Addictions
‘Harm Reduction’ is killing B.C.’s addicts. There’s got to be a better way
From the Frontier Centre for Public Policy
B.C. recently decriminalized the possession of small amounts of illicit drugs. The resulting explosion of addicts using drugs in public spaces, including parks and playgrounds, recently led the province’s NDP government to attempt to backtrack on this policy
Fuelled by the deadly manufactured opioid fentanyl, Canada’s national drug overdose rate stood at 19.3 people per 100,000 in 2022, a shockingly high number when compared to the European Union’s rate of just 1.8. But national statistics hide considerable geographic variation. British Columbia and Alberta together account for only a quarter of Canada’s population yet nearly half of all opioid deaths. B.C.’s 2022 death rate of 45.2/100,000 is more than double the national average, with Alberta close behind at 33.3/100,00.
In response to the drug crisis, Canada’s two western-most provinces have taken markedly divergent approaches, and in doing so have created a natural experiment with national implications.
B.C. has emphasized harm reduction, which seeks to eliminate the damaging effects of illicit drugs without actually removing them from the equation. The strategy focuses on creating access to clean drugs and includes such measures as “safe” injection sites, needle exchange programs, crack-pipe giveaways and even drug-dispensing vending machines. The approach goes so far as to distribute drugs like heroin and cocaine free of charge in the hope addicts will no longer be tempted by potentially tainted street drugs and may eventually seek help.
But safe-supply policies create many unexpected consequences. A National Post investigation found, for example, that government-supplied hydromorphone pills handed out to addicts in Vancouver are often re-sold on the street to other addicts. The sellers then use the money to purchase a street drug that provides a better high — namely, fentanyl.
Doubling down on safe supply, B.C. recently decriminalized the possession of small amounts of illicit drugs. The resulting explosion of addicts using drugs in public spaces, including parks and playgrounds, recently led the province’s NDP government to attempt to backtrack on this policy — though for now that effort has been stymied by the courts.
According to Vancouver city councillor Brian Montague, “The stats tell us that harm reduction isn’t working.” In an interview, he calls decriminalization “a disaster” and proposes a policy shift that recognizes the connection between mental illness and addiction. The province, he says, needs “massive numbers of beds in treatment facilities that deal with both addictions and long-term mental health problems (plus) access to free counselling and housing.”
In fact, Montague’s wish is coming true — one province east, in Alberta. Since the United Conservative Party was elected in 2019, Alberta has been transforming its drug addiction policy away from harm reduction and towards publicly-funded treatment and recovery efforts.
Instead of offering safe-injection sites and free drugs, Alberta is building a network of 10 therapeutic communities across the province where patients can stay for up to a year, receiving therapy and medical treatment and developing skills that will enable them to build a life outside the drug culture. All for free. The province’s first two new recovery centres opened last year in Lethbridge and Red Deer. There are currently over 29,000 addiction treatment spaces in the province.
This treatment-based strategy is in large part the work of Marshall Smith, current chief of staff to Alberta’s premier and a former addict himself, whose life story is a testament to the importance of treatment and recovery.
The sharply contrasting policies of B.C. and Alberta allow a comparison of what works and what doesn’t. A first, tentative report card on this natural experiment was produced last year in a study from Stanford University’s network on addiction policy (SNAP). Noting “a lack of policy innovation in B.C.,” where harm reduction has become the dominant policy approach, the report argues that in fact “Alberta is currently experiencing a reduction in key addiction-related harms.” But it concludes that “Canada overall, and B.C. in particular, is not yet showing the progress that the public and those impacted by drug addiction deserve.”
The report is admittedly an early analysis of these two contrasting approaches. Most of Alberta’s recovery homes are still under construction, and B.C.’s decriminalization policy is only a year old. And since the report was published, opioid death rates have inched higher in both provinces.
Still, the early returns do seem to favour Alberta’s approach. That should be regarded as good news. Society certainly has an obligation to try to help drug users. But that duty must involve more than offering addicts free drugs. Addicted people need treatment so they can kick their potentially deadly habit and go on to live healthy, meaningful lives. Dignity comes from a life of purpose and self-control, not a government-funded fix.
Susan Martinuk is a senior fellow at the Frontier Centre for Public Policy and author of the 2021 book Patients at Risk: Exposing Canada’s Health Care Crisis. A longer version of this article recently appeared at C2CJournal.ca.
Addictions
Coffee, Nicotine, and the Politics of Acceptable Addiction
From the Brownstone Institute
By
Every morning, hundreds of millions of people perform a socially approved ritual. They line up for coffee. They joke about not being functional without caffeine. They openly acknowledge dependence and even celebrate it. No one calls this addiction degenerate. It is framed as productivity, taste, wellness—sometimes even virtue.
Now imagine the same professional discreetly using a nicotine pouch before a meeting. The reaction is very different. This is treated as a vice, something vaguely shameful, associated with weakness, poor judgment, or public health risk.
From a scientific perspective, this distinction makes little sense.
