A harm reduction primer - Martin Girard for Victoria Municipal Council!

I wrote in An insider’s guide to homelessness that drug use is a different problem, which I think deserves its own article. So in this piece I shall elaborate on what harm reduction is and why it matters.

There is a lot of misinformation in the media that is fuelling a false debate between harm reduction and recovery, and higher levels of government haven’t been properly informing the public about how the system works, leaving most people in the dark pertaining to drug policy.

For example, the Downtown Victoria Business Association has recently issued a statement calling for the closure of supervised consumption sites, associating open drug use with a concentration of services downtown. The problem is that the proposal rests on basic factual errors which leads the association to obliviously argue against the best interest of its members.

Don’t just take my word for it, listen to Inspector Conor King of the Victoria Police Department:

In my experience this whole drug crisis has been one meandering journey of unintended consequences, time and time again. And what I worry about is the unintended consequence of moving a public facing supervised consumption site out of an area where a need is very high. And if the people don’t follow then you’re going to have people using drugs on the street, because there is no supervised consumption site.
Inspector Conor King, Victoria Police Department

To put things into perspective: when the police and drug user advocates agree on something, Hell freezes over.

So in this article I go through the topic of harm reduction from the beginning, remaining as factual as possible and providing ample references, with a focus on services available in Victoria. Then you’re free to make up your own minds about drug policy, having at least the basic facts straight.

What are street drugs?

In one short sentence: street drugs are overwhelmingly prescription medication.

This may come as a shock to many of you, but it is the undeniable truth.

For one, fentanyl is a prescription opioid painkiller, mostly used in hospital settings but occasionally dispensed directly to patients. It may come in patches, in pill form, or delivered intravenously.

Another is methamphetamine, which is available by prescription in the United States under the brand name Desoxyn for the treatment of extreme Attention-Deficit and Hyperactivity Disorder (ADHD) cases.

Then there are benzodiazepines, which are frequently prescribed to treat sleep or anxiety disorders under the brand names Ativan, Xanax, or Valium.

Of course the street supply may differ substantially from pharmaceutical sources. Usually the former is manufactured by criminal organizations having little care for the safety of their products, unlike the latter which are closely monitored by government bodies. In fact, street drugs are commonly contaminated, either cut to stretch out the supply or supplemented with unsuspected substances increasing their potency, even some clearly not meant for human consumption like animal tranquilizers.

A smaller but significant portion of the street supply consists of diverted prescription medication for those who can afford the premium. Otherwise illicit drug users are reduced to taking their chances with whatever comes with ‘down’, which is typically a random mix of stimulants (or ‘uppers’, like methamphetamine) and depressants (or ‘downers’, like fentanyl or benzodiazepines).

Since the street drug supply is unregulated, the only way to be sure of its contents is to test drug samples with a device called a chromatograph. Such a service is provided for free by Substance, a project run by the University of Victoria; its office is at 1802 Cook Street.

Avoid consuming an untested substance obtained from the illicit market, even if you believe it comes from a reliable source; it only takes one moment of carelessness to overdose and die.

Who are drug users?

Every drug user is first and foremost a mother’s child.

The demographics of drug users, whether those taking street drugs or abusing prescription medication, is quite broad, ranging across every age group, education level, and socioeconomic status.

Drug use is largely associated with homelessness, and there is indeed significant overlap. That being said, only a minority of homeless people use street drugs, and conversely only a minority of drug users are homeless. I elaborate on the topic in An insider’s guide to homelessness.

Recreational drug use is fairly common, especially cocaine among wealthier people, but it isn’t predominant. Usually people use drugs to treat a medical condition, cope with stressful conditions, or simply because they are addicted.

Let’s take methamphetamine, for example. Here’s an excerpt from an academic paper titled “We’re Supposed to Be Asleep?” Vigilance, Paranoia, and the Alert Methamphetamine User:

As CNS stimulants, amphetamine drugs lead to increased heart rate, sleeplessness, constricted blood vessels, decreased appetite, and increased alertness (Goode 2008; Rasmussen 2008). These properties have led to the use of amphetamine drugs for psychiatric and medical disorders such as the treatment of attention deficit disorder, depression, narcolepsy, and obesity (Rasmussen 2008). The drugs’ stimulant qualities also make them appealing for a variety of illicit and off-label purposes: late-night studying (McCabe et al. 2005; Quintero and Nichter 2011), increased work hours and productivity (Appel 2008; Crampton et al. 2008), weight loss (Brecht et al. 2004; Joe 1995), housework/child care (Dluzen and Liu 2008; Joe 1995), and recreation, including to enhance sexual and social experiences (Sherman et al. 2008; Dluzen and Liu 2008) and to achieve a euphoric high (Brecht et al. 2004).

