Exchange Series, etc.).

Health Canada established the PWLLE Council, the Expert Advisory Group on Safer Supply and the Expert Task Force on Substance Use as part of this engagement strategy. We have established federal, provincial and territorial governance tables, including the Special Advisory Committee on the Epidemic of Opioid Overdoses, the Federal/Provincial/Territorial Committee on Substance Use (formerly Problematic Substance Use & Harms), and the Federal/Provincial/Territorial Assistant Deputy Minister Committee on Mental Health and Substance Use to facilitate ongoing collaboration and consultation with provincial and territorial partners.

The Government of Canada continues collaboration between jurisdictions, health providers, researchers, people with lived and living experience, stakeholders and partners such as community-based organizations to reduce the harms associated with substance use and providing people with the culturally appropriate and trauma-informed support they need.

Some stakeholders have reported that the criminalization of illegal drugs for personal use can, increase risks of overdose and other harms, increase barriers to care and perpetuate stigma. Canada recognizes that stigma can prevent people who use substances from accessing the health and social services that they need and contributes to negative health outcomes. To help reduce stigma in police interactions with people who use drugs and to avoid causing more harm, Public Safety Canada launched an online training module specifically designed for law enforcement members in September 2020. The training raises awareness of the harms associated with substance use stigma and provides law enforcement members with practical tools to support their interactions with people who use drugs.

The federal government is committed to using every tool at its disposal and examining all evidence to respond to the tragic increase in overdoses and to help save lives, while also ensuring the safety of communities across the country. The Government is working to divert people who use drugs away from criminal justice systems and toward supportive and trusted relationships in health services and social supports, when needed. For example, the Good Samaritan Drug Overdose Act was passed into law in May 2017, providing some legal protection from simple drug possession charges for individuals who seek emergency help during an overdose.

Furthermore, Bill C-5, which received Royal Assent on November 17, 2022, made legislative amendments to the Criminal Code and to the Controlled Drugs and Substances Act (CDSA). Among other measures, the amendments encourage police and prosecutors to consider alternative measures – including diverting individuals to treatment programs – instead of laying a criminal charge or prosecuting individuals for personal drug possession. These amendments also repealed mandatory minimum penalties for certain offences in the Controlled Drugs and Substances Act to reflect the Government’s public-health-focused approach to substance use. These measures are consistent with the August 2020 Guidelines issued by the Public Prosecution Service of Canada directing prosecutors that alternatives to prosecution should be considered for the personal possession of drugs, except where public safety concerns arise.

In May 2022, at the request of the Province of British Columbia, the Minister of Mental Health and Addictions granted a time-limited exemption under the Controlled Drugs and Substances Act (CDSA) so that adults 18 years of age and older in the province will not be subject to criminal charges for personal possession of small amounts of certain illegal drugs. Instead, where appropriate, individuals may be provided with information regarding local health and social services. Upon request, they could also receive assistance to connect with those services. British Columbia requested this exemption, and it is an additional way that the federal government is supporting the province’s comprehensive approach to the overdose crisis. This time-limited exemption will be supported by rigorous monitoring and a third party evaluation to gather evidence and data on its impacts and outcomes. The results will help inform Canada’s comprehensive approach to addressing substance use harms. We have also received a request from Toronto Public Health and we are working with them toward a complete exemption request. Our Government continues to work in close partnership with various jurisdictions that have submitted an application to ensure both public health and public safety considerations are included for a successful application.

Moving forward, under the mandate of the new Minister of Mental Health and Addictions and Associate Minister of Health, Health Canada will continue working with its partners and stakeholders to advance a comprehensive federal strategy to address substance use in Canada, including the toxic drug and overdose crisis. Canada will continue to support provinces, territories and Indigenous communities to improve access to a full range of evidence-based treatment and harm reduction services, in addition to leading efforts to reduce stigma and create national standards for substance use treatment programs. The Government of Canada believes that substance use is a health issue, and is committed to examining all options and evidence to respond to the tragic increase in overdoses and to help save lives, while also ensuring the safety of communities across the country.