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Harm Reduction Reports

Find harm reduction reports, publications, case studies and program evaluations below.
Harm reduction reports

The BCCDC conducts research and evaluates provincial harm reduction programs. Find best practice guidelines and evaluation reports below. 

Harm Reduction Reports

The Importance of Harm Reduction (Oct 2018)

Position Statement


BC HRSS Policy & Guidelines (November, 2022)


Best Practice Documents

Evidence and Best Practice for the Employment of Harm Reduction Activities in Programs Aimed at Controlling Communicable Diseases (Apr 2007)


Harm Reduction - A BC Community Guide (2005)


Reports & Publications

HRSS Policy Indicators Report (July 2020)


A Cross-sectional Study of Public Attitudes Towards Safer Drug Use Practices in BC (Dec 2013)  Publication

Updated April 26, 2024: The Province of B.C. is working with Health Canada to make changes to the federal exemption to the Controlled Drugs and Substances Act. The requested changes would make illicit drug use illegal in all public spaces including inside hospitals, on transit and in parks. These changes are not currently in effect. For more information, read the news release: 

The federal government approved an exemption to the Controlled Drugs and Substances Act to allow for the removal of criminal penalties for possession of small amounts of some illicit substances for personal use by people over 18 years old within British Columbia. This exemption is effective starting January 31, 2023 until January 31, 2026. The purpose of the exemption is to reduce the stigma associated with substance use and support people in accessing important health and social services. Since decriminalization came into effect in BC, some local governments have expressed interest in understanding the potential impacts of decriminalization on public substance use as they consider the needs of their communities.

Reports and publications

Drug decriminalization in British Columbia: A pre-implementation qualitative study with people who use drugs (September 2023)

Harm Reduction Client Survey 2022 decriminalization data

The 2022 Harm Reduction Client Survey collected data pre-decriminalization to act as a baseline against which future changes could be assessed.  

Find results from the 2022 Harm Reduction Client Survey

Guidelines & Best Practice Documents

Communicating Drug Alerts (Nov 2016)  

Guideline Document

Reports & Publications

Drug Quality Assessment Practices & Communication of Drug Alerts Among People Who Use Drugs (Jul 2015)


Perceptions of Adulteration and Quality Assurance Practices Reported by People who Use Drugs: A Review of the Literature (Aug 2015)  Report

Harm Reduction Client Survey: Analysis of Supervised Injection Site Acceptability (Aug 2016)


History of Harm Reduction Supply Program (April 2021)


Best Practices for BC's Harm Reduction Supply Distribution Program (Sep 2008)

Best Practices Document

More than Just Needles: An Evidence-informed Approach to Enhancing Harm Reduction Supply Distribution (Dec 2008)  Publication

Harm Reduction Product Distribution in BC (Nov 2008)  Publication

HRSS Strategies Newsletter

Issue No.1 (May 2008)

Issue No.2 (Jan 2009) 

Issue No.3 (May 2010)

Issue No.4 (Jun 2011)

Training Resources

Harm Reduction Training Manual: A Manual for Frontline Staff Involved in Harm Reduction Strategies & Services (Jan 2011)  Training Manual

Supervised & Observed Consumption Sites

Gaining INSITE: Harm Reduction in Nursing Practice

(Apr 2009)  Publication

Substance use & overdose

The BCCDC with provincial and regional partners tracks substance use and overdose trends. Find research and reports below separated by substance and overdose topic.

Overdose Reports

Illicit Drug Toxicity Deaths and the COVID-19 Pandemic in British Columbia (Dec 2021) Knowledge UpdatePublication

Overdose in BC during COVID-19 (March 2021) Infographic

Overdose & Risk Factors for Coronavirus Disease 2019

(2021)  Infographic  Knowledge Update  Publication

Illicit drug toxicity deaths

  • Map: Illicit drug toxicity deaths (Updated monthly)  
  • 2015-2024 Reported by HSDA  Map (Updated monthly)  
  • 2015-2023 Reported by LHA  Map (Updated triannually)  
  • 2023 Reported by CHSA  Map (Updated annually)  ‎

Paramedic-attended overdose events

Opioid Agonist Therapy prescribers

Prevalence of co-occurring mental illness and substance use disorder and association with overdose: a linked data cohort study among residents of British Columbia, Canada (Jan 2022) Publication

