B.C. and Ottawa are showing leadership in fighting the scourge of drug overdoses

Posted on June 7, 2022 in Health Policy Context

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TheStar.com – Opinion/Editorial
June 4, 2022.   By Star Editorial Board

‘There’s abundant evidence that drug prohibition has little effect on how many people use drugs but plays a significant role in making an already risky activity even riskier.’

Amid an explosion of drug-related HIV infections in 2001, Portugal became one of the first jurisdictions in the world to decriminalize possession of recreational drugs like heroin and cocaine.

Predictably, a dramatic drop in HIV infections and drug deaths followed, as did the number of people in prison for drug offences. Less predictably, Portugal experienced no rise in rates of drug use, and 20 years later the rates remain lower than the European Union average.

Given this success, it’s surprising that few other jurisdictions have followed Portugal’s lead. But starting in January, British Columbia will join Portugal thanks to an exemption granted by the federal Ministry of Mental Health and Addictions.

The exemption, which is authorized by the Controlled Drugs and Substances Act, will decriminalize possession of small amounts of heroin, cocaine, methamphetamine and ecstasy. Toronto has applied for a similar exemption, and the feds ought to approve it now.

After all, there’s abundant evidence that drug prohibition has little effect on how many people use drugs but plays a significant role in making an already risky activity even riskier. Users are driven into dark, isolated places to avoid the prying eyes of the police, which results in compromising on safety and increases the likelihood of risky practices like needle sharing.

Criminalization also further stigmatizes an already stigmatized disorder, thereby increasing the number of people using alone, where no help is available should the user overdose. Users are also less likely to seek treatment, since that would require admitting to engaging in a shameful and illegal activity.

The consequences of this stigmatization are undeniable: According to preliminary data just released by Toronto Public Health, there were 511 opioid overdose deaths in Toronto in 2021. That’s just shy of the 539 deaths recorded in 2020, but still represents a 74-per-cent increase from 2019 and a 273-per-cent increase over 2015.

Now we don’t know if or how decriminalization would affect these statistics, nor do we know if Toronto’s experience would follow that of Portugal. But given Portugal’s success, we need to find out, and the only way to do so is through a carefully controlled, safeguarded exemption.

B.C.’s exemption is time-limited to three years, and during that period the province will be collecting data to determine the impact of decriminalization. In that sense, this is essentially an experiment, and most exemptions are in fact granted to scientists who conduct research on otherwise illegal drugs.

The exemption also includes significant safeguards: It applies only to those over 18, doesn’t apply in or near elementary or high schools or child care facilities or airports, doesn’t include trafficking or possession for the purpose of trafficking, and limits personal possession to 2.5 grams cumulative.

Advocates have criticized that 2.5 gram limit, since many users possess more than that for personal use — either because they’re heavy users of multiple drugs or because they have limited opportunities to access drugs and therefore “stock up” when they can. In fact, B.C. had asked for a limit of 4.5 grams.

But aside from that, the safeguards should help to decrease the risk of harm from decriminalization. A similar exemption in Toronto would provide valuable additional evidence on the effects of ending the criminal prohibition on drugs.

Indeed, many medical experiments are conducted at multiple sites simultaneously so that researchers can compare and contrast their results. And gathering data simultaneously from the two Canadian jurisdictions with the most severe drug problems could help us to understand and address the epidemic.

Now, all of that said, decriminalization will not by itself solve the problem. Officials in both Toronto and B.C. have stressed that they’re not treating decriminalization as a panacea, but instead view it as one part of a broader effort that includes improved access to treatment and innovative harm reduction measures.

And sadly, one part of that broader effort continues to face obstacles, partly because of criminalization: Safe supply — the provision, by pharmacies, consumption sites or medical or substance use facilities, of pharmaceutical-grade drugs to users.

It’s all well and good to decriminalize, but many of the drugs on the street will still be contaminated with potent opioids like fentanyl, or with benzodiazepines, which don’t respond to the anti-overdose drug naloxone, thereby making overdoses much more difficult to manage.

Ending criminalization will not, of course, eliminate this contamination in the short term. But improving access to safe supply should prove a lot easier if Toronto receives an exemption. All that’s needed is for Ottawa to change that “if” to “when” and the “when” to “now.”


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