Addictions
Nanaimo syringe stabbing reignites calls for involuntary care
Safe needle disposal box at Deverill Square Gyro 2 Park in Nanaimo, B.C., Sept. 5, 2024. [Photo credit: Alexandra Keeler]
By Alexandra Keeler
Some politicians, police and community groups argue involuntary care is key to addressing severe addiction and mental health issues
The brutal stabbing last month of a 58-year-old city employee in Nanaimo, B.C., made national headlines. The man was stabbed multiple times with a syringe after he asked two men who were using drugs in a public park washroom to leave.
The worker sustained multiple injuries to his face and abdomen and was hospitalized. As of Jan. 7, the RCMP were still investigating the suspects.
The incident comes on the heels of other violent attacks in the province that have been linked to mental health and substance use disorders.
On Dec. 4, Vancouver police fatally shot a man armed with a knife inside a 7-Eleven after he attacked two staff members while attempting to steal cigarettes. Earlier that day, the man had allegedly stolen alcohol from a nearby restaurant.
Three months earlier, on Sept. 4, a 34-year-old man with a history of assault and mental health problems randomly attacked two men in downtown Vancouver, leaving one dead and another with a severed hand.
These incidents have sparked growing calls from politicians, police and residents for governments to expand involuntary care and strengthen health-care interventions and law enforcement strategies.
“What is Premier Eby, the provincial and federal government going to do?” the volunteer community group Nanaimo Area Public Safety Association said in a Dec. 11 public statement.
“British Columbians are well past being fed-up with lip-service.”
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‘Extremely complex needs’
On Jan. 5, B.C.’s newly reelected premier, David Eby, announced the province will open two involuntary care sites this spring. One will be located at the Surrey Pretrial Centre in Surrey, and the other at the Alouette Correctional Facility in Maple Ridge, a city northeast of Vancouver.
Eby said his aim is to address the cases of severe addiction, brain injury and mental illness that have contributed to violent incidents and public safety concerns.
Involuntary care allows authorities to mandate treatment for individuals with severe mental health or substance use disorders without their consent.
Amy Rosa, a BC Ministry of Health public affairs officer, confirmed to Canadian Affairs that the NDP government remains committed to expanding both voluntary and involuntary care as a solution to the rise in violent attacks.
“We’re grappling with a growing group of people with extremely complex needs — people with severe mental health and addictions issues, coupled with brain injuries from repeated overdoses,” Rosa said.
As part of its commitment to expanding involuntary care, the province plans to establish more secure facilities and mental health units within correctional centres and create 400 new mental health beds.
In response to follow-up questions, Rosa told Canadian Affairs that the province plans to introduce legal changes in the next legislative session “to provide clarity and ensure that people can receive care when they are unable to seek it themselves.” She noted these changes will be made in consultation with First Nations to ensure culturally safe treatment programs.
“The care provided at these facilities will be dignified, safe and respectful,” she said.
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Maffeo Sutton Park, where on Dec. 10, 2024, a Nanaimo city worker was stabbed multiple times with a syringe; Sept. 1, 2024. [Photo credit: Alexandra Keeler]
‘Health-led approach’
Nanaimo Mayor Leonard Krog says involuntary care is necessary to prevent violent incidents such as the syringe stabbing in the city’s park.
“Without secure involuntary care, supportive housing, and a full continuum of care from detox to housing, treatment and follow-up, little will change,” he said.
Elenore Sturko, BC Conservative MLA for Surrey-Cloverdale, agrees that early intervention for mental health and substance use disorders is important. She supports laws that facilitate interventions outside of the criminal justice system.
“Psychosis and brain damage are things that need to be diagnosed by medical professionals,” said Sturko, who served as an officer in the RCMP for 13 years.
Sturko says although these diagnoses need to be given by medical professionals, first responders are trained to recognize signs.
“Police can be trained, and first responders are trained, to recognize the signs of those conditions. But whether or not these are regular parts of the assessment that are given to people who are arrested, I actually do not know that,” she said.
Staff Sergeant Kris Clark, a RCMP media relations officer, told Canadian Affairs in an emailed statement that officers receive crisis intervention and de-escalation training but are not mental health professionals.
“All police officers in BC are mandated to undergo crisis intervention and de-escalation training and must recertify every three years,” he said. Additional online courses help officers recognize signs of “mental, emotional or psychological crisis, as well as other altered states of consciousness,” he said.
“It’s important to understand however that police officers are not medical/mental health professionals.”
Clark also referred Canadian Affairs to the BC Association of Chiefs of Police’s Nov. 28 statement. The statement says the association has changed its stance on decriminalization, which refers to policies that remove criminal penalties for illicit drug use.
