June 1, 2022 – A growing group of drug policy and human rights organizations across Canada — comprising people who use drugs, health professionals, legal experts, academics, and others — say the Government of Canada’s latest move to decriminalize drug possession should go further to protect everyone, in particular those most endangered by drug prohibition and the drug toxicity crisis. We support policy that moves the needle forward; however, it is disappointing that decriminalization under the model announced on May 31st will not protect all people who use drugs from the harms of criminalization.
We support progress, but we dream bigger. We want full decriminalization for all.
Yesterday, the Government of Canada, led by its newly created Ministry of Mental Health and Addictions, joined with the Government of British Columbia to announce implementation of B.C.’s requested exemption to the Controlled Drugs and Substances Act (CDSA). B.C. is the first jurisdiction in Canada to effect this policy change. The policy provides legal protection to adults in B.C. who possess illicit drugs up to a cumulative total of 2.5 grams.
Yesterday’s announcement validates the efforts of people who use drugs and their allies across B.C. and Canada, who have for decades led the charge for drug decriminalization. But the announcement also signals a missed opportunity. A cumulative threshold quantity of 2.5 grams leaves many people who use drugs behind, namely those living in rural and remote communities who already bear the disproportionate brunt of drug prohibition and the drug toxicity crisis. People purchase larger quantities of drugs for myriad reasons: geographic restrictions, personal mobility reasons, and to limit interactions with the illicit drug market. Concerns over too-low threshold quantities were expressed repeatedly to B.C. and Health Canada by B.C.’s own Core Planning Table for Decriminalization and the Board of the Vancouver Network of Drug Users (VANDU) — to no avail.
This decision comes just as a more progressive drug policy bill, Bill C-216, is up for vote in Parliament today, on June 1. It is clear that the timing of the announcement is meant to hamper the progression of that bill through to committee stage, whereupon it could be further strengthened. Nonetheless, we call on Members of Parliament to listen to the voices of experts in this field and vote Bill C-216 through to committee stage today.
The fact that Canada is not considering national action towards decriminalization is shameful at this juncture, particularly as three jurisdictions have already applied for exemptions to date. The piecemeal approach the Government of Canada is now clearly taking does not adequately address the urgency of the drug poisoning crisis in this country.
We will continue to push for decriminalization for everyone and to turn the page on an outdated drug war that continues to kill as many as 20 people each day in Canada. Criminalization has failed, and there is no need to continue along this misguided path. Truly, a systems change is required in the context of a public health emergency caused by the system itself. We must decriminalize drugs and the people who use them, and provide access to a legal, regulated supply. Canada cannot wait.
Today marks the National Day of Mourning for workers killed or injured on the job. CDPC’s executive director Donald MacPherson participated in a memorial ceremony in Vancouver, B.C. to honour those who have died or have suffered injury or illness due to a work-related tragedy.
The Day of Mourning is a stark reminder of the urgent need for a safe supply of drugs in B.C. and across Canada, and increased access to harm reduction measures in the workforce.
A memorial wreath is placed at a ceremony in Vancouver, B.C. on April 28, 2022, honouring workers killed or injured on the job.
In British Columbia, the majority of employed people in the province who died of toxic drug poisoning from 2017 to 2021 were employed in the trades, transport, and equipment operator industries.
The impact of the drug poisoning crisis on those in the trades, construction, and transport industries can be attributed to factors such as managing physical pain, mental health, and a culture of substance use within the industry. 1
On this National Day of Mourning for workers killed or injured on the job, the Canadian Drug Policy Coalition is renewing its calls for an immediate, robust scale up of safe supply alternatives to the toxic illegal drug market and federal government action to decriminalize simple possession of drugs in Canada to reduce stigma and engage workers who may be at risk of drug toxicity deaths.
“It is common for people in these types of jobs to experience work-related injuries, stress and pain. They may not have or know where to find the resources they need to take care of these issues. This could lead to using pain medications and other substances more often to cope.” 3
In January 2022, the province announced new funding for the Vancouver Island Construction Association (VICA) to expand its Tailgate Toolkit project – a program aimed at harm reduction and prevention of toxic drug poisoning in B.C.’s construction industry. According to the province, the project will raise awareness of pain management and reduce stigma associated with drug use.4
A group of workers attend a memorial ceremony in Vancouver, B.C. on April 28, 2022, to honour those who have died or suffered injury or illness due to work-related tragedies.
April 28 is the national Day of Mourning for workers killed or injured while on the job.
A group of workers attend a memorial ceremony in Vancouver, B.C. on April 28, 2022.
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The Honourable Carolyn Bennett, M.D., P.C., M.P. Minister of Mental Health and Addictions and Associate Minister of Health
The Honourable Jean-Yves Duclos Minister of Health cc: Hon. Sheila Malcolmson, B.C. Minister of Mental Health and Addictions
Dear Ministers Bennett and Duclos:
Re: Proposed cumulative threshold of 4.5 grams in BC
We write as a coalition of over 20 civil society organizations in Canada, comprising people who use drugs and their families, Indigenous and racialized groups, service providers, legal organizations, research groups, and drug policy advocates. Our mission includes abolishing criminal and other laws, policies, and practices that control, stigmatize, pathologize, and punish people who use drugs.
We understand Health Canada is considering British Columbia’s request for an exemption from the Controlled Drugs and Substances Act to decriminalize simple possession up to a cumulative threshold quantity of 2.5 grams. As you know, this is far lower than the cumulative threshold of 4.5 grams requested by the province — already an exceedingly low cumulative threshold for many people who use drugs and near-unanimously rejected by BC’s Core Planning Table on Decriminalization.
Ministers: there is no legal or evidentiary basis for a cumulative threshold of 2.5 grams. Per the recommendation of our 2021 platform, we urge you to reject this quantity and dispense with threshold quantities altogether.1
As we’ve routinely communicated to you, there are significant risks of “net-widening” in defining a threshold that does not reflect real-world patterns of use. Drug markets will adjust to a low threshold, including via changes to the potency and amounts of drugs held or sold, potentially increasing overdose risk. Other harms resulting from a 2.5 grams threshold may include the incentivization of interactions with the unregulated market as people try to avoid criminalization by frequently purchasing smaller amounts.2 Those who will be most profoundly harmed by a low threshold will be Black, Indigenous, and other racialized, marginalized, and low-income communities, who are profiled and disproportionately arrested and incarcerated for drug offences.
A 2.5 grams threshold flies in the face of your governments’ commitment to evidence-based drug policy, anti-racism, and reconciliation with Indigenous communities. It sets a dangerous precedent for other municipalities across Canada seeking an exemption. It disregards the recommendations put forward by BC’s Core Planning Table and caters to the unsubstantiated, stigma-based requests of police. We know Health Canada has met with police as part of its decision-making process, while requests from drug user-led groups like the Vancouver Area Network of Drug Users (VANDU) have been ignored entirely.
Decriminalization must be done right. You have a moral, legal, and ethical responsibility to uphold the human rights of people who use drugs; this requires you to centre their expertise. A 2.5 grams threshold will continue to inflict grave harms on our communities and must be abandoned.
We ask that you therefore:
1) provide us with the rationale and evidence for a 2.5 grams threshold; and 2) meet with us this month to ensure that the perspectives of people who use drugs are prioritized and the recommendations of the BC Core Planning Table are ultimately adopted.
Signed,
Avenue B Harm Reduction AVI Health and Community Services BC Association of Aboriginal Friendship Centres Blood Ties Four Directions British Columbia Centre on Substance Use British Columbia Civil Liberties Association CACTUS Montreal Canadian Association of People who Use Drugs (CAPUD) Canadian Drug Policy Coalition Canadian Students for Sensible Drug Policy Centre d’intervention et de prévention en toxicomanie de l’Outaouais (CIPTO) Centre on Drug Policy Evaluation Drug Users Advocacy League Drug User Liberation Front ENSEMBLE Services Greater-Grand Moncton Gilbert Centre HIV Legal Network Indigenous Harm Reduction Network Moms Stop the Harm Multidisciplinary Association for Psychedelic Studies Canada Ottawa Inner City Health Pivot Legal Society South Riverdale Community Health Centre Vancouver Area Network of Drug Users (VANDU)
Additional signatures (added April 21, 2022 onwards)
Association des intervenants en dépendance du Québec (AIDQ) Sandy Hill Community Health Centre EACH+EVERY: Businesses for Harm Reduction Sandy Hill Community Health Centre PAN Student Overdose Prevention and Education Network (SOPEN) Gilbert Centre
2 A. Greer et al, “The details of decriminalization: Designing a non-criminal response to the possession of drugs for personal use,” International Journal of Drug Policy 102 (2022) 103605.
