Justice issue or health problem?

Decriminalization may be just what Canada needs to address the opioid crisis

On Jan. 31, British Columbia shook the Canadian drug policy landscape by decriminalizing the personal possession of illegal drugs. The province received an exemption from Health Canada’s Controlled Drugs and Substances Act to test decriminalization as a pilot until Jan. 31, 2026.

North America has had a shift in policy strategies that aim to address the rising rates of drug use by reducing barriers to treatment. Over 50 years have passed since Richard Nixon first declared the “war on drugs” in 1971, and we’ve learned much since then. We have shifted from excessive regulations, fines, and even jail time for personal drug use, to the legalization of marijuana and decriminalizing illicit drugs.

The question on everyone’s mind is whether B.C. is trailblazing the next big policy change in Canada or making a grave mistake.

SOBERING STATS

Before we look at past examples of decriminalization worldwide and how they fared, we need to look at the scale of the problem in Canada.

Opioid overdoses are one of Canada’s leading causes of preventable, injury-related deaths. Across the country, there have been as many as 10,300 opioid-related deaths between January 2016 and September 2018.

British Columbia had 1,644 overdose deaths between January and September 2022, putting them on pace to have over 2,000 overdose-related deaths for the second consecutive year. The overdose rates in B.C. are higher than in any other province in the country, which is why policymakers have been scrambling for solutions.

HEALTH ISSUE

The primary goal of decriminalization is to shift our current treatment of addictions from a criminal justice issue to a health issue.

People with addictions are faced with enough stigma and barriers to treatment that no one should ever fear incarceration when they are seeking treatment.

Health policy should focus on providing the population with equitable and fair access to resources, and our current system is failing in that respect. Harm-reduction strategies, including safe needle exchange programs, safe injection sites and drug testing kits have been gaining traction and showing positive results in recent years.

Substance use disorder is defined by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) as, “patterns of symptoms caused by using a substance that an individual continues taking despite its negative effects.”

People with addictions will continue to purchase, use and abuse illicit drugs despite the consequences that they may face. With this in mind, we should not punish drug users by locking them in jail, separating them from their families, and fining them money they can’t afford to pay.

Instead, we should give them every opportunity, resource, and support they might need on the path to recovery.

These are the reasons policy-makers want to use decriminalization to remove barriers and give drug users the help they need. For decriminalization to work in reducing problematic drug use, sufficient health-care and addiction resources must be in place once these barriers to treatment are removed.

SUCCESSES, FAILURES

B.C. is not the first place in the world to decriminalize drugs, and it won’t be the last. If the province wants to see a reduction in the rates of overdose injuries, deaths and transmission of blood-borne infections, it must learn from other jurisdictions.

First, we can learn from Oregon’s rocky decriminalization program. Oregon was the first state in the U.S. to decriminalize drugs, in February 2021. Surprisingly, the state saw a 52 per cent increase in opioid deaths in the first year, shocking policy-makers nationwide.

The unexpected increase could be the result of poor social support services or accessibility of these services, or because of delays in funding for addiction programs to meet the newly increased demands of the population.

Portugal saw the exact opposite outcomes for decriminalization when compared to Oregon. The country decriminalized drugs in 2001 and immediately saw improved health outcomes in the population. Overdose death rates went from some of the highest in Europe pre-decriminalization to a low of six deaths per million compared to the European average of 23.7 deaths per million in 2015-16.

Decriminalization has also drastically changed the prison population in Portugal because fewer people are being incarcerated for drug possession in low quantities.

Portugal’s creation of the Commissions for the Dissuasion of Drug Addiction was one of the major drivers for its success in reducing problematic drug use.

This panel consisted of legal, health and social professionals who met with addicted individuals on a case-by-case basis and helped them in a non-judgmental way by focusing on harm reduction.

Individuals who failed to appear before the commission when summoned could face legal consequences depending on the substance they were caught using.

British Columbia could benefit from a similar government-run committee that helps refer users to appropriate resources while ensuring their safety is the top priority.

B.C. is taking a leap of faith by decriminalizing drugs in the province, and it may become a frontrunner for innovative harm-reduction policy across Canada.