Addictions
Provinces are underspending on addiction and mental health care, new report says

The Greta and Robert H. N. Ho Psychiatry and Education Centre, the HOpe Centre, a health care facility for mental illness and addiction in North Vancouver, B.C. (Dreamstime)
By Alexandra Keeler
The provinces are receiving billions in federal funds to address mental health and substance use. Why are so many spending so little?
The provinces are failing to allocate sufficient funding to addiction and mental health care services, a new report says.
TheĀ report, released Dec. 19 by the Canadian Alliance on Mental Illness and Mental Health, criticizes the provinces for a ālong history of ā¦ demanding maximum cash for health care from the federal government with minimum accountability.ā
The alliance is a coalition of 18 prominent health organizations dedicated to improving Canadaās mental health care. Its members include the Canadian Medical Association, the Canadian Psychiatric Association and the Canadian Mental Health Association.
On average, the provinces have allocated just 16 per cent of $25 billion in federal health-care funding toward mental health and addiction services, the report says.
āGiven the crisis of timely access to care for those with mental health and substance use health problems, why are so many provinces and territories investing so little new federal dollars to improve and expand access to mental health and substance use health care services?ā the report asks.
However, some provinces dispute the reportās criticisms.
āThe funding received from the federal government is only a small part of Albertaās total $1.7 billion allocation towards mental health, addiction and recovery-related services,ā an Alberta Ministry of Mental Health and Addiction spokesperson told Canadian Affairs in an emailed statement.
ā[This] is a nation leading level of investment response.ā
āTake the money and run?ā
In 2023, Ottawa and the provincesĀ committedĀ to spend $25 billion over 10 years investing in four priority areas. These areas are mental health and substance use, family health services, health workers and backlogs, and a modernized health system.
The allianceās report, which looks at provincial investments in years 2023 through 2026, says mental health and substance use are being given short shrift.
B.C., Manitoba and P.E.I. have allocated zero per cent of the federal funds to mental health and substance use, the report says. Three other provinces allocated 10 per cent or less.
By contrast, Alberta allocated 25 per cent, Ontario, 24 per cent, and Nova Scotia, 19 per cent, the report says.
The underspending by some provinces occurs against a backdrop of mental health care already receiving inadequate investment.
ā[P]ublicly available data tells us that Canadaās mental health investments account for roughly 5% of their health budgets, which is significantly below the recommended 12% by the Royal Society of Canada,ā the report says.
However, several provinces told Canadian Affairs they took issue with the reportās findings.
āNeither the Department of Health and Wellness nor Health PEI received requests to provide information to inform the [allianceās] report,ā Morgan Martin, a spokesperson for P.E.I.ās Department of Health and Wellness, told Canadian Affairs.
Martin pointed to P.E.I.ās investments in opioid replacement therapy, a mobile mental health crisis unit and school health services as some examples of the provinceās commitment to providing mental health and addiction care.
But Matthew MacFarlane, Green Party MLA for P.E.I.ās Borden-Kinkora riding, says these investments have been inadequate.
āP.E.I. has seen little to no investments into acute mental health or substance use services,ā he said. He criticized a lack of new detox beds, unmet promises of a new mental health hospital and long wait times.
The allianceās report says New Brunswick has allocated just 3.2 per cent of federal funds to mental health and addiction services.
However, a New Brunswick Department of Health spokesperson Tara Chislett said the provinceās allocation of $15.4 million annually from the federal funds does not reflect the additional $200 million of provincial funding that New Brunswick has committed to mental health and substance use.
In response to requests for comment, a spokesperson for the alliance said the federal funding is important, but ādoes not nearly move the yardsticks fast enough in terms of expanding the capacity of provincial health systems to meet the growing demand for mental health and substance use health care services.ā
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āBlaming and shamingā
The discrepancies between the reportās findings and the provincesā claims highlight a need for standardized metrics around mental health and addiction spending.
The report calls on federal and provincial governments to develop national performance indicators for mental health and substance use services.
āAt the end-of-the day you cannot manage what you do not measure,ā the report reads.
It advises governments to communicate their performance to Canadians via a national dashboard.
āDashboards are being used with increasing frequency in the health system and other sectors to summarize complex information and would be one way to effectively tell a story ā¦ to the public,ā the report says.
It also urges Ottawa to introduce legislation ā what it dubs theĀ Mental Health and Substance Use Health Care For All Parity ActĀ ā toĀ ensure equal treatmentĀ for mental and physical health within Canadaās health-care system.
This call for mental and physical health parity echoes the perspective of other health-care professionals. In a recent Canadian AffairsĀ opinion editorial, a panel of mental health physicians argued Canadaās failure to prioritize mental health care affects millions of Canadians, leading to lower medication reimbursement rates and longer wait times.
The alliance says its call for more aggressive and transparent spending on mental health and addictions care is not intended to criticize or cast blame.
