Alexander Kwasniewski is a member of the Global Commission on Drug Policy and former president of Poland. Anand Grover is a member of the Global Commission on Drug Policy and former UN Special Rapporteur on the right to health.
Canada has recently become the centre of gravity of the global debate on drug-control policies. Indeed, not only did the government pass its bill to regulate marijuana, making it the first G7 country to legalize the recreational use of an illicit substance, it also hosts the 25th Harm Reduction International Conference in Montreal this week, at a time when the country is facing a countrywide opioid epidemic.
The question that arises is how a country that is courageous enough to address, once and for all, the harms related to marijuana by legally regulating it, can be this shy in addressing opioids, a substance that other countries have managed to control effectively? The responses relate to three different sets of interventions that the state chooses to implement, from prohibition, to harm reduction, and finally, regulation.
The prohibition of drugs, which stems from a misguided notion that drugs can be eradicated, guides the global approach based on punishment and social discrimination. It has caused numerous harms, which have been widely described in existing scientific literature. These include those that are a direct consequence of drug use, such as fatal overdoses and dependence, but also those fuelled by punitive policies, such as transmission of HIV or hepatitis, restricted access to health services, loss of employment, loss of custody of children, and other consequences of a criminal record.
The implementation of health- and social-based harm-reduction measures implies the recognition of the reality of drugs in society, which Canada clearly does. This is highlighted by last year's removal of the ban on heroin-assisted treatment and the projected repeal of the Respect for Communities Act. This should make it easier for more cities like Vancouver, and recently Montreal, to open, or to seek approval to open supervised consumption facilities.
However, the positive outcomes of harm-reduction measures are, to a large extent, impacted by the level of criminalization of drug use. Under the prohibitionist regime prevailing in Canada, their effectiveness remains limited. The opioid epidemic continues to drive the rise in drug-related deaths, and HIV prevalence among people who inject drugs remains above 11 per cent, while in countries that have implemented comprehensive harm-reduction measures, such as Australia or Western Europe, rates are below 5 per cent.
Criminalization further creates legal barriers that restrict access to harm-reduction services (in communities, as well as in close settings like prisons), but it also perpetuates the discrimination and marginalization of people who use drugs. This effectively means that they do not seek or have access to the health care and other rights that they are entitled to, preventing any opportunity for them to lead balanced, productive lives. Indeed, now that marijuana is being legalized, it is even more obvious that consumers whose lives are most affected by the criminalization of other drugs are the most vulnerable people in society, those without a voice.
These barriers can be removed more effectively when consumption and possession are decriminalized. Ending all criminal and civil penalties for the consumption of drugs and possession for personal use, however, should be considered as a step toward regulation, which represents the ultimate response that governments must implement to take control of drugs, their manufacture, their use and their market. It is the single solution to effectively limit not only health harms but also social harms, such as violence, poverty, corruption, and the power of criminal organizations.
Indeed, the more dangerous a substance is considered to be, the more reason there is to strictly regulate it. Each substance requires a distinct approach, since there are different levels of dangerousness and different ways of use, but we are hopeful that Canada's regulation of marijuana can inspire thoughtful policy reforms for other drugs as well – here and elsewhere. Certainly, we are grateful for the country in proving that courageous and innovative policies are still possible.
Canada's initiative will provide the world with a first-hand experiment on regulating an illicit drug, with tight scientific monitoring, delivering results that will hopefully eliminate the persistent prohibition-based misconceptions about illicit drugs and their use. It spearheads a truly global shift in mindset away from repression and towards policies more respectful of equity, justice, human rights, and the dignity of all citizens.