“Based on evidence and ongoing evaluation, we no longer view decriminalization as a primary mechanism for addressing the systemic challenges associated with substance use,” says the statement. The association represents senior police leaders across the province.
Instead, the association is calling for greater investment in health services, enhanced programs to redirect individuals from the justice system to treatment services, and collaboration with government and community partners.
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Vancouver Coastal Health’s Pender Community Health Centre in East Hastings, Vancouver, B.C., Aug. 31, 2024. [Photo credit: Alexandra Keeler]
‘Life or limb’
Police services are not the only agencies grappling with mental health and substance use disorders.
The City of Vancouver told Canadian Affairs it has expanded programs like the Indigenous Crisis Response Team, which offers non-police crisis services for Indigenous adults, and Car 87/88, which pairs a police officer with a psychiatric nurse to respond to mental health crises.
Vancouver Coastal Health, the city’s health authority, adjusted its hiring plan in 2023 to recruit 55 mental health workers, up from 35. And the city has funded 175 new officers in the Vancouver Police Department, a seven per cent increase in the force’s size.
The city has also indicated it supports involuntary care.
In September, Vancouver Mayor Ken Sim was one of 11 B.C. mayors who issued a statement calling on the federal government to provide legal and financial support for provinces to implement involuntary care.
On Oct. 10, Conservative Party Leader Pierre Poilievre said a Conservative government would support mandatory involuntary treatment for minors and prisoners deemed incapable of making decisions.
The following day, Federal Minister of Mental Health and Addictions Ya’ara Saks said in a news conference that provinces must first ensure they have adequate addiction and mental health services in place before discussions about involuntary care can proceed.
“Before we contemplate voluntary or involuntary treatment, I would like to see provinces and territories ensuring that they actually have treatment access scaled to need,” she said.
Some health-care providers have also expressed reservations about involuntary care.
In September, the Canadian Mental Health Association, a national organization that advocates for mental health awareness, issued a news release expressing concerns about involuntary care.
The association highlighted gaps in the current involuntary care system, including challenges in accessing voluntary care, reports of inadequate treatment for those undergoing involuntary care and an increased risk of death from drug poisoning upon release.
“Involuntary care must be a last resort, not a sweeping solution,” its release says.
“We must focus on prevention and early intervention, addressing the root causes of mental health and addiction crises before they escalate into violent incidents.”
Sturko agrees with focusing on early intervention, but emphasized the need for such interventions to be timely.
“We should not have to wait for someone to commit a criminal act in order for them to have court-imposed interventions … We need to be able to act before somebody loses their life or limb.”
This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.
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By Adam Zivo
Canada’s policy of deferring to the “leadership” of drug users has proved predictably disastrous. The United States should take heed.
[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]
Progressive “harm reduction” advocates have insisted for decades that active users should take a central role in crafting drug policy. While this belief is profoundly reckless—akin to letting drunk drivers set traffic laws—it is now entrenched in many left-leaning jurisdictions. The harms and absurdities of the position cannot be understated.
While the harm-reduction movement is best known for championing public-health interventions that supposedly minimize the negative effects of drug use, it also has a “social justice” component. In this context, harm reduction tries to redefine addicts as a persecuted minority and illicit drug use as a human right.
This campaign traces its roots to the 1980s and early 1990s, when “queer” activists, desperate to reduce the spread of HIV, began operating underground needle exchanges to curb infections among drug users. These exchanges and similar efforts allowed some more extreme LGBTQ groups to form close bonds with addicts and drug-reform advocates. Together, they normalized the concept of harm reduction, such that, within a few years, needle exchanges would become officially sanctioned public-health interventions.
The alliance between these more radical gay rights advocates and harm-reduction proponents proved enduring. Drug addiction remained linked to HIV, and both groups shared a deep hostility to the police, capitalism, and society’s “moralizing” forces.
In the 1990s, harm-reduction proponents imitated the LGBTQ community’s advocacy tactics. They realized that addicts would have greater political capital if they were considered a persecuted minority group, which could legitimize their demands for extensive accommodations and legal protections under human rights laws. Harm reductionists thus argued that addiction was a kind of disability, and that, like the disabled, active users were victims of social exclusion who should be given a leading role in crafting drug policy.
These arguments were not entirely specious. Addiction can reasonably be considered a mental and physical disability because illicit drugs hijack users’ brains and bodies. But being disabled doesn’t necessarily mean that one is part of a persecuted group, much less that one should be given control over public policy.
More fundamentally, advocates were wrong to argue that the stigma associated with drug addiction was senseless persecution. In fact, it was a reasonable response to anti-social behavior. Drug addiction severely impairs a person’s judgement, often making him a threat to himself and others. Someone who is constantly high and must rob others to fuel his habit is a self-evident danger to society.
