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Harm Reduction Comes of Age in Canada, or Does It?
This post first appeared in the Centre for Addictions Research of BC’s blog Matters of Substance.

The Supreme Court of Canada’s September 2011 decision allowing Vancouver’s supervised injection site, Insite, to keep operating was a critical milestone for harm reduction in Canada.

One only has to look at the list of interveners in the case in support of this innovative service to see that it has become a valued and mainstream service in Canada. Canadian health organizations including the Canadian Medical Association, Canadian Nurses Association, Canadian Public Health Association and 11 others saw fit to come before the court to support Insite. But even with this high level of support, scaling up harm-reduction services in Canada remains a challenge.

Harm reduction gained traction as a result of the HIV/AIDS crisis in the early 1980s and played a critical role as a strategy to engage injection-drug users in HIV prevention. Harm reduction’s more recent challenges have elevated the critique of policy-related harms – harm caused by policies that criminalize people who use illegal drugs.

Harm reduction acknowledges that there are significant risks associated with illegal drugs and also attempts to work towards mitigating harms within the criminalized environment where drug use occurs. This often puts the public-health goals of engaging people who use drugs in conflict with traditional public-safety strategies that rely on disruption of illegal drug markets, and in turn disruption of the lives of people who use illegal substances. Harm-reduction approaches balance these realities and focus on creating safer environments as much as possible within a context of criminalization. Some examples include promoting supervision of consumption or discouraging using drugs while alone, promoting rapid response strategies in the form of peer-delivered naloxone programs and strategies that work towards achieving a kind of détente between health efforts and enforcement practices. Given the context of criminalization, a key goal of harm reduction is to maximize the benefits of public-health interventions and minimize the harm of drug use and the enforcement of drug policy.

So what should Canada be doing to facilitate the development of a more robust harm reduction approach as a part of a comprehensive response to drug use? We urge governments to begin with a review of current drug policies to determine the benefits and harms to individuals and communities that accrue from the criminalization of drugs and the people who use them.

Other countries have done such an analysis and have decided to eliminate criminalization as a response to possession of drugs for personal use in an effort to maximize the benefit of a public-health approach to drug problems. Portugal (2001) and the Czech Republic (2009), are two examples of jurisdictions that have taken this step. Both have decriminalized all drugs that are deemed to be for personal use. Portugal decriminalized drugs as part of a response to an HIV epidemic and high rates of drug overdose. The Czech Republic did the same as a result of an extensive evaluation of the previous policy of criminalization. Evaluation of the experience in Portugal has shown that results have been positive overall – HIV incidence and overdose deaths have been reduced, police are supportive of the new law as it has given them more meaningful and helpful involvement in steering individuals towards health services, more people are accessing treatment and other health services which were improved as a part of the decriminalization policy. Additionally no negative trends have been seen in terms of increased harms attributed to this policy change.

Achieving a policy shift as significant as decriminalization will take some time. In the meantime, the Canadian Drug Policy Report, Getting to Tomorrow, outlines some possibilities for improving the development of harm reduction in Canada in the short term:
- Acknowledge that harm reduction is much more than supply distribution and is an essential component of a comprehensive public health response to problematic substance use that offers client-centred strategies with health engagement at their core.
- Acknowledge that harm reduction values the human rights of people who use drugs and affirms that they are the primary agents of change for reducing the harms of their drug use.
- Provincial governments can commit to articulating harm reduction strategies across mental health, addictions and infectious disease policy frameworks.
- Where harm reduction language is present within policy frameworks ensure implementation at the community level.
- Support innovation at all levels. An ethic of experimentation will help create an environment where new ideas and novel approaches can be developed and explored.
- Provide leadership to bring health and policing agencies together to get “on the same page” with regard to harm reduction. Opposition by some in the policing community is unfortunate and an unnecessary barrier to scaling up harm reduction programs.
Developing a robust and equitable harm-reduction approach for Canadians will necessitate new thinking about old strategies — thinking that exposes the harms that flow directly from our current policy frameworks and will open the door to new ideas and approaches that are emerging around the world.
April 7, 2014
The Road to 2016 – Drug Policy Consensus Shattered

There’s a Crack in Everything – That’s How the Light Gets In (with thanks to Leonard Cohen)

I couldn’t help it. Sometimes my mind would wander while attending the Commission on Narcotic Drugs (CND) meeting in Vienna – the annual drug policy palooza where UN member states gather to shore up the failed prohibitionist policies of the past. Even an unanticipated Russell Brand appearance could do only so much to enliven the sessions.

