Whistler

September 10, 2018

Act Local: Think National How localities can drive innovation in drug policy Union of BC Municipalities

Illicit Drug Overdose Deaths incl. and excl. Fentanyl (BC)

January 1, 2008 – January 31, 2018. BC Coroners Office, March 2018.

Historical Context

•  BC historically a leader in thinking related to problematic substance use: •  CCF MLA Ernie Winch – 1950’s advocated for maintenance doses (the

British system) for people who use drugs – health issue vs. criminal issue

•  The Community Chest and Council of Greater Vancouver’s Special Committee on Narcotics was established. Dr. Lawrence Ranta released Ranta Report (1952) calling for narcotic clinics to dispense maintenance doses of legal drugs like heroin and morphine

•  Robert Halliday, early 60’s – 1st Methadone prescribing in Canada for opioid dependency

•  1990’s Harm Reduction movement, Four Pillars Drug Strategy, heroin assisted treatment and Supervised Consumption Services

•  April 12th, 2018 – City of Vancouver calls for a Federal Task Force to explore decriminalization of drugs for personal use

3

The Gentlemen’s Club, 1975

“...The Commission has done truly constructive work.

By now, the problems have been clearly defined and some

of them have been solved, or the instruments of their

solution have been created: non-medical consumption of

opium, coca leaf, cannabis, and of the drugs manufactured

from them is outlawed in principle and is bound to disappear after transitional periods of adaptation…”

—”Twenty Years of Narcotic Control Under the United Nations— Review of the Work of the Commission on Narcotic Drugs,” Bulletin on Narcotics (1966)

The Iron Law of Prohibition

“The harder the enforcement, the

harder the drugs.”

Photo: Bruce Taylor, New Hampshire State Police Forensic Lab

The United Nations Gang

Photo: The Vancouver Sun (January 17, 2012)

The Bacon Brothers

1000 Crosses, Oppenheimer Park

Photo: Elaine Brière

Trends in Opioid-Related Deaths by Year and Age Groups (ON)

1991 to 2015. The Ontario Drug Policy Research Network, April 2017.

Apparent Accidental Fentanyl Poisoning Deaths (AB)

Alberta Health, Analytics and Performance Reporting Branch. Opioids and Substances of Misuse, Alberta Report, 2017 Q4. March 2, 2018.

Apparent Accidental Drug Poisoning Deaths Related to Carfentanil (AB)

Alberta Health, Analytics and Performance Reporting Branch. Opioids and Substances of Misuse, Alberta Report, 2017 Q4. March 2, 2018.

A Public Health Approach Reduces the Harms of Prohibition and Corporate Promotion

PublicHealth

Comprehensiveservicesforpeoplewhousedrugs

Prescriptionofheroinandstimulants

Decriminalization(Portugal,2001)

Regulation(cannabis,2018)

Drugchecking

Health Officers Council of BC (2011)

The Harms of Prohibition

CriminalProfit

Underminesdevelopmentandsecurity,fuelsconflict

Threatenspublichealth,spreadsdiseaseanddeath

Wastesbillionsondruglawenforcement

Createscrimeandenrichescriminals

Promotesstigmaanddiscrimination

Deforestationandpollution

Undermineshumanrights

Count the Costs (2016) Transform Drug Policy Foundation

17

Impact of Criminalization “Criminalization of substance‐using behaviors exacerbates stigma and produces

exclusionary processes that deepen the marginalization of people who use illegal substances.” Livingston, J. D. et al. (2012)

“However, the association of stigma and discrimination with the poor health among drug users is a cause for concern in a population that suffers from myriad health problems and has limited access to health care.” Ahern, Jennifer et al. (2006)

“This evidence base provides clear support for moving away from the use of criminalisation as a strategy to try to limit the harms of drug use.” DeBeck, Kora et al. (2017)

“Criminalization of drug use also increases exposure to violence and fosters stigma, discrimination, and social exclusion.” Maher, Lisa et al. (2017)

“The evidence presented here indicates that, in the absence of reforms to current legal and policy frameworks, attempts to end both the HIV and HCV epidemics, and to reduce the harms associated with injection drug use, will continue to fail.” DeBeck, Kora et al. (2017)

The Harms of Corporate Promotion

CorporateProfit

Industry-fundedresearchdiscreditsscientificfindingsabouthealthdangers

Maximizesprofitthroughpromotionandmisleadingsafetyinfo

Imperativetoexpandmarketsandtargetspecificpopulations

Cannabiscorporateprofits(tobedetermined)

J. Drope, S. A. Bialous, S. A. Glantz Tobacco Control, British Medical Journal (2004)

A Public Health Approach

Healthand

SocialProblem

s

HeroinCocaine

Tobacco

Alcohol

CannabisMethamphetamine

StrictLegalRegulation

ProhibitionProhibitionwithharm

reduction/decriminalizationLightMarketRegulation

CommercialPromotion

PublicHealth

CriminalProfit CorporateProfit

A Public Health Approach

Healthand

SocialProblem

s

StrictLegalRegulation

HeroinCocaine

ProhibitionProhibitionwithharm

reduction/decriminalizationLightMarketRegulation

CommercialPromotion

CannabisMethamphetamine

Tobacco

Alcohol

CriminalProfit CorporateProfit

PublicHealth

Responses Avail. for Illegal Drugs (Limited)

