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  • Time to rethink our approach to drugs in prisons: Barriers to in-prison substance use treatment and harm reduction programs

    Time to rethink our approach to drugs in prisons: Barriers to in-prison substance use treatment and harm reduction programs

    This is the third in a three-part series highlighting the critical need to consider policy and program reform in Canadian federal prisons. You can read the first post here, and the second post here.

    In this series, I’ve cast doubt on the effectiveness of in-prison drug enforcement and raised a number of issues related to access to medication in Correctional Service of Canada (CSC) institutions. Under the current federal government’s tough-on-crime agenda, the prison population is expanding and a majority of these prisoners report substance use problems. Given this, it’s important to ask: are prisoners receiving substance use interventions that improve their health and well-being, and assist with community re-entry?

    For people hoping to reduce or eliminate their use of alcohol and other drugs, substance use treatment can have a positive impact. Over the years, CSC has developed various programs that target prisoners’ substance use (e.g., moderate and high intensity programs) and has reported successes with those programs in terms of both institutional and post-release outcomes. CSC’s National Correctional Programs Referral Guidelines state that correctional planning should allow for prisoner participation in substance use programming “as soon as possible”. However, many prisoners, including those with severe substance use needs, end up on long waitlists.

    There are numerous barriers to timely and effective delivery of in-prison substance use treatment – prisons are, by design, difficult environments for rehabilitative programming. People are not sent there voluntarily. And the fact that security imperatives take precedence correspondingly shapes operational procedures (e.g., lockdowns) and correctional and program staff attitudes.

    Security infrastructure gets considerably more money than programming, and funding for the latter is more likely to face cuts. For example, Canada’s correctional services ombudsman has noted that investment in CSC’s methadone maintenance treatment – an effective substitution therapy for opiate dependence – was set to be reduced in 2014/15. As prison populations grow and funding becomes scarcer, the resulting overcrowding (e.g., “double bunking,” lack of rooms for programs) and resource issues (e.g., not enough trained staff to meet program demand) will affect access to and quality of programs.

    Another problematic issue is the prioritisation of candidates for substance use treatment programs. Former correctional staff explain that sentence length and release eligibility dates are often used as filters to determine who gets programming first. Those serving shorter sentences (e.g. four years or less) often get swiftly pushed through their sentence plan. Conversely, those serving longer sentences, regardless of their personal history, are de-prioritised or not even considered for programs until many years down the line. This situation creates a lot of inconsistency. And any prisoner applying for parole who has not been able to complete their designated programming is likely to be deemed ineligible or unsupported.

    Lack of timely access to substance use treatment is another reason why some people continue to use drugs while incarcerated. The zero-tolerance policies in place in federal prisons make it difficult to establish harm reduction education and services. Elsewhere I have written in detail about the political and operational barriers, including evidence suppression, that prevent certain in-prison harm reduction programs like safer tattooing and needle distribution initiatives in Canada. In some other countries, these types of programs are operational. Here in Canada, multi-stakeholder efforts are underway to build support for implementation of prison-based needle and syringe programs to help improve the health services available to prisoners.

    It’s essential to remember that most people who serve time in federal prisons eventually return to the community. For people who use drugs, the initial period after release is a critical window – they may return to enabling social networks or reinstate drug use that exposes them to increased risk of overdose. During this transition period, continuity of care, such as linking former prisoners to community-based substance use treatment and harm reduction services, is yet another area that requires significant improvements. This makes it that much more important that people who use drugs receive access to quality treatment programs and services that help them learn to stay safer while they are in custody. If we don’t address these issues, we are doing too little, too late.

  • A painful situation: Access to medication in prisons

    A painful situation: Access to medication in prisons

    This is the second in a three-part series highlighting the critical need to consider policy and program reform in Canadian federal prisons. You can read the first post here.

    When it comes to drugs in prisons, Canadian correctional officials are primarily concerned with keeping illicit drugs out. As a result, there’s insufficient attention given to in-prison use of and access to psychoactive medications prescribed for physical and mental health conditions. This neglect leads to gaps in our knowledge that negatively affect prisoner health and well-being. More research and improved policy that address prisoner access to medication are urgently needed.