Despite these obvious pitfalls, portraying drug addicts as a persecuted minority group became increasingly popular in the 2000s, thanks to several North American AIDS organizations that pivoted to addiction work after the HIV epidemic subsided.
In 2005, the Canadian HIV/AIDS Legal Network published a report titled “Nothing about us without us.” (The nonprofit joined other groups in publishing an international version in 2008.) The 2005 report included a “manifesto” written by Canadian drug users, who complained that they were “among the most vilified and demonized groups in society” and demanded that policymakers respect their “expertise and professionalism in addressing drug use.”
The international report argued that addiction qualified as a disability under international human rights treaties, and called on governments to “enact anti-discrimination or protective laws to reduce human rights violations based on dependence to drugs.” It further advised that drug users be heavily involved in addiction-related policy and decision-making bodies; that addict-led organizations be established and amply funded; and that “community-based organizations . . . increase involvement of people who use drugs at all levels of the organization.”
While the international report suggested that addicts could serve as effective policymakers, it also presented them as incapable of basic professionalism. In a list of “do’s and don’ts,” the authors counseled potential employers to pay addicts in cash and not to pass judgment if the money were spent on drugs. They also encouraged policymakers to hold meetings “in a low-key setting or in a setting where users already hang out,” and to avoid scheduling meetings at “9 a.m., or on welfare cheque issue day.” In cases where addicts must travel for policy-related work, the report recommended policymakers provide “access to sterile injecting equipment” and “advice from a local person who uses drugs.”
The international report further asserted that if an organization’s employees—even those who are former drug users—were bothered by the presence of addicts, then management should refer those employees to counselling at the organization’s expense. “Under no circumstances should [drug addicts] be reprimanded, singled out or made to feel responsible in any way for the triggering responses of others,” stressed the authors.
Reflecting the document’s general hostility to recovery, the international report emphasized that former drug addicts “can never replace involvement of active users” in public policy work, because people in recovery “may be somewhat disconnected from the community they seek to represent, may have other priorities than active users, may sometimes even have different and conflicting agenda, and may find it difficult to be around people who currently use drugs.”
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The messaging in these reports proved highly influential throughout the 2000s and 2010s. In Canada, federal and provincial human rights legislation expanded to protect active addicts on the basis of disability. Reformers in the United States mirrored Canadian activists’ appeals to addicts’ “lived experience,” albeit with less success. For now, American anti-discrimination protections only extend to people who have a history of addiction but who are not actively using drugs.
The harm reduction movement reached its zenith in the early 2020s, after the Covid-19 pandemic swept the world and instigated a global spike in addiction. During this period, North American drug-reform activists again promoted the importance of treating addicts like public-health experts.
Canada was at the forefront of this push. For example, the Canadian Association of People Who Use Drugs released its “Hear Us, See Us, Respect Us” report in 2021, which recommended that organizations “deliberately choose to normalize the culture of drug use” and pay addicts $25-50 per hour. The authors stressed that employers should pay addicts “under the table” in cash to avoid jeopardizing access to government benefits.
These ideas had a profound impact on Canadian drug policy. Throughout the country, public health officials pushed for radical pro-drug experiments, including giving away free heroin-strength opioids without supervision, simply because addicts told researchers that doing so would be helpful. In 2024, British Columbia’s top doctor even called for the legalization of all illicit drugs (“non-medical safer supply”) primarily on the basis of addict testimonials, with almost no other supporting evidence.
For Canadian policymakers, deferring to the “lived experiences” and “leadership” of drug users meant giving addicts almost everything they asked for. The results were predictably disastrous: crime, public disorder, overdoses, and program fraud skyrocketed. Things have been less dire in the United States, where the harm reduction movement is much weaker. But Americans should be vigilant and ensure that this ideology does not flower in their own backyard.
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A 2022 Los Angeles Times piece advocates following Vancouver’s model of drug liberalization and treatment. Adam Zivo argues British Columbia’s model has been proven a failure.
By Adam Zivo
Oregon and British Columbia neglected to coerce addicts into treatment.
Ever since Portugal enacted drug decriminalization in 2001, reformers have argued that North America should follow suit. The Portuguese saw precipitous declines in overdoses and blood-borne infections, they argued, so why not adopt their approach?
But when Oregon and British Columbia decriminalized drugs in the early 2020s, the results were so catastrophic that both jurisdictions quickly reversed course. Why? The reason is simple: American and Canadian policymakers failed to grasp what led to the Portuguese model’s initial success.
Contrary to popular belief, Portugal does not allow consequence-free drug use. While the country treats the possession of illicit drugs for personal use as an administrative offense, it nonetheless summons apprehended drug users to “dissuasion” commissions composed of doctors, social workers, and lawyers. These commissions assess a drug user’s health, consumption habits, and socioeconomic circumstances before using arbitrator-like powers to impose appropriate sanctions.
