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  • Canada charts a new path on drug policy

    Canada charts a new path on drug policy

    Scott Bernstein is the global drug policy program officer at the New York-based Open Society Foundations. He’s also the former health and drug policy campaigner for Pivot Legal Society, where he initiated legal challenges to anti-harm reduction bylaws and restrictions to opioid substitution treatments.

    Last week Scott attended the Special Session of the United Nations General Assembly on the World Drug Problem (UNGASS 2016), where Canada presented a new vision for drug policy.

    “I am proud to stand up for drug policy that is informed by solid scientific evidence and uses a lens of public health to maximize education and minimize harm.” 

    – Jane Philpott, Minister of Health

    Sitting in the gallery of the General Assembly of the United Nations in New York surrounded by non-governmental organizations from around the globe, I listened proudly as Minister Philpott said those words to representatives from nations of the world at UNGASS last week.

    Her statement supported harm reduction, proportional responses to drug offenses, and creation of a regulated market for cannabis in 2017. Canada’s new position around Vancouver’s Insite was clear and was finally in line with the monumental evidence supporting these facilities: supervised consumption sites work; people can access the care they need; Insite has saved lives.

    As one of the lawyers working on the Insite case years ago, and advocating for human rights and access to harm reduction services for Pivot clients, I reflected on the dramatic change in messaging from the last decade.

    For many years, the Conservative government not only declared to the world opposition to harm reduction, but fought a five-year legal battle to shut down Insite that put the lives of hundreds of individuals who rely on the service every day at risk and cost taxpayers millions in legal expenses. That fight ended poorly for the government when the Supreme Court of Canada declared in late 2011 that Insite saved lives and should remain open, but breathed new life into the Conservative’s war against evidence-based interventions to minimize the harms of drug use.

    Two years after the groundbreaking Supreme Court decision, the Harper government introduced new legislation that created 26 new hurdles that proponents of new consumption sites must jump before the federal government could even consider whether to allow this life-saving service to open. In March 2015, Bill C-2, the so-called Respect for Communities Act, became – and remains – the law of the land in Canada.

    Minister Philpott’s assertive and welcome statement to the UN began with a note of poignancy. Reflecting on a meeting a few weeks earlier, she noted how hearing from a mother who had lost her daughter to overdose had deeply affected her and helped to ground Canada’s new policy issues in a humanity that we all can understand. As Minister Philpott noted, we must do better.

    Even with a supportive government now in place, we can never bring back those whose lives were tragically lost or who suffered the harms of a policy based in an ideology that stigmatizes people who use drugs and stands in the way of evidence-based interventions.

    There is a new urgency to make up for lost time and to scale up consumption sites and overdose prevention across the country. We also need to begin implementing programs that provide prescription opioids to patients who need such interventions and explore new and better ways to reduce the personal and societal harms of drug use and prohibitionist drug policies. The Trudeau government must commit to repeal Bill C-2, roll back mandatory minimum sentences, and implement harm reduction services widely across the country. To do any less would not live up to the expectations created within Canada and the international community for change.

    Canada has stood in the UN as an international leader and must now put actions behind the words.

  • Are 420 gatherings still relevant?

    Are 420 gatherings still relevant?

    On April 20th, or 420, I spoke with several reporters. They were particularly interested in my thoughts on 420 protests calling for the legalization of cannabis and whether such gatherings would still be necessary once Canada lifts prohibition on cannabis in the spring of 2017.

    As I spoke to one reporter after another, my thoughts and speculations started formulating. I was quoted as stating that there might no longer be a need for 420 gatherings as a rebellious act. Perhaps, though this speculation brought me to think more deeply about the purpose of 420 gatherings.

    Beyond rebellion, and in my experience, 420 gatherings are an opportunity to “come out of the cannabis closet” and feel the freedom of openly consuming cannabis without too much fear of police intervention. For anyone who has experienced being closeted for something that is not socially accepted or illegal, the mere act of being amongst a crowd that shares your behaviour or identity can be quite liberating.