    Here’s brief context: Delivery of health services in federal prisons must conform to the Corrections and Conditional Release Act which states that every prisoner will be provided with “essential health care” and “reasonable access to non-essential mental health care” that contribute to successful rehabilitation and reintegration. The Correctional Service of Canada (CSC) has a Commissioner’s Directive plus other guidelines and procedures in place regarding the dispensing of medication, including a National Formulary  that all federal prisons must follow. The formulary lays out for physicians, pharmacists, and nursing staff which drugs are permissible inside prisons. Many psychoactive drugs are excluded from the formulary because they’re seen as having high potential for misuse and diversion (e.g., prisoners selling or being “muscled” for their meds). Psychoactive drugs that are on the formulary are subject to careful restrictions (e.g., only prescribed under certain circumstances, cannot be dispensed for longer than a week, must be taken by direct observation, etc.). Despite existing rules and regulations, people who work for external organizations and former CSC staff report a need for clearer policy and better practices.

    People who enter the prison system are typically destabilized as soon as they arrive – they are completely taken off or tapered off whatever medications they were taking in the community. A variety of factors, including lack of communication between health care providers and security staff, and strict adherence or changes to the formulary, can contribute to a lengthy period before a prisoner can get back on or initiate a medication schedule. Clearly, this has implications for the prisoner’s physical and/or mental health.

    System observers and former CSC staff report stories of prisoners experiencing severe mental health symptoms and getting, for example, involuntary transfers before or instead of receiving appropriate medication. For pain management, prison physicians face difficulty prescribing the few pain medications listed in the formulary. In some cases, prisoners experience interruptions to pain medication they were taking for years prior to incarceration. There are opportunities for community-based pain specialists to see prisoners and make recommendations to prison health care, but not necessarily in a timely or consistent manner. There is also a process to get exceptions to the formulary, but it’s an uncertain process with no guarantees. None of this is facilitated by the zero-tolerance setting inside federal prisons, where prisoners who request psychoactive medications for pain or other conditions often get labelled by staff as “drug-seeking” and are treated with suspicion.

    It is crucial to note that certain groups are more likely to be prescribed or taking psychoactive medications (often self-medicating), and are thus disproportionately affected by lack of timely access to medication. These groups include: prisoners with mental health needs, and those with histories of trauma; women prisoners, particularly Indigenous women; prisoners living with physical pain, including some people living with HIV who experience a painful peripheral neuropathy; and aging or elderly prisoners. The Office of the Correctional Investigator has long acknowledged the need to better address the mental health needs of prisoners, including access to medication, and recently reported  that 63% of women in federal prisons receive psychotropic medication for mental health symptoms.

    To ensure that prisoners receive the “essential health care” to which they are entitled, those of us who are researchers, service providers, and prison health advocates must ensure we continue to investigate this topic. If we strive for a compassionate society that considers prisoner health and well-being, we need to know a lot more about what is happening inside prisons regarding access to medication.

  • Drugs in Canadian prisons: has enforcement worked?

    Drugs in Canadian prisons: has enforcement worked?

    This is the first in a three-part series highlighting the critical need to consider policy and program reform in Canadian federal prisons.

    In recent years, the Correctional Service of Canada (CSC) has stepped up efforts to keep drugs out of prisons. Nonetheless, the emphasis on in-prison drug detection and enforcement is linked to numerous problems.

    For some people, a prison sentence is indeed a valuable opportunity to “get clean” from drugs. However, the idea that prison offers a safe and abstinent setting for everyone rests on flawed assumptions about reduced supply and demand for drugs in prison. In my research, I found that despite substantial funding and increased prison-based enforcement, the goal of “drug-free prisons” is still far out of reach in Canada.

    In 2007, CSC launched a Transformation Agenda that includes as one of its five priority areas “eliminating drugs from prison.” The following year, the federal prison system received an investment of $120 million over five years to augment its anti-drug strategy. The funding was to enhance tools to detect, disrupt, and deter drug use inside prisons such as random urine testing, security intelligence officers, drug-detector dogs, and ion scanners. It’s a big, expensive toolkit – and yet there is no clear evidence that these tools have proven effective.

    Depending on who you ask, you’ll get different opinions about drug enforcement and its impact inside prisons. Some highly informed observers – such as former correctional officers and people who work for community-based agencies that provide support to prisoners – say that not only have enhanced enforcement efforts failed to keep drugs out of prison, they may in fact be making matters worse. Problems related to enforcement include people switching the substances they use (e.g., cannabis to opiates) to avoid detection, increased risk behaviours (e.g., needle hiding and sharing), heightened tensions and violence related to the drug trade, and fewer visitors.

