Opinion: Decriminalize Drug Use

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2018 was previously the worst year on record, with 26 opioid-related deaths in Algoma that year

In the first half of 2020, there have already been 26 confirmed opioid-related deaths and 4 deaths that are likely opioid-related but not yet confirmed

This puts Algoma on pace to experience between 52 and 60 opioid-related deaths in 2020 if the current pace continues.

“Insanity is doing the same thing over and over again and expecting different results.”

Our current approach to drug use and addiction is an abject  failure.

Over 3,000 people in B.C. have died by overdose in the last two years.

B.C.’s provincial health officer, Dr. Bonny Henry is urging the government to decriminalize possession of hard drugs, to decriminalize people who use drugs, to address the overdose crisis.

Decriminalization means that the possession of illegal drugs for personal use would not lead to incarceration or a criminal record.

“Experts, including people with lived experience, agree that our existing drug laws are further stigmatizing people living with addiction, a chronic, relapsing health condition,” Henry said.

“The decriminalization of people who are in possession of drugs for personal use is the next logical and responsible step we must take to keep people alive and connect them to the health and social supports they need.”

Stigma leads drug users to hide their usage and creates barriers to accessing harm reduction and treatment services.

Dr. Henry says the evidence shows that criminalizing people who use drugs does more harm than good.

“This is not the same as legalization. What we are talking about is alternative pathways for people that are caught with substances for their own use, where there are alternatives to criminal charges and incarceration,” Henry said.

“We need to decriminalize people in possession of controlled substances for personal use so that we can protect them from the highly toxic street drug supply and curtail the mounting number of preventable overdose deaths in B.C.”

In 2001, Portugal took a radical step. It became the first country in the world to decriminalize the consumption of all drugs.

At least 30 countries are exploring or have put in place an alternative policy option that decriminalizes people for simple possession and use of controlled substances.

Portugal leads the way, having adopted a decriminalization approach to drug possession for personal use, a system that been endorsed by federal NDP Leader Jagmeet Singh.

Under the 2001 law, drug dealers still go to prison. But anyone caught with less than a 10-day supply of any drug—including cocaine and heroin—is typically sent to a local commission, consisting of a doctor, lawyer and social worker, where they learn about treatment and available medical services. And in Portugal, no distinction is made between “hard” or “soft” drugs, or whether consumption happens in private or public. What matters is whether the relationship to drugs is healthy or not.

Since then, Portugal has seen decreases in crime, spread of HIV and Hepatitis C and in deaths from drug overdoses as well as, surprisingly, overall drug use.

Other countries have changed their drug laws and approach to enforcement and addiction, including Switzerland, Spain, Norway, the Czech Republic, Australia, the Netherlands, Croatia, Argentina, Mexico, Ecuador and Uruguay.

Portugal provides the most comprehensive and well-documented example. The success of Portugal’s policy has opened the door for other countries to rethink the practice of criminalizing people who use drugs.

In the 1990s, Portugal faced one of the highest rates for overdose deaths and drug use in Europe, with people who inject heroin comprising 60 percent of the HIV positive population in the country.

One in every 100 Portuguese was battling a problematic heroin addiction at that time, but the number was even higher in the south. Headlines in the local press raised the alarm about overdose deaths and rising crime. The rate of HIV infection in Portugal became the highest in the European Union.

In response, the government appointed a committee of experts – including doctors, lawyers, psychologists and social activists – to study the problem and make recommendations for a national response. The committee recommended ending the criminalization of people who use drugs, regardless of what drug they are using.

Additionally, they recommended having an honest discussion on prevention and education; providing access to evidence-based, voluntary treatment programs; adopting harm reduction practices; and investing in the social reintegration of people with drug dependence.

The recommendations were accompanied by a new philosophy concerning drugs and drug use based on the following assumptions:

1)   drugs and drug use are not inherently evil; addiction is a disease, not a moral failure

2)  a drug-free society is unattainable;

3)  people use drugs for a number of reasons;

and

4)  punitive policies are unethical and totally ineffectual.

Their approach to solving the problem, instead of compounding it, was the humane, logical approach to helping its citizens.  Understanding it, and then looking at what we do here, should make us think of our approach and policies as almost barbaric.

The response to drug use here is more harmful than the drug use itself.

Harm reduction strategies have also been critical to Portugal’s success. In addition to its treatment centers, the government funds social work agencies that engage with people who use drugs in the street by distributing sterile syringes, hygiene materials, and condoms, while offering information about treatment and harm reduction services. Portugal offers syringe access programs, as well as methadone and buprenorphine, in addition to prison-based opioid substitution therapy.

Supervised drug consumption facilities were created, where drug users can consume drugs in safer conditions with the assistance of trained staff. Such facilities have been running in Europe since 1986, when the first was opened in Switzerland. Others have since been established in several other countries, including France, Germany, Spain, and Greece, while the city of Vancouver in Canada opened North America’s first supervised drug injection site in 2003.  Evidence shows these sites can save lives, reduce public disorder associated with drugs, and lead to a drop in the behaviours linked to HIV and Hepatitis C transmission.

Portugal went from having one of the highest rates of problematic drug use in Europe before decriminalization, to having a rate of overall drug consumption that is much lower than that of other European countries. Aside from marijuana, use for all other drugs has fallen below 2001 levels.

HIV infection plummeted from an all-time high in 2001 of 104.2 new cases per million to 4.2 cases per million in 2015.

Overdose deaths decreased by over 80 percent after decriminalization.  In 1999, 369 drug overdose deaths were recorded in Portugal (36.2 per million); by 2015 that number had fallen to 54 (5.2 per million), far lower than the European average of 20.3 deaths per million.

The number of people entering treatment has increased significantly since decriminalization.   Treatment centers also coordinate with social reintegration teams, which offer advice and support on finding a job or returning to higher education.

Portugal’s decriminalization model has not led to increases in overall drug use, while it has decisively lowered problematic drug use and improved health outcomes.

After decriminalization in Portugal, incarceration for all drug offences, including trafficking, fell by 43 percent.

The language began to shift, too. Those who had been referred to sneeringly as “drogados” (junkies) – became known more broadly, more sympathetically, and more accurately, as “people who use drugs” or “people with addiction disorders”. This, too, was crucial.

The public health community needs to step up and really demand that the criminal justice system separate themselves. They need to divest from each other. Addiction should be handled as a public health issue.

Drug use should be handled as a public health issue. The criminal justice system needs to let go.

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