    Much like the Pride movement of the LGBT communities, which started off with small parades by a few brave souls who walked through jeers of a disapproving crowd, 420 gatherings have brought the consumption of cannabis to the foreground. Until cannabis is regulated in Canada, such gatherings still bring attention to the issue of a law that is not in synch with the practices of many Canadians.

    As we roll up our sleeves and get ready to create a regulatory framework for cannabis in Canada, I urge the government to adopt a moratorium on arrests for cannabis possession while we sort it all out.

    I suspect that 420 gatherings may evolve into more of a festival of sorts, similar to what Pride events have now become. Reports on April 20th from cities across Canada seemed to indicate large crowds, in some cases larger than they have ever been before. Perhaps people feel more comfortable coming out since Canada is on the verge of legalization.

    I decided to venture out to the 420 event here in Victoria, BC to observe for myself. Quite a large crowd had gathered in Centennial Square. Many were youth, though ages ranged greatly. Many people were dressed up in festive wear. There were smiles, random music here and there, and laughter. The voice of a local protester was broadcasting through an inadequate amplifier so that no one other than the people standing a few feet away could make out what was being said.

    I listened to the conversations around me. People were wondering where the stage was and what happened to the music. They seemed to be seeking that festival atmosphere. Some attention seekers were chasing cameras. Others were lurking around groups sharing a joint, hoping for a toke. People were generously sharing. I saw some excessive use, as well as some restraint. Finally, the countdown to 4:20 pm, the loud cheers, and the large cloud of smoke bellowing over the crowd. And then many people left.

    Is this cannabis culture? Well, it is a snapshot of some of it. Mostly, though, I see it as a social movement advocating for change to laws that do not suit reality. Cannabis is the most widely used illegal drug in the world. 420 rallies have pointed this fact out, quite bluntly. Pun intended.

    Will 420 gatherings turn more into festivals, with music and vendors and such, much like the Pride festivals? Will they fizzle out, as implied in the media? That remains to be seen.

    One thing I do believe, though, is that in time, and with cannabis regulation, its use will become more normalized. We will be able to have more open dialogues about what is responsible use and what is not. We will develop social norms, much like we have with alcohol. We will have better information about how to use it more safely and reduce some of its harms. Personally, that is the kind of cannabis culture I would like to see.

  • War on Drugs Takes Center Stage at UN as Global Leaders and International Activists Assemble in NY

    War on Drugs Takes Center Stage at UN as Global Leaders and International Activists Assemble in NY

    Hannah Hetzer is the Senior Policy Manager of the Americas for the Drug Policy Alliance. Suchitra Rajagopalan is pursuing her Bachelor of Laws at the University of Mumbai and is currently interning for the Drug Policy Alliance.

    In April, the world will come together to talk about drugs. The United Nations will host a General Assembly Special Session on Drugs (UNGASS), the most significant high-level international drug policy event in almost two decades. At the last UNGASS in 1998, the international community met under the slogan “A drug free world – We can do it!” and committed itself to this unrealistic goal. Fortunately, we’ve come a long way since then. This time, when global leaders meet at the UN to discuss drugs once again, the farce of a drug free world will be far away. Influential voices from around the world are calling for new approaches to drug policy, countries and cities are experimenting with innovative reforms, and a global movement has emerged calling for an end to the failed prohibitionist policies of the past. From April 18 to 21, people from all over the world will be descending upon New York City to demand change.

    The UN shapes international drug policy. National drug laws must adhere to three UN treaties on drugs that prohibit the production and supply of certain drugs, and criminalize people who use them. The most significant of these treaties, the Single Convention on Narcotic Drugs, was ratified in 1961, over half a century ago. These treaties represent an outdated framework from a bygone time. There is ample evidence of the overwhelming failure of drug prohibition, and the human costs associated with it. This includes mass incarceration for drug offenses in the US, hundreds of thousands killed in drug war violence in Latin America, insufficient access to treatment and harm reduction services around the world, environments and livelihoods destroyed in forced crop eradication, and thousands executed for drug offenses, not to mention the fact that neither drug use nor supply has diminished.