    The consequences can be immediate or extend well beyond the prison sentence. For instance, when prisoners who inject drugs share needles, they are at risk of getting HIV and hepatitis C. When relatives, friends, and volunteers feel stigmatised and distressed due to invasive security procedures or are denied access based on potentially inaccurate information, they visit less or not at all. This weakens relationships that are vital to successful reintegration upon release.

    These problems tend to be reinterpreted or even dismissed by CSC. Instead, CSC points to the increases in drug seizures and fewer positive urine tests and refusals as indicators that enforcement is working. Visitors turning away at prison gates is offered as evidence that entrance procedures are effectively deterring people who are carrying drugs. In short, these issues remain contentious. But it’s important to emphasize that CSC – and other prison agencies, generally – tends to lay blame for drug-related problems on prisoners and visitors, without acknowledging the impact of their zero-tolerance policy and enforcement.

    This narrow focus that overlooks competing information and perspectives makes it difficult to reform current policy and practices. A few years ago, the Standing Committee on Public Safety and National Security brought together a variety of knowledgeable stakeholders and experts, including CSC officials, to investigate the “alarming problem” of drugs and alcohol in federal prisons. Witnesses voiced “very different positions on the policy and the measures taken by CSC,” with some testifying that the enforcement response has not eliminated drugs in prisons and plays a role in jeopardizing the health and safety of prisoners, prison staff, and communities. Despite this, the final report recommended continued investment in enforcement enhancements and upheld the “commitment to establish drug-free prisons.” In other words, it didn’t stray from the Transformation Agenda. Canadians should read such reports with a critical eye and ask what has actually been transformed.

    CSC manages a large population within prison walls in communities across Canada. While we advocate for drug policy reform outside of prisons, we must not forget about policy and programs that affect the many federally sentenced men and women (including disproportionate numbers of Indigenous people) who use drugs. Well-designed and comprehensive evaluations of drug enforcement efforts inside our prisons are long, long overdue. And given the persistence of drug use in Canadian prisons, realistic assessment of appropriate harm reduction programs, such as safer drug use education and syringe distribution, should also be a priority.

  • Keeping music festival-goers safe through harm reduction

    Keeping music festival-goers safe through harm reduction

    [vc_row][vc_column width=”1/1″][vc_column_text]With the onset of winter, I’ve been reminiscing about the summer. Like many young Canadians, I spent the summer adventuring around my province, hiking, camping and enjoying the extra freedom the warm weather offers. This summer I was also lucky enough to attend a number of music festivals. I love festivals. Spending a weekend away, great music, camping with your friends, dancing until the wee hours under starry skies… there’s something magical and ethereal about the festival community that draws in so many attendees every year.

    And yet, these festivals have a darker underbelly. “Party drugs” like ecstasy, ketamine and cocaine are common at music festivals, and their uncontrolled use can lead to serious consequences. This summer alone in Canada, almost 80 people were admitted to hospital after incidents with drugs at festivals. Two of these people died. They were only 20 and 22, respectively. Sadly, this is not an uncommon theme. Every year, kids go to festivals and every year kids die at festivals. The Canadian Centre on Substance Abuse reports that the largest number of ecstasy users are between the ages of 15-24. These are not dangerous criminals. Annie Trong-Le, 20, who died this summer of a recreational drug overdose, was a political science student at York and a regular volunteer in her community. These are normal kids from normal families. So what’s going on?

    The popularity of music festivals is on the rise. Shambhala, an electronic music festival near Salmo, British Columbia capped its attendance at 10,000, which represents a tenfold increase since its 1998 inception. The Squamish Valley music festival drew in nearly 100,000 guests this year. The Basscoast music festival, formerly held in Squamish, scaled up two years ago, capping attendance and moving to Merritt, BC.

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    This rise is, at least in part, due to the dramatic increase in popularity of Electronic Dance Music (or EDM) in the past several years. According to the International Music Summer Consumer report in 2012, $6.4 billion EDM industry is the fastest growing music genre in the US, with similar growth in Canada. Festivals that used to attract large rock acts are now drawing huge DJs like Skrillex and Deadmau5.

