The Street Is Where We Finally See the Problem

 

Nanaimo’s Hidden Substance Problem — Part Three

How Many Street Crises Began Behind Closed Doors?

By the time substance use produces an ambulance call, an eviction or an overdose on a sidewalk, the problem may have been developing privately for years.

The overdose on the sidewalk is impossible to miss.

The ambulance arrives. Firefighters or paramedics attempt to revive someone. Community Safety Officers administer naloxone. Bystanders watch, and another incident is added to Nanaimo’s street-level statistics.

What we do not see is everything that may have happened before that moment.

A substance problem can remain hidden while someone still has a home, holds a job and manages to pay the bills. The drinking or drug use occurs behind a closed door. Family members may know something is wrong, but public agencies may know nothing about it.

There is no government statistic for someone who is barely holding everything together. The official record begins only when something breaks.

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The Street May Be the End of the Story

It would be wrong to assume that everyone who drinks heavily or uses drugs will lose their home. It would be equally wrong to suggest that everyone experiencing homelessness has a substance-use problem.

People lose housing for many reasons, including inadequate income, unaffordable rent, illness, relationship breakdown, eviction and loss of employment.

But these pressures can overlap.

In B.C.’s 2023 homeless counts, 37 per cent of respondents identified insufficient income as one reason for their most recent housing loss, while 25 per cent identified addiction or substance use.

Respondents could identify more than one reason. Financial pressure and substance use may therefore operate together rather than as competing explanations.

These are province-wide findings, not Nanaimo-specific results, but the connection is important.

A person may still be paying rent, but spending on alcohol or drugs can make an already strained household budget even more fragile. At the same time, unemployment, high housing costs, loneliness or mental-health struggles may encourage greater use.

Substance use can worsen the financial problem. Financial stress can worsen the substance use.

Eventually, something gives way.

By the time someone appears in an encampment or is revived on a sidewalk, the substance problem may not be new. What is new is that it can no longer remain private.

More Than Three Ambulance Responses Every Day

BC Emergency Health Services recorded 1,287 overdose or drug-poisoning patient events in Nanaimo during 2025.

That was down from 1,525 in 2024 and the extraordinary peak of 2,136 in 2023.

It still amounted to an average of approximately three and a half paramedic responses every day.

The longer comparison is even more revealing. In 2016, BCEHS recorded 512 overdose events in Nanaimo. The 2025 total was therefore approximately two and a half times the level recorded when B.C.’s toxic-drug public-health emergency was declared.

These are patient events, not necessarily different people. One person may require emergency assistance more than once.

The figures also do not tell us how many incidents occurred downtown, in parks, inside apartments or in family homes.

BCEHS has emphasized that overdoses occur throughout communities, both inside and outside homes. The highly visible downtown incident is only one part of the emergency-response picture.

Naloxone Measures the Rescue

Nanaimo’s Community Safety Officers provide another indication of the intensity of the crisis.

The City reported that CSOs administered 1,292 doses of naloxone during 2024. Between 2022 and 2024, they also conducted more than 6,500 wellness checks involving people affected by substance use.

These figures require careful interpretation.

A dose of naloxone is not necessarily a separate overdose. One person may require several doses during a single incident, and the same individual may be revived on more than one occasion.

Nor should the CSO total be added to the ambulance numbers. Community Safety Officers, firefighters and paramedics may all attend the same emergency.

The figures measure responses by different agencies. They are not a clean count of unique incidents or individuals.

Naloxone records the rescue. It tells us very little about how the person arrived at that point.

What Is Nanaimo Fire Rescue Seeing?

Nanaimo Fire Rescue responds to medical emergencies and participates in the Take Home Naloxone program.

Its publicly available business plans do not provide a clear annual breakdown of:

• Suspected overdose or drug-poisoning calls
• Naloxone administrations
• Incidents occurring in private residences
• Incidents occurring in public locations
• Repeated responses involving the same address or individual

Those numbers should be available.

A useful request to Nanaimo Fire Rescue would ask:

How many suspected overdose or drug-poisoning incidents did NFR attend in each year from 2018 through 2025? How many involved naloxone, and how many occurred inside private residences rather than in public places?

The location breakdown could be one of the most revealing pieces of this series.

It would help show whether Nanaimo’s emergency statistics are primarily a downtown street crisis—or whether a substantial number originate behind apartment doors, inside houses and throughout the wider community.

The Invisible Stage

Before the ambulance call, there may be months or years during which the consequences remain largely private.

Bills begin arriving late.

Workdays are missed.

Relationships become strained.

Food, utilities and rent compete with the cost of alcohol or drugs.

The person withdraws from friends and family. Health deteriorates. Employment becomes less secure.

None of these developments necessarily produces a substance-use statistic.

Instead, they may appear separately as missed work, unpaid rent, family conflict, anxiety, depression, an emergency-room visit, an eviction, a police complaint or a request for shelter.

That fragmentation makes the full progression difficult to see.

One agency records the medical emergency. Another records the housing loss. Another records public disorder. Another pays for the ambulance.

No single ledger tells the whole story.

Not Everyone on the Street Started There

Public discussion often divides Nanaimo into two groups: ordinary residents and “street people.”

Reality is not that tidy.

Someone living outside today may once have had a home, a job, a vehicle and a family.

The slide into crisis may have involved substance use, but also unemployment, trauma, mental illness, physical disability, an unaffordable rent increase or the loss of someone who had been providing support.

The point is not to assign one simple cause.

It is to recognize that the visible street population did not appear from nowhere.

Nanaimo’s street-level statistics may include people whose problems spent years incubating behind closed doors—until the rent could no longer be paid, the family could no longer cope or someone finally called 911.

The Question Nanaimo Is Not Yet Answering

The City can count naloxone doses.

Paramedics can count overdose responses.

Housing agencies can count people in shelters or encampments.

Hospitals can count admissions.

What remains largely unmeasured is the path connecting them.

• How often did the overdose problem begin while the person was housed?
• How many emergency responses occur in private residences?
• How often does substance use contribute to an eviction or job loss?
• How many families are quietly keeping someone housed and alive?
• How many people behind a closed door are moving toward becoming next year’s street-level statistic?

The overdose on the sidewalk is not necessarily where the crisis began. It may simply be where the rest of the community finally noticed it.

This is Part Three of Nanaimo’s Hidden Substance Problem. Part Four will examine the uncomfortable financial question: government sells alcohol and cannabis, collects the revenue—and then pays part of the health, housing and emergency-response bill.

Sources

BC Housing: 2023 Report on Homeless Counts in B.C.

BC Emergency Health Services: Overdose and Drug-Poisoning Data

City of Nanaimo: Community Safety Officer overdose-response information

Nanaimo Fire Rescue: Nanaimo Fire Rescue information