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There has been, in recent months, intense attention paid to the devastation wrought by opioids and endless debate about the potential health impacts of legalizing marijuana.

Meanwhile, we continue to be willfully blind to the damage done by a deadly, damaging and commonly used drug: alcohol.

That opioids overdoses caused an estimated 2,000 deaths in Canada last year is front-page news, and rightfully so. The spike in mortality is troubling.

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A Killer High: How Canada got addicted to fentanyl

But alcohol kills more than 5,000 people annually, year in and year out. (And, of course, there's tobacco, which kills 37,000 Canadians a year, but at least we discuss and act upon the health impacts of smoking.)

Alcohol is too often portrayed as good, harmless fun.

Yet a new report from the Canadian Institute for Health Information shows that 77,000 hospitalizations in Canada last year were entirely caused by alcohol – more than heart attacks. And that doesn't include people treated in the ER for alcohol-related conditions and then released.

Alcohol kills and maims in a perversely diverse number of ways.

There are the acute problems such as alcohol poisoning (read: overdose), withdrawal and delirium. There are the long-term impacts such as cirrhosis of the liver, pancreatitis, an increased risk of developing several cancers and damage to the fetus such as fetal alcohol spectrum disorder and exacerbation of mental illness. All told, alcohol negatively affects more than 200 health conditions.

Alcohol misuse fuels violence, sexual assault, suicide and traumatic injuries, and does immeasurable damage to families and relationships.

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Impaired driving not only kills – 1,497 deaths last year, including 883 involving alcohol, according to MADD Canada – but it is the single most common criminal offence in Canada; 30 per cent of all criminal charges are related to alcohol abuse or misuse.

Needless to say, all this is costly.

Alcohol misuse cost the economy $14.6-billion – in lost productivity, direct health costs and enforcement. But note that this number is from 2002, the most recent year for which data is available; why we don't routinely measure the health and economic impact of a drug used by 80 per cent of adults beggars belief.

Now, at this point in the litany of alcohol's sins, the pot people will be chomping at the bit, claiming "cannabis never killed anyone." Some even suggest that we would be better off if there were fewer drinkers and more tokers.


There are a number of lessons, good and bad, that can be taken from our experience with alcohol that can inform the legalization of marijuana and, to a lesser extent, the opioid-overdose crisis.

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First of all, drugs – all drugs – can be used responsibly, or irresponsibly.

Prohibition doesn't work. We should legalize (and regulate) all drugs.

When you legalize drugs selectively – such as alcohol and now cannabis – you send an implicit message that they are safer and better.

Legalization doesn't magically make a drug safer. The dose makes the poison.

The biggest problem with alcohol is that it's overused. Drinking has become the norm in virtually all social settings, rather than an occasional pleasure.

If you want responsible, healthy drug use, smart regulation and good education are essential.

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With alcohol, we've done a middling job on both counts, and we shouldn't repeat those mistakes with marijuana.

For the longest time, driving was seen as okay if you only had "a few." That culture hasn't changed entirely.

The rules should be clear: Don't drive if you drink; don't drive if you smoke or otherwise consume marijuana. (There are already fatalities involving cannabis-impaired drivers; we don't need more.)

We need to do away with pointless criminalization of drug possession but, at the same time, we have to be unflinching in imposing penalties if misuse harms others.

With alcohol, we've learned that how a drug is labelled, where it is sold and how much it costs impacts consumption.

We know, too, that drugs can have a deleterious effect on the developing brain, so we have to pay particular attention to young people. That doesn't mean trying to scare them with Reefer Madness-type warnings. Currently, the guidelines for alcohol use are far more lax than for cannabis and that doesn't make sense.

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We need to talk frankly about the risks and benefits of drugs and encourage responsible use of alcohol, cannabis or whatever other drug people, young and old, choose to dabble in.

We also need to update our culture norms, beginning with abandoning our hypocritical romanticizing and normalization of alcohol.

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