    Synonymous with the EDM scene is MDMA, aka “molly” or ecstasy. MDMA is everywhere in popular culture. In Miley Cyrus’ hit song “We Can’t Stop”, she sings “la-di-da-da-d/We like to party/Dancing with molly/Doin’ whatever we want”. Madonna made waves this year, titling her new album the cheeky “MDNA”, and asking concert-goers at the Ultra music festival “Has anyone seen molly?” Having attended 3 festivals myself this summer, increased MDMA use was impossible to ignore. Festival dance floors that used to be littered with beer cups are now full of young people in neon taking pills. With the surge in EDM popularity, rave culture has come back in a big way, and despite a lack of data collection, my sense is that MDMA and recreational party drug use is on the rise.

    The problem with this, ironically, is not that kids are taking MDMA, but rather that they are NOT taking MDMA. In it’s pure, non-contaminated form, MDMA increases release of the neurotransmitter serotonin in your brain leading to a feeling of ecstasy, trust and connectedness and, though hotly contested, evidence suggest that the effects of pure MDMA are unlikely to lead to death (and actually, some labs are even looking at the potential to use MDMA for therapeutic use). The problem is that MDMA, usually purchased as capsules or pressed tabs, is often laced with dangerous substances like speed, cocaine, or other MDMA derivatives, like the dangerous PMMA. These substances, especially when ingested unknowingly, can lead to heart attacks, hyperthermia, seizures and many other symptoms. Most lethal cases of party drug use are actually a result of users unknowingly ingesting dangerous unknown substances.

    Most users of party drugs have no way of knowing what they’re taking. Even after many successful uses, a single dose of contaminated drugs can lead to unexpected and sudden death. Maintaining a staunch “anti-drug” approach is not preventing kids from taking drugs. And simply accepting that deaths are a consequence of festival culture is not suitable. We need better options to keep users safe – otherwise things are only going to get worse.

    Some groups have already started taking control. At the Shambhala festival, AIDS Network Kootenay Outreach and Support Society (ANKORS) sets up a booth to provide free drug testing for unidentified substances (And it’s working — see below for their stats). The Trip Project, out of Toronto, and Dance Safe, out of San Francisco, do advocacy education and drug testing for EDM festival-goers to try and increase drug knowledge and safety. Many festivals have “sanctuary” spaces, where drug users feeling overwhelmed or uneasy can relax in a non-judgmental space, staffed by emergency medical professionals. Many festivals, though clearly stating that they don’t promote drug use, are clear about where to find help if something goes wrong. Harm reduction is bubbling up all around the edges of the party scene.

    Small steps towards better harm reduction could make a big change. Improved access to testing kits at festivals and parties needs to become a norm. The University of Alberta is already developing quick drug testing kits, aimed for use by law enforcement to keep an eye on street drug makeup. Better drug testing could help weed out crooked dealers that lace their product, keeping users safer. Similarly, improved education about drug use in the home and school between youth and trusted adults can help kids make safer choices.

    The truth is that the party scene is changing. Kids are dying. It’s time to start thinking about how we can keep them safer.[/vc_column_text][vc_row_inner][vc_column_inner width=”1/1″][divider line_type=”Small Line” custom_height=”.25em”][/vc_column_inner][/vc_row_inner][/vc_column][/vc_row][vc_row][vc_column width=”1/1″][vc_column_text]ANKORS compiles statistics every year outlining the results of their drug testing efforts at Shambhala Music Festival. The following are the stats from the 2013 festival:

     

    Total tests done 2,254
    Number of drugs disposed of after the test 155 (6.8%)
    MDMA capsules that tested positive for MDMA 1,302
    MDMA capsules that tested negative for MDMA 339
    Failure rate of MDMA capsules 21%
    Ketamine samples that tested positive for ketamine 158
    Ketamine samples that tested negative for ketamine 63
    Failure rate of ketamine samples 29%
    Mystery substances 91
    PMMA 77

    [/vc_column_text][/vc_column][/vc_row]

  • To ticket or not to ticket – Conservatives take a tiny step on cannabis

    To ticket or not to ticket – Conservatives take a tiny step on cannabis

    For a split second, the door to drug policy reform in Canada opened ever so slightly. But then Justice Minister Peter MacKay was quick to slam it shut: “We’re not talking about decriminalization or legalization.”

