A review of policy actions implemented during a toxic drug public health emergency in British Columbia, Canada (2016-2024).

BACKGROUND: During a decade-long public health emergency, driven by a highly unpredictable unregulated drug supply, drug toxicity remains the leading cause of unnatural death in British Columbia (BC), Canada. In response, the province implemented a multi-faceted approach to prevent toxic drug harms and save lives. Our objective was to review all relevant provincial policy actions since the declaration of the emergency and identify evaluations of implementation and effectiveness. METHODS: We identified provincial-level policy actions related to unregulated substance use between 04/2016-12/2024 through a list provided by the BC Ministry of Health and searches of peer-reviewed and grey literature. We classified actions into nine provincial response domains, summarized over time, and noted if the policy change was evaluated. FINDINGS: We identified 146 policy actions concentrated primarily in three domains: treatment and recovery (n = 51 (35%)), overdose prevention services (n = 26 (18%)), and social stabilization (n = 21 (14%)). Actions slowed at the onset of the COVID-19 pandemic, resuming in 2021-24. Most actions (n = 85, 58%) have not yet undergone evaluations of implementation or effectiveness. CONCLUSION: Despite a broad and innovative provincial response, the toxic drug crisis remains a significant challenge across BC. More evaluation is urgently needed to identify the effects of policy actions to date.