Alcohol and tobacco consumption is higher on the Island than rest of BC

Island Health is calling for policies that can prevent and reduce harms related to psychoactive substances—particularly alcohol and tobacco, which are consumed more on the Island than in the rest of BC.

A report released earlier this month by Island Health's Chief Medical Health Officer Dr. Réka Gustafson looks at the Island’s unique relationship with the use of substances and how these substances are regulated by local and provincial authorities.

People in rural communities and Indigenous people are disproportionally affected by the harms of substance use, with the North and Central Island seeing the highest rate of hospitalization for alcohol and illicit substances.

The ‘paradox of prohibition’

The report compares how different substances are regulated and whether steps are taken to discourage their use, referencing a concept called the “paradox of prohibition.” The concept looks at the spectrum of policies: illegal and unregulated on one end (illicit drugs like opioids) and legal with little regulation on the other (alcohol). Both ends are considered harmful. The report argues that the middle of the spectrum—legal but moderately to strongly regulated (cannabis)—is the safest and most effective way to minimize harm.

UVic researchers have raised similar concerns about regulation, arguing alcohol should have warning labels explaining the links to cancer and other health problems, similar to cigarette cartons. One UVic researcher told Capital Daily that consuming one alcoholic drink is equal to smoking one cigarette.

Researchers from the UVic-led Canadian Alcohol Policy Evaluation (CAPE) research project found that all provinces are failing to properly enforce health-oriented alcohol policies, focusing too much on improving sales and not on lowering harm. BC received an F on almost every metric for an overall grade of 36%.

The report also argues against complete prohibition, citing the ongoing harm that unregulated illicit drugs, such as opioids, have had on the Island. Over the last decade, report says, opioids have become increasingly potent and contaminated because of lacking oversight.

The policy continuum graph, showing the spectrum of the "paradox of prohibition." Image: Island Health

Alcohol

Alcohol consumption has risen throughout the province since 2021, particularly on the Island, where consumption is higher on average than in BC as a whole.

Alcohol consumption on the Island was highest in remote communities, where 29% of people said they drink four to six times a week, compared with 14% of people in urban communities. Binge drinking was also reported more in remote communities with 44% of people saying they binge drink at least once a month compared with 26% in urban areas. The report says the high rate of alcohol consumption in remote communities reflects disparities in health and social conditions.

Hospital admissions for alcohol are higher on average on the Island than in BC—and significantly higher than in the rest of Canada. The rate of admissions on the Island is 500 per 100K people, almost twice Canada’s rate of 262 per 100K people. These admissions are higher for the North and Central Island than the South Island.

Youth appear to be less interested in trying alcohol—45% of youth aged 12-19 had reported ever sampling alcohol in 2023, compared with 77% of youth in 1992.

In 2023, Canada updated its drinking guidelines to address overwhelming evidence of the harms of alcohol, including the risk of cancer, and heart and liver disease. It is now recommended to limit drinking to two or fewer drinks per week—a dramatic reduction from the previous recommendation of 15 drinks per week for men and 10 per week for women.

Tobacco

Last week, after nearly 20 years of litigation, all provinces, plaintiffs, and creditors agreed to a plan to resolve the lawsuit against tobacco companies. In 1998, BC was the first province to take legal action—with other provinces eventually joining the lawsuit—against major Canadian tobacco companies and their international owners to recuperate losses for treating illnesses related to smoking cigarettes, arguing these companies misled consumers about the risks.

The plan, if the tobacco companies agree to it, would see these companies pay $32B, with $3.5B going to BC. The rest will go to other provinces, plaintiffs, and to funding healthcare and research across Canada. BC is planning to use the payout to invest in cancer treatments, care, and research, as well as promoting smoking cessation.

The amount of people who smoke daily is one-third of what it was in 1990 and one-fifth of what it was in the period covered by the lawsuit.

But for the Island, tobacco use still has a grip on residents—the rate is higher than the provincial average, particularly for the North Island. However, the report found that youth aged 12-19 are less likely to pick up a cigarette than previous generations. In 2023, 20% of youth reported ever smoking tobacco compared with 69% in 1992.

The premature death rate due to tobacco is declining, but it remains the top cause of substance-use-related premature death in Island Health’s jurisdiction.

The report looked at the use of commercial tobacco, including cigarettes, vapes, and chewing tobacco. The data didn’t focus on tobacco used for cultural or sacred purposes, as the composition, production, and usage are different.

‍ Cannabis

Unlike cigarettes, Islanders aren’t very likely to spark up a joint. The majority of adults on the Island—approximately 70%—never use cannabis, with just 7% considered daily users. Half of young people, aged 18-29, reported they use the drug, but only 12% are considered daily users. Island Health’s report suggests that usage is low because of the stigma surrounding cannabis from decades of being illegal, unlike alcohol which has long been societally acceptable.

Since legalization, cannabis use in Canada has risen a moderate amount among adults. However, 4% fewer youth reported ever trying cannabis since it was legalized and in the past 20 years, the number of youth trying the drug has decreased 1.6-fold.

Island Health offers cannabis as an example of a substance that is legal, but still highly regulated to protect public health, with measures like health warning labels.

‍ Illicit substances

Unregulated drug poisoning remains the leading cause of death among young adults aged 19-39, on the Island. The average number of toxic drug deaths on Vancouver Island is higher than the BC average. It’s the second-leading cause of years of life lost, with malignant cancers being the first.

The North and Central Island have significantly higher rates of death than the South Island. The report highlighted the disproportionate ways Indigenous people have been harmed by unregulated toxic drugs, such as opioids and stimulants.

“First Nation communities face higher rates of toxic drug poisonings, driven by a complex interplay of historical trauma, social exclusion, and inadequate access to culturally safe health services,” reads the report. “This disproportionate impact is a stark reminder of the ongoing effects of colonialism and systemic racism.”

BC is on track to have another year end with 2,000+ toxic drug deaths. Over the first 10 months of the year, 389 people on the Island were killed by toxic drugs.

Island Health recommendations

Gustafson, the Island Health chief medical health officer, made five key recommendations in her report that outline how municipalities on the Island can better address Island Health’s unique substance-use concerns.

Invest in prevention:

• Work with youth and adults to delay substance use and invest in programs that connect youth with supportive adults to create a sense of community
• Address health-care contributors to high-risk substance use
• Continue to enforce tobacco and vape use among youth by strengthening local restrictions, ensuring retailer compliance, and increasing education about tobacco’s harms

Empower communities with evidence to influence policy:

• Increase monitoring of substance use within local communities and support local researchers in gathering data to have the most up-to-date information

Develop a system of care for people who use substances:

• Provide a full spectrum of care for any individual on a recovery journey, while acknowledging that addiction is a chronic, relapsing condition
• Provide low-barrier access to recovery care at any stage of use or recovery
• Increase access to substance-use services for the North and Central Island where risk of harm is higher

Meaningfully address health inequities:

• Work directly with Indigenous communities to develop culturally appropriate care
• Engage and involve people with lived experience of substance use to guide educational programs

Advance healthy public policies for substance use:

• Adopt the recommendations of the Health Officers Council of BC
• Establish access to a strictly regulated class of opioid and stimulant drugs for those at risk of overdose
• Monitor consumption trends for tobacco and nicotine
• Research the health consequences of cannabis use
• Increase prevention programs for youth and young adults