āThis is not about blaming and shaming, but rather, this is about accelerating the sharing of lessons learned and the impact of innovative programs,ā the report says.
This article was produced through the Breaking Needles Fellowship Program, which provided a grant toĀ 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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Addictions
Calls for Public Inquiry Into BC Health Ministry Opioid Dealing Corruption

The leaked audit shows from 2022 to 2024, a staggering 22,418,000 doses of opioids were prescribed by doctors and pharmacists to approximately 5,000 clients in B.C., including fentanyl patches.
A confidential investigation by British Columbiaās Ministry of Health, Financial Operations and Audit Branch has uncovered explosive allegations of fraud, abuse, and organized crime infiltration within PharmaCareās prescribed opioid alternatives program. Internal audit findings, obtained byĀ The Bureau, suggest that millions of taxpayer dollars are being diverted into illicit drug trafficking networks rather than serving harm reduction efforts.
The leaked documents include photographs from vehicle searches that show collections of fentanyl patches and Dilaudid (hydromorphone) apparently packaged for resale after being stolen from the taxpayer-funded āsafer supplyā program. This program expanded dramatically following a federal law change implemented by Prime Minister Justin Trudeau’s government in 2020, which broadened circumstances in which pharmacy staff could dispense opioids, according to the documentās evidence.
āPrior to March 17, 2020, only pharmacists in BC were permitted to deliver [addiction therapy treatment] drugs,ā the audit says.
B.C.ās safer supply program was launched in March 2020 as a response to the opioid overdose crisis, declared in 2016. It allows people with opioid-use disorder to receive prescribed drugs to be used on-site or taken away for later use.
The Special Investigations Unit and PharmaCare Audit Intelligence team identified a disturbing link between doctors, pharmacists, assisted living residences, and organized crime, where prescription opioids meant to replace illicit drugs are instead being diverted, sold, and trafficked at scale.
āA significant portion of the opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients,ā the document states.
It suggests that financial incentives have created a business model for organized crime, asserting that āprescribed alternatives (safe supply opioids) are trafficked provincially, nationally, and internationally,ā and that āproceeds of fraudā are being used to pay incentives to doctors, pharmacists, and intermediaries.
BC Conservative critic Elenore Sturko, a former RCMP officer, began raising concerns about the program two years ago after hearing anecdotes about prescribed opioids being trafficked. She asserts that the program is a failure in public policy and insists that Provincial Health Officer Dr. Bonnie Henry be dismissed for having ādenied and downplayedā problems as they emerged. Sturko also argues that B.C. must change its drug policy in light of U.S. President Donald Trumpās stance linking the trafficking of fentanyl and other opioids to potential trade sanctions against Canada.
The document shows that PharmaCareās dispensing fee loophole has incentivized pharmacies to maximize billings per patient, with some locations charging up to $11,000 per patient per yearācompared to just $120 in normal cases.
Perhaps most alarming is the deep infiltration of B.C.ās safer supply program by criminal networks. The Ministry of Health report lists āGang Members/Organized Crimeā as key players in the prescription drug pipeline, which includes āDoctors, pharmacies, and assisted living residences.ā
This revelation confirms long-standing fears that B.C.ās āsafe supplyā policyāoriginally designed to prevent deaths from contaminated street drugsāis instead sometimes supplying criminal organizations with pharmaceutical-grade opioids.
The leaked audit shows from 2022 to 2024, a staggering 22,418,000 doses of opioids were prescribed by doctors and pharmacists to approximately 5,000 clients in B.C., including fentanyl patches.
Beyond organized crimeās direct involvement, pharmacies themselves have exploited regulatory gaps to generate massive profits from PharmaCareās policies:
- Pharmacies offer kickbacks to doctors, housing staff, and medical professionals to steer patients toward specific locations.
- Financial incentives fuel fraud, with multiple investigations identifying 60+ pharmacies offering incentives to clients.
- Non-health professionals, including housing staff, are witnessing OAT (opioid agonist treatment) dosing, violating patient safety protocols.
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Addictions
When pleasure becomes pain: How substance use damages the body and brain

By Alexandra Keeler
Sustained drug use profoundly impacts brain function and physical health, leading to irreversible damage and long-term health risks
On Jan. 3, the USās top doctor made headlines for recommending that alcoholic drinks include health warnings about their cancer risks. Alcohol consumption is a leading preventable cause of cancer, U.S. Surgeon General Dr. Vivek MurthyāsĀ advisoryĀ notes.
MurthyāsĀ recommendationĀ comes amidst mounting attention to the health risks of alcohol consumption. In 2023, the World Health Organization sparked controversy when itĀ saidĀ āno level of alcohol consumption is safe for our health.ā
But all substance use affects the body, sources say, with illegal substances damaging nearly every organ in the body. Yet, the health effects of illegal substances receive relatively little attention.