I know from experience that the use of methamphetamine is common among night shift workers. It is also common among university students struggling with both studies and employment, when the effect of prescription stimulants wears off. Homeless individuals often use it to remain awake when denied safe shelter. And then sometimes it’s just teenagers being teenagers, as in the case of a University of Victoria student who died of an overdose after snorting a substance she and her friends had the misfortune to stumble upon.

Many become addicted to hard drugs following exposure to prescription medication in clinical settings, either during surgery or being prescribed opioid painkillers by a family doctor. The number one ‘gateway drug’ is actually oxycodone, at the centre of a massive overprescription racket; OxyContin manufacturer Purdue Pharma has recently been dissolved after a rare corporate criminal conviction.

If a loved one of yours is struggling with addiction, you may be interested in Holding Hope, a network of support groups offered by Moms Stop The Harm.

What is harm reduction?

Harm reduction does just what the term states: it mitigates the adverse effects of drug use, either until recovery can be achieved, or on the contrary when continued drug use is a necessity.

Harm reduction supplies were originally intended to prevent the spread of diseases among drug users, such as HIV and hepatitis which can be transmitted by reusing syringes, hence needle exchange programs. Canada’s first sanctioned program in Vancouver in 1989 was actually started the year prior as an unsanctioned initiative run by a recovering heroin addict named John Turvey, who would later be admitted to both the Order of Canada and the Order of British Columbia for his advocacy.

More recently the focus has shifted to reversing opioid overdoses with naloxone, which can be delivered by injection or with a nasal spray, to counter the emergence of fentanyl, whose potency far exceeds that of heroine.

Since the greatest peril for drug users is to overdose alone, supervised consumption sites have emerged to ensure help can be delivered by professionals in emergencies.

And pharmaceutical replacement for street drugs, commonly referred to as a safe drug supply, eliminates the risk of contamination with unwanted substances or that of unexpectedly high potency, the primary causes of overdose deaths. The replacement drug may also be a different substance that is considered less harmful; for example, hydromorphone is the preferred alternative to strong opioids like heroin and fentanyl.

Supervised consumption sites

The most notable harm reduction facilities are supervised consumption sites, which provide safe indoor spaces to people using street drugs, attended by trained professionals ready to intervene in an emergency. No overdose death has been recorded at supervised consumption sites in British Columbia since their inception, despite the more than 18,000 recorded overdose deaths in the province since 2016.

There are currently two sanctioned supervised consumption sites available to the public in Victoria: the Harbour, located at 941 Pandora Avenue (right by Our Place), and another provided by AVI Health and Community Services which is located at 713 Johnson Street.

These sites are nowadays the object of a polemic by detractors depicting them as attractants spreading open drug use across entire neighbourhoods, and calling for their relocation or outright closure. There is no data nor plausible mechanism supporting this assertion. Supervised consumption sites purposefully move drug use indoors, and either closing or relocating them would most likely result in sudden explosion of open drug use in the area according to the Victoria Police Department. Likewise, a recent research paper has reported a reduction in public drug use among participants of a study on supervised consumption sites in Toronto. An average of 249 people use the Harbour’s supervised consumption services each day, according to Island Health.

Supervised consumption service use and high-frequency public injecting among people who inject drugs in Toronto: A cross-sectional analysis (2018–2020)

Highlights

Cross-sectional survey of 700 people who inject drugs in Toronto, Canada (2018–2020).

81% of participants reported any public injecting (at least once) within the past six months, while 15% reported high-frequency public injecting.

Recent supervised consumption service use, reported by 87% of participants, was associated with a lower prevalence of high-frequency public injecting overall and among those experiencing mostly unstable housing.

Reasons for public injecting, despite SCS use, were related to lack of housing, convenience, accessibility challenges, and SCS operational barriers.

Frishta Nafeh, Zoë R. Greenwald, Matthew Bonn, Jolene Eeuwes, Kate Atkinson, Steffanie A. Strathdee, Mohammad Karamouzian, Dan Werb, Supervised consumption service use and high-frequency public injecting among people who inject drugs in Toronto: A cross-sectional analysis (2018–2020), International Journal of Drug Policy, Volume 156, 2026, 105473, ISSN 0955-3959,

Safe drug supply

Despite the bad press, drug replacement therapy is a lot more prevalent than critics appreciate. By far its most common form is nicotine replacement therapy, delivered with patches, nasal spray, or chewing gum, for people trying to quit smoking tobacco. Also, medications like naltrexone and acamposate have been approved for the treatment of alcohol use disorders.