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I never made it to college or university. As a matter of fact, I never even completed high school. So the idea that I could one day be a skilled and experienced mixed-methods researcher, get paid for my knowledge and respected when I spoke, and co-author published papers and articles far exceeded my modest dreams. I had participated in research in the past as an interviewee—giving my perspective on a variety of subjects—but never from the investigative side. As you can imagine, when I was offered the opportunity to train and work as a qualitative researcher I was thrilled and jumped at the chance, particularly as the subject was one I was personally and professionally invested in: safe(r) supply.
“This project laid a path for me. Now all I have to do is walk it!”
~ Phoenix Beck McGreevy
Imagine Safer Supply is a massive undertaking—a multi-provincial qualitative research project seeking to explore the attitudes and perceptions people have about safer supply. We spoke to both people who identify as substance users and people who were primarily involved in frontline service provision to drug users. We found that there is less of a hard line dividing these two groups than we had expected.
I started with the project as a member of the Community Advisory Committee (CAC) in the summer of 2020. The team consists of the principal investigators, research associate, research assistants, and our community advisory team—the group with which I did most of my work on the project. Our committee had members with lived and living experience of drug use and/or the provision of frontline services for people who use drugs, as these were the two groups upon which our qualitative research was focused. Amongst our team, we found a similar level of crossover between the user/service provider camps as we did among the participants.
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We started from a blank slate, learning each step of research: developing interview questions, ethics review, leading interviews, and finally on to data analysis and knowledge translation. Unfortunately, as a result of the COVID-19 pandemic, which was in its first year, we were unable to do any of our work in person despite being dispersed across the country from British Columbia to Quebec. The team met frequently on Zoom and co-conducted qualitative interviews by phone or Zoom.
Safe supply rally; Vancouver; 2021
The research itself tested my newly minted but fierce qualitative interview skills. At first, I relied heavily upon the interview guides, asking each question in order and going through the prompts dutifully. I kept an eye on the time, shepherding participants along through the questions, neglecting to probe worthwhile digressions for the sake of following the guide in front of me. As each interview progressed and I debriefed with my colleagues—accepting constructive criticism—I became more comfortable with the art of interviewing. I began to sense where the really interesting stuff was and how to tease it out of each participant.
Our project has the word “imagine” in its title for a reason. We are asking people to envision their ideal safe supply program, from the available substances to the staff and the setting. We soon found that getting people to imagine something that doesn’t yet exist is very difficult and takes finesse to avoid influencing people’s responses. So many of the people we spoke to brought up ideas and then shot them down, saying things like, “Oh, well that would never work here because…” Many participants found their concepts limited by existing societal and governmental structures. However, we encouraged people to really dream, to imagine models of safe supply that could be possible outside prohibition or medical models, and even capitalism and criminalization. When people ventured outside the realm of what’s currently possible, that was where the really beautiful data lived.
Safe supply rally; Vancouver; 2021
For some participants, the primary focus of their ideal safe supply program was about the effect it would have on their lives. People dreamed of the life they could lead without having to hustle or do crime to feel normal. For others, it was about the physical, brick-and-mortar site of such a program. They laid out plans for community centres that welcomed people who use drugs and offered a sense of belonging and kinship where they could find wellness, however that felt for them.
We encouraged people to really dream, to imagine models of safe supply that could be possible outside prohibition or medical models, and even capitalism and criminalization. When people ventured outside the realm of what’s currently possible, that was where the really beautiful data lived.
Once the data collection phase was completed, we began data analysis. Spirited Zoom calls ensued as we developed our code book, combing transcripts and thinking critically about what each quote meant and how to categorize it. Each of us had different skills and interests that were shaped and honed further, bringing value to our analysis. Once our code book was fully developed and captured all the rich information our participants offered, we began to analyze the data in earnest. Currently, the team is working on analysis of the themes presented within the transcripts before we move on to knowledge translation. We plan to bring the project full circle by presenting the findings to our own communities, wider harm reduction and drug policy audiences, and drug user organizing groups, to inform their work moving forward.
On this project, I discovered a passion and aptitude for research that I didn’t know I possessed. Each new skill I learned was exciting and I burned to know more. The idea of taking things that the community knows and transmuting it into the hallowed form of “evidence” was thrilling to me. Creating data that could be used to make change and speak truth to power—I never dreamed it would be something I could do.
This project enabled me to imagine more than just safer supply programs: it led me to imagine a place for myself in academia and a career in research. This project laid a path for me. Now all I have to do is walk it!
Compassion—or buyers’—clubs are “autonomous association[s] of persons united voluntarily to meet their common economic, social and cultural needs and aspirations through a jointly-owned and democratically-controlled enterprise.”1 They first emerged in the 1980s and 90s in response to the AIDS epidemic when people living with HIV/AIDS used them to procure then-illegal cannabis for pain management. Today, they still provide a safe space for members to acquire one or more substances, most notably heroin, while connecting to like-minded peers. Compassion club models vary, with some functioning as small, underground initiatives and others operating more openly. Regardless, they appear when government inaction to crises—be that HIV/AIDS or drug poisoning—limits access to life-saving measures.2
Compassion clubs differ from market distribution models and maintain the following principles: voluntary and open membership; democratic member control; member economic participation; autonomy and independence; education, training, and information; cooperation among cooperatives; and concern for community.1 By aggregating purchasing orders, members can access volume discounts, price protection, shared storage and distribution facilities, and other economies of scale to reduce their overall purchasing costs.2 This happens regularly through the healthcare supply chain (e.g., health insurance) and across sectors (e.g., with housing and grocery supplies.)
An example of a prospective compassion club model has been outlined by the Vancouver-based Drug User Liberation Front (DULF). On August 31, 2021, members submitted a 56(1)-exemption request to the federal government for the DULF Fulfillment Centre and Compassion Club Model. If approved, this exemption would enable members to legally purchase pharmaceutical-grade cocaine, heroin, and methamphetamine from a properly licensed and regulated producer, securely store the substances, implement quality control measures, reliably package the substances, and distribute them to a screened members list.3
Eris Nyx, Drug User Liberation Front (DULF), with community-led safe supply
Controlled Drugs and Substances Act (CDSA)
The Controlled Drugs and Substances Act (CDSA) is Canada’s federal drug control statute. Originally passed in 1996 to replace the Narcotics Controlled Act and parts of the Food and Drug Act, it also serves as the implementing legislation for several international anti-drug treaties. The CDSA established eight “schedules” of substances, which are categories of drugs and devices related to creating drugs based on their perceived personal and public safety dangers, and two classes of “precursors” (compounds used to produce controlled substances). “Schedule 1” controlled substances have been deemed the most dangerous. Offences under the CDSA include possession, “double doctoring,” trafficking, importing and exporting, and production of substances included in the schedules. While the punishment for these offences depends on which schedule applies to the drug in question, there are mandatory prison terms under the CDSA and the most serious drug offences have a maximum penalty of life imprisonment.4
Notably, the Act also asserts that “The Governor in Council may, by order, amend any of Schedules I to VIII by adding to them or deleting from them any item or portion of an item, where the Governor in Council deems the amendment to be necessary in the public interest.” Several amendments have been made to the Act over time, all of which have also required amending adjacent legislation. For example, in 2018, Bill C-45: An Act Respecting Cannabis and to Amend the Controlled Drugs and Substances Act, the Criminal Code and other Acts was passed in parliament. This entailed repealing multiple sections of the CDSA as well as altering sections of the Criminal Code, Narcotic Control Regulations, Industrial Hemp Regulations, the Non-Smokers’ Health Act, the Criminal Records Act, and the Identification of Criminals Act, among others.5
Criminalization
Refers to the direct and indirect criminal penalties for any prohibited, drug-related activity in the CDSA. Although some forms of criminalization are obvious (e.g., criminal convictions for simple possession or drug trafficking), others are less so. For example, many of the circumstances associated with poverty are implicitly criminalized or make people more vulnerable to criminalization irrespective of whether they’ve broken the law. We see this dynamic manifest in “street sweeps” wherein police routinely confiscate and discard unhoused people’s belongings, which then exposes this population to being searched for illegal drugs. Even if they aren’t formally penalized for possession, their drugs may be taken and they may then be encouraged to commit acquisitive crime (e.g., theft) or engage in other illegal behaviours to obtain more drugs. Criminalization in this context, then, denotes the cyclical, mutually reinforcing nature of poverty, surveillance, and drug-related offences, as well as the impact this has on one’s psyche.