In those mind-wandering moments, I found myself humming Leonard Cohen’s famous song “Anthem,” especially the beautiful line: “There’s a crack in everything, that’s how the light gets in.”

I suppose my mind wasn’t so much wandering, as it was synthesizing the stark disconnect between the evidence presented at the outset of the meeting – in fact, the science at the heart of the enterprise – and the actual decisions arrived at by CND delegates.

There is unquestionably a crack in the consensus in these global discussions, a crack that may well end up being a chasm as wide as the Grand Canyon by the time the UN Special Session on Drugs (UNGASS) takes place in 2016 in New York.

Decriminalization

As for the light, that came in part from the two stellar UN-appointed scientific panels that reported out at the beginning of the meeting. Michel Kazatchkine, UN Envoy to Eastern Europe and Asia on HIV, and Nora Volkow, Director of the US National Institute on Drug Abuse, chaired panels that delivered strong statements on the need for problematic drug use to be dealt with as a public health issue not a criminal issue. Kazatchkine’s group noted: “Criminalization of drug use, restrictive drug policies and aggressive law enforcement practices are key drivers of HIV and Hepatitis C epidemics.” Volkow’s group added: “We consider that criminal sanctions are not beneficial in addressing substance use disorders and discourage their use.”

The divide between the above statements and the content of the negotiations at the CND was vast – the overwhelming majority of delegates clung to the status quo and refused to even consider language on decriminalization. Clearly we’ve made very little progress since Portugal (2001) and the Czech Republic (2009) decriminalized all drugs for personal use, on their own without fanfare or bringing it up at the CND.

Harm Reduction

In a somewhat Orwellian turn of language control, a number of countries including Canada demanded the words ‘harm’ and ‘reduction’ not appear side by side, but they could endorse “measures aimed at minimizing the negative public health and social impacts of drug abuse that are outlined in the WHO, UNODC, UNAIDS Technical Guide.”

Harm reduction, in other words.

These programs are the most cost effective way to engage people who use drugs and often the only bridge to more mainstream public health services. The scientific panel offered clear statements on the benefits and cost-effectiveness: “Harm reduction interventions are good value for money, with average costs per HIV infection averted ranging from $100 to $1,000.”

Apparently scientists can use the words, but not the members of the CND.

Death Penalty

Switzerland, with support from others, pushed hard at the meeting for the Joint Ministerial Statement to clearly state the death penalty was not an appropriate response to drug offenses of any kind. In the end they failed, being blocked by countries like Iran, China and a number of other Middle Eastern and Asian countries. Canada’s silence on this discussion was deafening.

The Swiss allowed the “consensus” document to go forward but not without delivering the following statement at the end of the meeting:

“The death penalty is in opposition to our position with regard to all offences. The International Covenant on Civil and Political Rights says that it should only be applied for very serious crimes and therefore very rarely. The human rights committee says we should very much limit the use of the death penalty. The International Narcotics Control Board (INCB) said that its application was never in the spirit of the (drug) conventions. The INCB encourages countries to consider its abolition. In this background, the silence of the Joint Ministerial Statement (JMS) on the death penalty is regrettable. It does not take into account our position and that of other (UN) bodies. We will continue to promote the abolition of the death penalty. We ask that our agreement with the JMS is on this understanding – capital punishment is not in line with our commitment to combat the world drug problem. International cooperation on drug law enforcement is contingent to respect for all human rights – as well as the right to life.”

