With the imminent legalization of cannabis and the ongoing carnage of the opioid epidemic, how to regulate the widespread use of so-called illicit drugs has become one of the dominant public policy issues in Canada.
That is true globally as well, with two philosophical camps vying for supremacy: those who believe drug use is destructive and warrants harsh criminal penalties and those who think that more harm comes from criminalization than from drug use itself.
At one of end of the spectrum is the relentless and chilling drug war waged by Philippines President Rodrigo Duterte, in which at least 4,500 suspected drug dealers and users have been killed.
At the other end is Portugal, which has decriminalized all drugs for personal use and opted to spend money on public health initiatives instead of prosecution and incarceration.
In between, most countries, including Canada, cling to an arcane prohibition regime, with some token harm-reduction measures thrown in for good measure.
All of this is occurring at a time when the supply of drugs, from cannabis to heroin, has never been more abundant. Prices are falling, drugs are increasingly pure and potent, and deaths are soaring.
A report published last year by Global Financial Integrity, a Washington-based think tank, estimated that the global drug trade could be worth about US$650-billion annually.
Yet we have little idea how many people use drugs or why.
The best data available comes from the World Drug Report, published annually by the United Nations Office on Drugs and Crime.
The most recent UNODC report estimates that, worldwide, there are 275 million people who used drugs at least once last year (excluding alcohol and tobacco, of course). That’s only 5.6 per cent of the adult population worldwide.
The total includes:
- 192 million users of cannabis;
- 34 million who take prescription stimulants like amphetamines for non-medical reasons;
- 34 million who take opioids (synthetic opiates);
- 19 million who consume opiates (derivatives of opium like heroin);
- 18 million who use cocaine;
- 21 million who take ecstasy and similar party drugs.
(The total exceeds 275 million because some people consume more than one type of drug. The UN agency also cautions that these figures probably underestimate the reality because it is difficult to collect accurate data when people fear prosecution.)
There were about 450,000 deaths attributed to drug use in 2015, and about half of those deaths were among opioid users.
(This pales in comparison to the six million tobacco-related deaths and the 3.3 million deaths caused by alcohol globally each year.)
The UNODC estimates that 31 million people worldwide have a substance use disorder - addiction in common parlance – and only one in six has received treatment.
The public face of addiction, for both the proponents of get-tough-on-crime and supporters of harm reduction, tends to be injection drug users.
But they are a small minority of drug users; there are about 10.6 million injection drug users (principally heroin) worldwide – with fully half in China, Russia and the United States.
In some parts of the world, like Eastern Europe and Central Asia, prisons are teeming with IV drug users. In places like the Philippines, they are shot to death on sight.
For public health officials, IV drug use is concerning because it risks spreading infectious diseases. Fully half of IV drug users have hepatitis C, and about one in eight are infected with HIV. Overdoses are also common, especially in places like Vancouver, where fentanyl-tainted products are common.
Yet harm reduction measures like providing clean needles, supervised injection sites, opioid substitution programs using methadone and buprenorphine, and heroin substitution are not widespread. According to a large global health study published by the Lancet, only 93 countries have needle exchange programs, and 86 allow opioid substitution.
In recent years, there has actually been a rollback of harm reduction measures as more countries embrace criminalization and repression. Yet we know that prohibition is a costly failure. People like to get high for a variety of reasons – to relax, to self-medicate, for ritualistic purposes. They always have and always will.
The war on drugs has always been about trade and politics, trying to control and contain a lucrative market, and an excuse for political interference. We need to stop treating drug users like commodities to be controlled and contained, and start treating them like people who need to be supported and informed.
The war on people has gone on long enough.