Decriminalization
Decriminalization refers to a range of policies and practices that replace criminal penalties with non-criminal ones for designated activities. There is not a single regulatory framework for decriminalization, and interpretations of what constitutes decriminalization; how formerly criminalized activities should be treated by police, medicine, and the state; and the extent to which these new treatments should be applied on a discretionary basis versus codified in law vary widely. When it comes to controlled substances, decriminalization exists on a continuum of legislative categories from criminalization (most restrictive) to decriminalization to legalization and regulation (most liberal.)
“De facto” decriminalization implies that criminal penalties for activities related to controlled substances are informally implemented. Put differently, the possession and distribution of controlled substances remains illegal, but police may be instructed not to enforce these laws. In British Columbia, there are discrepancies between reports by police and from people who use drugs on the extent to which simple possession has actually been decriminalized. Specifically, a 2020 analysis of provincial drug arrests dating back to 2014 found that drug possession charges are inconsistent inter-jurisdictionally.6 Furthermore, even if a person is not arrested or charged for drug possession, visible drug users (e.g., unhoused people, particularly if they are racialized and/or sex workers) may still have their drugs confiscated by police. This speaks to the benefits of “de jure” decriminalization, which is reflected in policy and legislation to limit discretionary powers of police.
There are many possible pathways to decriminalization. Municipally, any city council member, municipal board of health member, or local medical health officer can request a section 56(1) exemption under the CDSA to apply to a specific class of people or geographic region.7 Provincially, one option in British Columbia is to amend the provincial Police Act to allow the Minister of Public Safety and Solicitor General to set broad provincial priorities with respect to people who use drugs. This could include declaring a public health and harm reduction approach as a provincial mandate and providing mechanisms for police to link people to health and social services. The possession of a small amount of drugs for personal use would be changed from a criminal offence (with a potential jail sentence) to an administrative one. The second, more formal option is to develop a new regulation under the Police Act to include a provision that prevents any member of a police force in BC from expending resources on the enforcement of simple possession offences under Section 4(1) of the CDSA. BC’s provincial health officer, Dr. Bonnie Henry, recommended the province urgently pursue one of these two options in 2019.8 Finally, as with municipalities, government actors including the chief provincial health officer, premier, provincial ministers (of health, mental health and addictions, public safety, justice and attorney general, or the solicitor general) can also request a section 56(1) exemption under the CDSA to apply to a specific class of people or geographic region if deemed in the public interest.
Federally, the minister of health has broad power to exempt people or jurisdictions from provisions in the CDSA (e.g., the criminal prohibition on simple possession) without needing to consult parliament. We have seen this occur in the case of specific safe consumption sites (SCS) and for research purposes. Notably, provinces and municipalities can also request exemptions in their jurisdiction from the federal government.7
RCMP police cruiser; Maple Ridge
There are benefits and drawbacks to decriminalization. Evidence demonstrates that it is an effective framework for encouraging uptake of health and social services by people who use drugs and reducing crime and social disorder, drug-related littering, public drug use, and overall drug-related charges.9 However, this data obscures the limitations of decriminalization. First, decriminalization does not fundamentally alter the volatility of the drug market. This means that people who use drugs are no less likely to consume contaminated substances and are no more protected from accidental overdose and/or death than they are when drug use is criminalized. Next, discretionary enforcement disproportionately impacts poor and racialized people. Those who are stably housed and can use discreetly are not under surveillance and thus their drugs are rarely confiscated. Beyond this, “diversion” mechanisms introduced in lieu of criminal sanctions are not always appropriate. Portugal’s model of decriminalization, which was introduced in 2000 and is often cited as an example of successful reform, does not meaningfully address the violence, stigmatization, displacement, and discrimination that drug users experience. And, because police are still mandated to search and detain people suspected of possessing drugs, many people caught with drugs are still abused, this time “off-the-record,” and/or obliged to engage with the medical system, including attending addiction treatment despite not wanting to, instead of being incarcerated.10
Drug
Any chemical substance that, when consumed, alters psychological and/or physiological (bodily) processes. A drug may be legal to consume, illegal to consume, or legal to consume only for specific people in specific circumstances.
Examples of drugs that are usually or always legal to consume include alcohol, caffeine, nicotine, and drugs like antidepressants and antipsychotics. Examples of drugs that are usually or always illegal to consume include cocaine, crack cocaine, heroin, and methamphetamine. These latter drugs are more often referred to as “drugs of abuse” because they are considered more likely to cause mental or physical dependence in the user.
The legality or illegality of a drug is more complex than some realize. For instance, fentanyl is illegal to purchase on the street but physicians can legally prescribe it to patients in hospital for pain management. Similarly, it is legal for adults to purchase alcohol from licensed establishments, but they cannot consume it in most public places. Children can never purchase or consume alcohol legally. Next, cannabis, once illegal for everyone, is now legal for adults to purchase from licensed dispensaries. Finally, drugs such as Ritalin, which is legally prescribed to children and adults to treat the symptoms of attention deficit hyperactive disorder (ADHD), a clinically diagnosed neurodevelopmental difference, is almost chemically identical to methamphetamine, which is illegal for all people to manufacture, distribute, or purchase.
A drug’s level of risk or dangerousness is linked to how the public views it. Laws and policies that govern access to the drug also inform how safe it is to consume. Important to remember is that access to a drug (as well as punishment for using drugs illegally) depends on several factors, most of which are unrelated to the actual chemical structure of the drug.
Drug Consumption
Introducing any chemical substance that alters one’s mental and/or physical state to the body. The most common forms of drug consumption include swallowing, snorting, inhaling, smoking, and injecting.
Drug Dependence
The state of being mentally and/or physically reliant on one or more drugs. Typically, dependence develops over time and is preceded by increased physical tolerance to the drug(s). Absence of the drug may induce physical withdrawal symptoms that range from mild to very severe and may also be accompanied by mental and/or emotional discomfort. Drug consumption patterns, including duration and frequency of use, may predict dependence but this is not always the case. Finally, dependence does not just occur in illegal drugs: Caffeine, alcohol, tobacco, and prescription medications are also dependence-inducing.
Drug Poisoning Crisis
A more appropriate way to refer to what is sometimes called the “opioid epidemic” or “overdose crisis.” In Canada it is no longer accurate to attribute rates of accidental overdose and death to opioids because it is virtually impossible to procure unadulterated versions of these drugs outside of medically regulated contexts. Further, people who use stimulants and other non-opioids are now impacted by the toxic drug supply. This shift in terminology appropriately acknowledges that accidental overdose is predominantly caused by drug policy, not the drugs themselves. Specifically, prohibition destabilizes the drug market and people who use (and sell) drugs do not know what they are getting and may thus consume more of a substance, a different substance(s), or a dangerous combination of substances. The Canadian AIDS Treatment Information Exchange (CATIE) explains,
“Prohibition creates incentives to make and sell drugs that are smaller and stronger so that production and transportation volumes can be reduced and profits can be increased. 6 Prohibition is why fentanyl and fentanyl analogues, drugs that are many times stronger than heroin in much smaller doses, have severely contaminated the illicit drug supply and have been linked to the increases in overdose deaths.”11
(Interactive Graph)
Drug Selling
Commonly referred to as drug dealing, drug selling refers to distributing small quantities of illegal drugs (or legal drugs that are being distributed in an illegal way). Drug dealing is a common income generation strategy among many people who use drugs, particularly those who report daily use.12 And, although popular conceptions of drug selling are that it is a predatory or immoral activity, research demonstrates that: a) drug users and drug sellers are often the same people; b) drug sellers tend to have positive relationships with those they sell to; and c) drug sellers regularly participate in care practices that minimize the harms of a toxic drug supply (e.g., carrying naloxone, responding to overdose, developing rapport with buyers).