Use of Community Healthcare and Overdose in the 30 Days Following Release from Provincial Correctional Facilities in British Columbia (Sept 2021) Publication

Death After Emergency Department Visits for Opioid Overdose in British Columbia (Mar 2021)  Publication Infographic

Mortality & Healthcare Utilization following a Paramedic-attended Overdose (Jan 2021)  Publication Infographic

Declining Transport to Hospital for Paramedic-attended Overdose Events (Oct 2019)  

Knowledge Update  Infographic

Patterns of Health Care Utilization Among People Who Overdosed from Illegal Drugs (Sep 2018)  Publication

Leaving the Emergency Department Without Being Seen or AMA, Among People Who Overdosed from Illegal Drugs (Jul 2018)  Knowledge Update

Patterns of Health Care Utilization Among People Who Overdose from Illegal Drugs in B.C.   
Knowledge Update (April 2018)
Knowledge Update (Mar 2018)

Risk of Cardiovascular Disease in Relation to Substance Use Disorders (October 2021) Publication

Drug overdose and the risk of cardiovascular diseases: a nested case-control study (Oct 2021) Publication

Neurological Injury Following Overdose (Jan 2020)

Knowledge Update

Toxicological assessment of drug samples following atypical overdose presentations (ongoing, updated weekly)  Dashboard

Deaths from Exposure to Paramethoxymethamphetamine in Alb. & B.C. (Mar 2015)  

Opioid Agonist Treatment (OAT) Initiations Post-overdose from Illegal Drugs in B.C. (Jul 2018)  

Knowledge Update

Collaborative Data Governance to Support First Nations-led Overdose Surveillance and Data Analysis 

(January 2021)  Publication


Toxicology & Prescribed Medication Histories Among People Experiencing Fatal Illicit Drug Overdose in B.C. (Aug 2020)  Publication

Prescription-related Risk Factors for Opioid-related Overdoses in the Era of Fentanyl Contamination of Illicit Drug Supply (May 2020)  Case-control Study

Prescription History & Toxicology Findings Among People Who Died of an Illicit Drug Overdose in B.C. (Oct 2019) 

Knowledge Update  Infographic

Effects of the New Prescribing Standards in B.C. on Consumption of Opioids & Benzodiazepines & Z Drugs (May 2019)  Publication

Patterns & History of Prescription Drug Use Among Opioid-related Drug Overdose Cases in B.C. (Jan 2019) 


Recent Initiation, Discontinuation & Tapering Patterns of Prescription Opioids for Pain Among People Who Experienced a Drug-related Overdose in B.C. (Aug 2018) 

Knowledge Update

Analyzing Prescription Drug Histories Among People Who Overdose (Feb 2018)  Knowledge Update 

Identifying Time Varying Risk Factors for Non-fatal Overdose (Apr 2021)  Knowledge Update  Publication

Modelling the Combined Impact of Interventions in Averting Deaths During a Synthetic-opioid Overdose Epidemic (Jun 2019)  Publication

Acceptability of Technological Solutions for Overdose Monitoring: Perspectives of People Who Use Drugs (Oct 2019)  Publication

Evaluating the effects of Risk Mitigation Guidance opioid and stimulant dispensations on mortality and acute care visits during dual public health emergencies (January 2024) Knowledge Update ; Publication

Risk Mitigation Guidance (RMG) Evaluation Findings, March 2020 to December 2021 Infographic

Evaluation of risk mitigation measures for people with substance use disorders to address the dual public health crises of COVID-19 and overdose in British Columbia Publication

Toxicology Supplement: Post-mortem detection of hydromorphone among persons identified as having an illicit drug toxicity death since the introduction of Risk Mitigation Guidance prescribing (December 2021) Knowledge Update

Post-mortem detection of hydromorphone among persons identified as having an illicit drug toxicity death since the introduction of Risk Mitigation Guidance prescribing (October 2021) Knowledge Update 

Association of Mental Health Services Access and Reincarceration Among Adults Released From Prison British Columbia, Canada (Dec 2022) Publication

Association of Opioid and Stimulant Use Disorder Diagnoses With Fatal and Nonfatal Overdose Among People With a History of Incarceration  (Nov 2022) Publication 

