Decade of death: With 18,000 lives lost, B.C. counts cost of 10-year drug emergency

Ellen Lin remembers her daughter Emmy Liu as a creative teen with a love of playing the flute and a long reading list full of fantasy novels. She died of a fentanyl overdose in bed at the family’s home in Surrey, B.C., on Jan. 30, 2025, aged just 14.

The four young victims are among more than 18,000 people who have died from toxic illicit drugs in British Columbia since a public health emergency was declared on April 14, 2016.

Despite recent declines in fatality rates, almost five people in B.C. are still dying from unregulated drugs every day, on average. Illicit drug toxicity is the leading cause of unnatural death in the province, accounting for more deaths than homicides, suicides, motor vehicle incidents, drownings and fires combined.

As B.C. approaches the 10-year anniversary of the declaration, grieving friends and families, former policy makers, medical workers and those who use drugs are reflecting on the decade of crisis and what could have been done differently to save more lives. They describe the explosive and deadly impact of the arrival of synthetic opioids, the public policy battles to arrest the catastrophe as deaths soared, and the personal battles that also ensued.

Lenae Silva, 35, from Nanaimo, B.C., has been using opiates of some sort since she was about 15. She co-founded an organization that helped hand out harm-reduction supplies like clean syringes and smoking kits, while connecting those in need with support.

Hundreds of her friends have overdosed, she estimated. Many died, and she said there are many different answers for how each death could have been avoided.

“It’s almost like a road that each person tumbled down before they passed. All of those roads could have been diverted or forked or led to a door that, you know, could have led to safety,” she said.

“I wish I had a better answer than that, but …” she said, before her voice trailed off.

‘LIKE AN ATOMIC BOMB’

There were signs of trouble before provincial health officer Dr. Perry Kendall and health minister Terry Lake stood before a news conference and declared B.C.’s public health emergency over what they called a “significant increase in drug-related overdoses and deaths.”

The province had reported 474 apparent illicit drug deaths in 2015, a number that pales in comparison to the 2,000-plus annual deaths that would be recorded as the crisis progressed.

But at the time, it represented a 30 per cent increase in deaths from the year before. And the 76 deaths in January 2016 were the most in a single month since at least 2007.

Ian Tait had already been a paramedic for 15 years when the crisis was declared. He spent some of those early years on 135A Street in Surrey’s Whalley neighbourhood, on the front line of the battle.

He said the number of overdoses that were increasingly difficult to reverse had been growing a year or two before the emergency was declared.

“It just hit like an atomic bomb down there. And all of a sudden we were scrambling, literally, to keep up with the amount of Narcan we were using,” he said, referring to the brand name for the opioid reversal drug naloxone.

“We would go from half a dozen overdoses a day to like 30 overdoses.”

Now a quarter-century veteran of the paramedic service, he says his colleagues are sometimes responding to “hundreds” of overdoses a day. On Jan. 21, BC Emergency Health Services said paramedics responded to 256 overdoses across the province, setting a record.

“I don’t think people realize, if it wasn’t for Narcan, it would be … ten thousand a year (dead),” he said.

B.C. was the first province in Canada to establish a provincewide take-home naloxone program. It hands out 400,000 naloxone kits annually.

It was the introduction of fentanyl into the drug supply, a synthetic opioid that is 50 to 100 times more potent than morphine, that helped set off the crisis. First synthesized in the 1960s, it would become a common painkiller in hospitals and by prescription.

But it would also make its way onto the streets. Data from the BC Coroners Service show that in 2015, fentanyl was involved in about 29 per cent of drug deaths in the province. In 2016, that prevalence soared to 66 per cent.

As the presence of other opioids, such as heroin and oxycodone, in overdose deaths declined, fentanyl would become by far the most common drug involved, in B.C., the rest of North America and much of the world.

Brandon Jansen died from fentanyl poisoning in Powell River on the Sunshine Coast about five weeks before the emergency was declared.

His mother Michelle remembered the struggle to find help for her son. Private facilities cost her about $250,000 over two years before he died.

“There was nowhere you could turn to in terms of government resources. There was no one you could call. I brought Brandon to the doctor. It was all really new territory for the doctor,” she said.

On the streets of Nanaimo on Vancouver Island, people who used drugs were relying on each other for warnings about bad batches, and for help when someone was overdosing. That was long before official warnings became commonplace, Lenae Silva said.

“Pre-COVID, Narcan wasn’t really massively available either, so it was a lot of the old-schoolers teaching us young’uns how to reverse these overdoses,” she said.

“Breathe for them,” she said, referring to rescue breathing. “Make sure they go to the hospital if you can convince them to.”

Tait thinks declaring the public health emergency was important, even if the government may have been initially hesitant because it meant admitting what they were already doing wasn’t helping.

“It was one of the first times where we really said, this is a medical problem, this is health problem,” he said.

“So, I feel like when that finally got described as a public health emergency for the first time, the government really owned up to (the fact that) this is actually happening and we need to divert a large amount of resources to this.”

Kendall said in an interview that declarations are conventionally used for epidemics in situations where officials need to order people to get treatment or stay home.

