When the Options Disappear

Geral Kichok   at beataddictionnow.com

February 23, 2026

I was hoping that when the safer supply here in British Columbia started to disappear, and the choices became tougher, the people I am successfully trying to help would become more motivated to accept changes and push farther back into a better balance. Instead, I can no longer find many of my good clients; they don't answer their phones or return my calls. They're gone.

Some, I wonder if they finally were pushed far enough to ask their family or doctor for help, if so, then why can I not reach them? I fear most are in trouble, forced to buy more expensive alternatives or jump directly to the cheap, illicit, tainted drugs. Wondering if they are in a hospital after surviving an overdose or if they are dead. The few clients I still have visit come by to cry and sheepishly beg for a little money. They are gaunt and skinny and obviously hungry. When I ask them to go buy some food with the money they've borrowed, they begin to cry like children. The few clients I still have left visit me to cry and sheepishly beg for a little money, ask when it will get better. When will it go back to the way it was when they could manage? Walk through the Downtown Eastside long enough, and you begin to notice something that statistics cannot fully capture. It is not only the overdoses. It is not only the tents, the ambulances, or the boarded windows. It is the quiet resignation in people who were, not long ago, still trying to hold a line.

Dependence does not disappear when policy shifts. Biology does not negotiate with ideology. When access to prescribed opioids contracts and safer supply becomes harder to obtain, withdrawal does not politely step aside. It arrives on schedule.

For some, there used to be a narrow but stabilizing path. A prescription that reduced contact with the street market. A small margin that could be managed. Not recovery in the idealized sense, but stability. A way to wake up without panic. A way to avoid the hunt.

When that path narrows or evaporates, the street fills the vacuum.

The unregulated supply in Vancouver is not what it was a decade ago. Fentanyl dominates. It is potent, unpredictable, and often mixed with other sedatives. A person does not buy a substance anymore. They buy a probability.

The market responds faster than policy ever will. When one stream dries up, another floods in. Cheap, potent, easy to move. If heroin is unavailable, fentanyl appears. If opioids become inaccessible, some turn to stimulants. Not out of curiosity. Out of calculation. Out of economics. Out of the simple need to function or to avoid being sick.

I have watched people who never intended to use “hard drugs” begin experimenting because what is cheap and available becomes the only option. When the body is dependent, choice narrows. Survival logic takes over.

At the same time, housing offers little refuge. Many single room occupancy hotels absorb most of a person’s assistance cheque. The clean ones cost nearly everything. The neglected ones cost less, but sleep becomes impossible. Rats, bedbugs, noise, theft. Chronic sleep deprivation alone can erode judgment and resilience. Stability requires rest. Few get it.

After rent is deducted, little remains. Food competes with nicotine. Basic hygiene competes with transportation. There is no buffer. No margin for error. Any misstep cascades.

For years, some survived by operating in informal economies. A few resold part of a prescription to cover groceries. When prescriptions vanish, so does that fragile ecosystem. What remains is exposure to a market that is far more lethal.

Despair is not dramatic here. It is incremental. It accumulates.

Addiction is often described as a moral failure or a personal collapse. What I see is something more structural. When regulated options contracts are without equivalent transition pathways, people do not become virtuous. They become vulnerable. When housing is unsafe, substance use intensifies. When income barely covers shelter, instability grows.

None of this removes personal responsibility. But responsibility without viable options becomes a hollow demand.

The solution is not simply more prohibition or more ideology. It is calibration. Evidence-based treatment access. Low barrier opioid agonist therapy. Structured prescribing for those who do not stabilize on conventional options. Drug checking. Housing that permits sleep and dignity. Income is aligned with the actual cost of living.

Addiction stabilizes when chaos is reduced. It worsens when chaos multiplies.

In the Downtown Eastside right now, many are not asking for perfection. They are asking for something predictable. Something regulated. Something that does not carry a high probability of death.

When options disappear, the street does not become safer. It becomes rougher.

And the people trying to hold on are left with fewer and fewer places to stand.