    At the 1998 UNGASS, instead of using the opportunity to critically evaluate the global drug control regime, countries decided to perpetuate the failed policies of the past. But things have since shifted. There is growing consensus even within the UN that these policies do not work. And we have a strong movement of individuals and groups affected by the war on drugs that will come to NY in April to appeal to the UN to use the historic opportunity of this UNGASS to charter a different path for international drug policy. These groups will be rallying under Stop the Harm, a diverse, broad, and powerful movement of organizations from around the world who have united around one common purpose: rectifying the catastrophic failures of the current global drug policy regime through campaigning for a new course firmly grounded in health, compassion, and human rights.

    · Faith leaders taking lead will kick off the week of February 15th in Houston, Texas during the Samuel DeWitt Proctor Conference where hundreds of African American faith leaders will be educated on the UNGASS and will connect with drug policy reformers around the globe, uniting under the Stop the Harm umbrella to call for a more compassionate and just global drug policy. They will also be developing a multi-faith statement on drug policy reform, holding high level faith and policy events in New York and Washington DC, and utilizing important religious holidays and observances to highlight the plight of those impacted by the global drug war.

    · Making drug war devastation visible, encouraging debate, and demanding change are at the heart of the Caravan for Peace, Life, and Justice, comprised of families whose loved ones have disappeared or been killed in mindless drug war violence in Latin America as well as indigenous peoples, faith leaders, rights defenders, policy experts, health workers, student movements, farmers, and informed citizens all working together to end this war. The Caravan will begin in Honduras on March 28and travel to El Salvador, Guatemala, Mexico, and Texas before flying to DC and continuing on to NY, arriving on April 18 for a day of protest, reflection, and prayer on the eve of the UNGASS.

    · Dedicated to amplifying the voice of the global youth on matters of drug policy, Students for Sensible Drug Policy is bringing hundreds of students to NY to demonstrate their opposition to the drug war, and its harmful impact on communities in the US and around the world. They will be hosting a series of art installations representing the harms of the drug war at Bryant Park on April 18 and holding events at Foley Square and the UN along with their allies.

    · The crowd gathering in NY will be joined by International Families Against the Drug War, a global coalition of family members that have lost loved ones to overdose, incarceration, violence, and other harms associated with drug prohibition. Families involved with Anyone’s Child: Families for Safer Drug Controland Moms United to End the War on Drugs will join with others from Canada, Mexico, Kenya, Afghanistan and the Philippines. They will hold a press conference at the UN to tell global leaders, face-to-face, that their drug policies are harming our children and relatives, and that current drug laws are causing far more damage than the drugs themselves.

    · The leading US organization working to dismantle the drug war, the Drug Policy Alliance will host an invite-only meeting of its allies and partners, national and international, at Columbia University over the weekend preceding the UNGASS, to consider the most important work to be taken up after the UN session has concluded.

    · Prominent high-level individuals will also be adding their voice to the UNGASS debate. The Global Commission on Drug Policy, comprised of former presidents of Colombia, Mexico, Brazil, Chile, Switzerland, Poland and Portugal, along with other notable figures such as Richard Branson, and former UN Secretary General Kofi Annan, will be advocating to current world presidents, both before and at UNGASS, to redesign policies to reflect a more humane and effective way of dealing with the negative impacts of the current strategy. Global Commissioner and Former UK Deputy Prime Minister, Nick Clegg, recently wrote an article urging Europe to pull its weight on the international stage for drug policy reform.

    · Not only will be people be mobilising on the ground ahead of the UNGASS, but online, too. Already individuals from around the world have started to demand action from their governments at the UNGASS through a series of videos, highlighting the urgent need for reform, from ending the death penalty, to implementing an approach based on compassion and human rights.

