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​Logic Model

Topic: The disproportionately high rate of unregulated drug deaths occurring in British Columbia's Northern Health Authority.

October 18, 2025

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Exploring the Systematic Review

October 11, 2025

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​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Situational Assessment
Health Promotion Problem / Opportunity:
The disproportionately high rate of unregulated drug deaths occurring in British Columbia’s Northern Health Authority compared to other regions in the province

September 27, 2025

 

What is the situation?

What impact does the current situation have on health outcomes, quality of life and other societal costs?

The Northern Health Authority (NHA) represents a geographical region in BC that experiences disproportionately higher rates of unregulated drug deaths compared to other regions in the province (BC Coroners Service, 2025). From 2020-2024, the NHA had the highest rate of unregulated drug deaths per year in BC, ranging from 46.3 to 70.9  per 100,000 people compared to provincial range of 40.5 to 46.9 over the same timeframe (BC Coroners Service, 2025). For the last five years, the town of Terrace has experienced the highest rate of deaths due to overdose among rural communities in the NHA (BC Coroners Service, 2025). Since 2022, Terrace’s average rate of unregulated deaths per year was 105 per 100,000 people, demonstrating the significance of the toxic drug crisis in the community (BC Coroners Service, 2025).

 

Which groups of people are at higher risk of health problems and poorer quality of life?

In BC, the two highest risk age groups for death due to unregulated drug overdose are 40-49, at 25%, followed by 30-39 at 23% (BC Coroners Service, 2025). Since 2014, males have accounted for the majority of deaths in BC, ranging from 75 – 82% of total deaths per year (BC Coroners Service, 2025). The province recently began tracking the occupation of decedents due to drug overdose. Though the occupational industry is unknown for approximately 55% of deaths due to drug overdose, two occupational industries represent the majority of decedents past employment: trades (21%) and sales and services (10%) (BC Coroners Service, 2025).

First Nations people in BC are a population group that are disproportionally impacted by the toxic drug crisis. Accounting for 3.4% of the province’s population, they represent 19% of the total deaths due to overdose (First Nations Health Authority, 2025).

 

Which settings or situations are high risk, or pose a unique opportunity for intervention?

First Nations people represent approximately 17% of the population in the NHA (Northern Partnership Accord, 2022). The rural community of Terrace, located in the north coast First Nations region, has the highest percentage of First Nations people among the eight regions in BC at 60% (BC Assembly of First Nations). Terrace is a major hub and commercial centre in the region due to its centralized proximity, industry base, and access to public services (BC Assembly of First Nations).

The majority of overdose deaths in the NHA take place in private residents. In 2024, 57% of unregulated drug deaths in the NHA occurred in private residents (BC Coroners Service, 2025).

 

How do local stakeholders perceive the situation? What is their capacity to act? What are their interests, mandates, current activities?

In the early 2020s, a situation table was established in Terrace to promote collaborative, local level interventions to decrease risks for vulnerable groups of people (City of Terrace, 2024). The situation table is co-chaired by the City of Terrace and the NHA. Other organizations that participate in the situation table include the Northern First Nations Alliance (NFNA), KSAN social services society, and the Ministry of Social Development and Poverty Reduction. Recent collaborative efforts from the situation table resulted in the opening of a wet shelter in the community as well as provincial funding to implement community and acute-based withdrawal management services in Terrace. The NHA and the NFNA are in the process of collaboratively developing the withdrawal management services with the support of local stakeholders, including the KSAN society, BC’s First Nations Health Authority, representation from First Nations bands within the NW geographical region, and people with lived substance use experience in BC’s north.

The City of Terrace is a key local stakeholder on the issue, having identified mental health and substance use as a social development priority in its Social Development Framework (City of Terrace, 2024). Activities the city is directly involved in to mitigate substance use related harms include their participation in capacity assessments and building activities and advocacy related work (City of Terrace, 2024).

Founded in 2020, the NFNA represents nine united First Nations communities in the NW (NFNA, n.d.). With a focus on collaborative action to improve social determinants of health, the alliance is involved in a number of initiatives in addition to co-leading withdrawal management service development and implementation in Terrace including the establishment of mobile mental health and substance use outreach services across alliance communities (NFNA, n.d.).