The Drug Policy Alliance also notes that anti-drug laws in the US are written so broadly that people who get caught possessing drugs for personal use are often charged with drug selling, even if they do not distribute.13 In Canada, though the legal system has evolved to focus on “high-level” dealers (also known as traffickers) in theory, low-level sellers remain targeted by police.
Drug Trafficking
In section 2 of the CDSA, “trafficking” is defined to include any act of selling, administering, giving, transferring, transporting, sending, or delivering of a controlled substance—or offering to do any of these things—unless authorized by a regulation, whether for a profit or for free. Section 6(1) of the CDSA also prohibits importing controlled substances into Canada, while section 7(1) prohibits their production.
Under Section 5(1) of the CDSA, “traffic” means, in respect of a substance included in any of Schedules I to V,
(a) to sell, administer, give, transfer, transport, send or deliver the substance
(b) to sell an authorization to obtain the substance4
The criminal punishments for trafficking vary based on factors such as where the offence was committed, whether the accused is connected to a criminal organization, if the accused used violence when committing the offence, if they had previously been convicted of a designated substance offence, if minors were involved, and whether the prosecution treats the offence as an indictable one (more serious) or a summary conviction (less serious). In other words, there is significant diversity among those accused of trafficking and the penalties they receive. The maximum penalty upon conviction for trafficking or possession for the purpose of trafficking is life in prison (for a Schedule I or II substance), ten years (for a Schedule III or V substance), and three years (for a Schedule IV substance). There are also minimum penalties for some offences.
It is crucial to recognize that drug trafficking in Canada is tied to the global illegal drug trade. A demand for drugs exists, and prohibition has established the conditions through which transnational criminal organizations completely control the supply chain. For example, overcrowded prison systems in Latin America and the Caribbean have been described as “near-perfect recruiting centers and incubators for crime, as organized crime groups have come to control drug economies within prisons and use the facilities as bases by which to control trafficking operations outside.”14 An internationalist perspective is thus vital when considering how Canada influences and is influenced by trafficking. Regions that are affected by western imperialist expansion are fertile ground for volatile “turf wars” and, aided by government corruption and militarized responses that exacerbate local violence, there are strong incentives for maintaining control of transit routes.15 In Canada, prohibitionist approaches to drug importing similarly ensure that it is done through illicit means such as money laundering. Advocates of legal regulation thus emphasize that justice-oriented regulatory frameworks must consider the impact this would have on communities who are not directly impacted by Canadian federal law while paying heed to western destabilization of the global south as both a cause and effect of trafficking.
Insite, North America’s first sanctioned supervised consumption site
Harm Reduction
Harm reduction is a social justice movement built on a belief in the inalienable human rights of people who use drugs.16 Early proponents drew inspiration from LGBTQIA+ activists to implement care practices that protected the life, liberty, and freedoms of those suffering due to prohibition. This included distributing supplies (e.g., unused syringes, condoms), opening safe consumption sites, offering myriad forms of community support, practicing mutual aid, and engaging in civil disobedience. Harm reduction has thus traditionally existed in opposition to the state. However, its meaning has evolved, and some people now express concern over the co-option of harm reduction by medical, non-profit, and social service professionals whose values are not liberation from the drug war and its antecedents.17 For instance, it is common for access to medical care to be contingent upon one’s willingness to provide identification and have their movements tracked by employees. In our current context, then, harm reduction may denote state-sponsored programs that reduce the physical consequences of illegal drug use or grassroots care practices.
Medicalization
Broadly speaking, medicalization refers to the social, economic, and political processes through which human behaviour becomes defined and treated through a medical lens. Historically, the institution of medicine has had a narrow reach and scope: Only very specific phenomena were in its purview, and medical professionals had limited influence over the social world. Over time, however, and particularly in the last century, what were previously seen as “normal” human issues have been increasingly labeled as problems for medicine to diagnose and solve.18
Medicalization occurs on three levels: conceptual, whereby medical vocabulary is used to “order” or define a problem at hand; institutional, which entails medical organizations becoming involved in defining and treating problems as well as medical professionals functioning as “gatekeepers” or “institutionally legitimized claims-makers” with exclusive access to treatment through specialized institutions (i.e., hospitals, detox centers, addiction treatment centers); and interactional, by which medical understandings of phenomena shape our interpersonal relations.23 Practically, emphasizing the socially constructed nature of “sickness” enables us to interrogate taken-for-granted assumptions about the origins and effects of drugs, drug use, and drug policy. It also prompts us to consider which actors and institutions have authority to determine the meanings we attach to “abnormal” or “deviant” behaviour and what their nascent motivations are. Bluntly, we should ask who benefits from calling people “ill” and to what ends.
A specific example of medicalization occurring with drug use is the emergence of “substance use disorder” diagnoses. These labels are recent additions to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and their inclusion required significant lobbying by psychiatrists and other medical actors. Making substance use medical has benefits and drawbacks (see “substance use disorder”), but most crucially, it makes obvious that politics are as—if not more—important than science in creating diagnoses. Whether the expansion of disease and disorder categories leads to more equitable outcomes for people who use drugs is contested. Regardless, that drug use is a “disorder” is not politically neutral nor is it objectively “true”—this is being negotiated.
Safe Supply
The Canadian Association of People Who Use Drugs (CAPUD) defines safe supply as “a legal and regulated supply of drugs with mind/body altering properties that traditionally have been accessible only through the illicit drug market.”19 It denotes distributing regulated (pharmaceutical-grade) drugs through legal channels and enabling a person to know precisely what they are consuming and in what quantities. Like harm reduction, safe supply as a concept is rooted in the principles of human rights for all people, irrespective of how or why they choose to change their cognitive-affective-physiological processes. Safe supply is not the same as opioid agonist treatment (OAT) or other substitution therapies that may be prescribed in lieu of actual drug use.
Safe supply rally; Vancouver; 2021
In Canada, accessing safe supply is difficult. Presently, the federal government stipulates that healthcare practitioners (e.g., medical doctors, nurse practitioners, pharmacists) may prescribe opioids, stimulants, and benzodiazepines based on their professional judgement.20 However, it is common for someone who wishes to procure safe supply to first require a diagnosis of “substance use disorder” (SUD), which erroneously conflates drug use with addiction and ignores those for whom use is recreational. Additionally, not all drugs are available via current models (e.g., acquiring heroin requires enrolment in a highly specialized program) nor are all drugs dispensed in the form that some users prefer (e.g., injection drugs are excluded), nor are most people able to take home or “carry” more than a limited dose of their prescription. Unpredictable decisions by policy without the consultation of consumers are also points of tension,21 and the disparities between supply and demand are particularly pronounced in remote and rural areas. Though minor shifts during the COVID-19 pandemic have marginally enhanced the availability of prescriptions, the logistics of obtaining one remain extremely convoluted.
Social Control
The way that society regulates human action to maintain the status quo. Mechanisms such as rules, norms, laws, and policies are exercised interpersonally and through institutions to prohibit change. In terms of discouraging illegal drug use, social control is both formal (e.g., criminal punishments, ) and informal (e.g., shaming). Similarly, positive controls exist to reward those who do not use drugs or who reduce or stop their use. These include mechanisms such as having criminal penalties softened after periods of abstinence, being permitted to return to work once one has tested negative for drugs, and being congratulated by friends and family for “recovering” or “getting sober.” Social control is everywhere, and it is important to recognize that it primarily benefits those whose societal power requires wide-spread conformity.
When it comes to drug use, a crucial mechanism of social control is medicine. The origins of medical social control can be traced to the 18th century, at which time the west experienced a series of economic crises. Cities were increasingly concerned with productivity under capitalism, and “normalcy” and “morality” became defined almost exclusively by one’s ability to generate surplus wealth for large producers. Simultaneously, science replaced religion as the dominant institution of social regulation. With the introduction of secularism and democracy, the state needed new ways to regulate its citizens. It did this through the “science” of psychiatry, which hadn’t previously existed. By labeling the unemployed as “mentally ill” or “diseased,” it justified confining them in forced labour institutions, the legacy of which is felt today.22 Although “patients” are no longer obligated to work when confined, the notion that an inability to do so indicates a “brain disease” or “mental disorder” is the premise of much psychiatric and addiction-related care.
