Tuesday, March 31, 2026

When Addiction Becomes Brain Injury: The Cost We Refuse to See

  When Addiction Becomes Brain Injury: The Cost We Refuse to See

The Downtown Eastside is not separate from Canada. It is not isolated. It is not “over there.”

As Larry Campbell said:

“The Downtown Eastside is Canada. The Downtown Eastside is in everybody's community.”

And yet, we continue to respond as if this crisis is temporary, containable, or someone else’s responsibility.

But something has changed — and it is being quietly acknowledged.

Campbell recently stated that he is now seeing brain damage from fentanyl that he had not seen before.

That should stop us in our tracks.


This Is No Longer Just Addiction

For years, the conversation has been about addiction, recovery, and choice.

But what happens when choice is no longer fully there?

Fentanyl overdoses don’t just risk death. They can cause hypoxic brain injury — damage from lack of oxygen. And when overdoses happen repeatedly, the damage compounds.

This means many people are now living with:

  • memory loss
  • impaired judgment
  • reduced ability to function independently
  • difficulty with basic daily tasks

In other words, we are no longer just dealing with addiction.

We are dealing with acquired brain injury at scale.


The Story We Already Know

We wrote about it before.

A woman in the system. Multiple overdoses. Repeated hospital visits. Emergency responses again and again.

The cost of her care reached approximately $385,000.

And still — no stability. No long-term support. No real solution.

This is what our system does: It pays for crisis, over and over again, instead of care.


The System Is Not Built for This

Right now, supports are based on a model that assumes people will:

  • attend appointments
  • manage medications
  • maintain housing independently
  • make consistent decisions

But brain injury doesn’t work like that.

People with cognitive impairment often need:

  • structured, supportive environments
  • daily assistance
  • long-term care
  • human connection and consistency

Without that, they fall through the cracks — again and again.

And each fall is expensive.


The Cost Argument Is Backwards

We hear it all the time: “We can’t afford that level of care.”

But look closer.

We are already paying:

  • for ambulances
  • for emergency rooms
  • for hospital stays
  • for policing
  • for court systems
  • for failed housing programs

We are spending hundreds of thousands per person — without improving outcomes.

So the real question is not: Can we afford to care for people with brain injuries?

The real question is: Can we afford not to?


What Needs to Change

If what Campbell is saying is true — and frontline workers already know it is — then the system must evolve.

We need:

  • integrated health and housing models
  • long-term brain injury care
  • support for families and frontline workers
  • policies that recognize cognitive impairment, not just addiction

This is not about quick fixes.

This is about acknowledging reality.


A Turning Point We Can’t Ignore

When someone with decades of experience like Larry Campbell says he is seeing something new, we should listen.

Because this may be the moment where the narrative shifts.

From: “Why won’t they change?”

To: “What has happened to them — and how do we care for them now?”


We are already paying the price.

The only question left is whether we are willing to pay it in a way that actually helps.



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