In 2019, there were there were 24,166 overdose ambulance calls (~66/day) in BC, and in the Vancouver Coastal Health Region 39% of all ambulance calls were for an overdose. In 2020, 1,767 British Columbians died of an illicit drug overdose (~5/day) vs. approx. 957 from COVID-19 (~3/day). Harm reduction has certainly helped but is clearly not enough to keep things from getting worse. Stopping the overdose crisis will require improving our understanding of substance use disorders and risk factors for overdose that can be used to develop effective preventative measures.