    · Women too are calling for an overhaul of global drug policies as rates of incarceration of women skyrocket across the world. A group of more than 50 organizations representing every continent have joined in a Women’s Declarationcalling on the UN to consider harms women and their families face under punitive drug laws, and demanding change that promotes women’s human rights.

    · Support. Don’t Punish is a global advocacy campaign that brings together activists, affected communities and policy makers under a common message: that the harms caused by the war on drugs can no longer be ignored – it is high time to adopt drug policies that protect the health and human rights of people who use drugs. As part of the Support. Don’t Punish global advocacy campaign, activists will mobilize at the UNGASS to call for the end of the war on drugs and promote policies grounded on health and human rights.

    · Over 1,000 individuals and organizations have endorsed the Harm Reduction Decade Declaration, launched by the former president of Switzerland Ruth Dreifuss. Signatories include the Kofi Annan Foundation, Richard Branson, the Elton John Foundation and UNAIDS Asia and Pacific. The Declaration calls on governments to adopt harm reduction as a key principle of drug policy throughout the next decade and to redirect 10 percent of the resources that they currently spend on ineffective punitive responses to harm reduction.

    · And just last week, the largest national Latino online organization, Presente, launched a petition asking President Obama to address the UNGASS and “call for a change of direction from the failed “War on Drugs” towards common sense drug policies that prioritize public health, harm reduction, and human rights.”

    · With decades of experience collecting evidence on the catastrophic outcomes of drug policies, scientific experts from around the world are calling on the UN and national governments to put the needs of communities first. Instead of basing success on the number of drug busts or seizures, drug policy should be evaluated on its health, safety, development, and human rights impacts. Such an evaluation would undoubtable show that we need an entirely different approach, one based on evidence, not ideology.

    UNGASS 2016 is going to be a watershed moment. It is time that the health, safety and rights of human beings take center stage in the international drug control regime. Current UN drug treaties maintain that the “health and welfare of mankind” is their primary objective, but it is clear that this cannot be achieved if governments continue to criminalize, stigmatize, penalize and incarcerate people who use drugs. We must use this momentum for change to demand evidence-based policies that effectively deal with the risks associated with drug use and misuse, while maintaining respect for human rights and our compassion for individuals everywhere.

  • Drug policy should focus on harm reduction

    Drug policy should focus on harm reduction

    Katrina Pacey is the executive director of the Pivot Legal Society. Donald MacPherson is the executive director of the Canadian Drug Policy Coalition.

    The flurry of new initiatives introduced by the federal government signals a major philosophical shift on drug policy issues.

    First, Health Minister Jane Philpott approved the Dr. Peter Centre’s application to continue operating a supervised injection site in Vancouver, giving hope that similar sites in other parts of the country might also be welcomed by the government. Then, Minister Philpott visited Insite, Vancouver’s other supervised injection facility, which she described as “having a huge impact on people” and “incredibly moving.” That was closely followed by news that Health Canada would fast-track the process of changing the status of naloxone to a non-prescription drug, making it easier to access this life-saving medication that’s administered during overdoses.

    Together, these measures not only provide a desperately needed expansion of this country’s harm-reduction initiatives that are needed to address the drug overdoses plaguing our communities, they also represent a shift toward a drug policy that puts people’s lives first.

    The Harper government viewed illicit drug use as a criminal justice matter, a perspective that consistently led to punitive and stigmatizing measures being taken against people who use illegal drugs. The new government, on the other hand, has started to shift Canada’s drug policy towards a public health and harm reduction approach, which is grounded in scientific evidence and human rights. This shift was further reinforced when, this week, the Canadian delegation to the United Nations Commission on Narcotic Drugs in Vienna articulated the government’s commitment to advance evidence-based policies in considering all drug policy initiatives.

    We should celebrate this stated commitment to evidence-informed policy development and the tentative but important first steps. But we should also recognize that much more needs to be done.