    On March 5th, MacKay announced that the federal government is looking at changes to the Controlled Drugs and Substances Act that would make it possible for police to issues tickets for possession of small amounts of cannabis.

    The announcement follows last summer’s resolution from the Canadian Association of Chiefs of Police asking the federal government to consider ticketing options. But it also follows Justin Trudeau’s considerably bolder endorsement of cannabis legalization. So I can’t help but wonder if this is a move to stem the Liberals’ rise in the polls.

    MacKay’s proposal would allow police to issue tickets to people possessing less than 3 grams of cannabis. It’s a positive move in one way, because it means these cases will no longer be sent to criminal court. So otherwise law-abiding citizens will not be burdened with a record of criminal conviction, which can have serious implications for travel and employment.

    But it also comes with the potential of a significant downside. In Australia, for example, similar measures resulted in a “net-widening” effect. That is, because it was easier for police to process minor cannabis offences, individual officers shifted away from using case-by-case discretion in giving informal cautions, to a process of formally recording all minor offences. The result was a significant increase in formal infractions, but no change in the pattern of cannabis use.

    Still even if we assume MacKay’s changes hold promise, we need to be clear that these modest steps are not the endgame to a much needed overhaul to drug laws in this country – especially considering that jurisdictions bordering Canada are moving toward legalization. Is this is best Canada can do given the momentous changes taking place around the world?

    Critics of legalization take pains to point out that cannabis can harm the health of its users. Of course it can! So can alcohol, but the lesson of alcohol prohibition is that an underground market is an unsafe market. The purpose of a legally regulated cannabis market is to ensure that we use the painful mistakes of alcohol and tobacco regulation to create the best possible approach to cannabis. Regulation rather than prohibition will make this substance safer, control its production and distribution, and ensure that at least some of the profits go to the public coffers.

    The other problem with cannabis prohibition is that the effects of drug laws are inequitably applied to poor and Indigenous Canadians. And prohibition doesn’t keep cannabis out of the hands of kids. As Unicef’s 2013 report on the well-being of children in rich countries reveals, Canadian youth use the most marijuana compared to our economic counterparts around the world. Yet they use the third least amount of tobacco. What accounts for this second stat? A solid, legally regulated market that relies on stringent controls and education about the harms of tobacco.

    It’s great that MacKay has taken a first step, but we need to keep moving toward a saner, safer approach to cannabis use. The CDPC is committed to talking with Canadians about the possibilities of cannabis regulation. To that end, in the coming months we’ll unveil proposals to help to build a regulatory framework that takes into consideration what we’ve learned from public health approaches to alcohol and tobacco. Canada can do better.

  • Measuring lives saved: the facts about safer consumption services

    Measuring lives saved: the facts about safer consumption services

    This post first appeared in the Centre for Addictions Research of BC’s blog Matters of Substance.

    Despite the pragmatic nature of harm reduction programs, and their demonstrated ability to save lives, controversy still dogs efforts to scale-up harm reduction. One of the most misunderstood and controversial initiatives are safer consumption services (SCS).

    In the last 20 years, SCS services (sometimes also known as safer injection services (SIS) have been integrated into drug treatment and harm reduction programs in Western Europe, Australia, and Canada. The focus of these services is facilitating people to safely consume pre-obtained drugs with sterile equipment. These services can be offered using a number of models including under the supervision of health professionals or as autonomous services operated by groups of people who use drugs.

    The objectives of SCS include preventing the transmission of blood-borne infections such as HIV and hepatitis C; improving access to health care services for the most marginalized groups of people who use drugs; improving basic health and well-being; contributing to the safety and quality of communities; and reducing the impact of open drug scenes on communities.

    Safer consumption services grew out of the recognition that low-threshold, easily accessible programs to reduce the incidence of blood-borne pathogens were effective and cost-effective. This was the conclusion of over 30 research studies on Vancouver’s own supervised injection site known as Insite.

