Re: BC has the tools to address the drug poisoning emergency (1)

The editorial by Dr Michael Schwandt in the December issue of the BCMJ [2023;65:365-366] proposes dealing with the drug poisoning emergency by decriminalizing drugs, reducing stigma, and increasing the safe drug supply. The problem with this approach is that it looks at only one outcome, and that is to prevent drug poisoning and drug poisoning deaths. Unfortunately, there are many more issues to this complex problem.

There are enormous social costs associated with normalizing drug use. We have witnessed the ghettoization of Hastings Street in downtown Vancouver, the near extinction of Chinatown, and the open use of drug injections across the entire downtown of Vancouver. It is ironic that it is illegal to drink alcohol or smoke cigarettes in many public places when injecting opioids is legal.

Our neighbors to the south have witnessed the destruction of the downtown cores of Portland, Seattle, and San Francisco due largely to permissive drug policies. These cities are rejecting this approach and are now recriminalizing and discouraging drug use. A similar story is unfolding in Portugal.

A safe drug supply, in my view, appears to be increasing accessibility to drug use, and in some cases safe drugs are being diverted so that addicted persons can purchase fentanyl-based products.

I am concerned that we are setting a very poor example for young people by normalizing drug use. Contrary to the editorial, I want to stigmatize drug use so that it does not become an attractive lifestyle for our children, teenagers, and young adults. There are some consumer groups who defend the rights of adults who use drugs and the subsequent lifestyle of crime that supports drug use. This, in my view, is a mistake.

The current policies are simply not working, as evidenced by the persistently high rates of overdoses and deaths. It is time, in my view, to try a different approach. Already, the provincial government has reversed policies on drug use that allowed drug injections in parks and near schools.

I do not pretend to provide a comprehensive solution to the current problems, but we need a broader approach than simply supplying safe drugs to persons addicted to drugs. We need to consider the extensive social problems that are created by normalizing drug use. We certainly need more housing and treatment services. There may be a role for more coercive treatment approaches. Lifesaving approaches such as certification under the Mental Health Act need to be reviewed.

It is time for citizens to seize the agenda and to not rely on advocacy groups and so-called experts to get us out of this crisis.
—Derryck H. Smith, MD, FRCPC

This letter was submitted in response to “BC has the tools to address the drug poisoning emergency. Do we have the will to use them?” Read the author’s response in “Re: BC has the tools to address the drug poisoning emergency. Author replies.”


Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Derryck H. Smith, MD, FRCPC. Re: BC has the tools to address the drug poisoning emergency (1). BCMJ, Vol. 66, No. 2, March, 2024, Page(s) 39 - Letters.

Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.

For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit

BCMJ Guidelines for Authors

Leave a Reply