Debating decrim: hard drugs and hard decisions

Researchers are calling for a B.C. drug-decriminalization pilot project to be rolled out across Canada. They also want to see extensive research conducted in conjunction with the B.C. project, which is the first of its kind in Canada.

Starting in January, B.C. adults found in possession of 2.5 grams or less of four types of illicit drugs — opioids (including heroine, morphine, and fentanyl), cocaine, methamphetamine, and MDMA, more commonly known as ecstasy — will not be arrested or charged. Health Canada granted the province an exemption under Section 56 of the Canadian Drug and Substances Act.

During a May 31 news conference, Mental Health and Addictions Minister Carolyn Bennett said the B.C. exemption will work as a “template” for other jurisdictions across Canada. But she indicated that the federal government will review “evidence-based initiatives” on a case-by-case basis.

'Template' for other jurisdictions

The City of Toronto has formally applied to Health Canada for a similar exemption. But Prime Minister Justin Trudeau and his Liberal government have yet to render a decision, while pledging to work with other cities, like Edmonton, Saskatoon, that are also looking into filing applications. Vancouver had previously applied, but Mayor Kennedy Stewart announced the end of this effort, now that the exemption that covers the entire province.

According to Nicole Luongo, systems change co-ordinator for the Canadian Drug Policy Coalition, there is more that could be done. She is among several researchers who are calling for nation-wide decriminalization and for illicit-drug users to be allowed to possess more than 2.5 grams. In her case, she wants no limits on possession amounts.

“We know from all the available data that's been produced in the last several years that 2.5 grams cumulatively is only going to decriminalize simple possession for probably half, or less, of the people who use drugs, and it's going to exacerbate inequities,” she said. “For example, people in remote and rural areas tend to buy in larger quantities to reduce their engagement with the illicit market and because they have to travel [to get drugs]. So where there are already disparities, those are going to become even more pronounced. And with a threshold of 2.5 grams, that kind of incentivizes drug manufacturers and sellers to increase the potency of drugs, which is gonna, again, increase what is already an incredibly dangerous and volatile illicit market.”

Bennett said the 2.5-gram limit was determined through discussions with law enforcement agencies but could be subject to change. Luongo, a medical sociologist by profession, insisted that higher — possibly unlimited — thresholds need to be introduced.

“The federal government is quite hypocritical in that they're publicly supporting the decrim pilot and saying things like drug use is a public health issue; but then when others request federal decriminalization, [federal officials] defer to the criminal justice narratives. So [the decriminalization program] absolutely needs to be federal and it needs to be a lot more robust with things like those [possession-quantity] thresholds. Overall, I would say that it's partial, it's incomplete, and it falls far short of what we actually need to elicit meaningful change."

Higher threshold and higher impact

Luongo was homeless on Vancouver’s notorious, poverty-stricken Downtown East Side as a youth. She had “compulsive relationships with illegal drug use,” and was “in and out of abstinence and 12-step-based addiction treatment programs” before obtaining bachelor’s and master’s degrees in medical sociology.

With the coalition, she has designed — and now oversees — a project that advances civic and public support for the full legalization and regulation of all currently illegal drugs. In addition to full legalization and regulation, she is calling for elimination of quantity thresholds for “simple possession” and “necessity trafficking”, as well as comprehensive access to safer supply for drug users, and “some sort of reconciliation program” for Indigenous, poor, and racialized communities, so that they can “move up the social ladder.”

The B.C. program stems from the province’s and Ottawa’s desire to curb thousands of deaths linked to opioid use. In 2021 alone, said Bennett, more than 2,200 people in B.C. suffered toxic-drug-related deaths.

She indicated that Ottawa and the B.C. government want to build on the success of safe-consumption sites, also known as safe-injection sites that allow users to consume drugs through a similar exemption. But Luongo does not see a “direct causal link” between decriminalization of hard drugs and increased demand for safe-consumption sites.

“My hope is that, with this decrim pilot, some of the activity around safe-consumption sites will be somewhat safer for people who use drugs, i.e. police will be less incentivized to kind of hover on [safe-consumption site] edges,” she said.

But, she added, safe-consumption site history shows that drug users know what they need and should be at the negotiation table and “leading the charge” on drug policy change. Canada’s first safe-injection site, Vancouver’s Insite, operated illegally for years before a Supreme Court of Canada decision allowed it to operate under an exemption from drug laws. According to Bennett, 37 such safe-consumption sites now operate across the country.

Lack of evaluation metrics 'a flaw'

Luongo said researchers must examine the extent to which illegal drugs become more potent and poor, racialized, and Indigenous communities become more marginalized.

“The evaluation metrics for this pilot have not been decided upon,” said Luongo. “That’s another major flaw procedurally.”

Mark Haden, an adjunct professor in the University of British Columbia medical faculty’s School of Population and Public Health, said the B.C. pilot project is a small step in the right direction. He suggested it “waves the health flag”, which acknowledges the failure of drug prohibition and shifts discussion towards health-based solutions.

“[If provincial officials] only do that, and they don’t take the money that they would save from involving people in the criminal justice system and putting it into the health system, it won’t do a lot of good,” Haden told Research Money. “But it does wave a flag. That’s important [because], basically, what we know from the evidence is the process of drug prohibition is a miserable failure. It’s an economic failure. It’s a social failure. It’s a criminal justice failure.”

Haden said Canada needs to start integrating illicit substances into people’s lives and the country’s social policies, and health services, with more stand-alone safe-injection sites and others within health facilities. He is calling for all drugs to be decriminalized and then legalized with opioids made available through health-based facilities and psychedelics offered through “shamanic-type facilities.”

“So we should have the appropriate controlling mechanisms for these substances — and they vary widely,” said Haden, who is also the director of Clinical Research at Psygen, a manufacturer of pharmaceutical-grade psychedelic drugs for clinical research and therapeutic use.

He called for the B.C. pilot project to include research into the effectiveness of drug prohibition, “because all the research that’s been done to date says it doesn’t work”. Haden suggested researchers should also study the impact on HIV, hepatitis C, overdose death rates, and taxpayer cost savings achieved through fewer arrests.

“What we need as a society is to be guided by evidence because, right now, we’re not,” he said. “We’re largely guided by fear-based sound bites.”

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