    Alberta, Ontario and British Columbia have all reported staggering increases in the number of overdoses and overdose-related deaths over the past two years. These increases can be linked directly to a steady rise in the availability of fentanyl, an opiate drug regularly passed off as heroin by street dealers, but dangerously more potent.

    The statistics lay bare what public health officials have known for some time: we are in the midst of an epidemic. Instead of ignoring this national health crisis as the previous government did, however, the federal Liberals appear to be open to solutions, including ending the proliferation of new laws that punish drug users and create barriers to health services meant to support them.

    Another promising initiative is a Liberal MP’s private member’s bill that would grant amnesty to those reporting an overdose. Fear of prosecution has proven to be a barrier for people to call for help when they are with someone who’s having an overdose. Only 46 per cent of respondents to a Waterloo Region Crime Prevention Council survey said they would call 911 during an overdose situation. Seconds matter in these cases and saving a life shouldn’t be weighed against facing a potential drug possession charge. Granting amnesty to Good Samaritans is a simple answer. The Liberals should move to pass this bill as quickly as possible.

    Measures like the ones the federal government has introduced to date have their limits, however. They don’t stem the tide of dangerous, unregulated drugs that are readily available on our streets, nor do they address the myriad of reasons why people consume drugs in the first place.

    Larger — and, importantly, more impactful — solutions are still necessary, including reversing dozens of mandatory minimum sentence laws related to drug use and repealing The Respect for Communities Act, which was introduced by the Conservatives as a means of creating barriers to opening supervised drug consumption facilities.

    Innovative, scientifically proven substitution therapies to address the harms caused by addiction to illicit substances should also be encouraged. This includes clearing the way for physicians to offer heroin-assisted treatment in cases where methadone maintenance treatment has failed.

    When we recognize that all substance use is a public health issue, not a law enforcement issue, the blueprint for the way forward is to ensure that Canada’s drug policies are based on the best available evidence and aligned with the Charter of Rights and Freedoms.

  • Canadian Drug Policy Coalition/Canadian HIV / AIDS Legal Network Policy Briefs

    Canadian Drug Policy Coalition/Canadian HIV / AIDS Legal Network Policy Briefs

    Harm Reduction Brief

    Canada is known around the world as a leader in harm reduction. It is host to the first, and only supervised consumption site in North America, Insite, which has saved lives and helped to build a healthier community in one of the most at-risk neighbourhoods in the county. Unfortunately, the federal government has moved away from harm reduction and more towards a criminal approach to drugs. Of course, there is a way forward. In our policy brief, we make the case that not only should the federal government restore the harm reduction model, but expand upon what is already in place. Please click and read below.

    CDPC-HarmReduction-Brief English

    CDPC-HarmReduction-Brief Français

    Overdose Brief

    The tragedy of drug overdose has increased dramatically in recent years. The rise of fentanyl, an extremely potent opioid, has dramatically increased overdose deaths in recent months. Policy change at the federal level is urgently needed. Fortunately, overdoses are preventable. From allowing for easier access to lifesaving medication such as naloxone, to testing the purity level of street drugs, there are several actions the government can take right now to put an end to these avoidable deaths. Our policy brief contains many commonsense policy solutions that the government can enact immediately. Please click and read.

    CDPC-Overdose-Brief English

    CDPC-Overdose-Brief Français

    Cannabis Brief

    Cannabis law is changing around the world. From the United States to Latin America, a wider consensus is growing that cannabis prohibition has failed to prevent both the sale and consumption of the plant for non-medicinal purposes. Public opinion in Canada and worldwide is experiencing a paradigm shift, and the mindset of policymakers needs to change with it. Clearly, an alternative strategy to this broken system needs to be taken seriously. In the following brief, we outline our strategic recommendations on how the federal government can end prohibition, and use its power to begin the process to create a regulatory system that works.

    CDPC-Cannabis-Brief English

    CDPC-Cannabis-Brief Français

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

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

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

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

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

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

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

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

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

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

  • Why Canada is no longer a leader in global drug policy

    Why Canada is no longer a leader in global drug policy

    Co-authored with Jenna Valleriani, director of Canadian Students for Sensible Drug Policy.

