441-02041 (Health)

The 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. While there are a number of complex factors that contribute to the high rates of overdose that we are seeing today, a major driver is the increasingly toxic and unpredictable illegal drug supply, where fentanyl remains widespread and we have observed the rise or emergence of other substances, including stronger opioids, stimulants, and sedatives. In 2022, approximately four out of every five opioid-related overdose death involved fentanyl. The cost of substance use-related harms is not limited to the loss of lives alone and, more broadly, impacts health, social well-being, and public safety.

The Government of Canada takes this crisis very seriously and is committed to working together with all levels of government, Indigenous Peoples and communities, partners from law enforcement, criminal justice, health and social systems, and people with lived and living experience and other key stakeholders, to take urgent action and leverage every available tool to save lives and work towards an end to this national public health crisis.

Provinces and territories have a range of tools and authorities to address the ongoing overdose crisis in their respective jurisdictions. This includes the power to declare a public health emergency which allows a provincial or territorial government to access and exercise extraordinary measures in response to a significant increase in opioid-related deaths as was the case for British Columbia in April 2016 and Alberta in May 2017. More recently, in January 2022, Yukon declared a substance use health emergency. In addition to provincial and territorial emergency declarations, some municipalities and Indigenous communities have also declared emergencies in response to rising substance use-related harms and deaths.

Invoking the federal Emergencies Act is intended to serve as a tool of last resort to ensure the safety and security of Canadians in cases of temporary, critical national emergencies that cannot be addressed with existing federal, provincial or territorial laws. As such, 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 substance use-related deaths and harms.

The Government of Canada has publicly recognized the overdose crisis is a public health crisis. The federal government is committed to continued action using the broad range of tools at its disposal and to take steps to end overdose deaths and substance-use related harms. The Government’s approach to addressing the overdose crisis and substance use-related harms is comprehensive, equitable, collaborative, and compassionate, guided by our renewed federal drug strategy – the Canadian Drugs and Substances Strategy (CDSS). The renewed CDSS outlines the Government of Canada’s updated plan to address the overdose crisis, and other substance use-related harms in Canada.

Through the renewed CDSS, the Government is taking a holistic approach to addressing substance use and related harms, centered on promoting public health and protecting public safety. This whole-of-government initiative includes timely access to a full range of strategies to help people access the prevention, harm reduction, treatment, or recovery services and supports they need, when and where they need them.

The renewed CDSS uses an integrated approach that brings together prevention and education, substance use services and supports, evidence, and substance controls. New investments include supporting a wide range of activities, such as: community-based supports; streamlining authorizations for supervised consumption sites (SCS) and drug checking services; vital data collection on substance-related harms and lab-based analysis of the illegal drug supply; an overdose monitoring platform for law enforcement and other first responders; and further action with our partners to disrupt illegal drug production and trafficking and stem the global flow of these devastating substances. By using a wide-range of tools, we have the best opportunity to end this crisis, protect communities and save lives.

Since 2017, the federal government has made commitments of more than $1 billion and has taken significant action to address the toxic drug and overdose crisis and substance use-related harms. This includes a Budget 2023 commitment of $359.2 million over five years, starting in 2023-24, with $5.7 million ongoing, to support the renewed CDSS, which will continue to guide the government’s work to save lives and protect the health and safety of Canadians by:

• 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.

These investments have made a difference in reducing overdose deaths and harms. For example, since 2017 through the Substance Use and Addictions Program (SUAP), Health Canada has provided over $565 million to support nearly 390 community-based projects focused on innovative treatment, harm reduction, prevention and stigma reduction activities. More than $26 million of this funding was dedicated to expanding Naloxone awareness, training and distribution across Canada. As of May 2023, these projects contributed to more than 1.5M Canadians being trained on how to respond to an overdose, and more than 69,000 nasal naloxone kits being distributed across the country.

