Canada’s drug addiction crisis has been mounting for two decades, and shares many of the same features as the well documented experience of the United States. In both countries, the COVID-19 pandemic exacerbated the health harms, with rates of drug mortality in areas like British Columbia (BC) in 2022 as high as the worst affected parts of the USA.

There is more political attention on the issue compared to a decade ago, but a situation that warranted a declaration of a public health emergency in BC in 2016 has not improved since then – in fact the crisis has escalated. As of December 31, 2022, the rate of illicit drug toxicity deaths in BC has more than doubled since the emergency was first declared in 2016.

This report explores what is behind this dramatic deterioration and focuses on the characteristics of the crisis in British Columbia and Alberta – two neighbouring provinces in Western Canada that are home to a disproportionate share of the harm caused by opioid addiction today.