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Jane Philpott is a former federal minister of health and minister of Indigenous services. She is dean of the Faculty of Health Sciences at Queen’s University. Oyedeji Ayonrinde is an associate professor of psychiatry at Queen’s University.

Vancouver wants to be the first city in Canada to decriminalize the possession of small amounts of illicit drugs. We support Vancouver’s request for the federal government to grant an exemption to the criminal prohibitions that make it illegal to possess controlled substances. Within the provisions of the Controlled Drugs and Substances Act, the federal Minister of Health has broad power to grant this if she believes the exemption is in the public interest.

It should always be in the public interest to pursue evidence-based drug policy. Our support for decriminalization of the possession of illicit substances stems from a lens of compassion, a commitment to social justice and a recognition that criminal prohibitions have proven completely ineffective in minimizing the harms associated with using drugs.

This is not to say we encourage the use of illicit drugs, nor do we disregard the health and social harms that may arise from their use. Canadians should clearly understand that open access to habit-forming substances is not the purpose of Vancouver’s efforts. Nor should the call for decriminalization be extrapolated to assume legal acceptance of drug dealing.

The use of psychoactive substances can cause serious harms to individuals, their families and communities. The most ominous harm, in the context of a toxic drug supply, is that people who use drugs are at risk of fatal overdose. Opioid-related deaths are up in 2020, and federal models suggest they could surpass numbers recorded at the height of the overdose crisis in 2018. These devastating losses leave a trail of grief and abandoned hopes and dreams.

There is no single story about who uses illicit substances and why. Stereotypes abound, and the risk of criminal prosecution is not evenly distributed. Many Canadians experience problematic substance use. This includes those who suffer chronic pain or post-traumatic stress disorder, as well as victims of violence or sexual trauma. People with anxiety disorders or chronic depression often self-medicate to manage intolerable symptoms. Others with undiagnosed ADHD may use stimulants to help them focus. Individuals with chronic insomnia are also vulnerable. Consumers of prescription medication for pain, sleep disorders and anxiety may inadvertently become dependent and seek pills outside of regulated pharmacies or share with others. In each of these scenarios, Canadians sometimes obtain illicit drugs, breaking the law in their quest for wellness. This contrasts with perceptions of substance use being primarily in the quest of euphoria. These people are among those confronted with being criminalized. Problematic substance use is often the tip of a complex iceberg for individuals with considerable distress.

Criminalization has never been shown to minimize drug use, nor does it advance the pursuit of care, if needed. It may trigger a series of consequences and pathways that rarely help the individual, let alone promote public interest. The most pressing needs of people who depend on substance use are not met by the criminal justice system. What they may need instead are therapeutic interventions for infections, food, companionship or mental-health supports. Criminalization should not be justified as an alternative to the shortfall in services to support people with complex requirements to restore their well-being.

While incarceration may temporarily achieve abstinence from drug use in a controlled environment, it provides no guarantee of long-term abstinence. Nor does it eliminate the complex underlying health and social conditions associated with problematic substance use. We advocate for targeted social care, including housing, access to healthy food, skills training, counselling and employment services.

We acknowledge the need to ensure there are consequences for the opportunistic supply and sale of drugs to members of our communities for commercial gain. This should be well within the purview of the criminal justice system with sufficiently discouraging penalties. Likewise, the use of substances by people in situations that may seriously harm others, such as a pilot, surgeon or bus driver, should be met with proportionate legal and regulatory consequences.

People who are dependent on substances recognize the potentially adverse impact on their lives. From a biomedical perspective, the neurochemical bondage on their receptors is such that conscious and voluntary attempts to quit are fraught with numerous relapses and frustration. Dr. Gabor Mate takes the perspective of the human condition, noting that some people “are too deeply enmeshed in substance dependence for any realistic cure under present circumstances. There is, for now, too much pain in their lives and too few internal and external resources available to them.” This does not mean they are criminals.

We hope the Minister of Health will do what’s right and decriminalize the possession of small amounts of substances – first in Vancouver, then the rest of the country.

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