A 25 per cent drop in the rate of drug-poisoning deaths so far this year in B.C. is being attributed to factors ranging from a decline in the fentanyl concentration in the drug supply to harm-reduction measures such as wider availability of the drug-overdose reversing drug naloxone.
A recent B.C. Coroners Service report noted the decline in toxic-drug-overdose deaths from October to March.
Preliminary figures show 143 people died due to unregulated drug toxicity in March, down from 215 the same month last year, while 132 people died in February, down from 203 the same month last year.
Public health physician Dr. Alexis Crabtree said overall it represents a 25 per cent decrease in the rate of drug-poisoning deaths in 2025 compared with the prior year, and a 36 per cent decrease from the peak in October 2023.
“It’s such an encouraging trend,” said Crabtree, medical lead of harm reduction and substance use services at the B.C. Centre for Disease Control, and a clinical instructor at the University of B.C.’s School of Population and Public Health.
“I really hope to see it continue.”
Toxicological testing shows fentanyl remains the most common substance in drug toxicity deaths, with more than three-quarters of victims testing positive for fentanyl, according to the B.C. Coroners Service.
Crabtree said the decline in drug-poisoning deaths is widespread across North America, so whatever is driving it “is probably widespread as well.”
The U.S. Centers For Disease Control in February also noted a “continued steep decline in overdose deaths” — a nearly 24 per cent drop in drug-overdose deaths in the United States for the 12 months ending in September 2024, compared with the previous year.
The U.S. saw the fewest overdose deaths in any 12-month period since June 2020.
Crabtree said she now has more confidence in her earlier hypothesis that the decline is largely due to a change in the drug supply North America-wide. “There’s ongoing data to suggest a continued decline in the fentanyl concentration in the drug supply in B.C.,” she said.
It has been “such a dramatic change” in drug deaths that another hypothesis, such as fewer people starting or stopping drug use, seems less likely.
The B.C. Coroners Service said province-wide, Vancouver recorded the most deaths in the first quarter of 2025 with 97, followed by 52 in Surrey and 28 in Victoria.
Victoria-based Dr. Caroline Ferris, former medical lead for mental health and substance use addiction medicine for Island Health, isn’t convinced a change in the drug supply is a reason for the decline in deaths.
While median fentanyl concentrations may have decreased, the number and types of adulterants is increasing, said Ferris, citing a spike in benzodiazepines and powerful veterinary sedatives found in the toxic drugs killing people.
Ferris suspects the decline in deaths is partly because “a lot of people have died off and are not being replaced by new users.”
Other possibilities include people using drugs more safely, harm-reduction measures such as drug testing, wider availability of the overdose-reversing drug naloxone and overdose-prevention sites.
Crabtree agreed there’s good evidence to point to the role of naloxone in preventing deaths.
Another factor in the decline, said Ferris, is the provision of prescribed alternatives to toxic street drugs.
Ferris said recent efforts to increase the number of physicians prescribing Opioid Agonist Therapy medications, and improved access to these therapies in rural, remote and Indigenous communities, are paying off, resulting in “more people able to access this evidence-based treatment.”
Opioid Agonist Therapy includes use of long-acting medications such as methadone, Suboxone and slow-release morphine for drug users.
Long-acting injectable Suboxone (or Sublocade) has become “very popular” because users don’t have to go to the pharmacy daily to access it, which improves adherence and outcomes, even if clients continue to sometimes dip into the toxic supply, said Ferris.
Many physicians also continue to provide prescribed pharmaceutical alternatives to patients who have benefited from them, “in order not to destabilize them,” Ferris said.
Prescribed alternatives, known as safer supply, include hydromorphone tablets, oxycodone tablets, medium-release morphine, fentanyl tablets, injectable fentanyl, injectable hydromorphone and injectable heroin.
Crabtree said she “can’t rule anything out at this point” as a contributor to the decline in drug deaths in B.C.
While use of Opioid Agonist Therapy “is pretty widespread” in a lot of different provinces and states, prescribed alternatives are not as common, she said.
“I feel more confident saying that’s probably not behind the decline we’re seeing, particularly as the number of people accessing prescribed alternatives continues to decline.”
Victoria addictions specialist Dr. Ryan Herriot, one of the co-founders of Doctors for Safer Drug Policy, says changes in drug tolerance and behaviour of habitual users might also be a factor in the decline in deaths.
Chief coroner Dr. Jatinder (Taj) Baidwan declined an interview, but the coroners service said while the downward trend in drug deaths is encouraging, it is working with the province and federal government to better understand the statistics and is “unable yet to draw any conclusions.”
More than 16,000 people in B.C. have died of toxic drug poisonings since the public health emergency was declared in 2016.
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