KSAN society is local non-profit social services agency that has operated in Terrace and the surrounding area since 1979 (KSAN Society, n.d.a). It provides three primary services: anti-violence programming, emergency shelters and social housing, and food security and sustainability programs. KSAN’s programming also includes harm reduction, homeless prevention and supported recovery services, which includes access to free individual and group counselling. A key service towards mitigating harms related to unregulated drug use is the society’s recent establishment of Joe’s Place, an emergency, low barrier shelter (KSAN Society, n.d.b). The shelter provides food and temporary accommodation for people that are or may be under the influence of substances (KSAN Society, n.d.b).

The NHA is one of five regional health authorities in the province; it is responsible for delivering healthcare services to approximately 300, 000 people across nearly two thirds of the province’s geographical area (Government of B.C., 2021; NHA, n.d.). The NHA provides a number of evidence-based services to mitigate fatalities due to unregulated drug use such as supervised consumption sites, access to drug checking, naloxone distribution, an opioid agonist treatment program, opioid prescription monitoring, mobile safe drug use apps, and community-based outreach services. As stated, the NHA is co-leading the implementation of community and facility-based withdrawal management services in Terrace.

 

What influences are making the situation better and worse?

What high-risk or negative health behaviours by various groups of people are affecting the situation?

The use of unregulated drugs that may contain life threatening additives such as fentanyl is a high-risk behaviour. Unregulated drug use in private residences is of particular concern because drug use in these settings often occurs alone, thereby increasing risk for overdose related morbidity and mortality (Papamihali et al., 2020).

 

Which underlying causes or conditions are driving these behaviours (e.g. individual, community, organizational or system-level causes)?

The choice to consume unregulated drugs in private settings appears to be multifactorial (Fernando et al., 2022). Common factors for using drugs alone include feelings of stigma and shame, desire for personal privacy, limited availability of drugs, limited personal funds to purchase drugs, mental health conditions, and lack of engagement with harm reduction services (Bardwell et al., 2018; Fernando et al., 2022; Keyes et al., 2014; Latkin et al., 2010; Mclean, 2016; Rhodes et al., 2007). Environmental conditions also impact unregulated drug use behaviours. Rurality is a key condition impacting drug use behavior; rural and smaller semi-urban communities in BC consistently experience higher rates of overdose and death due to overdose in private settings compared to more populus areas (Fernando et al., 2022). Literature suggests that social exclusion related to drug use may be greater in smaller communities due to community members being challenged by complex social relationships resulting from being more visible to one another compared to larger urban settings (Mclean, 2016; Keyes et al. (2014).

 

Are there protective factors that can help avoid or alleviate the situation (such as ensuring walkable communities or encouraging strong parent-child relationships)?

Protective factors that can help avoid unregulated drug use and overdoses in private settings include reducing the availability of unregulated drugs, increasing access to supervised consumption, drug checking and withdrawal management services, reducing stigma related to drug use, and increasing public awareness of safe drug use practices (Centre for Disease Control, 2025; Lefebvre, 2013; Robinson et al., 2014; Synder and Hamilton, 2002).

 

Which opportunities and threats in your environment may affect your course of action?

Environmental opportunities within Terrace and the surrounding area that are relevant to taking action to mitigate deaths due to unregulated drug use include ensuring access to drug related harm reduction and treatment services, progressing with the Truth and Reconciliation Commission of Canada’s Calls to Action, strengthening social inclusion, and addressing income and education inequities (BC Ministry of Mental Health and Addictions, n.d.; Truth and Reconciliation Committee of Canada, 2015).

 

What possible actions can you take to address the situation?

What are other organizations doing, or what have they done in the past, to address this situation? Specifically, what local policies, programs and environmental supports are being developed or implemented within the community? What evaluation data are available for these activities?

Provincially, the government of BC’s response to the toxic drug crisis is comprised of six areas of focus (BC Ministry of Mental Health and Addictions, n.d.):

1. Overdose Reduction: Harm reduction services that the government is supporting to decrease overdose rates include naloxone training and distribution, supervised consumption services, community outreach services, and drug checking services.