We also invested $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. In addition, the Government of Canada is supporting policies and approaches to build the evidence around innovative care practices, including services that prescribe pharmaceutical-grade medications as an alternative to the highly toxic illegal drug supply for people at high risk of overdose – a practice often referred to as safer supply or prescribed alternatives. As of February 2024, Health Canada has supported 31 prescribed alternatives pilot projects across Canada through SUAP, representing total funding commitments of over $102 million. This includes supporting a range of service delivery projects in British Columbia, Ontario, Quebec and New Brunswick, as well as research/knowledge transfer and exchange projects to help share knowledge amongst stakeholders.

These investments have also improved access to treatment. For example, provinces and territories have used federal investments provided through Budget 2018 for the Emergency Treatment Fund to expand existing treatment approaches, such as services to support youth with substance use disorder, withdrawal management services appropriate for people who use methamphetamine, Rapid Access Addictions Medicine clinics, access to opioid dependence treatments, and culturally-appropriate care for Indigenous communities. Funds have also been used to implement innovative approaches to treatment, including ‘wrap-around’ care and the development of telehealth infrastructure to connect clients in remote and rural settings.

In addition to these investments, the Government of Canada has supported the expansion of supervised consumption services across Canada and also issued exemptions that allow provinces and territories to establish new temporary Urgent Public Health Need Sites (UPHNS)  within existing shelters or other temporary sites, as needed. There are currently 47 SCS offering services in Canada. From October 2017 to September 2023, they have received over 4.4 million visits, responded to over 52,000 overdoses, and made over 411,000 referrals to health and social services. Nobody has died of an overdose in these 47 sites.

Federal funds are enabling new drug checking technologies to be used at SCS and other associated services to provide people who use drugs and health workers with information on the contents of toxic street drugs, including whether they contain deadly fentanyl, benzodiazepines or other toxic substances. This gives people who use drugs the opportunity to make informed decisions that may reduce their risk of overdose. As of February 2024, of the 39  federally authorized SCS, 30 are authorized to conduct drug checking in Canada. In addition, there are 10 federally authorized stand-alone drug checking services. In addition, the Government of Canada held a Drug Checking Technology Challenge (October 2018 to July 2021), that provided a total of $1,724,500 million to nine participants to catalyze innovation in drug checking technologies. Through the renewed CDSS, we will streamline authorizations for SCS, UPHNS and drug checking services with clear public health and public safety requirements for organizations seeking to provide these evidence-based life saving services to Canadians.

We have also made a number of regulatory changes at the federal level to help improve access to medications used in drug treatment 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 as 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.

We will continue to use all the tools at our disposal to respond to this crisis and to keep communities safe. The government works closely with domestic and international partners to address the toxic illegal drug supply that is driving overdose harms and deaths. We continue to equip border agents with the tools necessary to intercept controlled substances. For example, we have made it harder to access chemicals used to make fentanyl by scheduling them under the Controlled Drugs and Substances Act (CDSA) and have also amended legislation to allow border officers to open mail of any weight, in order to stop drugs like fentanyl and carfentanil from entering Canada illegally through the mail system. The government also works with private sector partners to address money laundering of the proceeds of illegal drug trafficking in an effort to dismantle the organized crime groups involved in the supply of these toxic illegal drugs.

The Government of Canada continues to lead efforts to facilitate opportunities for collaboration between jurisdictions, health providers, researchers, people with lived and living experience, community-based organizations, and other partners and stakeholders, to reduce the harms associated with substance use and support efforts to provide a full range of culturally appropriate, evidence-based, and trauma-informed health and social services and supports to meet the diverse needs of people who use drugs.

The Government of Canada is also working closely with provinces and territories to change the way the healthcare system delivers mental health and substance use services to Canadians. On February 7, 2023, the Government of Canada announced it will increase health funding to provinces and territories by nearly $200 billion over 10 years, in order to improve Canada’s health care system. This investment includes $25 billion for shared health priorities, including increasing access to mental health and substance use services and supports. These commitments are in addition to existing bilateral agreements with provinces and territories for health priorities, including mental health and substance use, that were put in place in 2017. These investments will set the foundation for long-term, integrated and sustained health care system change that builds on existing, targeted actions to address mental health and substance use challenges.