2016 UN General Assembly Special Session on Drugs (UNGASS)

If there’s one thing that we learned while attending the CND it’s that any meaningful consensus on new approaches to addressing drug problems globally will be near impossible to attain when the biggest international drug policy meeting in 20 years – UNGASS 2016 – takes place in two years at the UN General Assembly in New York.

This meeting was called in response to the pleas from the presidents of Mexico, Colombia and Guatemala a little over a year ago, calling on the UN to facilitate real dialogue on alternative approaches to the global drug problems.

UNGASS is huge because it will undoubtedly precipitate a new approach to drug policy – either through the development of a more progressive global consensus, or, more likely, because it will shatter the distorted idea that a global consensus is possible.

Either way, countries should be free to chart their own appropriate path forward to address drug problems, grounded in the public health and human rights imperatives enshrined in various UN conventions, without the shackles of the misguided and restrictive drug control treaties.

“Ring the bells that still can ring
Forget your perfect offering
There is a crack in everything
That’s how the light gets in.”
– Leonard Cohen, Anthem

April 3, 2014
Treat drug use as a public health issue, not criminal issue, say UN agencies
Criminal activity and drug trafficking. Distressingly, those are dominant discussion points at this week’s annual UN drug policy conference – the Commission on Narcotic Drugs (CND).

As a result, public health considerations have been somewhat sidelined, but not, thankfully, among UN agencies, where a number of key representatives called for the removal of criminal sanctions associated with drug use, and the realignment of drug use as a public health issue.

Back in Canada, the federal government is considering changing Canada’s marijuana laws to allow ticketing by police instead of arrest, but Justice Minister Peter MacKay has insisted that even if that’s the case, “Criminal Code offences would still be available to police…. It’s not decriminalization. It’s not legalization.” What’s more, the move could be a step backwards if police begin issuing tickets, where in the past they might have turned a blind eye.

Regardless, under the current regime, simple cannabis possession charges in Canada numbered 61,406, a rate of 178 per 100,000 people as recently as 2011. This represented a 16% increase of such incidents since 2001. In BC alone, the arrest and prosecution of personal marijuana use costs taxpayers $10.5 million a year.

Contrast that criminalization framework with comments from UN agencies this week at the CND:
- UN Deputy Secretary Jan Eliasson tried to set a positive tone early by emphasizing the “public health imperative” in addressing drug use, and called for a “comprehensive and open-minded exchange” that included civil society input and that didn’t shy away from “discussing innovative ideas and perspectives.” He concluded by stressing that it is not enough to say no to drugs, “we are also saying yes… to human rights.”
- Gilberto Gerra, Chief of Drug Prevention and Health Branch for the UN’s drug control agency (UNODC) insisted that criminal sanctions are ineffective and counter-productive because they do nothing to address problematic drug use. He argued that drug policies should be based on health and not on punishment, and that nowhere do international drug conventions require that personal use should be criminalized.
- Two Scientific Working groups convened by the UNODC to advise the CND criticized criminal sanctions and implored delegates to base their policy decisions on science.The first – headed by Nora Volkow (Director of the United States National Institute on Drug Abuse) – insisted that “substance use disorders should be treated as medical and public health issue rather than a criminal justice and/or moral issue.” Imprisonment does not equate with treatment, and the group discouraged the use of “criminal sanctions” given that they “are not beneficial in addressing substance use disorders.”
  The second group – headed by Michel Kazatchkine (UN Secretary General’s Special Envoy on HIV/AIDS for Eastern Europe and Central Asia) – concluded that “we need to stop incarceration of people who use drugs for minor drug related offenses.” Its members highlighted the legal and regulatory impediments to implementing harm reduction initiatives and noted that the “criminalization of drug use, restrictive drug policies and aggressive law enforcement practices are key drivers of HIV and hepatitis C epidemics among people who inject drugs.” Basically, people are dying because they are treated as criminals rather than patients.
- UNAIDS director Michel Sidibe echoed calls to understand drug use as a public health and human rights issue, stating: “The criminalization of millions of people for minor drug offences exacerbates vulnerability to HIV infection, and does little to protect society from the health and social harms caused by drug dependence.” He added, “We must work towards transforming laws and law enforcement officials to become bridges to connect people who use drugs to life saving health services.”
- The UN High Commissioner for Human Rights Navi Pillay’s statement drew attention to “the intense focus of law enforcement against drug use” which “has resulted in large numbers of persons being arrested and held in prolonged periods of pre-trial detention for minor drug offences.” She condemned the “so-called ‘treatment’ in such centres” which “is frequently not based on individualized assessment and evidence-based medical practice, but rather in mass treatment with a focus on disciplinary-type interventions.”
These comments represent a striking scientific consensus on the harm created by the criminalization of drugs and those who use them. Clearly the language of public health is beginning to inform the deliberations at this forum. The real challenge for countries to put teeth into these recommendations by implementing concrete and comprehensive public health approaches to drug related harm.
March 18, 2014
What will Canada contribute to a new global drug policy?
Canadians take pride in being viewed favourably on the global stage. And not just for of our scenic landscapes or plucky Olympians, but also because our contributions in the realm of international diplomacy.