    Research has found that SIS services:

    • are actively used by people who inject drugs including people at higher risk of harm;
    • reduce overdose deaths — no deaths have occurred at Insite since its inception;
    • reduce behaviours such as the use of shared needles which can lead to HIV and Hep C infection;
    • reduce other unsafe injection practices and encourage the use of sterile swabs, water and safe needle disposal. Users of these services are more likely to report changes to their injecting practices such as less rushed injecting;
    • increase the use of detox and other treatment services. For example, the opening of Insite in Vancouver was associated with a 30% increase in the use of detoxification services and in Sydney, Australia, more than 9500 referrals to health and social services have been made since the service opened, half of which were for addiction treatment;
    • are cost-effective. Insite prevents 35 new cases of HIV and 3 deaths a year providing a societal benefit of approximately $6 million per year. Research estimates that in Sydney, Australia, only 0.8 of a life per year would need to be saved for the service to be cost-neutral;
    • reduce public drug use; and reduce the amount of publically discarded injection equipment; and
    • do not cause an increase in crime.

    Professional groups such as the Canadian Medical Association, the Canadian Nurses Association, the Public Health Physicians of Canada, the Registered Nurses Association of Ontario, and the Urban Public Health Network have expressed their support for SCS.

    Clearly it’s time to move beyond controversy and get on with creating more of these life-saving programs.

  • Cannabis regulation is by no means a simple matter, but it can be done

    Cannabis regulation is by no means a simple matter, but it can be done

    At the Canadian Drug Policy Coalition (CDPC) one of things we’ve noticed is that any blog we publish on cannabis regulation attracts more attention than any other topic. This is because there’s widespread interest in any discussion of changes to the laws that govern cannabis. Unfortunately when it comes to the nuts and bolts of cannabis regulation – in other words – the how of regulation, interest tends to drop off. This is because regulation is actually rather tedious. This claim is borne out by the length of the proposed regulations for legal recreational cannabis markets in the U.S. states of Washington and Colorado. That’s why I’m going to make a special plea to you our dear readers to stay with me as I say a few words about what regulation might actually entail.

    ucurveI think it’s fair to suggest that the CDPC favours a model of regulation that draws on the best evidence from public health regulation of alcohol and tobacco. But when it comes to cannabis regulation the devil really is in the details.

    There’s no magic bullet that will make all the current problems with cannabis prohibition disappear. But thanks to the Health Officer’s Council of BC, some of the heavy lifting when it comes to creating models for drug regulation has been done. If you’re curious, check out their 2011 report. As you can see from the diagram drawn from their 2011 report, regulations for cannabis should not be so loose that they create a free and unregulated market for cannabis; nor should regulations be so overly restrictive that we end up reproducing the negative aspects of the current underground economy (control by organized crime, etc.).

    At the same time we need to be clear about the goals we hope to achieve with a legal regulated market for cannabis. Ideally our regulations will help protect and improve public health, reduce drug related crime, protect the young and vulnerable, protect human rights and provide good value for money. So what are some of the things we’ll need to consider? How about we start with the basics.

    Presumably legalization would entail the removal of cannabis from Schedule 2 of the federal Controlled Drugs and Substances Act, followed by its inclusion in the Food and Drug Act. It seems like the next logical thing to do would be to then turn over the regulation of cannabis to the provinces, in the same way that alcohol is currently regulated. We would want to ensure that there is at least some consistency across the provinces so that means somebody at the federal level will have to oversee the regulations as they emerge. That’s the easy part because legalization would ALSO entail consideration of at least the following issues: production, product, packaging, vendor and outlet controls, marketing controls, creation of a system of regulators and inspectors as well as on-going research and monitoring.

    For this blog post, I want to focus on production and product controls. Future blogs may consider the other items on the already long list noted above. My comments are phrased as questions to stimulate discussion of regulation rather than to propose firm rules for how a legal recreational cannabis market might operate.

    IMG_2567In Canada, marijuana is currently produced in one of two ways – under existing legal medical marijuana guidelines or in illegal circumstances. Growing marijuana takes places in a vast array of situations ranging from a few plants grown for personal use all the way to large-scale industrial size operations with 100’s of plants.

    Thus regulating the growth of marijuana for a legal recreational market will not be simple. Many people are very attached to their small-scale gardens and it would be difficult to impossible (as well as undesirable) to eliminate growing marijuana for personal use. At the same time it’s important not to turn the whole thing over to heavily capitalized large scale commercial producers whose main motivation is profit, especially since the range of available strains of marijuana has been the result of innovation by many small-scale growers. Thus, we need to ensure that the best practices in indoor, outdoor, personal, commercial production are preserved while ensuring that cannabis is produced in safe and clean facilities. We will also need to decide who is the appropriate authority for regulating growing operations: municipalities or provinces or some combination of both. Neither seem overly keen on this role so they will require some convincing.

