Canada has long had a progressive drug reform policy that has broadly been applauded by liberals everywhere.
The government opened the first safe injecting room in North America in 2003, and there are now 39 across the country.
Australia has just two.
In 2018, Canada legalised cannabis, and in 2023 its western province of British Columbia (BC) did what drug reformers all over the world have been campaigning for governments to do: it stopped prosecuting people for carrying small amounts of heroin, cocaine, methamphetamine and MDMA.
The three-year pilot program was introduced amidst the region's drug overdose crisis; in the six years leading up to the reforms, BC accounted for about a third of Canada's drug overdose and trafficking deaths.
But two years into the trial, drug users in Vancouver are still dying.
And in recent months sections of the Canadian media and the public, along with some politicians, have started to push back against the reforms, putting their future in question.
Does decriminalisation work?
In April 2024, the Canadian government changed its mind about the decriminalisation trial, rolling it back so that it now only applies in private residences, and in designated places like homeless shelters or health clinics including supervised consumption sites.
The decision has dismayed public health professionals like Dr Kora DeBeck, a scientist with the British Columbia Centre on Substance Use, the organisation tasked with monitoring the drug trial.
"We have decades of research showing so many levels on which [drug prohibition] has failed individuals and failed communities," she tells ABC Radio National's Late Night Live.
"We know drugs are easily accessible and lots of people still want to use them."
However there are many issues with drug prohibition, she says.
"Moving towards [decriminalisation was] something different, some kind of reform that really came out as a first step."
So what led to the reforms and where might they be headed next?
The history of BC's drug crisis
Since the decriminalisation trial began in 2023, the rate of overdose deaths in Vancouver had more than quadrupled in a decade.
In 2014, 369 people in BC died of an illicit drug overdose.
In 2017, 1208 people died.
And then in 2023, there were at least 2,511 overdose deaths in BC.
In 2016, it was declared a public health emergency. Dr DeBeck describes it as an "unprecedented toxic drug crisis."
"It's really just devastating communities."
In 2019, the Vancouver City Council released a Safe Supply Statement that acknowledged the majority of overdose deaths in the province were due to a "drug supply poisoned with Fentanyl", a synthetic opioid more potent than heroin.
The statement said the presence of "further contaminants… [was] making it more difficult and complex to reverse overdoses".
"We often hear this crisis referred to as an overdose crisis, but really, we are in a drug-poisoning crisis," the statement says.
"One of the primary causes of overdose is the contamination of the illicit drug supply, and we believe that future deaths could be prevented if people could access a regulated safe supply."
Tainted drugs and street disorder
The decriminalisation pilot program was intended to reduce stigma preventing drug users from accessing life-saving medical care and "harm reduction" programs like needle exchanges and safe injecting sites.
It was also supposed to keep people out of the criminal justice system.
Drug possession charges in Vancouver fell 76 per cent during the first nine months of the trial compared to the annual average for the previous four years.
But while the reforms altered the way drug users were handled by police and the law, Dr DeBeck says they could never tackle the often-contaminated black-market drug supply.
At the end of the first year of the program, BC's toxic drug deaths reached record levels, with an average of seven people dying per day in 2023.
Dr DeBeck says the public was set up to have unrealistic expectations about what the program could achieve in the streets of BC.
"In our context, in Vancouver, and really in Canada, what is driving overdose deaths is fentanyl in the unregulated toxic drug supply," she says.
"[The drug supply] was still being produced by organised crime and drug cartels, and it was laced with fentanyl and benzodiazepines. So what people saw on the street was continuing suffering and continuing what would be described as street disorder.
"So I never expected that we would see a reduction in overdoses.
"I think some of the public were potentially misled into thinking that that's what they should expect, and that's what they were hoping for, but it was never a realistic objective.
"The public discourse has not been rooted in what science or data is showing … The narrative that I hear is that people believed that decriminalisation caused disorder on the street."
Decriminalisation abandoned
The rollback of the trial essentially made it a crime to use drugs in most public spaces, giving police the power to once again seize drugs, move people on from public areas and make arrests for drug use.
The decision was made in response to pressure from those opposed to the pilot program, including BC's then-leader of the opposition, Kevin Falcon, who called it a "harmful experiment".
Some residents and business groups, like the Save Our Streets coalition, had complained of open drug use on public transit and in retail areas, although provincial officials reported they had seen no evidence that this had increased following decriminalisation.
In a statement, provincial Premier David Eby insisted his government was "caring and compassionate for those struggling with addiction", but that it would not tolerate "street disorder".
He said the changes would ensure "police have the tools they need to ensure safe and comfortable communities".
However the Harm Reduction Nurses Association (HRNA) opposed the "punitive and political" changes, saying they would push people into alleyways and other hidden parts of the city, where they were most likely to fatally overdose.
The group of frontline health workers argued there was "ample evidence" that homelessness had increased in BC amid a housing crisis in the region, and that a lack of housing, health and harm reduction services left people with few alternatives.
"When we see public drug use, it is because people do not have housing, services or safe places to go — and because people are scared for their lives," DJ Larkin, a co-counsel for HRNA, said following the law changes.
HRNA suggested a number of alternative legal and policy responses that they said would increase public safety and better protect the lives of people at risk of overdose, including investing in housing and public health programs.
What works?
In February, the BC Coroners Service reported that toxic drug deaths in the province fell 13 per cent in 2024, the lowest toll since 2020.
Fentanyl was still the main driver of drug deaths, with the opioid detected in 78 per cent of drug tests.
Chief coroner Jatinder Baidwan said the decline in toxic drug deaths was not unique to BC, and that similar figures had been reported in other Canadian jurisdictions and internationally.
"This doesn't mitigate the fact that 2,253 members of our communities died in 2024, leaving behind grieving loved ones, friends, colleagues and teammates," Dr Baidwan said in a statement.
"Our thoughts are with all of those many, many people who have been touched by this crisis."
Dr DeBeck says treating drug dependency as a police matter, rather than a health crisis, would continue to put drug users at risk.
"We know that there's a lot of harm that happens with interactions between police and people who use drugs," she says.
"For example, when police seize drugs from someone who is dependent on drugs [that person is left] in a vulnerable state, where they then have to go and find some other way to get drugs again, particularly if they're physically dependent.
"And that can lead to more crime… or they might also go to a supplier that's less reliable."
Ultimately, Dr DeBeck says the evidence is clear that funding harm-reduction services — such as addiction treatment and drug testing facilities, along with providing affordable housing — "is a much more fruitful path" for saving lives.
"The reality from research and data is that policing is a very poor tool to address substance use and even things like public drug use. The things that do really help with that are better housing and having alternative places for people to go and to move," she says.
"Substance use is not a moral failing. It's not a criminal justice issue. It is something that should be in the realm of health and public health."
There is a benefit in changing the way police engage with people who use drugs.
"From my perspective, decriminalisation is such a small part of what we need. And I think if we're really going to tackle this challenge and this absolutely devastating situation of drug overdose deaths, we need a lot more than decriminalisation."