The annual UN Commission on Narcotic Drugs (CND) coming up in Vienna March 13-14, 2014 provides an opportunity to add to that proud legacy. There, the international community will gather to discuss how to improve the global response to problems related to drug use and the drug trade.

Canada has traditionally played a strong role in these discussions advocating for a broad range of public health approaches and evidence-based enforcement measures against organized criminal groups in the business of producing and selling illegal drugs. Our influence is boosted by the fact that we are a significant financial contributor to UN drug control programs.

But some international observers are worried about what we’ll say at this year’s CND.

In a recent Ottawa Citizen op-ed, Michel Kazatchkine, UN Secretary-General’s Special Envoy on HIV/AIDS in Eastern Europe and Central Asia, noted: “Canada has long been a world leader in implementing harm reduction policy when it comes to drug use at home. So it was almost shocking to see it aligning itself to countries such as Russia and China in vocally opposing the inclusion of ‘harm reduction’ in a new a new set of UN principles that will guide talks at the special session in 2016.”

Kazatchkine went on to describe an alarming upswing in HIV infections in Russia linked to the lack of harm reduction services for people who inject drugs. In fact the Russian government is generally hostile to services like needle exchange and methadone treatment – all of which have been proven to save lives.

As the former Executive Director of the Global Fund to fight AIDS, Tuberculosis and Malaria, and a member of the Global Commission on Drug Policy, Kazatchkine knows what he’s talking about. In fact, in 2012, the Global Commission raised the alarm about the on-going relationship between repressive drug policies and the spread of HIV. The take home message is simple: refusing to provide basic harm reduction supplies for drug use and criminalizing drug possession, forces people into the shadows where the transmission of HIV is more likely because of the use of shared drug equipment.

Kazatchkine isn’t the only international voice expressing misgivings about Canada’s position. As reported in a Canadian Medical Association Journal article, at a recent negotiation session leading up to the CND, “Canada once again led the charge” against a UN endorsement for “risk and harm mitigation and reduction measures” according to the International Drug Policy Consortium (IDPC), a UK-based group at the negotiations. In a blog report posted after the session, one IDPC observer stated that Canada was “very vocal throughout” the session and opposed any references to the term, “harm reduction.”

We don’t know precisely how Canada’s delegation is approaching this year’s CND, but we do have some recommendations we developed in collaboration with the Canadian HIV/AIDS Legal Network.

Click here to read the entirety of our submission.

In it, we urge the delegation to emphasize the following points in their discussions with other Member States:
1. Encourage all countries to adopt a comprehensive public health approach to substance use including decriminalization.
2. Support countries’ flexibility to experiment with alternative, health-oriented approaches to drug policy.
3. Respect, protect and promote human rights (in particular voicing objection to torture at drug detention centres, and opposing the death penalty for drug crimes)
4. Ensure full access to essential medicines
5. Promote the full engagement of civil society in drug policy discussions
6. Question the usefulness of the language of striving for a “drug-free world”
7. Recognize the unique mandate given to the WHO under the 1961 and 1971 Conventions to provide recommendations for scheduling substances.
Even if our recommendations aren’t adopted at this CND, we have 2 years to continue this conversation leading up to UN General Assembly Special Session (UNGASS) on drugs in 2016. This meeting is a big deal in the world of international drug policy politics and will be a major opportunity to advocate for the failings of the current drug control system. It presents a significant opportunity to shift global strategies towards comprehensive public health responses to address drug problems.