Caffeine and nicotine are both mild psychoactive stimulants. Both are plant-derived alkaloids. Both increase alertness and concentration. Both produce dependence. Neither is a carcinogen. Neither causes the diseases historically associated with smoking. Yet one has become the world’s most acceptable addiction, while the other remains morally polluted even in its safest, non-combustible forms.
This divergence has almost nothing to do with biology. It has everything to do with history, class, marketing, and a failure of modern public health to distinguish molecules from mechanisms.
Two Stimulants, One Misunderstanding
Nicotine acts on nicotinic acetylcholine receptors, mimicking a neurotransmitter the brain already uses to regulate attention and learning. At low doses, it improves focus and mood. At higher doses, it causes nausea and dizziness—self-limiting effects that discourage excess. Nicotine is not carcinogenic and does not cause lung disease.
Caffeine works differently, blocking adenosine receptors that signal fatigue. The result is wakefulness and alertness. Like nicotine, caffeine indirectly affects dopamine, which is why people rely on it daily. Like nicotine, it produces tolerance and withdrawal. Headaches, fatigue, and irritability are routine among regular users who skip their morning dose.
Pharmacologically, these substances are peers.
The major difference in health outcomes does not come from the molecules themselves but from how they have been delivered.
Combustion Was the Killer
Smoking kills because burning organic material produces thousands of toxic compounds—tar, carbon monoxide, polycyclic aromatic hydrocarbons, and other carcinogens. Nicotine is present in cigarette smoke, but it is not what causes cancer or emphysema. Combustion is.
When nicotine is delivered without combustion—through patches, gum, snus, pouches, or vaping—the toxic burden drops dramatically. This is one of the most robust findings in modern tobacco research.
And yet nicotine continues to be treated as if it were the source of smoking’s harm.
This confusion has shaped decades of policy.
How Nicotine Lost Its Reputation
For centuries, nicotine was not stigmatized. Indigenous cultures across the Americas used tobacco in religious, medicinal, and diplomatic rituals. In early modern Europe, physicians prescribed it. Pipes, cigars, and snuff were associated with contemplation and leisure.
The collapse came with industrialization.
The cigarette-rolling machine of the late 19th century transformed nicotine into a mass-market product optimized for rapid pulmonary delivery. Addiction intensified, exposure multiplied, and combustion damage accumulated invisibly for decades. When epidemiology finally linked smoking to lung cancer and heart disease in the mid-20th century, the backlash was inevitable.
But the blame was assigned crudely. Nicotine—the named psychoactive component—became the symbol of the harm, even though the damage came from smoke.
Once that association formed, it hardened into dogma.
How Caffeine Escaped
Caffeine followed a very different cultural path. Coffee and tea entered global life through institutions of respectability. Coffeehouses in the Ottoman Empire and Europe became centers of commerce and debate. Tea was woven into domestic ritual, empire, and gentility.
Crucially, caffeine was never bound to a lethal delivery system. No one inhaled burning coffee leaves. There was no delayed epidemic waiting to be discovered.
As industrial capitalism expanded, caffeine became a productivity tool. Coffee breaks were institutionalized. Tea fueled factory schedules and office routines. By the 20th century, caffeine was no longer seen as a drug at all but as a necessity of modern life.
Its downsides—dependence, sleep disruption, anxiety—were normalized or joked about. In recent decades, branding completed the transformation. Coffee became lifestyle. The stimulant disappeared behind aesthetics and identity.
The Class Divide in Addiction
The difference between caffeine and nicotine is not just historical. It is social.
Caffeine use is public, aesthetic, and professionally coded. Carrying a coffee cup signals busyness, productivity, and belonging in the middle class. Nicotine use—even in clean, low-risk forms—is discreet. It is not aestheticized. It is associated with coping rather than ambition.
Addictions favored by elites are rebranded as habits or wellness tools. Addictions associated with stress, manual labor, or marginal populations are framed as moral failings. This is why caffeine is indulgence and nicotine is degeneracy, even when the physiological effects are similar.
Where Public Health Went Wrong
Public health messaging relies on simplification. “Smoking kills” was effective and true. But over time, simplification hardened into distortion.
“Smoking kills” became “Nicotine is addictive,” which slid into “Nicotine is harmful,” and eventually into claims that there is “No safe level.” Dose, delivery, and comparative risk disappeared from the conversation.
Institutions now struggle to reverse course. Admitting that nicotine is not the primary harm agent would require acknowledging decades of misleading communication. It would require distinguishing adult use from youth use. It would require nuance.
Bureaucracies are bad at nuance.
So nicotine remains frozen at its worst historical moment: the age of the cigarette.
Why This Matters
This is not an academic debate. Millions of smokers could dramatically reduce their health risks by switching to non-combustion nicotine products. Countries that have allowed this—most notably Sweden—have seen smoking rates and tobacco-related mortality collapse. Countries that stigmatize or ban these alternatives preserve cigarette dominance.
At the same time, caffeine consumption continues to rise, including among adolescents, with little moral panic. Energy drinks are aggressively marketed. Sleep disruption and anxiety are treated as lifestyle issues, not public health emergencies.
