e-4292 (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. While there are a number of complex factors that contribute to the high rates of overdoses 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 deaths 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 orders 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 powers 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, Yukon declared a substance use health emergency in January 2022. In addition to provincial and territorial emergency declarations, some Indigenous communities have also declared emergencies in response to rising substance use-related harms and deaths.

The Government of Canada has publicly recognized the overdose crisis is a public health crisis. Canada is committed to continued action using the broad range of powers at its disposal and to take steps to end overdose deaths and substance-use related harms. Canada’s approach to addressing the overdose crisis and substance use-related harms 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 and keep our communities safe. Recognizing the need for comprehensive approaches to save lives, our government supports a full range of integrated, evidence-based services and supports, including improving access to treatment and harm reduction; increasing awareness, prevention and stigma reduction activities; further building the evidence base; and strengthening enforcement to address illegal drug production and trafficking.

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 a 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 $500 million to support more than 380 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. 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 for greater access to pharmaceutical-grade alternatives to the toxic illegal drug supply – a practice often referred to as safer supply. As of June 2023, Health Canada has supported 31 safer supply pilot projects across Canada through SUAP representing total funding commitments of over $100 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 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, and 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 (SCS) across Canada and also proactively issued exemptions that allow provinces and territories to establish new temporary Urgent Public Health Need Sites – also known as overdose prevention sites – within existing shelters or other temporary sites, as needed. Since January 2016, the number of federally approved SCS has grown from one to 40. Since 2017, they have received over 4.3 million visits, responded to almost 50,000 overdoses, and made 257,000 referrals to health and social services [as of October 2023].

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 November 2023, there are 30 federally authorized SCS that are authorized to conduct drug checking in Canada, and 5 federally authorized sites that offer 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, urgent public health need sites 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 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.

We will continue to use all the tools at our disposal to respond to this crisis and to keep communities safe. Our government works closely with domestic and international partners to address the toxic illegal drug supply that is driving substance use harms and overdose 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. Our 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.

With respect to the call for immediate collaboration with provinces and territories, 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.

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, our 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.

Our government is committed to 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 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 that alternatives to prosecution should be considered for the personal possession of drugs, except 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 will not be subject to criminal charges for the personal possession of small amounts of certain illegal drugs. Instead, individuals will 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 remains committed to examining all options and evidence to respond to this tragic and complex public health crisis to help reduce harms and save lives, while also ensuring the safety of communities across the country.

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.