Canada is in the grips of a deepening crisis caused by toxic drugs that federal modelling predicts will likely result in thousands more deaths this year.

Against that stark backdrop, advocates and people who use drugs are urging the federal government to ensure there is widespread access to a safe — or regulated — drug supply.

They say a safe supply is crucial in combating the crisis, along with decriminalization — something the government has slowly started to warm up to, having recently granted British Columbia residents a three-year exemption from the criminal offence of possession of small amounts of drugs.

“Without access to a regulated, safe supply, decriminalization alone doesn’t pose many opportunities to really stem the tide of overdose deaths that we’ve seen here,” said Corey Ranger, president of the Harm Reduction Nurses Association.

“What we need to see is action from the federal government now.”

The overdose crisis has been fuelled by an illicit drug supply that’s contaminated with powerful opioids like fentanyl. More than 7,500 people died of overdoses last year, according to the Public Health Agency of Canada, which estimates that the number of such deaths could increase this year.

Organizations led by people who use drugs say there needs to be a complete rethink in Canada on having a regulated drug supply — moving away from pilot projects and short-term funding and looking at models that could include individuals being able to access drugs at pharmacies without a prescription, or even a liquor store-type establishment.

In the meantime, short-term solutions are needed. Ranger said a broad exemption granted by the government under the Controlled Drugs and Substances Act could allow those organizations to dispense a safe supply without the need of a prescription, pointing out that the majority of people who use drugs do not have a substance use disorder and therefore don’t need to see a doctor in the first place.

“They can create exemptions so that people and organizations can do the work in community to create models that are actually going to be accessible for people,” Ranger said.

The Vancouver Area Network of Drug Users (VANDU) and the Drug User Liberation Front (DULF) applied last year for an exemption to run a “compassion club,” which would provide a safe supply of methamphetamine, cocaine and heroin that would be procured through the dark web, rigorously tested and packaged with labels reflecting the contents in each substance.

Health Canada has said it intends to reject the proposal. Two main reasons were given, according to Brittany Graham, VANDU’s executive director, the first being that it would be “harmful to the Canadian public” for a compassion club to be engaging in the illicit market.

“This is a really hard line to be holding when there are people overdosing every day,” Graham said.

“People are using drugs. People are buying drugs illegally. They cannot access safe supply for a variety of reasons. So to ignore the systemic barriers of our current system and completely reject our proposal is quite ignorant to the situation and to the crisis we are in at this moment.”

The second reason, she said, is that Health Canada said the organizations would need to connect with pharmaceutical companies to have a system in place for procuring the drugs before an exemption could be approved. Graham said a legal source would be the preferred route for procurement, but that the government should be doing that kind of negotiation.

“Pushing the job of the federal government off of their own shoulders and putting it on these small organizations to do negotiations on procurement and production of currently illegal substances — without any guarantee of any exemption request being accepted — is once again them not understanding the realities of the current overdose crisis,” she said.

Mental Health and Addictions Minister Carolyn Bennett’s office said additional information received from the organizations following Health Canada’s intent-to-reject letter in April will be considered before a final decision is made, and that it would be inappropriate to discuss the applications further as they remain under review.

“Our government is committed to supporting efforts to expand access to safer supply, including exploring alternative models that will remove existing barriers to access,” the office said in a statement, noting the government is supporting 17 safer supply projects across the country, for a total investment of more than $64 million.

VANDU and DULF argue in their exemption application to Health Canada that some safe supply programs are limited in reach, noting that not everyone who uses drugs meets the eligibility criteria to access them and they don’t always provide the drugs people want, leading them to still turn to the illicit market.

“At the end of the day, the more accessible the supply of safe drugs is, the more users will access those drugs and the more lives will be saved,” they wrote.

Last August, the government’s expert task force on substance use recommended a comprehensive “emergency response strategy” to scale up safer supply, which could include using pharmacies, public health clinics and harm reduction services as distribution methods.

The government was able to move very quickly to address the COVID-19 pandemic and should be able to pivot just as fast to deal with the public health emergency presented by the toxic drug supply, said Natasha Touesnard, executive director of the Canadian Association of People who Use Drugs.

Touesnard stepped down as co-chair of the expert task force in April, saying she was dissatisfied there weren’t other active drug users on the panel.

“I do believe that the federal government has been, might I say, cowardly in actually addressing this crisis, and I think further it speaks loudly to how they actually view our community,” Touesnard said. “I would say that we’re, in their eyes, lesser than the larger Canadian community.”

Eris Nyx, co-founder of DULF, pointed out that when there was an unregulated market for alcohol during the prohibition era, the substance was more potent, toxicity in the market increased, and it gave more power to organized crime.

“If we drive the direct parallel with currently illegal narcotics, our argument is that if you improve regulation, the harms done to society by that trifecta of things will dissipate,” she said.

“We’re not advocating for everyone to be messed up on drugs and alcohol. What we’re saying is if you do not regulate this market, people will continue to die.”

Ultimately, Nyx would like to see establishments distributing regulated drugs not totally dissimilar to liquor stores.

“Do I think we can get there overnight? No. The larger conversation about drug regulation, that has to be had, but right now my only concern is everyone I know is dying,” she said.

“What you need in the short term until this bureaucratic red tape can be cleared are these models that operate between drug checking and drug dealing in every community. That’s what’s going to save lives.”

Jacques Gallant is a Toronto-based reporter covering politics for the Star. Follow him on Twitter: @JacquesGallant