In this case, declaring the emergency meant the government could require that more information be released faster.

“We got more and quicker data from the coroner’s office. We could get data from police forces. We could get data from the emergency ambulance service,” he said.

He said the numbers could be used to determine quickly where overdoses were happening so services could be developed and deployed.

“It also brought a ton of political and media interest into the issue, and we put a lot more time and effort into prevention, into intervention, into drug treatment, whether it was medication-based or behaviourally based,” he said.

The province said B.C. had more than 3,700 treatment and recovery beds of which 790 are new since 2017.

But a decade after her son’s death, Jansen said the government needed to do more to create dedicated places where people can quickly get help.

“It is absolutely nonsensical and unrealistic to expect someone who is in the throes of addiction, where the drug is making the choices for them to be able to … find and source the appropriate treatment facilities, make the calls, set up appointments, get themselves to there,” she said.

“They might not have availability for two weeks. Well, you’ve lost them, you lost them. It doesn’t make any sense.”

THE DECRIMINALIZATION EXPERIMENT, THEN A RETREAT

The trajectory of the crisis has not been a straight line.

BC Coroners Service data show that toxic drug deaths in the province dropped significantly in 2019 to fewer than 1,000, down more than a third from the year before.

Kendall said the decrease had been “encouraging.” Then the pandemic hit.

“What would have happened after that if COVID hadn’t come along? I have no idea,” said Kendall, who retired in 2018.

“I would like to think that we would have gotten on top of it and been able to manage it because it looked like we made a big start. I think COVID threw a lot more people into the ringer.”

In 2020, as the global pandemic shut down borders and forced many to stay inside, there were 1,775 deaths from illicit drugs in B.C., up 79 per cent from the year before.

Silva remembered people she knew “disappearing.”

“It takes a friend of a friend, of a friend of a mom who knows them to come out and say like, ‘Hey, sorry, this person passed away,'” she said.

“So, we were just seeing this massive loss of people, of our friends, of familiar faces who’ve been around for decades and just weren’t there anymore.”

Closed borders had an impact on drug supplies, leading to the creation of new clandestine labs, Silva said.

The number of deaths kept climbing: 2,294 in 2021, 2,390 a year after that, before peaking at 2,590 in 2023.

As the crisis unspooled, British Columbia was thrust onto the cutting edge of global drug policy, expanding safer supply policies and supervised drug consumption sites. In 2016 there was one safe consumption and overdose prevention site in B.C.; by 2021 there were 38, and by the middle of last year there were 58, plus nine in hospitals.

Most controversial was the experiment with decriminalization, launched in 2023, allowing adults to possess up to 2.5 grams cumulatively of opioids, cocaine, methamphetamine and MDMA under a three-year pilot program.

Advocates would push for higher limits, and seek expansion of safer supply to allow opioids to be provided without a prescription.

But such efforts are now in retreat. B.C. declared in January that the decriminalization experiment was over, having already tightened rules about public drug consumption amid a backlash.

Critics called decriminalization a failure, while studies gave varying opinions on its effectiveness and it became fodder for the 2025 federal election.

A study published in JAMA Health Forum in 2025 found that both safer supply and drug decriminalization policies in British Columbia were associated with increased opioid overdose hospitalizations, although not with an increase in deaths.

In 2024, the province placed tighter restrictions on where the drugs could be possessed and by early 2026 Premier David Eby told reporters that decriminalization “didn’t work.”

Silva maintained that while decriminalization was “not perfect,” it saved lives by allowing people to use around others. “It prevented a lot of people from dying inside alone,” she explained.

As for the province’s safer supply program, which provides pharmaceutical grade opioids to people at risk of overdosing, it has also seen significant changes since it was introduced in 2020.

The B.C. Health Ministry said users of the program peaked at almost 5,200 patients in March 2023, decreasing to fewer than 3,900 in December 2024.

In February 2025, Health Minister Josie Osborne announced the roll back of the program to a “witnessed-only” model in which users are watched as they consume opioids.

The move followed an outcry over the diversion of the prescribed opioid hydromorphone. A leaked report by a Ministry of Health investigative unit found that a “significant portion” of prescribed opioids were being diverted, with some trafficked provincially, nationally and internationally.

Like many of B.C.’s cutting-edge policies, the safer supply program was extensively studied, with one study published in the British Medical Journal finding that there was a 55-per-cent reduced risk of overdose death in the week after receiving at least one dispensation of safe-supply opioids.

Four or more dispensations of safe-supply opioids were associated with a 91 per cent reduction in risk of death from all causes in the following week.

But a second study published in JAMA Internal Medicine found an almost 63 per cent “relative increase” in the opioid overdose hospitalization rate across B.C. after the introduction of safer supply.

Silva has been using the safer supply program for years and calls it the most life-saving help she has received.

“I was on my way to almost entirely off (street drugs) when they changed it,” she said.

Under the new program, Silva said she had access to less of the safer drugs and has been forced to rely more on what she can get from the street.

“They’re pulling it way faster than our bodies can handle. I’m sick every day now and I’m just barely, barely pulling through and I’m housed and healthy. You know, it’s scary right now,” she said.