Canada is well placed to take a leadership role in pushing for this shift. The international community would expect nothing less.
March 6, 2014
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.
March 4, 2014
Our 2013 Top Ten Drug Policy Moments Countdown

What a year it’s been. Litigation, legal regulation, anniversaries, confessions, people in high places talking about their drug use and political leadership drew the headlines. We launched our cornerstone report; Getting to tomorrow. And overall things are beginning to change in the global drug policy arena. One can clearly see the cracks appearing in the old international regime that has stifled the discussion of alternatives to the war on drugs for over 40 years. Now countries are beginning to look for approaches that are less punitive for people who use drugs and more targeted on the violent actors in our communities. A better drug policy is possible and we are building it, but we need your help.

Please consider making a donation to support the activities of the Canadian Drug Policy Coalition. A generous donor has agreed to match your donations, but only until December 31. So take action now and click here to donate.

Wishing you season’s greetings and a happy new year.

Here we go! Our Top Ten Drug Policy Moments in 2013

10. The Organization of American States (OAS) ignites hemispheric dialogue on alternative approaches to the drug problem in the Americas.

[The Americas]-In may the OAS launched two reports on the Drug Problem in the Americas. Inspired by the vigorous discussion on drug policy at the Summit of the Americas in 2012 these reports lay out the extent of the drug problem in the hemisphere. The reports also provided a set of scenarios for the next 15 years envisioning ways to reduce violence related to the drug trade and harm from substance use. We were involved in creating the scenarios along with 46 other drug policy representatives from across the hemisphere. We commend the leadership shown by the OAS in pushing for a dialogue on alternatives. They have formalized a discussion that was already taking place. At the international level it’s a big question that they have dared to ask: Is there a better way to reduce the harms from the business of illegal drugs in the hemisphere and better protect those people who use drugs from disease, dependence and overdose death?

9. Canada implements mandatory minimum sentences for drugs just as US Attorney General calls the practice and policy “broken”

[North America]- In a speech to the American Bar Association last August,US Attorney General Eric Holder called mandatory minimums “draconian” and asked Congress to reform a system which can “breed disrespect” for itself. “When applied indiscriminately, they do not serve public safety. They –- and some of the enforcement priorities we have set –- have had a destabilizing effect on particular communities, largely poor and of color. And, applied inappropriately, they are ultimately counterproductive” Kudos to Holder and his staff for taking the leadership to stop this nonsense. Meanwhile here in Canada…

8. Insite celebrates 10 years, 2 million injections, and no deaths

[Canada] – In September Insite, Canada’s first sanctioned supervised injection site celebrated 10 years of serving the Downtown Eastside community in Vancouver. 10 years, 2 million visits and zero deaths. Need we say more? Kudos to PHS Community Services Society, Vancouver Coastal Health, City of Vancouver, Government of BC, the Vancouver Area Network of Drug Users (VANDU) and the people of British Columbia for supporting this life saving innovation in health care. We ask: Where are the other sites across Canada?

7. Federal government continues to try and thwart life-saving harm reduction programs

[Canada] – For reasons that defy us, it is clear that the federal government is doing it’s best to thwart the expansion of life saving services. Bill C -65, (later renamed C-2) the so called Respect for Communities Act sets out 26 additional requirements that must be met before the Federal Minister of Health will entertain a decision on approval of Canada’s next supervised injection site. Bill C-2 is another measure intended to stall the expansion of life saving programs that have been shown to improve the lives of people who use drugs. With a mountain of peer reviewed papers demonstrating the positive impacts of injection sites and a unanimous Supreme Court of Canada decision supporting Insite one has to wonder what the real agenda is. We will continue to call for action in Canada to scale up these services.

