Smoking, Not Injecting, Now Linked to Two-Thirds of BC Overdose Deaths

October 2, 2023

Amid a mass exodus from injecting drugs to smoking them, the push for safe consumption sites (SCS) in North America has yet to fully mobilize around safe inhalation spaces. According to data from the British Columbia Coroners Service, 65 percent of unregulated drug deaths recorded from January 2023 through the end of August were linked to smoking. Injecting was linked to 15 percent of deaths, and snorting/sniffing to 14 percent.

CBC reported that Chief Coroner Lisa Lapointe described the urgent need for SCS as including “a safe place to smoke drugs.”

According to the BC Ministry of Mental Health and Addictions, 19 of the province’s 47 sanctioned SCS include inhalation spaces as of July 2023. Visit records for that month show that inhalation services were accessed more than 40,000 times.

An average of more than five deaths per day in August was attributed to BC’s unregulated drug supply. Though that rate represents a slight decrease overall, the rate of deaths associated with smoking drugs in BC has more than doubled since the province first declared the opioid-involved overdose crisis a public health emergency in 2016.

That was the most recent year that Coroners Service data showed injection as the most prevalent method of drug consumption; by 2017, data showed a shift to smoking, and the majority of BC harm reduction service participants surveyed continue to report smoking as their primary consumption method. Data from other provinces show the same pattern along the same timeframe. The BC Coroners Service report reasserted that medical safer supply. has not been associated with any increase in overdose deaths.



Two of Canada’s legal inhalation spaces currently operate under federal authority: Casey House Day Health Program Supervised Consumption Services in Ontario, and Prairie Harm Reduction in Saskatchewan. The majority are under provincial jurisdiction, and the regulations they’re subjected to vary accordingly.

In Ontario, for example, provincial authorities capped the number of SCS and banned inhalation in 2018, not long after Moss Park Overdose Prevention Site opened Toronto’s first safe smoking tent without authorization. Moss Park was relocated indoors to operate as a government-sanctioned site, minus the safe inhalation services.

One barrier to safe inhalation spaces is the additional layer of bureaucracy entailed in ventilation requirements. But another is that government-sanctioned SCS are limited to evidence-based interventions, and peer-reviewed research in Canada and the United States alike has historically been less interested in stimulant use than opioid use. Sanctioned SCS in Europe have accommodated smoking for decades, and dozens of SCS with safe inhalation spaces operate legally around the world.

The shift to smoking mirrors that taking place in the western US. 

Most drugs consumed at SCS across Canada are opioid-based. The shift to smoking mirrors that taking place in the western US. 

Since the onset of the COVID-19 pandemic, fentanyl pressed pillsAKA “the blues”—have rapidly overtaken less-potent substances like black tar heroin in the unregulated opioid supply. Deaths associated with fentanyl pressed pills more than doubled during the pandemic.

By December 2020, more than half of all overdose deaths reported in Western jurisdictions no longer showed evidence of injection use. In an effort to mitigate the heightened risk, more and more people using unregulated opioids were opting to smoke them.

Safe inhalation spaces are integrated into New York City’s two authorized SCS, as will be the case with the state-authorized SCS set to open in Rhode Island in early 2024. But those services are almost never referenced by legislators or media.

Stimulants are frequently injected and opioids frequently smoked, but smoking and stimulants have long been paired in the public consciousness. The stigma levied against stimulant users is a unique barrier to inhalation sites, one that persists even with the proper ventilation permits and sufficient academic evidence. Methamphetamine-involved deaths are being disastrously blown out of proportion in US overdose data—a body of evidence for safer smoking sites that isn’t accurate, but that still hasn’t generated much interest in them.



Top photograph of Insite Vancouver via Laura Thomas/Drug Policy Alliance/State of Massachusetts. Inset graphic via British Columbia Coroners Service.

Kastalia Medrano

Kastalia is Filter's deputy editor. She previously worked at a number of other media outlets and wouldn’t recommend the drug coverage at any of them. When not at Filter, she works with drug users in NYC and drug checkers in North Carolina to track hyperlocal supply changes, and cohosts a national stimulant users call with Isaac Jackson.

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