    Okay, if your head doesn’t hurt yet lets turn our attention to product controls. Product controls include issues like price, age limits, potency, permissible preparations (edibles, tinctures, etc.), quality control, and labeling and packaging requirements. Price is a key issue when it comes to meeting public health goals. Price can help shape sales and thus use of cannabis, so we want to ensure that pricing reflects what we’ve learned from alcohol – namely that alcohol consumption is sensitive to price and that price must in some way be related to potency. Related to price is taxation – at what point in the chain from seed to sale will cannabis be taxed and at what rate? And what preparations will cannabis regulations allow; plant materials, tinctures and oils, edibles? Right now Canada’s medical marijuana access program only allows for the distribution of plant material. Clearly this is a very limited approach given that the medical cannabis dispensaries have created a range of edible and other products that eliminate the necessity of smoking cannabis. We will also need to decide where we stand on potency: in other words will we put limits on how potent products can be, and given that there are over 100 cannabinoids, how will we decide which ones we want to measure and regulate.

    Okay so I haven’t covered other essential issues like vendor controls, marketing and evaluation and monitoring but I think you get the picture. Regulation is by no means a simple matter, but it can be done. In fact, experience from legal recreational markets in Washington and Colorado will provide valuable insights that can inform Canada’s approach. And regulation has the potential to create conditions where cannabis production and use is a whole lot safer than the current approach – prohibition.

     

  • Did You Know that Marijuana is Illegal in Canada?

    Did You Know that Marijuana is Illegal in Canada?

    The idea that marijuana is legal in this country is one of the persistent myths about this substance. In fact, marijuana is still illegal and is listed in Schedule 2 of the federal Controlled Drugs and Substances Act. This means that unless you have authorization to use medical marijuana, you cannot possess, sell or produce marijuana without risking a criminal penalty.  In fact, under 2012 revisions to the law, you could receive a mandatory minimum prison sentence for growing just six plants if any of a number of “aggravating factors” are present (such as being near a school or having children at the same place as the plants).

    Another persistent myth is that police don’t bother to enforce cannabis laws especially possession. It’s true that some police forces have de-prioritized enforcement of possession, but certainly not all.

    According to Statistics Canada, in 2012, there were 57,429 police reported incidents of cannabis possession. This number represents police resources that could be better spent elsewhere and this number also represents a ridiculous incursion on the civil liberties of far too many Canadians.

    Prohibition of cannabis seems even more regressive when we consider that legal recreational marijuana will soon be available in the U.S. states of Colorado and Washington. In the aftermath of successful 2012 ballot initiative campaigns, both states have released draft regulations to govern the production and sale of recreational cannabis. Changes in these U.S. states were a hot topic at the recent International Drug Policy Reform conference in Denver where speakers from Colorado and Washington outlined the rules for “tightly controlled” markets for recreational cannabis.

    Both models of regulation draw on experience with regulating alcohol, although regulations for recreational cannabis will be far more stringent. Both states require numerous controls including age limits, packaging information, and closely controlled documenting of wholesale and retail sales of cannabis to recreational users. Some of the proceeds of taxation will be directed to public health and educational goals.

    In Colorado the legalization of cannabis builds on a successful model of medical cannabis developed in that state over a number of years. In fact, during the three-day conference I had an opportunity to visit two medical cannabis dispensaries and an industrial size cannabis garden. Good Medicine and River Rock Medical Cannabis are just two of the companies in Denver that offer patients an array of medical cannabis products ranging from raw plant materials, to oils, and edibles in a myriad of forms. Lessons learned from these operations will be transferred to recreational cannabis when it becomes available for sale on January 1, 2014.

    What’s remarkable about the changes taking place in these two states is that they employ full legal regulation, not the models of decriminalization already in operation in other parts of the world. Decriminalization involves reducing or eliminating penalties for possession while still keeping production and sales illegal. Though an important step in the right direction, decriminalization still leaves cannabis in an unregulated market of producers and sellers.