6. Canadian NGO sues federal government over lack of needle exchange in prisons

[Canada] – On September 25th, 2012, former federal prisoner Steve Simons, the Canadian HIV/AIDS Legal Network, Prisoners with HIV/AIDS Support Action Network, the Canadian Aboriginal AIDS Network and Canadian AIDS Information Exchange filed a lawsuit in Ontario’s Superior Court of Justice, which claims the federal government is violating prisoners’ rights under the Canadian Charter of Rights and Freedoms by failing to provide access to sterile injection equipment in prison. This has led to rates of HIV and HCV that are, respectively, 15 and 39 times higher in prison than they are in the community. For more information about the case, see www.prisonhealthnow.ca and this event post for an upcoming public panel on this issue.

5. Washington State and Colorado introduce regulatory schemes for the production and sale of cannabis to adults.

[United States] – In October the Washington State Liquor Control Board adopted rules for the implementation of a legal regulated market in cannabis for adults. These rules serve as the basis for Washington’s newly created adult use marijuana market and are the result of 10 months of research and public input. Voters of the state voted to legalize cannabis in November of 2012. Colorado is also implementing its regulatory system as we write this.

4. Providence Health Care and PIVOT Legal Society sue federal government over special access to diacetylmorphine

[Canada] – Developing policy through the courts is not advised but there comes a time when it is the only way to get things done. On November 13th Providence Health Care, PIVOT Legal Society and five patients in the SALOME clinical trial launched a constitutional challenge in the wake of the federal government’s decision to prohibit the prescription of diacetylmorphine (heroin) to people with chronic addictions. Providence Health Care President and CEO Dianne Doyle announced the legal action with the aim of reversing a decision taken by federal Health Minister Rona Ambrose that prevents doctors from giving prescription heroin to patients with severe heroin addiction as part of a treatment regime. “Diacetylmorphine treatment, or heroin-assisted treatment, is a proven treatment option,” said Doyle. Why isn’t Canada scaling up drug treatment priorities?

3. Uruguay makes history by becoming the first country in the world to legalize the production, sale and use of cannabis by adults.

[Uruguay] -There is no contest for the award for political leadership in drug policy in 2013. Hands down it goes to President José Mujica of Uruguay who persisted in the face of significant opposition to deliver groundbreaking legislation that creates the first legal regulated market for cannabis at a country level in the world, a market that will be under state control. On December 10th the Uruguayan Senate voted to adopt a bill that will begin the implementation of the cannabis regulatory system. Asked why Mujica was so clear about moving in this direction he said: “The traditional approach hasn’t worked. Someone has to be the first to try this.”

2. Sensible BC proposes innovative amendment to the BC Policing Act to lighten up enforcement on mere possession of small amounts of cannabis.

[Canada] – Congratulations to the folks at Sensible BC for putting together a creative and innovative campaign to reduce the harm of the criminalization of cannabis possession this year. You came up short but you certainly made your point and set the stage for the next stage towards the inevitable change in cannabis policy in Canada. December 9th 2013 marked the final day of the 90 day Sensible BC campaign as they turned in 200,000 signatures from BC voters who supported new legislation to move towards the decriminalization and then regulation. The legislation, called the Sensible Policing Act is an amendment to the BC Police Act, which redirects all police in the province from using any police resources, including member time, on investigations, searches, seizures, citations, arrests or detentions related solely to simple possession of cannabis. In essence, if implemented it would have decriminalized the possession of cannabis in BC without actually changing the federal law. By the end of the campaign over 4500 volunteers were seeking signatures across the province. Thanks to all of them for working towards a better drug policy for BC and Canada.

1. Canadians take the gloves off when talking about substance use

[Canada] – Seems like all year! We think the number one drug policy moment in Canada this year is: Canadians talking about drug use! Thanks to politicians like Liberal leader Justin Trudeau and Toronto Mayor Rob Ford, Canada got into high gear this year. Justin admitted smoking pot recently even while a sitting MP. Rob Ford – well we really don’t want to go in the details but he admitted smoking pot, “lots of it” as well as using crack cocaine. Canadians piled on. They blamed, they shamed, attacked and showed compassion, argued, vilified, reflected on their own drug problems, lined up addictions experts on talk shows and generally demonstrated the full range of responses that many people who use drugs experience every day – the good the bad and the ugly.

It’s an important moment for Canada. We know we have a drug policy problem and it shows. This January, before all the New Year resolutions have faded, join us as we, along with our partners across the country, ramp up a discussion on the future of drugs and drug policy. Keep an eye out, as there will be many opportunities to get involved.

The Canadian Drug Policy Coalition relies on donations from people like you to operate. Our small team ensures even the smallest contributions go a long way to make your voice heard. Please donate today.

December 16, 2013
World Aids Day 2013: If our goal is zero, drug policy reform is crucial

Zero New HIV Infections. Zero Discrimination and Zero AIDS-related deaths. That is the goal set by UNAIDS over the next two years. But when it comes to stopping HIV transmission associated injection drug use, we have a long way to go.

“An effective AIDS response among people who inject drugs is undermined by punitive policy frameworks and law enforcement practices” (UNAIDS 2013)

The 2013 UNAIDS Global report notes that HIV prevalence among people who inject drugs ranged from 5% in Eastern Europe to 28% in Asia. Rates of HIV among drug injectors in Canadian cities range from approximately 5% to more than 30%. According to Canada’s own Public Health Agency, more than 50% of new HIV infections among Aboriginal people in Canada were caused by intravenous drug use. Rates of HIV and hepatitis C among people incarcerated behind the walls of Canada’s prisons are 10 to 30 times outside those same walls. Although Corrections Canada claims that injection drug use is strictly prohibited within its facilities, no prison system in the world is able to keep drug use out. But only two of 32 reporting countries surveyed by UNAIDS provided adequate access to sterile syringes for persons who injects drugs in prison.

In 2012 the Global Commission on Drug Policy released a groundbreaking report titled “The War on Drugs and HIV/AIDS: How the Criminalization of Drugs Fuels THE Global Pandemic.” The report points to the inability of law enforcement to reduce global drug supply and raises the alarm about the role that repressive drug control policies play in driving the HIV epidemic in many regions of the world. The report also details how policies that prohibit needle distribution result in increased syringe sharing. In fact the Global Commission confirms what others have been saying: the fear of arrest drives people underground and away from needed services. Together these repressive policies help to escalate HIV infections. The Commission urges countries to make available proven drug treatment and harm reduction services, to reduce HIV infection and protect community health and safety.

It’s clear that ending prohibition and scaling up harm reduction is an integral part of solving the complex global HIV problem. By drawing on the evidence of what works, British Columbia has made significant strides at reducing infection rates, but our federal government willingly refuses to acknowledge the role that harm reduction plays in protecting everyone’s health.

On September 30, 2013, the second anniversary of the Supreme Court of Canada decision that instructed the Canadian government to issue a permit for the supervised injection site, Insite in Vancouver, we worked with the Canadian HIV/AIDS Legal Network and PIVOT Legal Society to register our concerns to Health Minister Ambrose about attempts by the federal government to block the implementation of life-saving health services for people with addictions, in the face of extensive scientific evidence of their benefits in protecting public health and public safety. Our letter to Ambrose, which garnered the support of more than 50 organizations in Canada, challenged her government to get going on life-saving harm reduction services. We are still waiting for a response.

Along with our commitment to World Aids Day, we will also continue to mark September 30 (9-30), the anniversary of the Supreme Court decision supporting Insite. We invite you to join us and help ensure that supervised consumption services become a part of the continuum of care for people who use drugs in Canada. And finally, please consider contributing to help our small but mighty team continue to work for evidence based and human rights focused drug policy reform in Canada.

November 28, 2013
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.

I 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.

In 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.

November 20, 2013
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?

October 29, 2013