In practice, formal medical social control for drug use manifests as involuntary admission to hospital; extensive medical documentation being a requirement for accessing safe supply or substitution therapies; policing strategies that “divert” people caught using drugs to drug treatment courts; and mandatory urine screenings as a condition for maintaining housing and employment. Informal social control for drug use manifests as being told by doctors and medical professionals that drug-related illness is one’s own fault; being encouraged to see oneself as “sick” for using drugs, including in 12-step programs that promote quasi-religious self-surveillance; being called “junkie” or “addict” by strangers; and the common myth that doctor-prescribed medications such as those given to people diagnosed with ADHD or other disorders are more respectable than street-based medication, despite their similar effects.5
Stigma
The most common description of stigma comes from sociologist Erving Goffman, who defined it as, “an attribute that is deeply discrediting that causes one’s identity to be ‘spoiled’ compared to the dominant group.” He divided stigma into three types: those linked to “abomination of the body” (e.g., physical disability); those that incite “tribal” responses (e.g., race, religion); and those derived from “character traits” (e.g., drug use, mental illness, HIV status).24 Published in 1963, Goffman’s theory is dated but remains influential. For instance, the Government of Canada defines stigma as “negative attitudes, beliefs or behaviours about or towards a group of people because of their situation in life.” This is a limited depiction of how and why stigma emerges, who benefits from enacting it, and the different ways it is sustained.
Specifically, stigma is not stable. Whether a certain characteristic is stigmatized is constantly negotiated and re-negotiated, and this changes over time.25 Consider that homosexuality was once criminalized, and it later appeared as a mental disorder in psychiatric texts. Although queerness is still “non-normal” in some contexts, general responses to it have shifted dramatically alongside legislation, policy, and evolving trends in medicine. Drug use is no different. Before anti-drug laws were implemented, and long before “substance use disorders” existed as official diagnoses, drug use was deemed neutral. It became stigmatized as the “war on drugs” escalated and, with it, so too did racial, ethnical, religious, and class-based inequalities. Important to remember is that in both the cases of sexuality and drug use, alterations in public perception have been due to grassroots activism and civil disobedience.
Next, stigma is not just interpersonal. It is more trenchant than individual attitudes and behaviours, and stigma becomes institutionalized and systemic when official policies (in housing, employment, education, the child welfare system, and so on) prohibit entrance based on identification with a particular class. For example, compulsory attendance at 12-step meetings as a condition of not being re-incarcerated reflects this latter type of stigma. So too do requirements placed on healthcare professionals who have been to addiction treatment who must complete regular drug tests to remain employed.
Finally, stigma becomes internalized. Research on this phenomena repeatedly concludes that viewing oneself as “bad,” “Mad,” and/or “diseased,” which is an outcome of institutionalized and systemic stigma, leads to negative outcomes.26 People who are stigmatized begin to anticipate rejection, they may alter behaviour based on these expectations, and their material conditions deteriorate. This is especially true of people who are stigmatized on multiple axes, which highlights that drug use alone is not a sufficient condition for being stigmatized. Those who use drugs but are otherwise stably housed, employed, and part of dominant racial and cultural groups can consume with near-impunity. Anti-stigma campaigns, then, which address drug use and drug use alone, may not be effective because this is just one facet of one’s identity.
Substance Use Disorder (SUD)
A category of disorders that reflect the medical label for addiction. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), the official text on which diagnoses are based in North America, lists 11 criteria for SUD that include “hazardous use” (using a substance in ways that are dangerous to oneself and/or others), “social or interpersonal problems related to use,” “much time spent using,” and “spending a good deal of time getting the drug, using the drug or recovering from the effects of the drug.” In order to be diagnosed with a SUD, a person must demonstrate at least two of these symptoms within a 12-month period. A taken-for-granted assumption associated with this category of diagnoses is that drug use takes place “against one’s will” in ways that are aberrant, chaotic, and compulsive.
The medical profession considers SUD to be an incurable brain disease or mental disorder, which has consequences for users. As stated, stigma research has shown that being labeled as “mentally ill” triggers distrust among professionals and lay people. People with a “SUD” are seen as being less likely to maintain employment or be fiscally responsible, even if these biases are unconscious, and even to themselves.26 At the same time, the notion of SUD as illness may elicit sympathy from outsiders; it is preferable to being criminalized; and accessing safe supply and other healthcare may require having this label on one’s medical records.
Ultimately, there is no agreed upon definition for SUD. Critical researchers, as well as drug users and advocates, point out that many of the criteria for SUD are environmentally specific. For instance, whether or not a person has “social or interpersonal problems related to use” will depend on the norms in their peer network, their housing status, whether they have prior drug convictions, whether they have to complete drug screenings to maintain employment, and how often they use drug(s) in public. Similarly, the time one spends acquiring drug(s) will be influenced by their wealth and drug use scene. Finally, when two people exhibit identical behaviour, only one may be told they have a SUD while the other may go straight to jail based on race and class. For our purposes, “substance use disorder” will be used to confer official medical diagnoses.
War on Drugs
Broadly, the war on drugs refers to a series of policies, practices, and laws introduced throughout the 20th century to criminalize drug consumption and activities associated with it. By now, it is well documented that the so-called drug war has been a proxy war whose true “enemies” are racialized, immigrant, and poor communities. Over the last 110 years, anti-drug laws have been an effective tactic for preventing the economic, political, and social advancement of those whose ways of life differ from those deemed ideal by the settler-colonial state.
In Canada, the war on drugs officially coincided with the anti-asiatic riots. Prior to this, tensions had escalated between Chinese men who lived on the West Coast after building the Canadian Pacific Railway (CPR) and white settlers: white settlers were threatened by a perceived lack of employment opportunities as well as the racist assumptions they held about non-white, non-Christian immigrants. On Sept. 07, 1907, fueled by fears of “moral decline” linked to “racial mixing,” 9000 people, including political and labour leaders, marched to Vancouver city hall to protest immigration. Some proceeded to vandalize and destroy Chinese and Japanese businesses. Deputy Minister of Labour Mackenzie King was then sent from Ottawa to investigate, and rather than focus on reparations, he concluded that opium, which was used for festive and economic purposes by the Chinese, should be banned. King stated,
“The Chinese with whom I converse on the subject assured me that almost as much opium was sold to white people as Chinese, and the habit of opium smoking was making headway, not only among white men and boys, but also among women and girls…to be indifferent to the growth of such an evil in Canada would be inconsistent with those principles of morality which ought to govern the conduct of a Christian nation.”27
The recreational use of other drugs was outlawed in subsequent years, and by the time US President Richard Nixon officially declared a “war on drugs” in 1971, anti-drug propaganda had solidified in the public imagination. Penalties for drug possession and distribution intensified in the ‘70s, as did racial disparities in arrests, criminal convictions for possession, and sentencing severity. Throughout, the war on drugs was driven by white, Christian values and economic goals, so much so that a top Nixon aide later admitted,
“You want to know what this was really all about. The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and Black people. You understand what I’m saying. We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”28
Since then, despite—or because of—its race and class-based motives, the war on drugs continues. Its influence is felt not just in the criminal justice system but in education, employment, housing, media, medicine, and families. Its impacts have been devastating. The drug war has destabilized entire nations, cost trillions of dollars in enforcement, ended countless lives, fueled organized crime; and still, the illegal drug trade remains the world’s most profitable illicit business.15 It is not uncommon to hear that “drugs have won the war on drugs,” but the drug wars’ losers, who are also society’s most marginalized, bear the brunt of this.
