Why your friends, neighbours and colleagues may use unregulated drugs

September 6, 2023

Shane and Joanne have faced stigma around addiction and homelessness, and say the shame and judgement needs to end. You can watch Shane's and other stories in our End Stigma video series

If there’s one lesson to take away from the toxic drug crisis – now sometimes referred to as the unregulated drug poisoning emergency – it’s that things are not always what they may appear.

Despite what we might believe about who uses substances and why, or what we see in our communities or in the media, consider these stats from the BC Coroners Service:

In 2023, 81 per cent of unregulated drug deaths occurred inside
Poisonous drugs are now the second leading cause of all deaths after malignant cancers
In B.C., 1,455 people have lost their lives to unregulated substances in the first seven months of 2023 – more than six people per day. Within the Interior 253 people lost their lives in the same time period, up from 226 in the same period in 2022.

People who use substances are your friends, neighbours and colleagues. Perhaps a family member is using substances, but hasn’t shared this, due to fear and shame.

One of the main challenges we face when addressing this public health emergency is the stigma associated with drug and substance use.

In this Story…

Report on the toxic drug crisis in B.C.’s Southern Interior (trigger warning)

Committing to anti-stigma work with knowledge and understanding

What our staff say about why people may use substances

What you can do

Report on the toxic drug crisis in B.C.’s Southern Interior (trigger warning)

Every year, Interior Health’s medical health officers (MHOs) publish a report that addresses health topics that may interest British Columbians. These reports contain recommendations for changes to legislation, or for new programs and policies to improve health.

This year, we published The Toxic Drug Crisis in BC’s Southern Interior Region Medical Health Officer (MHO) Report Part 2. While Part 1 described the health impacts of the toxic drug supply, Part 2 explores why people may use substances, among other topics.

Read Report Part 1

Read Report Part 2

These reports include information related to unregulated substance poisoning deaths. We recognize this content and subject matter may be triggering and cause trauma to readers. Please find the right time and space where you are ready to engage with the material before you proceed, and care for your safety and wellbeing. You can also contact our emergency and crisis lines, and we have substance use services and resources you can access.

Committing to anti-stigma work with knowledge and understanding

For the report, a team met with a group of people with lived and living experiences – called peers – who use substances. Here, in their own words, are some of the reasons they started or continued to use substances:

“[I have a] broken back and nothing numbs the pain.”

“To manage acute pain due to injury and being prescribed an opiate. Once a doctor stops prescribing, you turn to street drugs.”

“It’s like I blinked and I needed it, it wasn’t a want anymore.”

“I stay an active user ‘cause I’m not ready to deal with my psychological issues.”

One peer who was interviewed spoke to the misconceptions around those who use substances:

“There are a lot of users in hiding who work and have jobs. It’s not just a homeless problem, but it seems people focus on that and I’m not sure why.”

What our staff say about why people may use substances

Every day, hundreds of Interior Health staff and health-care workers, along with first responders like paramedics and firefighters, provide care to those whose substance use has put them in crisis. In April, we interviewed our staff about the toxic drug crisis anniversary.

For the release of the medical health officer report on the toxic drug crisis, we spoke with a number of our staff about why people may use substances. Here's what they said:

Alison, practice lead, Substance Use Team

“People across cultures have been using substances for thousands of years for personal, social, recreational, ritual and medicinal reasons. People use substances to celebrate, to give them energy, to relax, to alter their reality, to change their perspective, to feel connection, to manage pain, to feel relief from sadness and grief, etc. Using substances has rewards and it also has the potential to cause harm. Many people who use substances do not develop substance use problems, but any substance use comes with risks and for some it can become a problem.”

Alison, project lead, Sexual Health & Harm Reduction

“I know there’s a lot of people saying that harm reduction enables people who use substances and that these anti-stigma campaigns will only encourage public substance use. If people are using in public, it’s because they don’t have homes and have nowhere else to go. Just look at the BC Coroner Services’ report: 81 per cent of those who have died were inside. The shame and stigma are a profound weight that really and truly only drives people deeper into addiction and isolation. ‘Stigma kills’ is not a hollow, meaningless statement; it is literal.”

Corinne, manager, Substance Use Services

“People use substances for many reasons but people who become dependent are often trying to alleviate some kind of pain and want to feel better. Many have histories of trauma, often as children, and want to escape from their suffering. Dependency on a substance is a legitimate health-care condition and it should be treated like any other health-care condition and without judgement. Sadly, stigma is still one of the main reasons people do not seek support and why people use alone even though the risk is so high.”

What you can do

As a society, we often judge those who drink too much, smoke cigarettes or cannabis, overeat, have mental health challenges – and any other number of reasons.

The MHO report asks that “everyone reflects on the perspectives of people who have lived the experiences presented in this report, and commits to anti-stigma and anti-racism work within yourself, your family, your community and your workplace.”

Here are just a few ways you can cultivate self-reflection, empathy and understanding.

Watch these videos

The Stigma and Substance Use playlist contains a series of short videos about ending stigma:

Watch the Stigma and Substance Use videos

Paper People is a poem written by Alison Ko, a former Interior Health staff member, about her experiences reviewing the medical charts of those who died from suspected drug poisoning.