These sanctions depend on the nature of the offense. In less severe cases, users receive warnings, small fines, or compulsory drug education. Severe or repeat offenders, however, can be banned from visiting certain places or people, or even have their property confiscated. Offenders who fail to comply are subject to wage garnishment.
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Throughout the process, users are strongly encouraged to seek voluntary drug treatment, with most penalties waived if they accept. In the first few years after decriminalization, Portugal made significant investments into its national addiction and mental-health infrastructure (e.g., methadone clinics) to ensure that it had sufficient capacity to absorb these patients.
This form of decriminalization is far less radical than its North American proponents assume. In effect, Portugal created an alternative justice system that coercively diverts addicts into rehab instead of jail. That users are not criminally charged does not mean they are not held accountable. Further, the country still criminalizes the public consumption and trafficking of illicit drugs.
At first, Portugal’s decriminalization experiment was a clear success. During the 2000s, drug-related HIV infections halved, non-criminal drug seizures surged 500 percent, and the number of addicts in treatment rose by two-thirds. While the data are conflicting on whether overall drug use increased or decreased, it is widely accepted that decriminalization did not, at first, lead to a tidal wave of new addiction cases.
Then things changed. The 2008 global financial crisis destabilized the Portuguese economy and prompted austerity measures that slashed public drug-treatment capacity. Wait times for state-funded rehab ballooned, sometimes reaching a year. Police stopped citing addicts for possession, or even public consumption, believing that the country’s dissuasion commissions had grown dysfunctional. Worse, to cut costs, the government outsourced many of its addiction services to ideological nonprofits that prioritized “harm reduction” services (e.g., distributing clean crack pipes, operating “safe consumption” sites) over nudging users into rehab. These factors gradually transformed the Portuguese system from one focused on recovery to one that enables and normalizes addiction.
This shift accelerated after the Covid-19 pandemic. As crime and public disorder rose, more discarded drug paraphernalia littered the streets. The national overdose rate reached a 12-year high in 2023, and that year, the police chief of the country’s second-largest city told the Washington Post that, anecdotally, the drug problem seemed comparable to what it was before decriminalization. Amid the chaos, some community leaders demanded reform, sparking a debate that continues today.
In North America, however, progressive policymakers seem entirely unaware of these developments and the role that treatment and coercion played in Portugal’s initial success.
In late 2020, Oregon embarked on its own drug decriminalization experiment, known as Measure 110. Though proponents cited Portugal’s success, unlike the European nation, Oregon failed to establish any substantive coercive mechanisms to divert addicts into treatment. The state merely gave drug users a choice between paying a $100 ticket or calling a health hotline. Because the state imposed no penalty for failing to follow through with either option, drug possession effectively became a consequence-free behavior. Police data from 2022, for example, found that 81 percent of ticketed individuals simply ignored their fines.
Additionally, the state failed to invest in treatment capacity and actually defunded existing drug-use-prevention programs to finance Measure 110’s unused support systems, such as the health hotline.
The results were disastrous. Overdose deaths spiked almost 50 percent between 2021 and 2023. Crime and public drug use became so rampant in Portland that state leaders declared a 90-day fentanyl emergency in early 2024. Facing withering public backlash, Oregon ended its decriminalization experiment in the spring of 2024 after almost four years of failure.
The same story played out in British Columbia, which launched a three-year decriminalization pilot project in January 2023. British Columbia, like Oregon, declined to establish dissuasion commissions. Instead, because Canadian policymakers assumed that “destigmatizing” treatment would lead more addicts to pursue it, their new system employed no coercive tools. Drug users caught with fewer than 2.5 grams of illicit substances were simply given a card with local health and social service contacts.
This approach, too, proved calamitous. Open drug use and public disorder exploded throughout the province. Parents complained about the proliferation of discarded syringes on their children’s playgrounds. The public was further scandalized by the discovery that addicts were permitted to smoke fentanyl and meth openly in hospitals, including in shared patient rooms. A 2025 study published in JAMA Health Forum, which compared British Columbia with several other Canadian provinces, found that the decriminalization pilot was associated with a spike in opioid hospitalizations.
The province’s progressive government mostly recriminalized drugs in early 2024, cutting the pilot short by two years. Their motivations were seemingly political, with polling data showing burgeoning support for their conservative rivals.
The lessons here are straightforward. Portugal’s decriminalization worked initially because it did not remove consequences for drug users. It imposed a robust system of non-criminal sanctions to control addicts’ behavior and coerce them into well-funded, highly accessible treatment facilities.
Done right, decriminalization should result in the normalization of rehabilitation—not of drug use. Portugal discovered this 20 years ago and then slowly lost the plot. North American policymakers, on the other hand, never understood the story to begin with.
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