    It was clear from visiting the two medical cannabis dispensaries that legalization makes this substance available in a variety of well-labeled forms and gives consumers the option to choose organic products. Security cameras that feed back to state regulators in real-time, monitor the dispensaries and the gardens. The people working in these operations are clearly knowledgeable and professional in the care they take with their products and their customers. Not only does this model work for consumers, but it also provides badly needed jobs.

    The scientific evidence suggests that cannabis has a smaller public health impact than alcohol. It seems that the real crime is staying a course that actually makes us less safe and less healthy because right now, marijuana is only available in Canada in an unregulated market. So what’s holding us back in this country? Maybe it’s that drugs are still politically expedient and some politicians don’t seem to have any qualms about using fears about drugs to get votes. At the Canadian Drug Policy Coalition we think it’s time for change and it’s time to challenge regressive and uninformed policies on cannabis. What do you think?

     

  • Lifesaving Heroin Assisted Treatment Dealt Serious Blow

    Lifesaving Heroin Assisted Treatment Dealt Serious Blow

    By Connie Carter and Susan Boyd

    On October 3, 2013, federal Health Minister Rona Ambrose announced new regulations that became effective immediately to prevent Health Canada’s Special Access Programme from approving the use of prescribed diacetylmorphine* as a treatment for addiction for a small number of patients finishing the clinical trial SALOME, in Vancouver, BC. Health Canada’s Special Access Programme (SAP) allows practitioners to request access to drugs that are unavailable for sale in Canada.

    Ambrose’s comments at the October 3rd press conference misrepresented the extensive evidence supporting heroin-assisted treatment (HAT). She claimed HAT is unsafe and expensive and not in keeping with her government’s National Anti-Drug Strategy.  Her comments reflected the Harper government’s refusal to acknowledge the eight peer-reviewed research HAT trials worldwide that have found it to be a beneficial, safe, and cost-effective approach for patients where methadone and other conventional treatments have not worked.

    Ambrose promoted the virtues of abstinence-based drug treatment failing to mention that Canada’s system of treatment programs is a patchwork of private and public providers. As the CDPC’s report on Canadian drug policy found, private treatment programs are expensive, and in the absence of national accreditation standards, these programs can vary in quality. Abstinence based treatment is also ineffective for many people with long-wait times for publicly-funded services.

    Ambrose’s press conference included supporters who were called upon to back the federal government’s position. One speaker, Marshall Smith, a former political staffer with the BC Liberal Government, described his own struggles with drugs including crystal meth, and his recovery through abstinence-based treatment. Smith currently works for Cedars at Cobble Hill, a privately run drug treatment facility on Vancouver Island. Smith comes from a self-admitted well-to-do family, who can afford private treatment facilities that can cost upwards of $10,000 a month. Every person’s story of recovery and change is important, but with all due respect to Mr. Smith, it’s vital that no one person’s story stand in for the range of experiences with substance use.

    Comments at the press conference reflected a narrow view of recovery from substance dependency and assumed that all people will benefit from conventional drug treatment approaches. In a turn about from previous calls for abstinence-only drug treatment, speakers’ called for expanded opiate-substitution programs like methadone. But HAT is only offered to patients who have failed repeatedly with methadone and abstinence-based programs.

    Ambrose called Health Canada’s recent decision to approve the use of diacetylmorphine for 20 patients a “loophole” in the Special Access Program regulations. But the Special Access Program is supposed to provide patients with serious or life-threatening conditions, access to drugs on a compassionate or emergency basis and especially when conventional therapies have failed. Under these conditions, many of the seriously ill patients who enter HAT would certainly qualify for access.

    No one knows better the concerns of patients in these research trials than SNAP, an independent Vancouver based group comprised of former and current members of Vancouver based HAT research trials (former NPA). SNAP advocates for human rights and access to appropriate health care for its members and has been working since January 2011 to establish permanent HAT programs. SNAP members also have first hand experience with the use of diacetylmorphine. Their experiences confirm the findings of other research studies that this drug is a proven safe and effective treatment for opiate dependency. Patients’ physical and psychological health improved, accompanied by decreased criminal activity and illegal drug use. Given the positive results from studies around the world and here in Canada, the federal government’s refusal to recognize the best treatment for this small groups of patients is an egregious violation of their rights to access to health care.

    * Diacetylmorphine is the active ingredient in heroin. It is pharmaceutical-grade product manufactured by a company outside Canada. For the purposes of research trials, it is purchased and imported with permission of the Government of Canada.