    This op-ed first appeared in the Globe and Mail, Feb. 27, 2015

    Prime Minister Stephen Harper’s statement about the failures of our existing drug policy is mostly on point. It’s just the last bit he gets wrong: “I think what everyone believes and agrees with, and to be frank myself, is that the current approach is not working, but it is not clear what we should do.”

    He’s wrong, because we know what we should do: Supervised injection sites; prescription heroin; medical cannabis dispensaries; crack pipe distribution; drug testing kits; Naloxone for reversing opioid overdose.

    We know these innovative health services reduce the harms of drugs and save lives, and we all agree “the current approach is not working.” And yet, access to these important innovations is unequal across Canada because of a lack of leadership at the federal level, and a failure to collaborate across all jurisdictions – local, provincial, national and international.

    We don’t need to look far to start. Vancouver is known internationally for its innovation in drug policy reform – it houses North America’s first supervised injection site and prescription heroin program, and has recently seen a proliferation of medical cannabis dispensaries. The city’s drug policy is based on an evidence-based four pillar approach: harm reduction, prevention, treatment and enforcement. This approach has been adopted around the world, but also here in Canada, officially forming the basis for the Toronto’s drug strategy.

    Unfortunately, the federal government is out of step with international dialogue and doesn’t believe in the four pillars – it dropped harm reduction in 2007 when it changed the National Drug Strategy to the National Anti-Drug Strategy. While countries like Portugal have moved towards decriminalization and a more health-focussed approach, Canada has instead pursued a more punitive, conventional “war on drugs” approach – epitomized by the introduction of mandatory minimum sentencing for low level drug offenses. Recently Health Canada spent $7-million of our precious tax dollars on a fear-based anti-cannabis ad blitz that the country’s top physician groups suggested was politically motivated.

    The lack of vision at the top means that in a country known internationally for its innovation in harm reduction, many of our best public health interventions only exist in isolated local cases. This is not entirely unexpected. The story of drug policy reform is often one of grassroots change lead by users, local authorities, politicians, drug policy experts, service workers, and organizations. In Europe, for example, cannabis social clubs are driving much of the pressure for cannabis reform. Harm reduction services in countries like Germany, Switzerland, and the Netherlands started as trials in innovative cities before being scaled up nationally.

    In Canada, this bottom-up drive for change is exemplified by the current explosion of medical cannabis dispensaries in Vancouver. Dispensaries have always operated outside the federal access program, in a type of quasi-legal status, or as an act of ‘civil disobedience.’ But the city’s recent explosion of these storefronts has underscored the disconnect between local and national. Although the federal government projects a $1-billion free market medical cannabis industry in the future, currently it’s a notoriously slow, selective, bureaucratic process with little approvals and many rejections.

    The result is a void that “unofficial” dispensaries have been happy to fill. One Vancouver city councillor recently pegged the number of dispensaries at 61. Because of shifting of cultural norms around the acceptance of cannabis – polling shows that Canadian attitudes on cannabis are well ahead of the laws – the city and the police aren’t entirely sure what to do. But they are on record saying they will not bother dispensaries that follow best practice dispensing.

    This is fine for Vancouver, but we need a comprehensive national drug policy, so that essential healthcare innovations like medical cannabis – and prescription heroin, harm reduction kits, and product testing – are available consistently, throughout the country.

    Instead, Canada heads backwards, no longer an international drug policy leader, and our reputation on the international stage suffers for it. Innovation at the municipal level is essential, but it needs to be backed by federal support. Canada needs to stop criminalizing people and instead address the health needs of Canadians. The current approach is not working.

  • A painful situation: Access to medication in prisons

    A painful situation: Access to medication in prisons

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

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

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

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

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

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

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

  • Drugs in Canadian prisons: has enforcement worked?

    Drugs in Canadian prisons: has enforcement worked?

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

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

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

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

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

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

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

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

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