2. Stigma Reduction: BC’s Stop Overdoses BC public awareness campaign delivers overdose awareness messaging to increase public education and knowledge related to substance use disorders with the intention of reducing substance use related stigma and discrimination. 

3. Create an Evidence-based Framework for Treatment and Recovery Services: The provincial government is collaborating with provincial stakeholders, partners, and across its levels of government to create an evidence-based strategy to guide the mental health and substance use service delivery to support an integrated response to the toxic drug crisis.

4. Create Supportive Environments: The provincial government recognizes that people who have or at risk of a substance use disorder must have access to safe, culturally appropriate social supports. The government of BC continues to invest in affordable housing initiatives for people experiencing homelessness, including people living with mental health and/or substance use disorders. Additional investments have been made to Indigenous housing , both on and off reserve, increases to income and disability assistance rates, and recent increases to minimum wage .

5. Increase Prevention: The Government of BC communicated a commitment to early intervention and education to decrease childhood trauma and other mental health issues from driving substance use disorders. The Ministry of Education and Mental Health and Addiction’s iMinds program is an example of an evidence-based school program intended to support educators to engage youth in productive dialogues related to substance use.

6. Improve Public Safety: As a major international mail centre and port hub, the provincial government recognizes that it has a significant role to play in disrupting unregulated drug trafficking and the crime and violence that accompany it. In addition to targeting organized crime related to importing and trafficking unregulated drugs, BC’s police agencies are applying a harm reduction approach to people with substance use disorders, focusing their enforcement efforts on people involved in importing, manufacturing and tracking drugs.

 

Within BC, The Walk With Me project is applying a community centered, harm reduction initiative to improve community resilience and mitigate the negative impacts of the toxic drug crisis (Wideman et al., 2024). The initiative utilizes a community-engagement research framework grounded in Indigenous values and practices to promote grass roots, community led harm reduction interventions in rural and semi-urban communities (Wideman et al., 2024). Given the disproportionate impact the toxic drug crisis is having on Indigenous peoples and Terrace’s high proportion of First Nations peoples, the Walk With Me initiative presents a highly applicable harm reduction model.

 

At the local level, Terrace’s situation table continues to promote local level interventions to mitigate the effects of the toxic drug crisis. The recent opening of a wet shelter in the community along with the development of community and facility-based withdrawal management services are examples of collaborative initiatives that the situation table and its core participants are involved in. 

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References

Bardwell, G., Boyd, J., Kerr, T., & McNeil, R. (2018). Negotiating space & drug use in emergency shelters with peer witness injection programs within the context of an overdose crisis: A qualitative study. Health & place, 53, 86–93. https://doi.org/10.1016/j.healthplace.2018.07.011

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BC Assembly of First Nations. (n.d.). Fist Nations in BC: north coast. Retrieved September 25, 2025, from https://www.bcafn.ca/first-nations-bc/north-coast

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BC Coroners Service. (2025, July 23). Unregulated drug deaths. https://app.powerbi.com/view?r=eyJrIjoiMDg2ZGZmOGItZGQ1Ny00NTY3LThiYmEtYmExN2M0YmFjYTUxIiwidCI6IjZmZGI1MjAwLTNkMGQtNGE4YS1iMDM2LWQzNjg1ZTM1OWFkYyJ9

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BC Ministry of Mental Health and Addictions. (n.d.). Escalating BC’s response to the overdose emergency. https://www2.gov.bc.ca/assets/gov/overdose-awareness/mmha_escalating_bcs_response_report_final_26feb.pdf

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Centre for Disease Control. (2025, June 9). Preventing opioid overdose. Retrieved September 26, 2025, from https://www.cdc.gov/overdose-prevention/prevention/index.html

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City of Terrace. (2024, November). City of Terrace social development framework. https://www.terrace.ca/sites/default/files/docs/city-services/Social%20Development/Terrace-Social-Development-Framework-Nov2024.pdf

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Government of British Columbia. (2021, June 9). Regional health authorities. Retrieved September 25, 2025, from https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities/regional-health-authorities