āIf youāve ever looked at a population of people with substance use disorder [and] compared them to the general population, they would be worse off in terms of their cardiovascular risk,ā said Dr. Christopher Labos, a Montreal-based cardiologist and host ofĀ The Body of EvidenceĀ podcast.
Several confounders
Illicit drugs like fentanyl, heroin and cocaine affect the body in all sorts of ways. But isolating their direct effects can be difficult, experts say, due to the social factors that often accompany addiction.
āPeople who are suffering from substance use disorder probably have poor nutrition, probably donāt exercise as much,ā said Labos.
āAnybody whoās suffering from these problems is going to have several confounders that are going to increase the risk of cardiovascular disease.ā
But Labos says cocaine is known to be the most damaging to the heart.
āIn terms of which [illegal] substances are directly damaging to the heart, we clearly have a number one winner, and that would be cocaine,ā Labos said.
āCocaine is the one thatās very deliberately going to lead to higher rates of atherosclerosis [thickened artery walls] by increasing your heart rate, increasing your blood pressure and actually having a direct effect on thrombosis, so clogging of the arteries,ā he added.
Opioids such as fentanyl and heroinĀ also influence heart activity, Labos says. They lengthen theĀ QT intervalĀ ā a measure of heart electrical activity ā which increases the risk of abnormal heart rhythms and potentially life-threatening cardiac issues.
Brain injury is another significant risk associated with illicit drug use.
Mauricio Garcia-Barrera, a psychology professor at the University of Victoria, says opioids such as fentanyl and heroin cause respiratory depression, leading to oxygen deprivation in the brain that damages brain cells.
āBetween one to two minutes [after overdose, before resuscitation], the brain damage can start initiating, and between five minutes of cells in the brain not receiving oxygen, then we have the death of brain cells,ā said Garcia-Barrera.
By contrast, stimulants like cocaine accelerate brain aging by damaging neurotransmitters, causing grey matter loss that leads to cognitive decline and impaired decision-making.
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Brain changes
Neuropsychologist Carolyn Lemsky is the clinical director of Community Head Injury Resource Services, a Toronto not-for-profit that runs a brain rehabilitation program.
Lemsky says many of her patients want to quit using substances. But habitual drug use alters brain structure and function, making it difficult to quit.
āIn people who use opioids and who have a lot of these non-fatal overdoses, their brain changes in many ways,ā said Lemsky.
The brain atrophies in critical areas like the hippocampus, the region responsible for memory, and the temporal lobes. Simultaneously, neural pathways linked to habitual behaviour āget a little fatter,ā reinforcing addiction.
This rewiring ātilts the brain toward immediate gratification,ā Lemsky said. Meanwhile, impairments in the hippocampus diminish the ability to recall the negative consequences of past actions, making recovery even more challenging.
But Lemsky says alcohol remains the most problematic substance for her clients, due to its widespread use.
And while it is a legal substance, alcohol also affects the brain, she says. It leads to cognitive issues like memory and executive functioning problems. Many of her clients develop alcohol-related dementia due to vitamin deficiencies caused by chronic alcohol use.
Cannabis, another legal substance, has also become āmore and more problematicā for her clients over the past 15 years, Lemsky says.
āCannabis also interferes with cognitive functioning,ā she said.
According to Health Canadaās 2024Ā cannabis survey, 80 per cent of Canadians recognize cannabis can be habit-forming and detrimental to youth brain development. Only 71 per cent said they were aware it is linked to mental health issues such as psychosis.
āFurther research is neededā
In a statement to Canadian Affairs,Ā Health Canada said the long-term health consequences of illegal drug use require further study.
āFurther research is needed to better understand long-term impacts of opioid-related harms, including the relationship between brain injury and substance use, as well as predisposing factors and long-term effects,ā said Marie-Pier Burelle, a media relations advisor for Health Canada.
Lemsky says it is problematic that theĀ Canadian Drugs and Substances StrategyĀ ā the governmentās framework for addressing substance use-related harms ā does not address the known health effects of illegal drugs.
āIf you look at the Canada drug strategy, it doesnāt mention brain or cognition once,ā she said.
In 2022,Ā NDP MP Alistair MacGregor introducedĀ Bill C-277, a private memberās bill that aims to establish a national strategy on brain injuries. The bill was at the report stage when Parliament was prorogued in early January. Further work on the bill could resume in the next parliamentary session.
āThey need a brain injury strategy,ā says Lemsky, explaining that cognitive impairment is the leading reason people disengage from medical support services, such as getting treatment for addiction.
āThe treatment has too high a cognitive load and isnāt adapted to their needs,ā she said. āThey canāt manage, and they leave.ā
This article was produced through the Breaking Needles Fellowship Program, which provided a grant toĀ 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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Subscribe to get BTNās latest news and analysis, or donate to our journalism fund.
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