Overdose deaths are falling. Will fentanyl crackdowns change that?

CBC

07-05-2025

It's hard to believe opioid deaths are dropping when you're walking on Vancouver's Downtown Eastside, where B.C.'s drug crisis is most visible.
Open drug use is still common and on a dry day, you can count on seeing dozens of people unconscious on the sidewalk.
But the numbers don't lie: overdose deaths in 2024 decreased 12 per cent in B.C. and across the country compared to the previous 12 months, according to January data from the province and March data from Health Canada.
The epidemic has killed 50,928 Canadians since 2016 — that's all the seats in Rogers Stadium in Toronto, and then some. According to Health Canada, 21 people a day, on average, die from toxic drugs in this country.
But the declines mark a small but distinct shift in the country's overdose epidemic, which was officially declared a health emergency in B.C. nine years ago last month.
The downward trend is even more pronounced in the U.S., where drops in fatalities of up to 45 per cent have been seen in states like North Carolina, according to the Centers for Disease Control and Prevention (CDC), which aggregates state numbers.
However, any progress could be undermined if either country sees a dramatic shift in drug supply or harm reduction measures, warns Nabarun Dasgupta, a senior scientist at the University of North Carolina's Opioid Data Lab, which has been closely monitoring the shift in the U.S.
"The worst thing we could do right now is crack down too quickly on fentanyl," he said.
But that's what Canada's federal government has vowed to do in border measures initally crafted to stave off tariff threats from the U.S. — even though Canada has questioned the rationale, given that less than one kilogram of fentanyl has been seized on the U.S.-Canada border since January.
Stopping "production and trafficking of illegal fentanyl" is part of the scope of the $1.3-billion Canada Border Plan, which also promises to strengthen border security.
Staving off tariffs
Inside our borders, the government is also making plans to more strictly control some of the secondary chemicals used in the illegal production of fentanyl, on top of the already controlled essential ingredients.
In a statement to CBC News, the RCMP's national office says it's already uncovered "many chemicals" that are used as cutting agents for synthetic opioids like fentanyl, including veterinary drugs — not fit for human consumption.
China had also made moves to demonstrate a co-operation on fentanyl to avoid tariffs, releasing a White Paper in March to show the actions it's taken to "curb the illegal manufacturing, smuggling, and trafficking of fentanyl-related substances," including reining in precursor chemicals.
Those who work in harm reduction and people who use drugs fear a repeat of what happened during the pandemic, when closed borders and disrupted supply chains became a factor in "increased toxicity," a key issue discussed in a Canada-U.S. joint white paper.
The report, co-authored by U.S. and Canadian authorities, including Health Canada and the Public Health Agency of Canada, noted in March 2022 that "changes in the availability of substances may contribute to drug shortages, increased toxicity, stockpiling, and changes in tolerance among people who use drugs, which may increase substance-related harms."
"It's happened dozens of times before with drugs," said Dasgupta at the Opioid Data Lab.
"A new more potent opioid will come into the market. The market is completely primed for that kind of a shift."
What's next?
The illicit drug supply is always evolving.
From month to month, certain unregulated drugs like fentanyl or methamphetamine will appear in varying amounts in samples tested by drug checkers at a local level, or through autopsies and toxicology tests.
The unpredictability of ingredients is what makes accessing this uncontrolled supply so dangerous, says Sarah Blyth, executive director of the Overdose Prevention Society (OPS).
"If it gets hard to get fentanyl, there will be other drugs that flood the market," she said. "What's the next drug? Is it carfentanil? Then we're worse off."
Carfentanil, like fentanyl, is a synthetic opioid. People worry about it leaching into the drug supply, because it's about 100 times more toxic than fentanyl. It looks like table salt and just a few grains can be fatal.
Frequent changes in the illegal drug supply are of course felt deepest by the people who consume them.
It's important to remember drug users are all somebody's brother, sister, daughter or son, says Nick Reagan, a 31-year-old from Calgary who has used opioids for 10 years to manage his chronic pain after a car accident.
He lives in Vancouver's Downtown Eastside and worries about his drug supply being cut off through crackdowns or becoming more contaminated.
"My life is at risk," he told CBC News.
It's not hard to imagine overdose deaths numbers getting worse in B.C., given it was just a few years ago that almost seven people a day were dying, compared to almost five a day as of January 2025. At the time, then-chief coroner Lisa Lapointe pointed to the dangers of people using toxic drugs alone, as well as supply chains disrupted by the COVID-19 pandemic creating a void for drug makers to produce more powerful substances.
CBC News asked Health Canada about its new Precursor Risk Management Unit, which is helping lead the crackdown, on whether policy makers had considered how an abrupt shortage of fentanyl could affect drug users.
In a statement, the agency said the unit was following precedent set by similar federal government initiatives in the past, adding that "substance use harms and the overdose crisis are driven by complex and interrelated factors, and require a range of services and supports to address them."
The impacts of the additional enforcement might not be immediately obvious. It takes time to collect data on an unregulated drug supply, and if the supply does start to change, it'll take at least few weeks for a pattern to emerge, says Dasgupta.
3 theories
Dasgupta's team in North Carolina is still trying to nail down the reasons behind the significant decrease in overdose deaths, which have been seen in all U.S. states except Nevada and Alaska.
He has three main theories, which at first appeared like total anomalies.
The first is an apparent shift toward a more varied drug supply that's less based on fentanyl and includes lots of ingredients, like other synthetic opioids or amphetamines. Simply put, the drug supply may be getting saturated with substances that are less dangerous than large amounts of fentanyl.
"People are telling us in our field studies that the dope isn't the same as it used to be," Dasgupta said.
Then there's the drug users themselves. People who regularly crunch the numbers on overdose deaths know there's a certain cohort of people that commonly makes up a majority of fatalities. In Canada in 2024, 73 per cent of overdoses deaths happened to men aged 30 to 39, according to Health Canada.
In the U.S., about 70 per cent of overdose deaths hit men in their late-40s to mid-50s. Dasgupta suspects parts of that cohort may have stopped using drugs or could be dying of other causes.
'It adds up'
The last hypothesis for the decline is more hopeful.
Interventions could be having a real impact. Treatment options, including lifesaving opioid reversal drugs like naxolone, which people regularly carry with them, or programs to reduce the stigma of drug use or educate young people on the dangers, might be making a dent.
It adds up, says Sarah Blyth, who says the Overdose Prevention Society saves people every day in different ways.
Still, she remains sceptical of a permanent improvement in the long-running drug crisis, as she personally knows people who have recently died from the supply. Optimism in this rolling crisis is easily broken and people are desperate to see things improve.