VANCOUVER — Hundreds of British Columbians have died from overdoses in recent months, but the powerful painkiller fentanyl isn't the first drug to spark a crisis in the province. Here's a look at British Columbia's history with drugs:
1870s to 1900s:
British Columbia's first troubles with illicit substances stemmed from racism, not public health concerns, says Neil Boyd, a criminologist at Simon Fraser University.
Chinese workers brought opium with them when they came to build railways in the late 1800s. The substance was legal at the time, with Vancouver, Victoria and New Westminster all home to opium smoking establishments in the 1870s.
Places that sold alcohol were seen as the bigger threat, Boyd says, because they were associated with violence.
"For 40, 50 years opium was tolerated. It was not seen as an issue," he says.
The tenor changed around 1907, due to labour strife and racism against Chinese workers.
Following public outcry, then-labour minister William Lyon Mackenzie King brought in the Opium Act, which banned opium from being imported, manufactured or sold in Canada for non-medical purposes.
"The decision to criminalize smoking opium had nothing to do with public health and everything to do with a racist riot on the coast of British Columbia," Boyd says.
Criminalizing drugs laid the groundwork for future epidemics, he adds.
"The consequences of that decision to use the criminal law to respond to a public health problem, those consequences have really been devastating."
The province's history with drugs continued throughout the 20th century, with much of the activity centred in Vancouver.
Efforts to stem the effects of illicit substances go back as far as 1989, when Vancouver launched a pilot project that offered a needle exchange in the Downtown Eastside.
But Dr. Thomas Kerr with the B.C. Centre for Excellence in HIV/AIDS says the program wasn't ready when heroin faded from use, only to be replaced by powdered cocaine. Users who had been injecting once or twice a day now needed to inject between 20 and 30 times.
"The needle exchange was totally ill equipped to deal with this new and emerging drug trend," Kerr says.
He says overdose deaths climbed to about 350 in the early 1990s and rates of HIV infection spiked. In 1997, Vancouver's health authority declared a public health emergency.
Mark Tyndall, director of the B.C. Centre for Disease Control, says the response to the crisis included discussion about the need to open supervised consumption sites and consider prescription opiates, similar to what experts have pushed for as the fentanyl crisis continues to claim lives.
By the early 2000s, research and programs to help drug users were gaining momentum.
Some, like the needle exchange, looked at what went wrong in previous crises to create plans for moving forward.
"You can point to several examples where we have learned from our mistakes and done better as a result. But there's still obviously a lot of work to be done," he says.
The College of Registered Nurses of British Columbia voted in 2002 to start providing supervised injection services at Vancouver's Dr. Peter's Centre to help prevent illness and promote health. In September 2003, Insite opened, becoming the first officially sanctioned supervised injection site in North America.
Injecting drugs was always popular, but what substances went in the needles varied through the years, Kerr says. Heroin and powdered cocaine were replaced by crack in the late 1990s. Around 2003, crystal methamphetamine gained prominence. Prescription opioids like dilaudid and morphine became popular around 2006.
In more recent years, the quality of the heroin supply around Vancouver has fluctuated, Kerr says. At times, the drugs have seemed stronger, suggesting they were mixed with another substance like powdered methadone or fentanyl.
Now and the future:
More than 900 people fatally overdosed across B.C. in 2016, prompting the provincial health officer to declare a public health emergency.
Statistics from the coroner's office suggest about 60 per cent of the deaths were linked to fentanyl, but experts say many users don't realize they're ingesting the dangerous substance.
"When you look at the toxicology of people who are dying, the other drugs are still very common in people who are dying," says Tyndall, noting that cocaine is the substance found most often in toxicology reports following a fatal overdose.
Fentanyl is appearing in drugs across the country, he says, but it seems to be in higher concentrations in B.C.
Carfentanil, a substance commonly used to tranquilize large animals, is increasingly showing up in toxicology reports, too, making it more difficult to address the overdose issue, Kerr says.
"The drug pattern is changing again kind of mid-crisis," he says.
Kerr wants to see officials "dramatically scale up" access to a variety of opioid replacement therapies, including prescription heroin. It's important to give drug users options for staying safe the same way a sick patient is given a variety of treatment options, he says.
"I can't think of another patient population where you're told, 'We've got one approach, and if that doesn't work for you, too bad.' Even when there are other things."
Kerr, Tyndall and other experts say cracking down on powerful painkillers won't solve the overdose crisis and they're urging officials to focus less on criminal justice and more on harm reduction.
"If we stopped all fentanyl tomorrow, it wouldn't reduce the number of people using drugs," Tyndall says. "And people would access something else that would even be worse. It's not a matter of cutting off the supply, it's a question of stopping the demand and helping people who are in need."
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Gemma Karstens-Smith, The Canadian Press