Top health officials in British Columbia are calling for a significant change in drug policy that would ensure people who use illicit drugs do not face criminal charges for it.
Dr. Perry Kendall, B.C.'s provincial health officer, said he supports decriminalization because treating users as criminals has been costly and ineffective.
"Focusing on people who have become dependent on drugs as criminals means we spend a lot of money on law enforcement, which doesn't actually appear to have stemmed the appetite for drugs," he said. "It hasn't helped move people who are dependent on drugs into health-care facilities; in fact, they have become very marginalized over time. Because they are marginalized, their use of drugs has often gone up, and has been accompanied by HIV and hepatitis C infections."
Dr. Kendall and other B.C. health officials' call to decriminalize personal drug use and possession echoes that of the John Hopkins University – Lancet Commission on Public Health and International Drug Policy. The international commission of medical experts recently asserted that the "war on drugs" has undercut public health and resulted in collateral harms while doing little to affect drug markets or address drug use.
Canada and the United States are currently grappling with opioid-related crises; B.C. declared a public health emergency last week over a significant increase in illicit drug overdoses. In Kamloops on Thursday, fentanyl was suspected in six non-fatal overdoses in a couple of hours.
Dr. Patricia Daly, chief medical health officer and vice-president of public health for Vancouver Coastal Health, said she supports a regulatory approach to all psychoactive substances.
"Personally, I think we need to be thinking about the decriminalization of drug use and perhaps having legal options for all drug users, including opioid drug users, so that they don't have to go to the illicit drug market for their addiction," she said.
B.C. Health Minister Terry Lake suggested decriminalization is a direction worth considering.
"As Health Minister, public health is always the biggest priority," he said. "I'm not the justice minister, I'm not the attorney-general, so I don't want to speak for them, but I would say that we have recognized over the years that the war on drugs has largely been a failure.
"And I think all levels of government are recognizing that, so let's put a public health lens on this, treat it as a health and social issue that we need to manage … I think there's a general movement in that direction."
Dr. Kendall noted that Portugal experienced significant benefits after decriminalizing all drugs in 2001. This included reduced rates of incarceration and associated harms and control of an HIV epidemic linked to unsafe injections. As of 2011, Portugal's total drug use is among the lowest in the European Union, according to the international public health commission.
The commission published a report on the matter shortly before this week's United Nations General Assembly Special Session on drugs, held in New York, where UN member states convened for the first time to discuss global drug strategies since 1998.
The commission is recommending the decriminalization of all minor, non-violent drug offences – use, possession and petty sale – and the strengthening of health and social-sector alternatives to criminal sanctions. Policies that criminalize drug users can further exacerbate problems by way of stigmatization, mass and disproportionate incarceration, the spread of infectious diseases through unsafe injections and impeded access to live-saving medications or treatments, the commission found.
Under decriminalization, which is different from legalization, manufacturing and selling illicit drugs would remain unregulated and illegal. Personal drug use and possession, however, would not be subject to criminal sanctions.
On marijuana legalization, which is expected to become law federally next year, Mr. Lake said a proper regulatory environment will serve to protect young people better than the system we have today.
Under legalization, a heroin addict, for example, could inject unadulterated, prescription-grade heroin in a sterile, medical setting as is currently done at Vancouver's Crosstown Clinic on a limited basis.
Dr. Thomas Kerr with the B.C. Centre for Excellence in HIV/AIDS, who is a member of the John Hopkins University – Lancet Commission, noted that in American states where marijuana has been legalized, emerging research shows that prescription opioid deaths have dropped, suggesting a shift by users to the less harmful drug.
"In our own data, we have also seen that a number of people who are users of hard drugs like cocaine and methamphetamine are actually substituting cannabis and are feeling better and are enduring fewer risks as a result," Dr. Kerr said. "The whole prospect of decriminalization offers many interesting possibilities."
There were 476 apparent illicit drug overdose deaths in B.C. last year, a 30.4 per cent increase from 2014. There were 76 such deaths in January alone – the most in one month since at least 2007.