Ideal drug policy would strictly regulate illicit substances in order to ensure composition and reduce toxicity, according to a report by Island Health's chief medical health officer.
Dr. R茅ka Gustafson's report from last month to psychoactive substance use in the region, which includes cigarettes, alcohol, cannabis and unregulated prohibited substances such as heroin, cocaine and methamphetamine.
"Since these substances are illegal, there are no regulations in place for their manufacturing and distribution," she wrote. "Opioids in the unregulated market have become increasingly potent and contaminated over the past decade."
In 2023, there were 487 deaths due to toxic drugs in the Island Health area, a record number, according to data from the B.C. Coroners Service.
Island Health's report noted that toxic drugs are currently the leading cause of death for the 19-39 and 40-49 age groups, second-leading cause of death for those under 19, and second-leading cause of overall potential years of life lost. Unregulated drug deaths are higher on the central and north Island compared to the south Island.
The report states that mortality related to unregulated opioid toxicity is now more than two times higher than when the public health emergency was declared, which is attributed to the concentration of fentanyl in the unregulated drug supply.
"The ideal policy landscape would be one where all psychoactive substances were strictly regulated and controlled under a public health framework. This means that regulations would be devised, monitored and evaluated, and changed as needed to address potential and actual harm of each substance," the report noted. "Creating and maintaining effective policies and regulations is a societal challenge that requires sustained commitment to public health goals and implementing, evaluating, and adjusting regulations as needed."
Gustafson wrote that "extensive harms" have come from drug prohibition including illegal markets and organized crime, violence, increasingly potent substances, criminalization of already marginalized groups, stereotypes, discrimination, stigma and even reduced access to supports and services.
"For illegal, unregulated opioids, we are unable to use the evidence-informed policy and regulatory mechanisms that can ensure that they are less toxic and accessed in ways that cause less health and societal harm," the doctor wrote.
In an interview with the News Bulletin, Gustafson said the report is a reflection of the historical path of psychoactive substances and the strategies that have made them more or less harmful.
"I'd like us together to reflect on those things and have conversations about how we want to apply that knowledge to make sure that these substances that are causing significant harm to our population cause less harm and we are healthier together," she said.
On the opposite end of the legal spectrum, there's alcohol, and Gustafson said there's a lack of national and international regulatory agreements to reduce consumption.
The report noted the rate of Island Health hospital admissions caused by alcohol in 2022-23 was 500 per 100,000 people, which was 1.3 times higher than the B.C. average of 385 per 100,000 people and nearly twice the Canadian average of 262 per 100,000 people. Rates on central and north Vancouver Island were 1.3 times higher than on the south Island.
"I think we're at the stage where we're really recognizing the health harms of alcohol, a significantly harmful substance in Island Health and I think we need to think about how we're going to use those regulatory mechanisms such as taxation, limitation of access and availability and to some extent de-normalization of this very hyper-normalized substance in our society," she told the News Bulletin. "Then on the other end, the other very harmful substance of course is the unregulated substances and thinking through what would be the regulatory framework for them in order to minimize the harms."
Gustafson pointed to tobacco use as an example of effective regulatory management, noting that smoking is on the decline in the region.
"It took years and years of regulatory work, of the recognition of the harm, the decision to have a strategy and then apply these regulatory mechanisms through taxation, through availability, through age restrictions and then de-normalizing tobacco smoking in many ways in our society," she said. "That has led to a gradual decline in tobacco smoking and now we're seeing some of the health benefits to that."
Island Health's current approach on psychoactive substances is to invest in prevention, empower communities with evidence to influence and support policy changes, develop a system of care for people who use substances in the region and meaningfully address health inequities.
"The prevention part needs to recognize what leads to substance use and we know the determinants are trauma and poverty and adverse childhood experiences," Gustafson said. "So investing in the foundations of a healthy childhood and a healthy perinatal period, which is supporting parents who are struggling, high-quality childcare, and really addressing some of the inequities people face 鈥� that's a societal level prevention method."
The report can be read in full on at
The message Gustafson said she would like to get out is that there should be more talk about substances.
"We've learned a great deal from tobacco. We're not done with tobacco, but it has taught us a great deal, we're learning from cannabis as a regulatory framework is put in place, so let's talk about it in our communities. What are the tools available to us at a municipal level and a community level and let's talk about what kind community we want to have."