The asymmetry is revealing.
Coffee as the Model Addiction
Caffeine succeeded culturally because it aligned with power. It supported work, not resistance. It fit office life. It could be branded as refinement. It never challenged institutional authority.
Nicotine, especially when used by working-class populations, became associated with stress relief, nonconformity, and failure to comply. That symbolism persisted long after the smoke could be removed.
Addictions are not judged by chemistry. They are judged by who uses them and whether they fit prevailing moral narratives.
Coffee passed the test. Nicotine did not.
The Core Error
The central mistake is confusing a molecule with a method. Nicotine did not cause the smoking epidemic. Combustion did. Once that distinction is restored, much of modern tobacco policy looks incoherent. Low-risk behaviors are treated as moral threats, while higher-risk behaviors are tolerated because they are culturally embedded.
This is not science. It is politics dressed up as health.
A Final Thought
If we applied the standards used against nicotine to caffeine, coffee would be regulated like a controlled substance. If we applied the standards used for caffeine to nicotine, pouches and vaping would be treated as unremarkable adult choices.
The rational approach is obvious: evaluate substances based on dose, delivery, and actual harm. Stop moralizing chemistry. Stop pretending that all addictions are equal. Nicotine is not harmless. Neither is caffeine. But both are far safer than the stories told about them.
This essay only scratches the surface. The strange moral history of nicotine, caffeine, and acceptable addiction exposes a much larger problem: modern institutions have forgotten how to reason about risk.
Addictions
Manitoba Is Doubling Down On A Failed Drug Policy
From the Frontier Centre for Public Policy
Manitoba is choosing to expand the same drug policy model that other provinces are abandoning, policies that normalize addiction while sidelining treatment, recovery, and public safety.
The New Democrat premier of British Columbia, David Eby, stood before reporters last spring and called his government’s decision to permit public drug use in certain spaces a failure.
The policy was part of the broader “harm reduction” strategy meant to address overdose deaths. Instead, it had stirred public anger, increased street disorder and had helped neither users nor the communities that host them. “We do not accept street disorder that makes communities feel unsafe,” Eby said. The province scrapped the plan.
In Alberta, the Conservative government began shutting down safer-supply prescribing due to concerns about drug diversion and misuse. The belief that more opioids can resolve the opioid crisis is losing credibility.
Ontario Progressive Conservatives are moving away from harm reduction by shutting down supervised consumption sites near schools and limiting safer-supply prescribing. Federal funding for programs is decreasing, and the province is shifting its focus to treatment models, even though not all sites are yet closed.
Yet amid these non-partisan reversals, Manitoba’s government has announced its intention to open a supervised drug-use site in Winnipeg. Premier Wab Kinew said, “We have too many Manitobans dying from overdose.” True. But it does not follow that repeating failed approaches will yield different results.
Reversing these failed policies is not a rejection of compassion. It is a recognition that good intentions do not produce good outcomes. Vancouver and Toronto have hosted supervised drug-use sites for years. The death toll keeps rising. Drug deaths in British Columbia topped 2,500 in 2023, even with the most expansive harm reduction infrastructure in the country. A peer-reviewed study published this year found that hospitalizations from opioid poisoning rose after B.C.’s safer-supply policy was implemented. Emergency department visits increased by more than three cases per 100,000 population, with no corresponding drop in fatal overdoses.
And the problem persists day to day. Paramedics in B.C. responded to nearly 4,000 overdose calls in July 2024 alone. The monthly call volume has exceeded 3,000 almost every month this year. These are signs of crisis management without a path to recovery.
There are consequences beyond public health. These policies change the character of neighbourhoods. Businesses suffer. Residents feel unsafe. And most tragically, the person using drugs is offered little more than a cot, a nurse and a quiet signal to continue. Real help, like treatment, housing and purpose, remains out of reach.
Somewhere along the way, bureaucracies stopped asking what recovery looks like. They have settled for managing human decline. They call it compassion. But it is really surrender, wrapped in medical language.
Harm reduction had its time. It made sense when it first emerged, during the AIDS crisis, when dirty needles spread HIV. Back then, the goal was to stop a deadly virus. Today, that purpose has been lost.
When policy drifts into ideology, reality becomes an afterthought. Underneath today’s approach is the belief that drug use is inevitable, that people cannot change, that liberty means letting others fade away quietly. These ideas do not reflect science. They do not reflect hope. They reflect despair. They reflect a politics that prioritizes the appearance of compassion over effectiveness.
What Manitoba needs is treatment access that meets the scale of the problem. That means detox beds, recovery homes and long-term care focused on restoring lives. These may not generate the desired headlines, but they work. They are demanding. They are slow. And they offer respect to the person behind the addiction.
There are no shortcuts. No policy will undo decades of pain overnight. But a policy that keeps people stuck using is not mercy. It is maintenance with no way out.
A government that believes in its people should not copy failure.
Marco Navarro-Genie is vice-president of research at the Frontier Centre for Public Policy and co-author, with Barry Cooper, of Canada’s COVID: The Story of a Pandemic Moral Panic (2023).
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