By Jeremy Eckert Devine, June 22, 2022
On May 31, 2022, Federal Minister of Health and Addictions and Associate Minister of Health, Dr. Carolyn Bennett, announced that British Columbia will decriminalize the possession of “hard” drugs, including cocaine, heroin, methamphetamine, and fentanyl. Drug users found in possession of less than a cumulative 2.5 grams of substances will be released without an arrest or criminal charges and will maintain possession of their substances.
The announcement was viewed as a victory for progressive drug policy reformers who have long argued that drug addiction should be addressed as a matter of public health rather than of criminal justice. Yet these developments should be of concern to Canadians. Decriminalization, as currently proposed, is proceeding in an ideologically narrow manner that risks worsening the nation’s opioid crisis.
Critical flaws are revealed in Canada’s approach to decriminalization when compared with Portugal – a nation which decriminalized drug use in 2001 in response to its own opioid epidemic.
In Portugal, drug use remains illegal. If an individual is found using prohibited substances, they are arrested, and their drugs are confiscated. Instead of facing criminal charges, the drug user is mandated to appear before a “dissuasion commission” comprised of health care professionals skilled in addressing drug use and addiction. For those whose drug use is identified as problematic, the commission directs the individual towards fully publicly-funded addiction recovery programs – up to three years of residential care for the most severely addicted.
While treatment is technically voluntary, failure to comply with the commission’s recommendations can result in administrative penalties including a fine, community service, or even the interruption of one’s social welfare benefits. Summarizing the philosophy, one of the major architects of the Portugal system, Dr. João Goulão, states: “Our first goal is to help people to resume their dignity.”
Portugal’s approach is compassionate yet realistic. While rightly identifying that the drug user needs treatment, not jail, the system acknowledges that, when dealing with the wickedly coercive power of drug addiction, sometimes, as said by Dr. Goulão, an element of “muscle” is needed to get the individual well.
Decriminalization was one part of a centralized and comprehensive national drug strategy. It was successful because Portugal ultimately maintained a prohibitive system that explicitly recognizes the personal and social harms of drug use.
This is in stark contrast to “decriminalization” as it is unfolding in British Columbia.
The federal government is decriminalizing drug use in BC not as part of a comprehensive strategy to address drug use, but to meet the demands of an ideologically driven agenda crafted by vocal anti-prohibition drug user activist groups.
The Canadian Association of People who use Drugs (CAPUD) and the Vancouver Association Network of Drug Users (VANDU) both appear to deny that drug use is intrinsically harmful. Rather, they imply it is the barriers created by prohibition that makes drug use dangerous.
This idea is broadly articulated by Jordan Westfall, co-founder of CAPUD, when he states, “I’m not recovering from drug addiction; I’m recovering from bad drug policy.” Another CAPUD member, Ashley Smoke states, “The drug use itself is not necessarily the issue … The social structure of our society is to blame for problematic drug use.”
However, it is far from self-evident that drug-related harm is largely the result of “social structure.”
Fundamentally, this is a belief that stems from a utopian vision of safe and harm-free drug use in the setting of addiction. It ignores both the intrinsic vicious mechanics of addiction (which by its nature features gradual tolerance and uncontrollable escalation of use) as well as many drug users and their families’ sincere desire to be free of addiction.
Following this faulty logic, these parties have agitated for drug policy reforms that, unlike Portugal, only “dismantle” structural barriers against drug use while making no serious attempt at treating addiction.
To this end, the Canadian government has focused almost unilaterally on implementing increasingly extreme “harm reduction” measures, which some view as a corrective to the prohibitionist status quo. Most alarming of all, the federal government appears to be pinning its hopes on the experimental and dangerous practice of “safe supply” in which highly potent medical grade opioids are distributed directly to those with a severe opioid addiction.
First articulated in 2017 in the BC Overdose Action Exchange II Meeting, a document that was written in partnership with VANDU, CAPUD, and other activist organizations, safe supply has been embraced by the federal government and appears to be their primary strategy to address the opioid epidemic.
Commenting on safe supply, Dr. Bennett believes we can “regulate” the active drug user. During the recent announcement regarding decriminalization in BC, she explained her reasoning: “We want to make sure that there is a regulated supply of drugs, regulated production, regulated distribution, and regulated consumption, and that’s how we’re going to save the lives.”
Yet, Dr. Bennett’s idea that we can “regulate” the drug user in the setting of severe opioid addiction is unproven and highly questionable. The increasing popularity of safe supply reflects the extent to which Canada’s response to the epidemic has been subservient to antiprohibition drug ideology.
This is even more apparent when scrutinizing how the government trials and evaluates these proposed interventions.
Often, activist-researchers are granted generous funding to evaluate their own proposed policy changes. The results are invariably positive and are then taken as clear-cut “evidence” that their intervention is successful and should continue.
However, there is no convincing evidence that the government’s strategy thus far has been successful. Despite the creation of nearly 40 supervised injection sites and the increasing availability of safe supply, opioid overdose deaths have continued to rise. In British Columbia, over 2200 individuals died in 2021 alone – the province’s worst year on record.
With respect to decriminalization, Dr. Bennett has stated that an evaluation will occur three years after its implementation; however, we have reason to doubt the quality of the proposed evaluation process.
While details are sparse, it appears the government has trusted this issue to BC’s “Decriminalization Research and Evaluation Committee.” Included on this committee are “members with lived and living experiences of substance use,” which generally involves one of several drug user activist groups. One confirmed member of the committee is harm reduction advocate and researcher Bernadette Pauly. Pauly has collaborated with drug user activist group the Society of Illicit Living Drug Users (SOLID) and firmly backs “regulated safe supply” as an effective step in addressing the crisis.
We can fairly question if this committee can conduct a truly impartial evaluation. And decriminalization might not be limited to BC. Dr. Bennett has stated that her government is “receptive” to future requests for decriminalization by other Canadian jurisdictions.
Vancouver mayor Kennedy Stewart has said that “[decriminalization] marks a fundamental rethinking of drug policy that favors healthcare over handcuffs.” This is only true if decriminalization is a step towards freeing the drug user from addiction. The mental handcuffs of addiction are as crippling as physical ones. It is time to rethink Canada’s misguided ideological approach to the opioid epidemic.
Jeremy Devine is a psychiatry resident at McMaster University.