Likewise, Opioid Agonist Treatment treats opioid withdrawal symptoms by replacing powerful opioids with some reducing dependence. The most commonly prescribed OAT drugs are methadone and buprenorphine, which are typically dispensed by specialized pharmacies under mandatory witnessed consumption.

A spectacular example of harm reduction leading to recovery from substance abuse. *Source: Facebook.*

Unfortunately, OAT doesn’t work for everyone. Some opioid users do not respond favourably to either methadone or buprenorphine. Also, Health Canada has yet to approve a replacement drug for stimulants like methamphetamine. In those cases, patients may be prescribed the actual drug, from a pharmaceutical source rather than the illicit drug market. The main rationale of course is to avoid the likelihood of contamination with undesirable substances, which may result in death or unwanted side effects.

There used to be safe supply pilot programs funded by Health Canada between 2020 and 2025; those were terminated without explanation, against the advice of experts. One such program was MySafe, which automatically dispensed hydromorphone to participants authenticated using their biometric signature; Victoria participated in the pilot.

British Columbia also runs a prescribed drug supply at the provincial level, called Prescribed Alternatives. Patients used to take their drugs home, but this practice has been discontinued in December 2025 in favour of witnessed consumption over concerns that a significant amount of medication was being diverted to the illicit market. The number of patients has plummeted over the years, from about 4500 in March 2023 to 2200 in February 2025. While no data has been released pertaining to the current number of patients, anecdotal evidence suggests that this number has dropped even further since December 2025, leading to questions about the province’s commitment to the program.

In Victoria, Prescribed Alternatives is made available via AVI Health and Community Services as part of its SAFER program; its clinic offers alternatives to the unregulated drug supply. The program has a capacity of 75-100 clients, and 89 were confirmed in February 2021. The current number of clients is unknown, as is the proportion of Prescribed Alternatives beneficiaries among them; current figures are again most likely lower than at the onset of the program.

Contrary to popular belief, the cost of prescribed safe supply isn’t universally covered by PharmaCare. Although OAT is indeed provided for free, Prescribed Alternatives may not be, although the indigent are usually eligible for extended coverage.

While a safe drug supply is properly regulated and controlled, it is not necessarily pharmaceutical. Tobacco, alcohol, and cannabis are examples of drugs that have been legalized under strict regulations but are available over the counter. Bars and pubs may also be construed as safe consumption sites for alcohol users, albeit lacking the strict safeguards of supervised consumption sites for hard drugs. Cannabis may be procured with or without a prescription, patients having the option of ordering pharmaceutical-grade products from licensed providers while retaining the ability to purchase from retail stores.

It is also worth noting that a safe drug supply isn’t incompatible with a recovery plan. Replacement drugs are only prescribed for as long as needed, which for some patients may only be long enough to taper off usage until completely weaned off the substance.

Mother running across B.C. for safe supply

Compassion clubs

As just stated, not every safe drug supply provider is a government-regulated pharmaceutical entity, and this extends to the illicit drug market. Some entities address shortcomings in legal offerings for patients in need by providing drugs outside of a legal framework.

Compassion clubs are run by activists providing a service to vulnerable clients when the legal offering is perceived as deficient. It may be that the specific drug isn’t legally available in a given jurisdiction, that access is limited to invitation-only government pilots, that its potency is inadequate for some patients, or simply that the legal format is prohibitively expensive.

Canada’s oldest compassion club is the Victoria Cannabis Buyers Club, which has been operating since 1996. The club provides high-potency edible cannabis products to patients with medical conditions as varied as chronic pain, epileptic seizures, and cancer. Its offering also provides an off-ramp for many substance use disorder patients.

In June 2015, the Supreme Court of Canada ruled in favour of the club, in a decision which asserted the legality of edible medical cannabis products and paved the way to the legalization of cannabis in October 2018. The compassion club’s legal troubles are far from over, however, as it is challenging a $3.2-million fine issued by the Community Safety Unit for selling cannabis without a license. Mayor Marianne Alto has publicly come out in support of the club with a letter to Attorney General Niki Sharma and Minister of Public Safety Nina Krieger requesting that any further enforcement be deferred until the conclusion of judicial proceedings.

The Victoria Cannabis Buyers Club is located at 1625 Quadra Street.

Another such club was the Drug User Liberation Front, founded in 2022 by Vancouver activists Jeremy Kalicum and Eris Nyx, for the purpose of avoiding drug overdoses by untested illicit drugs. Their novel concept was to dispense tested street drugs provided from the illicit market via so-called dark web marketplaces, thus combining a dispensary with a drug-testing service.