DECLINING DEATHS AND A CHANGING SUPPLY

Starting in 2024, the number of opioid deaths in B.C. began to decrease as part of a trend seen in cities across North America.

But for all its policy efforts, the decline was slower to arrive in B.C. than in some other places.

The first year of decriminalization had coincided not with a decline in drug deaths but with a record number of fatal overdoses.

The 2,590 deaths in 2023 represented an increase of eight per cent over the previous year. That rise was faster than in some other places in Canada, such as Ontario, where deaths were up four per cent. And deaths had already started falling in the United States after peaking in 2022.

In 2024, the year decriminalization was curtailed, drug deaths in B.C. fell 10 per cent. That was slower than in Ontario, which experienced a 15 per cent decline, while deaths dropped by 27 per cent in the United States that year.

The decline in deaths in B.C. now appears to have caught up to elsewhere, falling by about 21 per cent last year to 1,833, roughly the same year-on-year percentage decline as in the United States according to the latest data from the U.S. National Center for Health Statistics. Canada witnessed a 17 per cent decrease in deaths between 2024 and 2025, representing what the Public Health Agency called “the first sustained decline since deaths surged during the COVID-19 pandemic.”

What might be behind the continental decline in drug deaths is the subject of much debate.

In a report updated in December, the Public Health Agency of Canada lists changes in the drug supply, the availability of naloxone and a “declining population at risk” as “likely” factors.

Hints can be found in a study published in the April 2026 edition of the International Journal of Drug Policy where tested samples of unregulated opioids in B.C. found that median fentanyl concentrations peaked provincially at 11 per cent in mid-2023 before declining to 5.1 per cent in early 2025.

The thesis around reduced fentanyl concentrations may be bolstered by geopolitical analysis. An article published in the journal Science about the decline in overdose fatalities in the United States suggests the trend is related to “a major disruption in the illicit fentanyl trade” possibly tied to actions by the government of China, where most precursor chemicals used to make fentanyl are believed to originate.

It says in 2023 the government of China began more aggressive law enforcement against synthetic drug and chemical precursor suppliers, and by June 2024, it claimed to have taken down 140,000 advertisements and 14 online platforms.

Among other potential factors noted by the Public Health Agency of Canada: regions that distributed more naloxone kits experienced larger declines in deaths, while the sheer number of people who have died — reducing potential future victims — may also have played a role. The agency notes that the largest declines in deaths were in regions with more previous fatalities.

Among “unlikely” causes of the decreasing death numbers? The agency’s report lists supervised consumption and overdose prevention sites as well as opioid agonist therapy.

A STRATEGY SHIFT

A shift on addiction policy in B.C. is now underway, with a stronger public emphasis on treatment and involuntary care for people with severe and overlapping mental-health and substance-use challenges.

“When someone is so unwell they can’t make decisions about their own safety, we have a responsibility to step in with compassion and care,” Premier David Eby said in a statement in November.

The shift includes legislative changes to the Mental Health Act that passed in December, strengthening liability protection for health workers involved in involuntary-care decisions and treatment.

The government also said in November that it was urgently working to boost the more than 2,000 mental-health beds in B.C. available to provide involuntary care.

A panel put together by B.C.’s coroner in 2023 estimated that 225,000 people in the province use drugs.

Some who grieve losses or have been on the front line of the drug battle over the past decade suggest the shift has come too late. Some wonder why more isn’t done about the criminals behind the flow of drugs.

Ellen Lin blamed death of her daughter Emmy on the “absurd” decriminalization experiment.

She said the policy “opened the floodgates to widespread drug abuse, exposing children and youth to extreme danger.

“They created conditions for adults, including drug dealers and other predatory individuals, to supply or sell dangerous substances to vulnerable minors,” said Lin.

Glenn Rebic’s mother, Meredith Dan, agreed that more needed to be done to stop those who sold the deadly drugs.

“Why aren’t they charged with murder? Because essentially they are murdering people,” she said.

She said more resources were needed by both people who use drugs and grieving families.

“I don’t think that there’s a single person in society that hasn’t been impacted by it somehow between a friend, a relative or a colleague,” she said.

Paramedic Tait said his colleagues question how increasingly toxic drugs arrive in Canada and why more isn’t done to stop it.

“Where in the world are they mixing in horse tranquillizers and 100 times more potent narcotics into street drugs? How is that happening? How is it getting into our country? Are they making it here? It’s almost like a geopolitical logistical chain issue,” he said.

Maria Rantanen attends a support group specifically for people who have lost someone in the crisis.

She said it’s hard for people who haven’t experienced that kind of loss to relate.

“There’s a certain stigma around losing someone to drugs that I think in that context people understand. I feel understood and heard in that group,” she said.

“Having to have these groups is indicative of the fact that we are losing so many people.”

— With files by Nono Shen in Vancouver

This report by The Canadian Press was first published April 8, 2026.

Ashley Joannou, The Canadian Press

by The Canadian Press

Decade of death: With 18,000 lives lost, B.C. counts cost of 10-year drug emergency

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