How did Canada fall victim to an opioid epidemic that killed nearly 4,000 people across the country last year? What responsibility does the government bear in failing to prevent many of those deaths? For some of them, to what extent was Ottawa—via prosecutorial and counter-productive drug policies—directly culpable?

They're big questions, and a pioneer of Vancouver's harm-reduction movement wants answers.

Last May, Dan Small, a co-founder of North America's first supervised-injection facility, Insite, wrote a letter to Prime Minister Justin Trudeau requesting the appointment of a royal commission "to examine the variables that have accounted for the dramatic overdose tragedy".

It was a long shot, Small told the Straight. But now the Canadian government has responded with a letter that he described as thoughtful, and one which suggests it is possible his royal commission could actually come to fruition.

"While a Royal Commission specifically has not been considered to date, I would suggest that you contact the Governor General’s office to identify your concerns and your ideas on the matter," Heidi Jackson, executive director of Health Canada's opioid response team, wrote to Small on behalf of Health Minister Ginette Petitpas Taylor on July 9.

In a telephone interview, Small, a medical anthropologist and adjunct professor at UBC, outlined his next steps.

"Ms. Jackson is recommending that I follow it through to the Governor General," he said. "And, I will."

"We need a royal commission that accountably investigates our nation's values as they have impacted, and continue to impact, societal approaches to opioid use," Small continued. "A royal commission would allow us to look backwards at the mistakes we’ve made with our societal institutions charged with the responsibility to address deaths from addiction while creating recommendations that contemplate a healthier future for the children of tomorrow. 

"So, then, I will write to the Governor General," he repeated.

Jackson's letter also outlines the Liberal government's response to the opioid epidemic thus far. It describes harm-reduction programs such as an expansion of supervised-injection services and the authorization of drug-checking programs.

"The federal government is committed to a comprehensive, collaborative, compassionate and evidence-based approach to drug policy, which uses a public health lens to address substance use in Canada," it reads. "The federal government is committed to a comprehensive, collaborative, compassionate and evidence-based approach to drug policy, which uses a public health lens to address substance use in Canada."

If a royal commission is eventually established to investigate the causes of Canada's opioid epidemic, it will likely focus on the years that former prime minister Stephen Harper and the Conservative party held power in Ottawa.

In British Columbia, the first province hit by the crisis, there were roughly 200 fatal overdoses each year during the first half of Harper's time in office.

Then, nearing the end of his term as prime minister, in 2013, there were 333 fatal overdoses in B.C. Then 368 in 2014 and then 522 in 2015, the year that Harper was defeated by Trudeau and the Liberals.

Statistics show that the epidemic of overdose deaths that last year claimed 1,449 lives in B.C. began on Harper's watch.

Speaking to the Straight in June, Small argued it was not a coincidence that overdose deaths rose under Harper's leadership; rather, it was a direct result of the former Conservative government's policies related to addiction and drug use, Small maintained.

"The view that they [the Conservatives] put forward, which was very persecutory towards opioid users, has had a long-reaching influence across the country and into communities," he explained. "It represented a decade of structural violence toward a marginalized group of people."

A royal commission is a research body appointed by a government’s cabinet to “carry out full and impartial investigations of specific national problems”, according to Library and Archives Canada. In the past, royal commissions were convened to investigate the contamination of the country’s blood-donor and distribution systems, for example, and the status and relations of Canada’s Indigenous peoples.

While B.C. has kept reliable statistics on illicit-drug overdose deaths since the early 1990s, Canada only began counting fatal overdoses at the federal level after Harper and the former Conservative administration were voted out of power in 2015.

At least 6,965 people in Canada died of an opioid overdose between January 2016 and December 2017, according to the federal government.

Speaking this week, Small argued that a royal commission would save lives.

"Without it, we will continually move from initiative to initiative, approach to approach, all the while ignoring the elephant in the room that has some people believing that people with addictions have tarnished identities, that they have earned their lot in life, and that they are someone less than fully human despite a constitution that enshrines their rights to security of the person."