The pair had previously sought approval for an exemption to the Controlled Drugs and Substances Act from Health Canada, only to be declined; the matter is currently before the BC Supreme Court pending judicial review, on the grounds that the decision violates Article 7 of the Canadian Charter of Rights and Freedoms guaranteeing the life, safety, and security of the person. They have recently been convicted of drug trafficking, to the dismay of their many supporters who had rallied across the world to protest their prosecution; the convictions are also on hold pending the said judicial review.

An academic research paper published in 2024 by the International Journal of Drug Policy concluded that the club proved effective in reducing drug overdose deaths among participants of a study:

In this study involving 47 individuals who were admitted to an unsanctioned compassion club, we found that enrolment in the program was associated with a reduction in any type of non-fatal overdose as well as non-fatal overdose involving naloxone administration. These findings, suggesting that enrollment in DULF’s intervention likely decreased overdose rates, appear to be amongst the first in a growing body of research on the impacts of a safer drug supply that does not employ the medical system.
Jeremy Kalicum, Eris Nyx, Mary Clare Kennedy, Thomas Kerr, The impact of an unsanctioned compassion club on non-fatal overdose, International Journal of Drug Policy, Volume 131, 2024, 104330, ISSN 0955-3959, https://doi.org/10.1016/j.drugpo.2024.104330.

Decriminalization

Drug prohibition has been an unmitigated disaster, failing to achieve any of its purported goals. It has caused mass incarceration, enabled powerful drug cartels, and worsened the dug toxicity crisis. In fact, authorities have even failed to keep drugs off carceral institutions, which are the territory of street gangs that offer ‘free drugs’ to fellow inmates in order to get them perpetually addicted and indebted, thus fuelling the vicious cycle of homelessness, addiction, and crime.

Criminalisation and prohibition have failed to reduce drug use and failed to deter drug-related crime. These policies are simply not working—and we are failing some of the most vulnerable groups in our societies.
United Nations High Commissioner for Human Rights Volker Türk

Consequently, advocates worldwide have called for the decriminalization of illicit substances. Portugal has been widely lauded as a pioneer for treating substance use disorder as a public health issue rather than a law enforcement matter. While drug possession remains illegal, offenders are referred for addiction treatment instead of being incarcerated. The integrated model, which combines law enforcement with health care, harm reduction, addiction treatment, and housing, has resulted in a drastic reduction in arrests, incarceration, drug overdose deaths, and spread of sexually-transmitted infections.

Alas, some jurisdictions have failed to replicate those results. Experts attribute disappointing outcomes to merely repealing criminal provisions without implementing a comprehensive pipeline leading to full recovery.

British Columbia has recently attempted an ill-fated decriminalization pilot allowing simple possession and open drug consumption, by obtaining an exemption to relevant provisions of the Controlled Drugs and Substances Act. The pilot was aborted after three years amidst public outcry, a decision which advocates attribute to moral panic rather than sound public policy. It is worth noting that the province did not sufficiently invest in the other pillars of recovery, thus setting itself up for failure.

Nevertheless, police officers across the province wield broad discretionary powers in which offences to pursue, exemplified by the Vancouver Police Department’s informal depenalization policy in place since 2006. Likewise, the Victoria Police Department’s policy is stated as follows, according to minutes from the police board:

Current practice prioritizes discretion and avoiding jail time for individuals with substance use disorder. Arrests are now infrequent and based on individual assessment.

The consensus among law enforcement officers, in contrast to that of drug user advocates, is indeed that the decriminalization pilot failed due to lack of discretionary police powers. According to VicPD Chief Constable Fiona Wilson: “The thing about the Portugal model was it gave police options, but it didn’t take them out of the equation. That’s what decriminalization here in British Columbia tried to do, and it’s just not practical, it’s not reasonable, and it didn’t work.”

Nevertheless, there is widespread agreement among police and advocates that more collaboration with outreach and health services is crucial in addressing the drug overdose crisis.

The police philosophy has shifted from solely enforcement to opportunities to partner with health. Why we took that pivot is because when we entered into the toxic drug crisis, which was declared in April 2016, it became clear to us that the rinse wash repeat of enforcement—of which I was part of for many, many years—was not actually making any viable change with respect to reducing overdose deaths.
Inspector Conor King, Victoria Police Department

On a side note, Canada has enacted the Good Samaritan Drug Overdose Act, which effectively decriminalized simple drug possession in the context of emergency calls, the rationale being that offenders would otherwise be deterred from calling emergency services in the event of a drug overdose.

References

Previous Krista Loughton misses the mark on homelessness

Next I am withdrawing my support for the apartheid-free pledge

Discover more from Martin Girard for Victoria Municipal Council!

Subscribe to get the latest posts sent to your email.