Across the country, communities are grappling with a profound health emergency that continues to claim lives at a staggering pace. Communities are encountering increases in alcohol consumption and methamphetamine use, alongside street opioids and benzodiazepines. According to the Public Health Agency of Canada, more than 47,000 people in Canada have died from opioid toxicity since 2016. In the first three months of 2024 alone, nearly 2,000 people lost their lives to toxic drugs. The crisis is national, but each community experiences it differently. From small towns in the North to suburban neighbourhoods in the East, the harms of substance use are showing up in  emergency departments, encampments and homes. The system is overwhelmed, and often people who are ready to ask for help cannot find it or face barriers. This is not just a story about overdose. It is also a story about access, service gaps and a system that too often fails to respond before it is too late. A national survey conducted by the Canadian Centre on Substance Use and Addiction (CCSA) and CAPSA found that 62% of respondents had never been asked about their substance use in a healthcare setting. Even more stark: 79% had never received direct support. People are not being seen, screened or supported early enough. There is pain and tragedy. At the same time, small cities and towns are dealing with public disorder that feels increasingly unmanageable. Many communities feel neither healthy nor safe. Surveillance systems like the Canadian Community Epidemiology Network on Drug Use (CCENDU) provide timely monitoring of emerging contaminants and changing patterns of use. In some cases, these systems are the first to detect dangerous batches of drugs in circulation. But early warnings are only effective when there are systems and partnerships ready to act. Right now, those systems are uneven, under-resourced or absent in many communities.

These challenges are not limited to health care, justice or social services. They reflect a broader community crisis. In Canada today, one in four households report being unable to cover an unexpected $500 expense. Economic instability, housing insecurity, social isolation and untreated trauma all shape people’s vulnerability to substance use harms. Substance use does not exist in a vacuum — it’s intertwined with daily life. When systems fray, harm compounds. For those already pushed to the margins, the consequences can be fatal. A piecemeal approach will not work. The toxic drug crisis is not a singular emergency, but a convergence of many. As municipal leaders respond to overdoses, they are also contending with unaffordable housing, declining mental health, economic strain and resource pressures on emergency and public health services. People are not only dying in alleyways — many are suffering privately in homes, often without any contact with health or social supports until it is too late. The data tells us what’s broken, and it also shows what works, and where it works. The very things that make small cities and towns distinct — connection, compassion for neighbours and family, and crosssector partnerships — are the raw ingredients for evidence-based and evidence-informed solutions. This playbook is grounded in the understanding that every crisis is unique and that not every intervention will work in every jurisdiction. Early screening, low-barrier treatment, harm reduction, youth-specific services and coordinated care all have a place. Municipal leaders have a critical role in bringing these solutions closer to the ground. They can advocate, convene and build the local infrastructure needed to turn evidence into practice. What is needed now is urgency and clarity. We cannot address what we do not measure, and we cannot solve what we do not name. The current substance use crisis is complex, but not insurmountable. With better data, stronger partnerships and shared resolve, communities can chart a path forward.

Contents Include:

• About this playbook
• How the playbook was created
• Who this playbook Is for
• How to use this playbook
• Area for action 1: prevention and early intervention
• Area for action 2: harm reduction and outreach
• Area for action 3: treatment and recovery
• Area for action 4: community and cultural supports
• Area for action 5: housing and employment supports
• Area for action 6: policing and public safety