2005. Conrad, P. “The Shifting Engines of Medicalization. Journal of Health and Social Behavior, 46(1), 3 – 14. URL: https://www.jstor.org/stable/4147650
1963. Goffman, E. “Stigma: Notes on the Management of Spoiled Identity” New York: Simon and Schuster.
2017. S. Fraser, K. Pienaar, E. Dilkes-Frayne, D. Moore, R. Kokanovic, C. Treloar, et al. “Addiction Stigma and the Biopolitics of Liberal Modernity: A qualitative analysis.” International Journal of Drug Policy, 44, 192-201. URL: https://www.sciencedirect.com/science/article/abs/pii/S0955395917300531
1987. Link, B. G. “Understanding Labeling Effects in the Area of Mental Disorders: An Assessment of the Effects of Expectations of Rejection.” American Sociological Review, 52(1), 96 – 112. URL: https://www.jstor.org/stable/2095395?origin=crossref
N.D. Boyd, S. C. “History of Drug Policy in Canada.” Excerpt from: Busted: An Illustrated History of Drug Prohibition in Canada. 2017. Fernwood Publishing. Blog. Canadian Drug Policy Coalition. URL: https://drugpolicy.ca/about/history/
responding to overdoses during covid responding to overdoses during covid
“The context of BC’s dual public health emergencies related to the toxic drug supply and the COVID-19 pandemic requires providing access to harm reduction services including overdose prevention services (OPS) and supervised consumption services (SCS) while maintaining measures to prevent the spread of COVID-19. This document provides guidance on responding to illicit drug poisonings or overdoses in OPS/SCS settings, where there will be a need for flexibility and consideration of the facility, staff training and available resources when implementing public health guidelines for preventing the spread of COVID-19.”
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“It’s simple, hun—you have the disease.”Bill says this as he hands me a wooden chip inscribed with the serenity prayer:
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
An biker who somehow landed in Westbank, Kelowna, Tom is paternal. I’ve never been told that I have a disease, but his words incite relief. I cannot stop drinking, and illness is better than badness. I have done horrible things.
I accept a tattered copy of the Big Book and devour it, highlighting, underlining, and earmarking earnestly until I have it memorized. I meet others who do the same. We form unexpected kinships, our lives irrevocably intertwined through a singular, obstinate pursuit of wellness. I repent. They hold me. I have never felt such intimacy.
When I leave 28 days later, we promise to stay in touch. I never speak to them again.
I am 18 years old.
I have been sober for 45 days, and something is very wrong. My legs have stopped working, and when I try to articulate how physically enervated I am—how utterly incapacitated—my councillors tell me to pray.
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
I am drowning in a vast, violent emptiness. Anhedonia. Near-catatonia. The obsessions, the compulsions, the counting, the rituals; these I must relinquish to a Higher Power (though without them, I’m not sure who I am).
“Stop thinking so much.”
“You need humility.”
I eat 1175 calories a day—no more, no less. Identical meals at breakfast, lunch, and dinner. To deviate would trigger a binge. Pleasure is not safe. I attend group sessions and while other women weep, I try to stay awake.
Am I a sociopath?
All I want is chocolate.
I am 19 years old.
I arrive with a black eye and hematoma on my chin. It obscures my jawline and deforms my cheekbones, my reflection as grotesque as the memories I suppress. I don’t know how it (I) got there.
“Third time’s the charm.”
I am too tired to have hope. After nearly three years of homelessness, I am also too tired not to. Alcohol and bulimia have been replaced by crack cocaine. I no longer feel human. The things I did at 18 pale by way of comparison.
“Your brain is broken.”
I am hostile. My mind is a rabid animal, and I don’t trust this place—these people—to tame it. One month becomes two. Two becomes three, then six, then seven. Something shifts. I listen in a way I never have before. I believe in a way I never have before. The obsessions, rituals, counting, compulsions; they haven’t left, but they have transmogrified into something like spirituality.
“I could drink.”
I stop what I am doing.
Fall to my knees.
Pray.
“God, grant me the serenity to accept the things I cannot change, the courage to change the things I can, and the wisdom to know the difference.”
Once. Twice. Three times.
Six if the thought returns. Nine times. Twelve. Fifteen.
I am terrified of myself.
“Every moment you spend in treatment, your disease is outside doing push-ups in the parking lot. It gets stronger as you do. It will never go away.”
In my sixth month I enrol in two university courses. One of them is introductory sociology. I am intrigued.
The councillors become trusted confidantes. They convince me I can leave. They expect to see me regularly.
I move into a basement apartment two blocks away. I visit the councillors every day, sometimes once, sometimes twice or more. I relay my academic successes.
“Don’t let it go to your head. Recovery must come first.”
I am 22 years old.
“Fuck you!”
The voice is not my own. A new woman has just arrived, and she is detoxing—hard. I am five months sober, and I have entered treatment voluntarily. I may return to my PhD, but I know I’m not prepared. I was promised that staff were trauma-informed.
That was bullshit.
Publicly funded, there are two councillors for thirty patients. Most have been street-entrenched for years or decades. We are told not to discuss drug use. Or violence. Or sex work. Or poverty.
“If you get triggered, we don’t have the tools to contain you.”
Twelve-step meetings are optional. AA members come bi-weekly to share their experience, strength, and hope. When they do, I look away.
“God, grant me the serenity.” —
I walk past the door, my fists clenched tightly. Bile rises in my throat.
I see myself in them. I will see myself in them when a month, two months, a year, from now they use again. They will hate themselves. It will not be their fault.
“This place is a joke!”
This time the voice is mine. I am with the psychiatrist. I denigrate her profession.
“I do not consent to being pathologized.”
She raises her eyebrows; takes notes; says nothing.
I leave early. In addition to bipolar disorder, obsessive compulsive disorder, borderline personality disorder, possible dissociative identity disorder, complex post-traumatic-stress disorder, somatoform pain disorder, possible autism, and, of course, severe alcohol and stimulant use disorders, my discharge summary notes that I present as rather angry.
I am 30 years old.
As I write this, I am 31 years old. I have been abstinent from alcohol and illicit drugs for nearly two years. Before my last relapse, I had been abstinent for eleven months. Prior to that (and prior to the two-year bender that was my Masters’ degree), I hadn’t touched drugs or alcohol for well over five years.
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My adult life has been shaped by substance use (or lack thereof): freneticism during periods of active use; temporal boundaries demarcated by surges of euphoria and devastating loss; rigidity and suffocation while sober; crystalline awareness that despite my Herculean efforts to think, look, and act normal, the best I’ll do is pass.
Panic, regardless. I fully expect to use again. Perhaps not immediately but eventually, definitely.
I am still recovering.
Only now, I don’t say that I’m recovering from addiction. Alcohol and drug use were never the problems. In a society that was built on oppression, though (that is, in a society that wouldn’t exist without the ongoing displacement, dispossession, and disappearance of Indigenous peoples; that has been designed to control, regulate, and disadvantage Black communities; that approaches disability as a fatal character flaw; that produces enormous wealth disparities and prohibits anyone who can’t or won’t conform to White, cis-hetero patriarchal standards of productivity from access to power or resources), alcohol and drugs are convenient red herrings.
I am still recovering.
Rather than focus on recovering from a “hopeless state of mind and body,” however, I have turned my efforts outward.
For someone who once espoused the merits of sobriety (and who viewed sobriety as the pinnacle of addict achievement), to now be unbothered by the idea of substance use (mine and anyone else’s) is a radical departure.
How did I get here?
During my third round of addiction treatment, I found sociology. I had very few expectations, but “the systematic study of society” seemed interesting, and it also fit my schedule. I still lived in extended care at treatment centre three, so I took the bus to campus between morning check-in, individual and group therapy sessions, and my daily chore routine. I wrote my first essays in the communal kitchen I shared with 120 other patients, and I asked staff to proofread my work because I didn’t own a computer (not that I would have been permitted to use one even if I had).
At first, education was jarring. After four years immersed in twelve-step programs, to be introduced to the social determinants of health (that is, the socio-cultural, economic, and political conditions that positively or negatively influence one’s health status) was de-stabilizing. Specifically, the insight that exclusion on the bases of income, race, sex, gender, and disability, among other facets of one’s identity, is correlated with outcomes such as substance use confounded me. I had been taught that addiction was solely my responsibility. It was the product of a malignant mind, nothing more, and so extraneous conditions such as homelessness were consequences of one’s usage, not causes.
The more I reflected, however, the more sociology made sense. I developed an “awareness of the relationship between personal experience and the wider society,”1 and was able to understand patterned behavior responses among social groups as they pertained to rates of addiction.
