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A New Approach to Managing Illegal

Psychoactive SubstancesCPHA Conference

May 27 2014

Brian Emerson and Seema Nagpal Co-chairs

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- CPHA Resolutions- CPHA Alcohol and Tobacco Papers

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- Health Officers Council of BC- CPHA Illegal Psychoactive Substances

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Overview of PaperPurpose: –Review available information –Identify options–Provide recommendations and–Stimulate discussion Leading to a public health

approach to managing currently illegal substances.

4

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Overview of paper - continued

Foundational conceptsPublic health importance illegal

psychoactive substancesPolicy Approaches Criminalization and

prohibition; State Control; Commercialization; Prescription

Harms of prohibition & criminalization Public Health Approach – Framework

and examples

5

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Barriers and Facilitators to Public Health Shift

• Values and principles • Economics • Infrastructure • Canadian laws and international

conventions • Programs and projects• Leadership • Evaluation • Research

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Overview of paper - continued

Unintended Consequences of shifting paradigms – risk of commercialization

Vision for 2025Framework for Action and

RecommendationsGlossary

7

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Public Health Approach• Principles based - social justice,

equity, human rights, evidence-informed

• Addresses determinants of health • Organized, multi-level,

mulitsectoral, coherent, comprehensive, efficient, and sustainable

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Public Health Approach (continued)• Recognizes that people use

substances for anticipated and actual beneficial effects

• Attentive to the potential harms of the substances, as well as the unintended effects of associated policies

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• Directional Elements –Vision–Assumptions - explicit–Guiding principles/ethics –Goals and objectives

10

Public health framework

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• Strategies – Universal and Targeted:–Health Promotion –Health Protection–Prevention –Harm-reduction–Health Assessment and

Surveillance –Services for people who are at risk

or develop problems with substances. 11

Public health framework

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Framework for Action and RecommendationsAwareness, Information, and Knowledge Analyze political parties positions Develop national research agenda Public awareness campaigns about a public

health approach Encourage research on therapeutic uses i.e.

stimulant substitution/maintenance treatment, psychedelic medicine

Monitor and disseminating information about the changes in other countries

Establish a national monitoring capacity

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Framework for Action and Recommendations

Collaboration on Strategies and Initiatives Collaborate on communications and advocacy Government of Canada should

Move “Anti-Drug Strategy” lead back to Health Canada

Re-instate harm reduction in federal policy Undertake consultations to prepare Canada’s

input to the 2016 UN General Assembly’s Special Session on Illicit Drugs.

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Framework for Action and Recommendations

Primary Prevention - Children and Youth Create a national dialogue about child and youth

health and prevention of problematic substance use

Empowerment, Harm Reduction and Treatment Broadly implement evidence-based harm

reduction measures Meaningfully involve people who use

substances and support development of peer run organizations

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Framework for Action and Recommendations

Stigmatization & DiscriminationImplement anti-stigma and discrimination

strategies

Evaluation Review the Controlled Drugs and

Substances Act

 Legislative Change Support regulatory changes for managing

cannabis

The Paradox of ProhibitionH

ealt

h a

nd

So

cial

Pro

ble

ms

Market Regulation

Illegal Market Gangsterism

Corporate Profit

HeroinCocaine

Tobacco

Alcohol

ProhibitionDefacto

Decriminalization

Decriminalization Prescription Legalize with

Many Restrictions

Legalize with Few

Restrictions

Public Health

CannabisMethamphetamine

The Paradox of ProhibitionH

ealt

h a

nd

So

cial

Pro

ble

ms

Market Regulation

Public Health

Illegal Market Gangsterism

Corporate Profit

HeroinCocaine

ProhibitionDefacto

Depenalization

Decriminalization PrescriptionLegalize with

Many Restrictions

Legalize with Few

Restrictions

CannabisMethamphetamine

Medical Cannabis

Tobacco

Alcohol

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Key MessagesProhibition & criminalization not

working, creating much harm Public health approach holds

much promise Many lessons to be learned from

tobacco and alcohol experienceMuch to be learned from other

jurisdictions

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Key MessagesManagement of substances - alcohol,

tobacco, pharmaceuticals, and currently illegal substances - is a public health challenge.

Public health needs to step up to the plate to do what it canadvocate for the resources to do morecollaborate with the usual and

unusual partners to shift to a public health model.

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Acknowledgements• CPHA Board and CEO Ian Culbert• Working Group – especially Betsy MacKenzie• Reference Group• Society of Living Illicit Drug Users (SOLID)• Folks at Niva Inc., Anton Holland, for writing and

production• CPHA Staff – Initially Jim Chauvin, subsequently

Frank Welsh, and the dedicated, selfless interns Tasha Shields, Chandni Sondagar, Julia Neufeind, Dominique Morneau; and many others at CPHA.