One Vancouver man continues with a lone mission to see the Canadian government investigate the root causes of the country's overdose epidemic.

"I believe that there is a legitimate cause for action in the form of a Royal Commission," Dan Small writes in a letter mailed to Canada's governor general dated July 24, 2018.

"The fact that the failure to scale up supervised injection services across Canada would have saved hundreds, if not thousands, of lives across the nation is as subtle as an open grave," it continues.

"The barriers that have prevented harm reduction service innovations are not scientific, medical or epidemiological. The barriers are, in my view, implicit and explicit values, the bedrock of our culture and institutions, regarding addiction and drug use.

"As such, in the public interest, I ask that you establish a Royal Commission to examine the cultural ideas and overarching institutional variables that have accounted for the dramatic overdose tragedy."

At least 6,965 people in Canada died of an opioid overdose between January 2016 and December 2017, according to the federal government.

Small is a co-founder of the continent's first sanctioned injection facility, Insite, and a medical anthropologist and adjunct professor at UBC. Last May, he wrote a letter to Prime Minister Justin Trudeau requesting the appointment of a royal commission "to examine the variables that have accounted for the dramatic overdose tragedy".

Somewhat to his surprise, Small previously told the Straight, the letter was acknowledged. Heidi Jackson, executive director of Health Canada's opioid response team, suggested to Small that he file his request with the office of Canada's Governor General.

Now Small has done that.

The July 24 letter recounts how the administration of former Prime Minister Stephen Harper fought Insite and stalled an expansion of similar harm-reduction services across Canada.

"In light of this legislative violence, Vancouver’s Insite remained as the only supervised injection facility open to the general public in Canada until the advent of temporary pop up services in 2016," Small writes. "Despite the [2011 Supreme Court's] decision in favour of Insite and its establishment as a key part of the standard of care, supervised injection services remained isolated to a single program in Vancouver operating for only 18 hours per day....For the rest of Canada, that number remained at zero."

Small notes that it was not until late-2016, several years after the dangerous synthetic-opioid fentanyl was identified for killing hundreds of drug users in B.C., that governments finally began expanding access to supervised-injection and other harm-reduction programs.

"It took the tragedy of an astonishing overdose epidemic in order to bring about significant government or institutional action to substantively address the dangers of illicit drug use," he writes. "Were this any other group, the failure of societal institutions to address the preventable deaths would be a source of public outcry."

"Without a Royal Commission, it is my fear that we will not truly face (and overcome) the systemic violence that exists beneath the surface of our society towards a population of people that has been failed repeatedly when the circumstances that took their lives were entirely amenable to efficacious, evidence-based, intervention," Small continues.

A royal commission is a research body appointed by a government’s cabinet to “carry out full and impartial investigations of specific national problems”, according to Library and Archives Canada. In the past, royal commissions were convened to investigate the contamination of the country’s blood-donor and distribution systems, for example, and the status and relations of Canada’s Indigenous peoples.

If a royal commission is eventually established, it will likely focus on the years that Harper and the Conservative party held power in Ottawa.

While B.C. has kept reliable statistics on illicit-drug overdose deaths since the early 1990s, Canada only began counting fatal overdoses at the federal level after Harper and the Conservatives were voted out of power in 2015.

In British Columbia, the first province hit by the crisis, there were roughly 200 fatal overdoses each year during the first half of Harper's time in office.

Then, nearing the end of his term as prime minister, in 2013, there were 333 fatal overdoses in B.C. Then 368 in 2014 and then 522 in 2015, the year that Harper was defeated by Trudeau and the Liberals.

Statistics show that the epidemic of overdose deaths that last year claimed 1,449 lives in B.C. began on Harper's watch.