Fatal overdoses after release from prison in British Columbia: a retrospective data linkage study (Sept 2021) Publication

Risk of Overdose‐related Death for People with a History of Incarceration (Oct 2020)  


Demographic Factors, Incarceration History & Risk of Overdose-related Death (Oct 2019)

Knowledge Update  Infographics

Illicit Drug Overdose Deaths Resulting from Income Assistance Payments (Jun 2016)  

Preliminary Findings from the 2017 B.C. Provincial Overdose Cohort Refresh (May 2019) 

Knowledge Update

Overdose Emergency Response Committee Meeting Reports

Key Recommendations (Apr 2017)


Response Strategy (Feb 2016)


Rural & Indigenous Action Exchange 

Report (Oct 2019)

BC Overdose Action Exchange

Report (Jun 2018)

Report (Aug 2017)

Report (Jul 2016)

Substance Use Reports

Findings and knowledge summaries for each year the survey was administered are published on the Harm Reduction Client Survey page. 


A Drug Use Survey Among Clients of Harm Reduction Sites Across BC (Apr 2014)  Publication

Decreasing HIV Infections in People Who Use Drugs by Injection in BC (Mar 2011)  Publication


Opioid Use Disorder among Youth in BC (June 2023) Infographic

Reorienting Risk to Resilience: Street-involved Youth Perspectives on Preventing the Transition to Injection Drug Use (Aug 2015)  Publication

Finding a Voice: Participatory Research with Street-involved Youth in the Youth Injection Prevention Project (Sept 2014)  Publication


Illicit Alcohol in BC: Qualitative Research Study (Jul 2013) 

Executive Summary   Study Paper


Potent Sedatives in Opioids in BC: Implications for Resuscitation, & Benzodiazepine & Etizolam Withdrawal (May 2021)  Publication

Known Fentanyl Use Among Clients of Harm Reduction Sites in B.C. (Mar 2020)

Publication  Infographic

Assessing the Risk of Occupational Fentanyl Exposures in OPS & SCS Sites in B.C. (Aug 2018)

Knowledge Update

A 52-year-old Man with Fentanyl-induced Muscle Rigidity (Apr 2018)


Why the FUSS (Fentanyl Urine Screen Study)? A Cross-sectional Survey to Characterize an Emerging Threat to People Who Use Drugs in B.C. (Nov 2015)

Research Summary  Publication 


Patient Perspectives of Methadone Formulation Change in B.C. (Jan 2016)


Perspectives On Methadone Formulation Change: 2014 Harm Reduction Client Survey (Jul 2015)



What we know about stimulant use and drug poisoning in BC (Jan 2023) Infographic

Concurrent use of opioids and stimulants and risk of fatal overdose: A cohort study (Nov 2022) Publication

Crystal Methamphetamine Use in BC: A Study of People who Access Harm Reduction Services (May 2021)  Publication

Genetic Determinants of Cocaine-associated Agranulocytosis (Jun 2015)

Research Article

Levamisole Tainted Cocaine Causing Severe Neutropenia in Alb. & B.C. (Nov 2009)

Case Report


Toxic Leukoencephalopathy (Feb 2021)

Fact Sheet


Program reports & documents

Person carrying backpack and lots of Naloxone kits

Peer engagement, naloxone distribution and overdose prevention services are at the core of the BCCDC's overdose response. Find evaluations, guidelines and reports on this work below.

Overdose prevention services

Overdose Prevention Services (OPS)

BC Overdose Prevention Services Guide (2019) (PDF)


This document provides guidance on providing overdose prevention services outside of an established supervised consumption or overdose prevention site (SCS/OPS) such as in acute care, shelters, supportive housing or other social service settings. This guidance supports staff who may receive requests from patients, clients or residents to observe substance use and respond to overdose or may recognize the benefit of providing this service.

Provincial Episodic Overdose Prevention Service (eOPS) Protocol (2023) (PDF)

Communicable disease prevention

This document provides guidance on infection prevention practices to reduce communicable disease transmission while ensuring access to drug poisoning prevention and response in OPS/SCS settings:

Peer engagement

Contents of a Naloxone kit

Naloxone programs

THN Program Monthly Update FORB Program Monthly Update


Reports & publications

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