Indigenous peoples, for example, report much higher rates of alcohol and illicit drug addiction than other ethnic groups. Why? Because White frontiersmen introduced alcohol as a tool of colonization. Not only was it a profitable trade good, but authorities knew it would distract from the violence they enacted.3 The attempted genocide that followed included confining Indigenous peoples to reserves, apprehending and abusing generations of children through the residential school system and, in Canada, the “60’s Scoop,” prohibiting cultural engagement, non-consensual medical experimentation, and legislation that continues to disproportionately inflate Indigenous rates of poverty, homelessness, unemployment, and murder. Furthermore, mainstream addiction treatment approaches substance use through a Western world-view, erasing traditional knowledge systems and perpetuating colonial disruption.
Is it any wonder, then, that Indigenous people are more “prone” to substance use?
This is not to say that personal stories aren’t unique, or that individual trajectories won’t be informed by multiple, intersecting forces throughout the life course. We can’t accurately predict behavioural outcomes based on one or two bits of demographic information, but we can (we must) analyze trends (addiction-related and otherwise) within their historical contexts.
This is hard to see. I was a member of the New Westminster “recovery community” circa 2007/8. I was 19 y/o and in my 2 (of 5) abstinence based treatment centres.
Initially, I was fascinated by this information but didn’t think that it applied to me. I was raised in a wealthy suburb. I’m White. I had been sexually harassed, sure (and raped multiple times while homeless), but every AA sponsor I’d had told me this was further evidence of my powerlessness over substance use. “We put ourselves in vulnerable positions while using—when you stay sober, you’ll stop being taken advantage of.” My life chances hadn’t been constrained by systemic oppression (other than ableism, but I did not yet identify as neurodivergent), just my own bad choices, so I remained convinced that while addiction is beyond some, less privileged, people’s control, the origins of my own usage still lay firmly within me.
Then I learned about trauma. My professors introduced me to the implications of interpersonal trauma, and they demonstrated that prolonged developmental trauma, regardless of perceived severity, fundamentally alters one’s nervous system.2 I won’t disclose intimate details of my childhood, but I will say that one needn’t be raised in poverty or contend with racism to regularly feel afraid. This can have enormous physiological consequences in childhood, as being in “fight or flight” mode can lead to mood disturbances4, emotional dysregulation5, and loss of connection6—all potential roots of addiction.
Over time, it became evident that personal traumas are inextricable from broader (“macro-level”) structures such as the economic system. Our “micro-level” communication is shaped by the norms and expectations of society, so values such as individualism, a product of capitalism, invariably affect our actions. AA itself is hyper-individualized: It treats addiction as a “spiritual malady,” and in so doing it mars one’s ability to interrogate how social inequalities (and the maladaptation they evoke) make substance use desirable—and sometimes very necessary.
With this, I questioned everything.
“What if I had been raised differently because my parents had been raised differently? If my Grandparents hadn’t been impoverished immigrants, would we all have been a bit more inclined toward tenderness? Would I still have developed an eating disorder?”
“What if I developed an eating disorder, but the response to it had been less informed by a lineage of poverty? Rather than see bulimia as indulgent, would my parents have had the skills to inquire about the feelings underneath? Would I still have started drinking?”
What if, when I started drinking, I hadn’t been sent to addiction treatment that taught me that sickness was innate? Would I still have blamed myself for all that had happened, prompting an endless cycle of institutionalization, homelessness, self-flagellation via health-negating behaviours, subsequent institutionalization, and even fiercer destruction each time it didn’t have the desired result?
On and on and on. But, most importantly:
“Wait. Why is high-intensity alcohol and illicit drug even considered bad in the first place?”
I specialized in the medicalization of deviance (“abnormality”) as a mechanism of social control.7 In so doing, I catapulted head-first into a voyage of unlearning everything I knew about addiction. I was enabled in part by research, yes, but mostly grew from a) leaving AA and figuring out who the hell I was beneath the meetings and the chanting; and b) connecting with drug user activists. They, more-so than any text, instilled in me that the war on drugs, not drugs themselves, is a threat to our survival.
The history of alcohol and drug prohibition has been thoroughly documented elsewhere, so I needn’t repeat it here. Suffice to say that some substances are illegal not due to their chemical properties, but because they used to afford racialized immigrants and descendants of slavery economic and festive alternatives to wage labour. This threatened colonial nation-building projects, so state officials criminalized anything that might undermine their access to a compliant, exploitable workforce. Substance use also triggered fears of racial mixing (a major no-no among White European settlers obsessed with racial purity), and it threatened Victorian-era morality because ultimately, getting high feels really fucking good.
We must understand what is at stake: the alternatives to abstinence and “the program,” we are told, are jails, institutions, and death. Many arrive at treatment having already experienced a sort of social death. We are excluded from our families, the economy, housing, etc.
Today, the “disease model of addiction” has been naturalized in common discourse. That frequent, high-intensity substance use is a “chronic, relapsing condition” is a taken-for-granted assumption, with few publicly questioning why so many of us get and stay afflicted.
But, when we closely examine the most damaging outcomes of addiction—unemployment, incarceration, lack of access to medical treatment, homelessness, fatal overdose, suicide—we see that most are derived from the stigma, discrimination, and legislation surrounding use, not the actual act of using.
If, for example, heroin were to be publicly available, regulated, and normalized, people wouldn’t have to use in secret. They would know exactly what and how much they were getting instead of being poisoned by a toxic drug supply, and this would substantially reduce one’s risk of overdose. Beyond this, not getting fired or acquiring a criminal record by using would enhance employment options, and homelessness due to “unemployability” would thus be less prevalent.
Additionally, sustained illicit use necessarily propels one into a nefarious shadow world, one in which using becomes priority and social norms are suspended in favour of acquiring one’s next fix. How much of deviance is the result of not caring to participate in society, and how much is learning to not care after being treated like a degenerate? We internalize the labels ascribed to us, and we begin to act accordingly.
So where does this leave me?
Ultimately, I have come to see my own alcohol and crack-fueled binges, which now happen roughly once every 12 – 18 months, as the culmination of economic, political, legislative, institutional, and inter-personal failures. When I have tried to prevent benders by seeking help for post-traumatic stress (and the terrifying dissociative and somatic symptoms that accompany it), my first option is a sterile psychiatric ward, where I exist behind locked doors, am medicated beyond recognition, and am released with an appointment slip reminding me that a month later I am to meet with a harried psychiatrist who will review my medical records, tell me to consider permanent institutionalization, and prescribe me sufficient doses of antipsychotic and mood-stabilizing drugs to kill myself should I opt to (which I always seriously consider).
Mid-bender, trying to seek support looks like presenting at an emergency room, waiting for hours while hallucinating or in severe withdrawal, being given hefty doses of diazapam with the instruction not to ingest while drinking (ha!), and continuing to use. My roommates don’t know how to cope, I invariably lose my housing and employment, and those I should be able to call for help have been told by well-intentioned but misguided acquaintances that offering shelter, food, and safety is “enabling” my addiction (for the record, it is not).
To counter this, we need political education. Incorporating this is tough, because disease models of addiction actively de-politicize it. But there are inroads we can make.
I am left to fend for myself, and after four or so weeks of this I am so depleted and ashamed that I crawl into detox (after a bed becomes available, which can easily take weeks). Afterward, I’m still broke, alienated, and I have nowhere to go.
When I went to addiction treatment for the final time, I thought that perhaps my experience would be different. I was going of my own volition, I hadn’t just been scraped off the street, and I was optimistic that I might receive the trauma care that I still desperately need. Instead, I watched horrifically abused women be blamed for their condition, and as I felt myself deteriorate, I got the hell out of dodge.
I am not broken. The system is.
In some ways, medical sociology ruined me. I can no longer cope with the cognitive dissonance of sitting in twelve-step meetings while people discuss their “selfishness” and “self-centeredness” (the true etiology of addiction, according to the Big Book) while all I see are oppression and bad policy. I’ve tried many times over the years, and each meeting I attend reinforces that these are not, nor have they ever been, my people.
I also no longer pray to accept the thing I cannot change. I work (even as I oft question whether doing so is useful) to change that which I cannot—will not—accept. The former was easier, but given what I know, being passive in the face of injustice is not a viable option
I am still recovering.
By working with other user-activists on drug policy reform, I am recovering from loneliness and despair.