Enforcement

Educationandawareness

Sociallystigmatizedthroughcriminalization

TreatmentandHarmReduction

Regulation of Cannabis

Age

Degreeofintoxification

Volumerationing

Limitedplacestouse

Requiredtrainingpriortouse

Maximumvolumesforpurchaseandpossession

Trainingofsupplier

Monitoringofusewithdriving

Illegaldealerspursuedbyenforcement

Retailoutletslicensedandlimited

Appearanceofretailoutlets

Taxed

Licensing,locationandopeninghoursofconsumptionfacilities

Sociallystigmatized

Preventionprograms

Treatment

Plainpackaging

Warninglabels

Noadvertisingoreventsponsorships

Regulation of Heroin Age

Degreeofintoxification

Volumerationing

Limitedplacestouse

Requiredtrainingpriortouse

Registrationofpurchasers

Licensingofusers

Trackingofconsumptionhabits

Drugconsumedonlocationofsale

Prescriptiononly

Maximumvolumesforpurchaseandpossession

Trainingofsupplier

Monitoringofusewithdriving

Illegaldealerspursuedbyenforcement

Retailoutletslicensedandlimited

Appearanceofretailoutlets

Pharmacyspecialistrequired

Priceandprofitcontrols

Taxed

Licensing,locationandopeninghoursofconsumptionfacilities

Sociallystigmatized

Preventionprograms

Treatmentavailable

Plainpackaging

Concentrationofproductisrestrictedandlabeled

Warninglabels

Noadvertisingoreventsponsorships

Cleanneedlesandhealthinformationprovidedwithpurchase

Consumers Union Report 1972

“On the central issue of narcotics addiction, accordingly,

Consumers Union recommends (1) that United States drug policies and practices be promptly revised to insure that no

narcotics addict need get his drug from the black market;

[...]; (3) that other forms of narcotics maintenance, including

opium, morphine, and heroin maintenance, be made avail-

able along with methadone maintenance under medical

auspices on a carefully planned, experimental basis.”

—Consumers Union Report on Licit and Illicit Drugs (1972)

Vince Cain Report 1994

On legalization:

“Canadian laws and United Nations conventions control this matter, but that ought not detract from the reality of the

situation in British Columbia. We have the problem, and we must

do what we can about it, now. Consequently, I am recommending

the establishment of a commission to examine and challenge

those legal aspects of the problem, […].”

—Report of the Task Force into Illicit Narcotic Overdose Deaths in British Columbia, Office

of the Chief Coroner (1994)

Vince Cain Report 1994

“The problem must be looked at with regard to not only the

aspect of deaths from heroin and cocaine, but rather the entire

smorgasbord of available illicit narcotics, both so-called ”soft”

and “hard” drugs. Simultaneously, I am recommending

the decriminalization of simple possession of specific

“soft” and “hard” drugs, […].”

—Report of the Task Force into Illicit Narcotic Overdose Deaths in British Columbia, Office of the Chief Coroner (1994)

City of Vancouver 2005

“Recommendation 24: That the Federal Government initiate a

process of reviewing Canada's legislative, regulatory and policy

frameworks governing illegal drugs with regard to their effecti-

veness in preventing and reducing harm from problematic drug

use and their effectiveness in enabling municipalities to better

address the harm from the sale and use of these substances at the local level AND establish a process with broad participation

to consider regulatory alternatives to the current policy of

prohibition for currently illegal drugs.”

—Preventing Harm From Psychoactive Substances (2005)

Lancet Commission 2016

“Decriminalise minor drug offences—use, possession, and petty

sale: The long experiences in Portugal, the Czech Republic, and

other countries with decriminalisation of minor drug offences

demonstrate the benefits of treating minor infractions without

recourse to criminal sanctions.”

—Lancet Commission on Public Health and Drug Policy (2016)

Lancet Commission 2016

“Scientific approach to regulatory experiments: We believe

that the weight of evidence for the health and other harms

of criminal markets and other consequences of prohibition

catalogued in this Commission is likely to lead more countries

(and more US states) to move gradually towards regulated

drug markets—a direction we endorse.”

—Lancet Commission on Public Health and Drug Policy (2016)

British Medical Journal 2016

“Evidence and ethics should inform policies that

promote health and respect dignity. It is no surprise, then,

that (there have been calls for reform, including from the

World Health Organization, UNAIDS, the UN Development

Programme, and the UN human rights agency, as well

as non-governmental organisations, former heads of state, UK parliamentarians, some law enforcers,

and medical journals.)”

—The war on drugs has failed: doctors should lead calls for drug policy reform (Nov 14, 2016)

•  Acknowledge the catastrophic drug policy failure

•  Stop pretending that more of the same will work.

•  Facilitate implementation of harm reduction services where needed including supervised consumption sites, overdose prevention sites, naloxone and other life saving measures

•  Advocate for decriminalization of possession for personal use

•  Support efforts to replace the drug supply through public health distribution mechanisms

•  Work towards ending prohibition and building a comprehensive system of care for those who need it

What can local governments do

Thank you!

drugpolicy.ca