We have also established federal, provincial and territorial (FPT) governance tables, including the Special Advisory Committee on the Epidemic of Opioid Overdoses, the FPT Committee on Substance Use (formerly Problematic Substance Use & Harms), and the FPT Assistant Deputy Minister Committee on Mental Health and Substance Use, to facilitate ongoing collaboration and consultation with provincial and territorial partners. In addition, discussions are held with provinces and territories at the Deputy Minister and Ministerial level through meetings of the Conference of Deputy Ministers of Health and the Federal, Provincial, Territorial Health Minister’s Meetings.

To inform the federal approach, the government also regularly consults with stakeholders and has convened several expert advisory groups, including people directly impacted by substance use. Health Canada established the People with Lived and Living Experience Council, the Expert Advisory Group on Safer Supply and the Expert Task Force on Substance Use as part of this engagement strategy. We recognize 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 so 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.

With respect to prescribed alternatives, a number of researchers in academic institutions across Canada are studying this emerging approach, contributing to the evidence base that can inform decision-making at local, provincial and federal levels. Prescribed alternatives builds on the evidence from medication-assisted approaches to the treatment of substance use disorder, with prescribed alternatives services having a number of unique goals and approaches that need to be assessed and evaluated on their own merits.

The evidence base around prescribed alternatives is still developing, but is growing. Existing studies and evaluations of prescribed alternatives programs are showing some promising early outcomes, including:

• reduced overdose-related mortality, emergency department visits and hospitalizations; and,
• client reports of reductions in overdoses and illegal drug use, reduced engagement in criminalized activities, access to health and social services, improved trust in primary care providers among clients who face barriers to care, and other quality of life improvements.

Health Canada is supporting several studies of prescribed alternatives. This includes a preliminary assessment of prescribed alternatives pilot projects in Ontario, British Columbia and New Brunswick. The federal government, through the Canadian Institutes of Health Research (CIHR), is also supporting a study being conducted by a research team from the Canadian Research Initiative in Substance Misuse. This four-year evaluation research project focuses on program implementation and the short-term health outcomes of 11 of the government funded prescribed alternatives pilot projects. The final results of this study are expected in 2025. Additionally, CIHR has awarded $2 million to the University of Victoria to support a four-year study evaluating the prescribed alternatives initiatives in British Columbia, in partnership with Indigenous leaders, Elders and system partners. We will continue to monitor outcomes of prescribed alternatives, so that the government’s response to the overdose crisis is evidence-based and focused on saving lives.

The government is committed to working to divert people who use drugs away from the criminal justice system 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 personal drug possession charges as well as from breach of some conditions related to personal possession, 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 CDSA. Among other measures, the amendments require 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 CDSA 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 to consider alternatives to prosecution for the personal possession of drugs, except in the most serious cases where public safety concerns arise.

In addition, in May 2022, at the request of the province of British Columbia, a time-limited exemption was granted under the CDSA so that adults 18 years of age and older in the province are not subject to criminal charges for the personal possession of small amounts of certain illegal drugs. Instead, individuals can be provided with information regarding local health and social services. Upon request, they can also receive assistance to connect with those services. This exemption, which is in effect from January 31, 2023, to January 31, 2026, is part of a much broader strategy British Columbia and this Government are taking to help people who use drugs access supports and services, rather than face criminal charges. This time-limited exemption is being supported by rigorous monitoring and a third-party evaluation to gather evidence and data on its impacts and outcomes and inform implementation.

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 items above are some examples of concrete actions taken by the federal government to address the overdose crisis. Please visit the following website for a comprehensive list of all the actions taken to date.

The Government of Canada will continue working with our partners and stakeholders to implement the renewed CDSS and 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 advancing work on the development of standards for mental health and substance use health services. 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.