Strategy and Entropy Cultivate Clarity Amid Entropy

An Analysis of British Columbia's Harm Reduction Program

For quite some time, I've been following policy updates, news, and shared experiences on British Columbia's harm reduction services in tackling our grim drug-related deaths. Below, I discuss a basic systems analysis of key variables involved in the system behind harm reduction, which are often referenced in news reports and in election-time rhetorics.

In the causal loop model displayed below from Insight Maker, I have included causal relationships between key variables in the harm reduction narrative:

In this model, several reinforcing and balancing loops can be identified and analyzed:

Increased access to safer supply leads to less overdose deaths, which in turn should galvanize public support for harm reduction. That will then lead to increased funding for harm reduction services, which further boosts access to safer supply. Then, increased access to safer supply reduces hospitalizations due to overdose, which in turn boosts public support for harm reduction, which then encourages further funding for harm reduction, thus increasing access to safer supply.

But that can't go on forever, since increased hospitalizations due to overdose (e.g., from illicit toxic drugs) boost public support for punitive justice, which discourages funding for harm reduction services, thus reducing access to safer supply. To see how, the following act accompanies the previous two reinforcing loops: Public support for punitive justice encourages policies for punitive justice (we can already observe this rhetoric in this 02024 electoral period in BC and Canada). In turn, illicit drug use will increase, further boosting hospitalizations. Generally, punitive justice policies imply diversion of safe-supply drugs, which in turn increases illicit drug use (think fentanyl) – there's a balancing act to these reinforcing loops.

Moving on, hospitalizations can strain ER, thus further reducing public support. A related causal chain that reduces access to safer supply is misinformation fueled by illicit drug use, which is in turned fueled by diversion of safe-supply drugs, punitive justice policies/ rhetoric, hospitalizations, and so forth in causal chains.

There's more variable that can be added with more causal relationships and systemic structures to analyze. The key here, especially during elections, is to park rhetoric and especially biases and disinformation and examine facts, evidence, as well as high-leverage interventions.

Systems are complex things pregnant with surprises and hidden structure. That said, I see three high-leverage intervention points for our Province to succeed in harm reduction: