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Lifesaving Heroin Assisted Treatment Dealt Serious Blow

By Connie Carter and Susan Boyd

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

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

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

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

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

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

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

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

October 24, 2013
Voices of the Drug War: Mexico and Canada

In Mexico the drug war has had a devastating impact on communities, families, the social fabric and the economy. Deepen your understanding of the complex roots of this tragedy and hear ideas for new and better ways forward.

Join the Canadian Drug Policy Coalition, Global Exchange and the Movement for Peace with Justice and Dignity for an evening with Javier Sicilia and Teresa Carmona. Both of these outstanding Mexicans have lost children in the drug-war-driven violence of recent years. Both have chosen to forge their tragedies into opportunities to become agents of the changes so urgently needed in Mexico as well as in North America.
Mr. Sicilia and Ms Carmona will share their experiences as both victims of the drug war and founders of an important peace movement. They will lead a discussion on why they are committing the moral weight of Mexico’s Movement for Peace with Justice and Dignity to the call for drug policy reform throughout our hemisphere.

In Canada the drug war has had devastating impacts on individuals, families and communities across the country. Canada’s current drug laws support a lucrative underground and violent drug trade, fuel the spread of HIV and Hepatitis C, disproportionally target marginalized populations, and ensure the availability of illegal drugs to young people in our communities. Bud Osborn poet and Downtown Eastside activist will read and talk about his own journey through the drug war in North America.

Donald MacPherson, Director, Canadian Drug Policy Coalition will moderate the discussion and highlight the opportunities coming towards us to accelerate the movement for ending the war on drugs.

You are invited to attend – Voices of the Drug War: Mexico and Canada

Register here: drugpolicy.ca/javier-sicilia/

Monday, October 28, 7-9 PM
World Arts Room
SFU Woodward’s
149 West Hastings Street
Vancouver, BC

For more info: [email protected]

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.

October 13, 2013
Illegal Drugs Get Cheaper, More Potent

Sometimes my work as a drug policy analyst is really hard to explain to my non-drug policy friends. Most of the research findings about drug policy that I deal with on a daily basis fly in the face of conventional wisdom about drugs, drug users and drug laws. One of these pieces of conventional wisdom taught routinely to Canadian high school students is that drug law enforcement is necessary to keep the supply of illegal drug under control, and to discourage young people especially, from using these drugs.

Change in estimated heroin price and purity in the context of the annual drug control budget in the United States. Source: Global Commission on Drug Policy

As any of you in the field of drug policy reform know, despite the claims by police, drugs are now more available, higher purity and more potent than they were 20 years ago. So says a recent publication in the British Journal of Medicine Open, entitled, “The temporal relationship between drug supply indicators: An audit of international government surveillance systems.” Whew that’s mouthful. Authors of this study at the BC based International Centre for Science in Drug Policy culled from two decades (1990 to 2010) of government databases on illegal drug supply, and found the supply of major illegal drugs has (with a few exceptions) increased. With the exception of powder cocaine, the purity and/or potency of illegal drugs in the U.S. generally increased. Their findings also confirm that the price of illegal drugs generally decreased.

These findings once again throw into question the effectiveness of current government drug policies that emphasize supply reduction at the expense of other goals. These deficiencies are aptly illustrated by the World Drug Report, an annual publication of the United Nations Office on drugs and Crime that relies on reports of police drug seizures (i.e. size and estimates of drugs found in raids) along with police-based estimates of crop size (i.e. for cannabis and coca) to evaluate the effectiveness of drug policies. The larger the seizure, the more enforcement officials assert the effectiveness of their approaches. But the findings described above suggest that no matter how hard we try to apply supply-side drug enforcement, drugs are still widely available, cheap and increasingly potent.

As the authors of this study suggest, new measures of the success of drug policies are urgently needed. Rather than using measures of drug supply, its time for governments to assess the effectiveness of their drug policies by using indicators of drug-related harm like overdoses, rates of blood-borne disease transmission (i.e. HIV or Hep C) and emergency room visits…you get the picture. And as the Global Commission on Drug Policy reports, supply-side drug enforcement actually exacerbates the problem of drugs by driving people away from supports and services, at the same time as it creates a growing underground market in drugs.

Sounds sensible, but Canada has poor quality data for measuring the health of people who use drugs. The Canadian Alcohol and Drug Use Monitoring Survey is small and relies on the use of land-lines. There’s no national level data on drug overdoses like there is in the U.S. This lack of data seemingly reinforces the proposition that if you can’t count it, it’s not a problem.

We do know how many people are arrested for drug crimes (57,000 plus for cannabis possession in 2012). But these measures only tell us about police priorities, though they do suggest that the criminalization of people who use drugs is a major way Canada attempts to limit drug use – an approach shown to be less than effective at stopping drug use and a key driver of stigma and discrimination.

So it’s time for all of us to sit down with our friends and family and explain that the conventional maxims of drug policy fail to keep us safe, do not limit the supply of drugs and overlook the health and other needs of people who use drugs. Clearly it’s time for a new approach.

October 10, 2013
9/30

It’s 9/30 and way past time for the federal government to get moving on safer consumption services.

September 30, 2013 (9/30) marks the two-year anniversary of Canada’s Supreme Court decision that unanimously granted constitutional protection to Vancouver’s supervised injection site, Insite. To mark this important anniversary, the Canadian Drug Policy Coalition is spearheading a campaign to let our federal government know that there is widespread support for safer consumption services. In conjunction with the Canadian HIV/AIDS Legal Network and PIVOT Legal Society, we’ve created a sign-on letter to federal Minister of Health Rona Ambrose. Our letter demands that the federal government get going in the right direction to support the scale up of these important and life-saving services.

That decision recognized the improved public health and public order that stems from the implementation of this service. The Court also recognized that, under the Canadian Charter of Rights and Freedoms, people who need such life-saving health services should not face possible criminal prosecution and imprisonment for attempting to use them. The decision created an important precedent supportive of expanding similar services in other communities.

An overwhelming amount of research evidence on supervised injection sites (SIS) has been published in a wide range of scientific and medical journals since Insite first opened its doors in 2003. The evidence of Insite’s positive benefits is conclusive and these services should be scaled up where needed across Canada. Indeed numerous localities are working towards this.

Supervised consumption services (SCS) have been proven to:

• decrease overdose death and injury;
• decrease risk behaviours associated with HIV and hepatitis C infection;
• increase access to health services for people who are most marginalized;
• save health care costs; and
• decrease open drug use and publicly discarded drug use equipment.

Furthermore, the evidence shows that such services do not increase crime, nor do they increase drug use.

There are over 90 SCSs operating around the world today, and considerable research about the positive public health and safety outcomes of SISs. There is also broad agreement among health professionals that SCSs should be part of a comprehensive continuum of health services for people who use drugs.

INSITE, Vancouver BC

On September 30, 2011, the Supreme Court of Canada (SCC) ruled that it would infringe constitutional rights to security of the person to deny an exemption from the provisions of the Controlled Drugs and Substances Act so that Insite could operate without staff or users fearing criminal prosecution when using this health service. The Court declared unequivocally: “Insite saves lives. Its benefits have been proven.” The Court also stated: “Where, as here, a supervised injection site will decrease the risk of death and disease, and there is little or no evidence that it will have a negative impact on public safety, the Minister should generally grant an exemption.”

All across Canada organizations of people who use drugs, front-line organizations, researchers, professionals, and community members who work with people who use drugs, are demanding increased access to supervised consumption services. It is unacceptable that a decade after Insite first opened, Vancouver remains the only city in Canada with a sanctioned supervised consumption service – and only one such service of this sort, which numerous studies have demonstrated is simply inadequate to meet local needs.

It is unethical, unconstitutional and damaging to both public health and the public purse to block access to supervised consumption services which save lives and prevent the spread of infection.

It’s time to stand up for people’s lives and take the leadership to ensure that supervised consumption services become a part of the continuum of care for people who use drugs in Canada.

September 18, 2013
Overdose Awareness Requires Federal Attention

Today the White House based Office of National Drug Control (ONCDP) released a letter in honour of International Overdose Awareness Day (August 31^st). The take home message of the letter emphasizes Obama’s support for overdose initiatives and announces the release of the new toolkit on opioid overdose. As the letter states:

“This toolkit builds upon our efforts to expand prevention and treatment. It also promotes the use of naloxone, a life-saving overdose reversal drug which we believe should be in the patrol cars of every law enforcement professional across the nation. Please join us in spreading the word about overdose prevention by sharing a link to this toolkit on your social media platforms.”

Let’s be clear about one thing: in the slow-moving world of drug policy reform, this is a major step forward. Prior U.S. administrations condemned the use of naloxone to treat opioid overdoses and this one supports it use. In fact, check out the outgoing head of the ONDCP Gil Kerlikowske’s interview with the Washington Post. Kerlikowske mentions the importance of naloxone in this interview and talks about the necessity of evidence-based drug policy reform. This interview comes on the heel’s of yesterday’s announcement that the U.S. Federal government will allow marijuana legalization laws to proceed in Colorado and Washington.

I don’t want to romanticize the US approach. That government still supports Plan Colombia, an expensive and wasted effort to eradicate coca growing. But change is definitely in the air.

Unfortunately, the Canadian federal government is nowhere near making similar pronouncements or providing any sort of open support for overdose prevention and treatment initiatives. The CDPC has written to Health Minister Rona Ambrose to emphasize the need for a national overdose strategy that includes harm reduction approaches like take-away naloxone programs. These programs train overdose witnesses to respond effectively to overdose and to prevent them from occurring in the future.

The math is simple on this one – these programs save lives, so why I ask is Canada now falling behind the US on these initiatives? International Overdose Awareness Day is an opportunity to honour those we’ve lost to overdose but it’s also a time to reflect on how we can do better in Canada.

August 30, 2013
How a Prorogued Parliament Could Help Harm Reduction

Today the Conservative government prorogued the Canadian parliament. What this means is that the current legislative agenda, on hold when parliament recessed for the summer, is now dead. This move does not come as much of a surprise given the recent cabinet shuffle that signaled some shifts in direction for the current government, and prorogation will give them a chance to reboot its legislative and parliamentary agenda.

This is potentially good news for those of us who have been watching the progression of Bill C-65 (Respect for Communities act). The extensive provisions of Bill C-65 promised to make it more difficult to implement new supervised injection services in Canada because of the myriad levels of approval that service providers would need to demonstrate in their applications (potential service providers must make an application to the federal Minister of Health for an exemption to the Controlled Drugs and Substances Act if they wish to shield clients and staff from potential drug charges). Now that Bill C-65 is dead it gives us some breathing room to continue to work on getting more supervised injection services in Canada.

But dead does not necessarily mean buried. The CDPC will be watching closely when the Harper government announces its new legislative agenda in the fall. There’s always the chance the Harper government could reintroduce the bill in either its current form or as a revised attempt to muzzle harm reduction in Canada. Stay tuned. You know we will be.

In the meantime, September 30, 2013 (9/30) is the second anniversary of the Supreme Court of Canada’s decision that allowed Insite (Vancouver’s supervised injection site) to stay open. The CDPC is working with our partners across the country to encourage local groups to host events and activities that mark this important occasion and raise the profile of safer consumption services in Canada. We hope you will join or help organize one of these events in your community.

For organizations: Consider creating a mock injection site open to the public and the media and ask local supportive nurses to be on hand to answer questions. You might also want to do something simple like creating a media release making the case for these services in your city.

For individuals: Send a letter to the local paper expressing your dismay at the lack of support for safer consumption services in your region or write an editorial for you local paper and along the lines of the letter suggested above. Visit your local MP, mayor, or other politicians and make the case for these services in your community. Let them know that the safety and health of every member of your community is important and that’s why you support these services. And don’t forget to the write letters to the Prime Minister’s Office expressing your concerns about the lack of federal support for harm reduction services.

We are creating a tool kit of ideas for this day so contact Connie Carter if you would like more information.

August 19, 2013
The Harm Reduction debate: Political Expedience vs Progress

On June 24th, the Urban Health Research Institute released a report on 15 years of data on drug use in the city of Vancouver. The results of their analysis are significant, but predictable to those who work in the field – harm reduction has saved lives and led to a decrease in drug use, while the war on drugs had failed to do either.

Since the mid 1990’s, the number of people sharing needles has fallen dramatically while usage of needle exchange services and methadone treatment programs has increased. This means that far fewer people are getting HIV and Hep C from drug use and fewer are dying of overdoses because of services like Insite. Such would not have been possible without key champions and advocates from across the spectrum including health, municipal, and police officials, and of course organizations of people who use drugs including VANDU.

An equally apparent takeaway from this report is that the “war on drugs” in Vancouver has completely failed to meet any of its objectives. Data from the same 15 years shows that despite the millions spent on drug enforcement and interdiction, drug availability and pricing has remained unaffected and stable.

The findings in this report also illuminate the many misperceptions about harm reduction services that we often see in the media. One such misperception is that harm reduction services are somehow the opposite of abstinence-based drug treatment. In fact, when people access harm reduction services, including unused drug use supply distribution and methadone, they are often taking the first step towards abstinence and recovery.

The Conservative Party of Canada is capitalizing on these misperceptions to support and promote the introduction of Bill C-65, the Respect for Communities Act. This legislation, if passed, will make it more difficult to set up life-saving supervised injection services in other parts of the country and is part of a sustained attack on harm reduction programs by the government’s National Anti-Drug Strategy.

We know from talking with people from across the country, that many Canadians are concerned about this hostility to well-established harm reduction services, which are supported by organizations such as the United Nations Office on Drugs and Crime, UNAIDS, and the World Health Organization.

It’s time to take a deeper look at the myths about harm reduction and expose them for what they are – politically expedient and uninformed dismissals of well-researched and successful health care services. It comes down to a rather obvious choice: Do we want people to use drugs openly in our streets or in other unsafe and unhygienic conditions, or do want to provide services that have shown to engage people in life-saving health care and drug treatment? It’s as simple as that and the Urban Health Research Institute’s report underscores this point with a wealth of data.

Harm reduction services are based on a pragmatic, non-judgmental approach to the provision of health services that respects the dignity of people who use drugs and values their human rights. Because these services have minimal requirements for involvement, they are often the first points of entry to other health and social services.

Harm reduction is not the only approach to problematic substance use but it is a major means of preventing the transmission of disease, overdose and death, connecting people to services and opening a pathway to change. These services have key secondary benefits such as increased access to health services, housing referrals, referrals to drug treatment, counseling, education, and testing for HIV and HCV.

So next time you hear politicians saying they favour drug treatment over harm reduction consider the possibility that these services are part of the same continuum and ask them why they keep repeating these myths despite the existence of so much evidence to the contrary.

July 5, 2013
The Evidence Enigma: Correctional Boot Camps and Other Failures in Evidence-Based Policymaking

Book review:

The Evidence Enigma: Correctional Boot Camps and Other Failures in Evidence-Based Policymaking, Tiffany Bergin, (Ashgate, 2013), 213 pages.

Why do policy makers adopt policies for which there is no evidence that they will work or for which the evidence is clear that they will not work? Why do they continue to defend policies which have demonstrably failed or for which the unintended consequences are so costly as to undermine their rationale? Why do policy makers ignore evidence that policies are failing thereby squandering resources that could be diverted to policies with a better track record? The Evidence Enigma does not answer all of theses questions, but it does shed some light on the complexity of policy making in one highly contested policy domain.

Bergin begins with a question: What explains the rapid diffusion of boot camps – correctional facilities inspired by military drills, physical exertion and rigid discipline – to almost every U.S. state during the 1980s and 1990s when it was clear that these facilities were not reducing either recidivism rates, prison overcrowding or justice system costs? Their failure to achieve any of these objectives did not reduce their appeal to policy makers – indeed their popularity grew with evidence of their failure to deliver on their promises. The same questions can be posed for Drug Abuse Resistance Education (DARE), which survives in many jurisdictions despite numerous well-designed meta-analyses and evaluations demonstrating little to no deterrent effect on participants. The granddaddy of all failed policies to which policy makers are still committed, of course, is the war on drugs. The example of boot camps, however, is particularly interesting because so much was known about them so early in their diffusion across the United States.

Bergin employs a multi-method approach to unravel her problem, involving extensive quantitative, qualitative and event history analysis of the diffusion and then contraction of the boot camp model, the racial composition of jurisdictions in which boot camps were located, the economic conditions for which boot camps were supposed to be a partial remedy, the geographic proximity of one boot camp jurisdiction to another, the prevalence of military veterans among policy makers in a given jurisdiction, the pervasiveness of media articles about boot camps, the influence of federal funding programs, the percentage of Evangelical Christians in a given jurisdiction, the north-south geographic location of boot-camp jurisdictions, the nature of local electoral competition and numerous other variables.

She finds that boot camps were more likely to be adopted in jurisdictions with higher adult incarceration rates and conservative populations; more popular in jurisdictions with higher percentages of African Americans and Evangelical Christians and higher levels of income inequality. In fact, these three variables correlate reliably with early adoption of boot camp regimes. Furthermore, state governors who were military veterans – and jurisdictions with a high percentage of military veterans in their populations – were less likely to abolish boot camps once the contraction set in.

Of the contending theoretical streams, Bergin finds that Windlesham’s populist theory – a conservative political climate in a racially charged environment – was the strongest predictor of the adoption of boot camps. By contrast, Kingdon’s theory that boot camps found their way onto legislative agenda in response to “problems” – i.e., high rates of crime, incarceration and levels of prison overcrowding – found little support in the analysis. Boot camps, in other words, were not so much a solution to a problem but a predilection arising out of the particular ideological needs of specific populations and their political leadership.

Bergin’s analysis concludes that the diffusion of boot camps is easier to explain than their contraction. Jurisdictions with higher levels of military veterans, higher levels of Black and Hispanic populations and greater numbers of Evangelical Christians proved more resistant to the evidence that boot camps were not delivering savings, lower rates of re-offending or reduced rates of prison overcrowding.

So what light does this study – of one policy model in the United States – tell us about the general problem of policy makers’ adherence to failed policies, or to policies for which there is no support in evidence or for which the evidence contradicts the policy preference? No single theory of policy diffusion seems adequate: all explain some aspect but leave other issues unaddressed. Missing from Bergin’s account is a discussion of power – specifically the power to frame a particular problem area as responsive to a preferred policy response. What we have, in the boot camp example, are indicators of kinds of power without an articulate account of how power frames and circumscribes the limits of the possible – making some options live and rendering others out of order.

Policy makers do not simply do what they want, particularly in a realm like criminal justice, which is costly and involves deprivation of liberty. They must fashion responses according to the menu of available and acceptable options and within the requirements of electoral survival – which involves a shrewd estimation of what their constituents will endorse or at least tolerate. When populations are largely passive in their preferences, of course, policy makers can exercise discretion – but when policy makers are constrained by electoral competition, the need to be seen to be doing something can overwhelm even the most honourable political instincts. The need to be seen to be doing something – which is distinct from the reality of actually doing something – looms large in domains like criminal justice where policy makers know, or rapidly learn, that they can do little of long-term substance in the short mandates available to them. This is how we come to see – particularly in criminal justice – the triumph of symbol over substance and the willingness to subordinate principle to electoral opportunity.

Bergin’s study of boot camps offers valuable insights into the diffusion and contraction of a discredited policy – but the book provokes as many questions as it answers. And that is often the mark of a good book.

– Craig Jones, PhD

Craig Jones is the former Executive Director of The John Howard Society of Canada.

June 21, 2013
Why Decriminalize Drugs?

On Thursday, May 24^th the Canadian Drug Policy Coalition released a report on Canadian drug policy. The report calls for the replacement of Canada’s National Anti-Drug Strategy with one focused on health and human rights, the scale-up of comprehensive health and social services, including housing and treatment services that engage people with drug problems; more robust educational programs about safer drug use, the decriminalization of all drugs for personal use and the creation of a regulatory system for adult cannabis use.

The Canadian media responded quickly to our recommendation to decriminalize personal possession of drugs with questions about how this approach would work, especially when it comes to drugs like heroin and cocaine. Canada’s Conservative government also reacted swiftly to media coverage of our report and publicly dismissed our proposal to decriminalize the personal use of all other drugs.

Let’s be very clear about what the Canadian Drug Policy Coalition is recommending: the full legal regulation of cannabis for adult use and the decriminalization of possession of small quantities of all other drugs for personal use. We do not at this time recommend full legal regulation of drugs other than cannabis; nor do we suggest that all currently illegal drugs should become widely available. Decriminalization of possession of these drugs will not address the harms associated with an underground market. But it is a first step towards a more effective policy. Decriminalization, a strategy currently in use by up to 30 countries world-wide, has been quietly adopted in the wake of the escalating costs of prohibition and its failure to stem the tide of drug use and eliminate drug markets.

Politicians still insist that decriminalizing drug use would send the “wrong message”. This idea is grounded in the false belief that criminalizing drugs keeps people from using them and lessening penalties for drug use will in fact result in higher rates of drug use. But in countries and regions where decriminalization has been implemented, this has just not been the case. As the Global Commission on Drug Policy suggested in 2011,

“A key idea behind the ‘war on drugs’ approach was that the threat of arrest and harsh punishment would deter people from using drugs. In practice, this hypothesis has been disproved – many countries that have enacted harsh laws and implemented widespread arrest and imprisonment of drug users and low-level dealers have higher levels of drug use and related problems than countries with more tolerant approaches. Similarly, countries that have introduced decriminalization, or other forms of reduction in arrest or punishment, have not seen the rises in drug use or dependence rates that had been feared.”

International comparisons also show us that there is no correlation between the harshness of enforcement and the prevalence of drug use. Even in states that have decriminalized all drugs, the sky has not fallen. In 2000, Portugal moved to decriminalize all drugs, including cocaine and heroin, at the same time as it scaled up the availability of services to address drug use problems. By moving personal possession away from law enforcement, drug use did not rise significantly, especially when compared with neighbouring countries. Portugal has also seen a reduction in illegal drug use among problematic drug users and teens, a reduced burden on the criminal justice system, and a significant drop in HIV infections and drug-related deaths.

Prohibition has failed. Drug use is still high, incarceration for drug offenses is increasing and despite billions of dollars spent over the years, law enforcement has failed to meet its objectives of protecting public health and public safety.

One of the drugs that causes the most health and public safety harms – alcohol — is completely legal and widely available yet other drugs with a relatively small public health footprint remain completely illegal. Using the criminal law to discourage a behaviour like drug use only throws the law into disrepute because a complex phenomena like harmful drug use is the result of many factors, none of which the law, police, courts or prisons are prepared to address.

In preparing our report, we talked to people across the country – service providers, family members, people who use drugs — and they told us again and again that Canada’s outdated approach to drug policy is hurting our citizens. In fact, using law enforcement to curb drug use increases its harms by driving it into the shadows. The criminalization of drug use also makes it more difficult to engage people in vital and life-saving health care services.

We need to overhaul our approach to drugs. Globally, the current system of drug control is under considerable pressure to change. Some national governments have begun to chart their own paths when it comes to drug control, including experimenting with decriminalization. It’s time to follow suit, and modernise Canada’s legislative, policy and regulatory frameworks that address drugs.

June 20, 2013