By writing, I am recovering from years of capitalist-induced performativity and my realities being denied.
According to AA, I am delusional. I most certainly will die soon. To this I say, maybe, but at least I’ll have died not hating myself.
I also refuse to invite people into my life whose love for me is conditional, so when (not if—when) I use again, I will not be alone. This fills me with great comfort, and it is now more important than a sobriety date ever was.
I dare call it spirituality.
Notes
Please note that I’m not claiming that trauma is the sole cause of addiction, which would be as reductive and deterministic as the program I malign. I broadly define trauma as structural violence, symbolic violence, and the more obvious interpersonal troubles it induces. With a background in medical sociology, I have been trained to minimize biological contributions to addiction; but severe, sustained use (which is more prevalent in marginalized groups), leads to physiological adaptations that make reducing or stopping one’s use more difficult.
I fully believe that some people (most people, actually) can transition away from problematic use and learn to use moderately. I am not one of those people.
I don’t wish to dispute that sustained substance use can have deleterious mental and physical health outcomes. As someone who narrowly evades death semi-regularly, it absolutely can. Still, I maintain that this is mostly a result of policy and stigma.
References
Mills, C. W. (1961). The sociological imagination. New York, NY: Grove Press
2. van der Kolk, B. A. (2014). The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. (pp. 99)New York, NY: US: Viking
Frank, J. W., Moore, R. S., & Ames, G. M. (2000). Historical and cultural roots of drinking problems among American Indians. American Journal of Public Health, 90(3), 344–351.
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Toronto, ON—In the wake of almost 23,000 drug poisoning deaths since 2016, twenty-one civil society organizations across the country, including groups of people who use drugs, families affected by drug use, drug policy and human rights organizations, frontline service providers, and researchers, have collaborated to release Canada’s first civil society-led policy framework for drug decriminalization in Canada.
“The Canadian Association of People Who Use Drugs welcomes this timely national call to action on drug decriminalization. This rights-based path for drug policy reflects the input of many people who use drugs and presents a decriminalization model that serves as an important starting point for policymakers to decriminalize and regulate presently illegal drugs,” said Natasha Touesnard, Executive Director of the Canadian Association of People Who Use Drugs.
“Only with comprehensive drug decriminalization, allowing the provision of an effective and accessible safe supply of presently illegal drugs, will the devastating ongoing overdose epidemic stop.”
~ Natasha Touesnard, Canadian Association of People Who Use Drugs
This comprehensive platform, endorsed by more than 100 organizations calls for the following:
— Full decriminalizationof all drug possession for personal use—as well as sharing or selling of drugs for subsistence, to support personal drug use costs, or to provide a safe supply—by doing the following:
Repeal section 4 of the Controlled Drugs and Substances Act (CDSA) and section 8 of the Cannabis Act
Amend section 5 of the CDSA, which criminalizes trafficking-related offences
Remove all sanctions and interventions linked to simple drug possession or necessity trafficking
Automatically expunge past convictions for simple drug possession and past convictions for breaches of police undertakings, bail, probation, or parole conditions associated with charges for these acts
Set strict rules around when police can stop, search, and investigate a person for drug possession
Remove police and law enforcement as “gatekeepers” between people who use drugs and health and social services, and replace them with organizations led by people who use(d) drugs or trained frontline workers
— Redistribution of resourcesfrom enforcement and policing to non-coercive, voluntary policies, programs, and services that protect and promote people’s health and human rights, including health, education, housing, and social services that support people who use drugs.
“The war on drugs has been a colossal failure. Under a regime of criminalization, people who use drugs are vilified, subject to routine human rights abuses, and denied access to life-saving healthcare, leading to preventable infection and death,” said Sandra Ka Hon Chu, Co-Executive Director of the HIV Legal Network. “To undo those harms, decriminalization must be done right. Reflecting community voices, including those most directly affected by drug prohibition, this platform presents a vision for governments to remove the stifling threat of criminalization from the lives of people who use drugs.”
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More than a century of drug prohibition aimed at deterring drug use has failed, and there is no greater evidence of this failure than the thousands of deaths due to drug poisonings across Canada and an overdose crisis that continues unabated. Prohibition is rooted in, and has reinforced, racism, sexism, and colonialism and has disproportionately affected Black and Indigenous people who are at much higher risk of arrest and severe punishment for drug offences.
“Cops have been enforcing the drug war for over a century. Carding, harassing, arresting, beating and incarcerating drug users—especially if we’re Black or Indigenous. It’s high time cops stand down and get out of our lives. They have caused so much harm,” said Garth Mullins, member of the Vancouver Area Network of Drug Users.
“No more cops, courts and jails for drug users. No more para-military police occupation of marginalized communities. That’s what real decriminalization means.”
~ Garth Mullins, Vancouver Area Network of Drug Users
The harms of criminalization follow people for the rest of their lives: criminal records limit employment and housing opportunities, affect child custody, and restrict travel, among other repercussions. Additionally, enforcing drug offences consumes billions of dollars annually.[1] “We continue to resource policing and punishment while defunding services in our communities that actually address the roots of harm and violence. Our prisons are full of people who need help, not a record,” said educator and activist El Jones.
“The stigma of drug use ruins lives. It is long past time to stop funding a war on drugs, and to invest in real public safety: housing, mental health, childcare, and living in a society free of oppression for all people, including those who use drugs.”
“The sharing of different experiences and expertise across this country has resulted in a common vision of what drug policy should be in Canada. By opting for this civil society platform, the federal government has the power to reduce the harms associated with the criminalization of people who use drugs. We all have the right to respect, safety, access to healthcare and social services—and to a better life, free from judgment and discrimination.” (Sandhia Vadlamudy; Executive Director, Association des intervenants en dépendance du Québec (AIDQ))
“The war on drugs has not only fed policing and prisons in this country, it has had devastating effects on our families. Black and Indigenous mothers in particular have seen their children taken into the child welfare system, causing generational trauma. Schools, hospitals, and even our homes have become sites of violent policing which has done nothing to address trauma, to heal, or to help people who want treatment for addictions. (El Jones; Educator, Journalist, Activist)
“Decriminalization Done Right proposes a policy shift that is long overdue and is a first step to change a historically cruel and misguided application of the criminal law that has devastated the lives of countless Canadians. If adopted by Canada, it would be an important step towards a compassionate, human rights-based approach based on evidence that builds stronger communities for everyone.”(Donald MacPherson; Executive Director, Canadian Drug Policy Coalition)
“Punishing people who use drugs is unfounded drug policy and creates stigma that is much more detrimental than drugs themselves.” (Jean-Sebastien Fallu; Professor, University of Montreal)
“Led by respected and internationally recognized national organizations, this platform on drug decriminalization is now the centerpiece of actions that our governments must take. The principles it defends and the values it advocates represent civil society’s contributions to essential reforms that are faithful to human rights and social inclusion.” (Louis Letellier de St-Just; lawyer (health law), Board Chair and Co-Founder CACTUS Montréal)
“Punitive drug policies rooted in racism and colonialism have failed and caused catastrophic harm. Youth are particularly stigmatized and targeted because they are young. As decriminalization now seems closer to reality than ever before, it’s crucial that we ensure voices of young people who use drugs are central to these discussions.” (Kira London-Nadeau; Chair, Canadian Students for Sensible Drug Policy)
“Neither sick nor guilty—people who use drugs are not criminals, and the legislation must reflect this reality.” (Chantal Montmorency; Executive Director, Association québécoise pour la promotion de la santé des personnes utilisatrices de drogues)
Contributors
Association des intervenants en dépendance du Québec (AIDQ)
Association québécoise pour la promotion de la santé des personnes utilisatrices de drogues (AQPSUD)
Punitive drug laws and policies aimed at ending illegal drug use have failed; and worse, they have done catastrophic harm to communities and society. These laws have fuelled stigma; epidemics of preventable illness and death; poverty; homelessness; and widespread, systematic, and egregious violations of human rights. Recognizing the many lives that have been lost and ruined to the state-sanctioned “war on drugs,” we must act to end the harm. Decriminalizing personal drug possession and necessity trafficking are fundamental, necessary steps towards a more rational and just drug policy grounded in evidence and human rights. It is a change that is long overdue. [Read more…]
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