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Fernando, S., Hawkins, J., Kniseley, M., Sikora, M., Robson, J., Snyder, D., … Salmon, A. (2022). The overdose crisis and using alone: perspectives of people who use drugs in rural and semi-urban areas of British Columbia. Substance Use & Misuse, 57(12), 1864–1872. https://doi.org/10.1080/10826084.2022.2120361

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First Nations Health Authority. (2025). First Nations and the toxic drug poisoning crisis in BC. https://www.fnha.ca/Documents/FNHA-First-Nations-and-the-Toxic-Drug-Poisoning-Crisis-in-BC-Jan-Dec-2024.pdf

 

FNHA, FNHC, & NHA. (2022, May 10). Northern partnership accord. https://www.northernhealth.ca/sites/northern_health/files/about-us/indigenous-partnerships/documents/northern-partnership-accord-2022.pdf

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KSAN Society. (n.d.a). About us. Retrieved September 25, 2025, from https://ksansociety.com/about-us

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KSAN Society. (n.d.b). Joes Place: emergency shelter. Retrieved September 25, 2025, from https://ksansociety.com/joesplace

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Latkin, C., Srikrishnan, A. K., Yang, C., Johnson, S., Solomon, S. S., Kumar, S., Celentano, D. D., & Solomon, S. (2010). The relationship between drug use stigma and HIV injection risk behaviors among injection drug users in Chennai, India. Drug and alcohol dependence, 110(3), 221–227. https://doi.org/10.1016/j.drugalcdep.2010.03.004

 

Lefebvre, R.C. (2013). Social marketing and social change: strategies and tools for improving health, well-being, and the environment. Jon Whiley & Sons. https://www.gale.com/ebooks/9781118235249/social-marketing-and-social-change-strategies-and-tools-for-improving-health-well-being-and-the-environment#:~:text=The%20book%20teaches%20how%20to%20adapt%20design%20thinking,%20social%20media

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Papamihali, K., Yoon, M., Graham, B., Karamouzian, M., Slaunwhite, A. K., Tsang, V., Young, S., & Buxton, J. A. (2020). Convenience and comfort: reasons reported for using drugs alone among clients of harm reduction sites in British Columbia, Canada. Harm reduction journal, 17(1), 90. https://doi.org/10.1186/s12954-020-00436-6

 

Northern First Nations Alliance. (n.d.). Empowering Indigenous communities through unity and action: about us. Retrieved September 25, 2025, from https://dev.nfna.ca/about/#

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Northern Health Authority. (n.d.). Quick facts. Retrieved September 25, 2025 from https://www.northernhealth.ca/about-us/quick-facts

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Rhodes, T., Watts, L., Davies, S., Martin, A., Smith, J., Clark, D., Craine, N., & Lyons, M. (2007). Risk, shame and the public injector: a qualitative study of drug injecting in South Wales. Social science & medicine, 65(3), 572–585. https://doi.org/10.1016/j.socscimed.2007.03.033

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Robinson, M. N., Tansil, K. A., Elder, R. W., Soler, R. E., Labre, M. P., Mercer, S. L., Eroglu, D., Baur, C., Lyon-Daniel, K., Fridinger, F., Sokler, L. A., Green, L. W., Miller, T., Dearing, J. W., Evans, W. D., Snyder, L. B., Kasisomayajula Viswanath, K., Beistle, D. M., Chervin, D. D., Bernhardt, J. M. (2014). Mass media health communication campaigns combined with health-related product distribution: a community guide systematic review. American journal of preventive medicine, 47(3), 360–371. https://doi.org/10.1016/j.amepre.2014.05.034

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Synder, L.B., Hamilton, M.A. (2002). A meta-analysis of U.S. health campaign effects on

behavior: emphasize enforcement, exposure, and new information, and beware the secular trend. Lawrence Erlbaum Associates. https://www.ncbi.nlm.nih.gov/books/NBK69351/

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Truth and Reconciliation Committee of Canada. (2015). Truth and Reconciliation Committee of Canada: calls to action. https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf

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Wideman, T., Karsten, S., & Walk With Me Team (2024). Walk With Me: reducing harm and confronting the toxic drug poisoning crisis in small British Columbia cities through community engaged research. Harm reduction journal, 21(1), 106. https://doi.org/10.1186/s12954-024-01022-w

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