Key Points
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Addressing the Canadian opioid crisis begins with harm reduction. Every aspect of our lives is relevant to the opioid crisis and must be reformed. This includes our criminal justice system, healthcare system, education, and so on, and of course how systemic racism permeates them all to disproportionately impact BIPOC.
Harm Reduction
Harm reduction is not a failed approach, but it was never intended to respond to such a toxic drug supply. Additionally, it never tried to pretend to be the entire solution to the opioid crisis. It is still a band aid, but a necessary one. It takes time for policy implementation, but we need action now. Harm reduction strategies can save lives in the short-term with the reversal of overdoses and increasing access to treatment for those interested.
When it comes to the significance of harm reduction, it is important to not let the best be the enemy of the good. This means that only aiming for gold standard of treatment or “best outcome” (abstinence) prevents progress. And that progress means something – it means saving lives. That’s something, we can’t just wait around as people continue to die. (Szalavitz, 2021). Opioid deaths have going up every year for over 20 years and even more would have been lost without implementation of harm reduction techniques. Supervised injection sites are an incredible tool that have saved countless lives and encompass various harm reduction strategies in addition to reversing overdoses, including needle exchange, naloxone distribution, drug testing, and harm reduction/safer smoking kits. Additionally, they increase access to voluntary care with less barriers.
The expansion of naloxone education and distribution is relevant to a harm reduction approach as well. This is especially important as the fentanyl crisis makes overdose reversal more challenging, as it requires a quicker response and higher dose of naloxone to be administered (Szalavitz, 2021).
Care with less barriers is hugely important for people who use drugs. The criminal code exemption in place within supervised injection sites and a harm reduction approach to providing care make a huge difference. One study found that those who attend supervised injection centers are actually more likely to engage in treatment! (Gordon, 2018). The care provided at supervised injection sites may include health education, treatment for infections, access to opioid agonist therapies like methadone maintenance treatment, and more, which help reduce harms and improve quality of life.
Part of harm reduction is also providing hope by showing drug users that people care about their well-being. Harm reduction helps people prove to themselves that they are capable of progress and that can mean everything to someone. To participate in harm reductions strategies as a drug user means to do something for yourself and your health, which can empower people who use drugs by realizing they do have power over their actions (Szalavitz, 2021). A harm reduction approach helps decrease the stigma of behaviors associated with drug use, which is one of the most significant barriers for drug users to access care. As a result, harm reduction strategies help people who use drugs feel heard and begin their unique, nonlinear path to healing.
Furthermore, investing in harm reduction will increase the possibilities for harm to be reduced. For example, current education encourages abstinence from drugs while pregnant, without acknowledging that this is not possible for everyone. Things like choline supplementation for women who cannot quit drinking during pregnancy may reduce permanent damage to fetus brain and should be further explored (Szalavitz, 2021). We also need more funding for pilot programs for new strategies, such as what Timmins, Ontario is doing with Sublocade (keep a look out for a future post on this).
Individual needs are important to consider. What works for one individual may not work for another. Recovery may involve trying out a variety of approaches until one works. There is treatment, but no single answer or “cure.” However, based on the current literature, harm reduction may just be the way to get individuals on the road to recovery in today’s climate.
Decriminalization and Safe Supply
Responding to the tainted supply means implementing an evidence-informed model of decriminalization and safe supply. Criminalizing drug use does nothing to support drug users. Aside from wasting so much money that doesn’t serve communities, arrests don’t determine who needs support, prison doesn’t treat addiction and is not widely available within the system, incarceration makes factors that can help with healing more difficult upon release (ex. Unemployment), and users are more likely to overdose just after being released with programs to educate on these risks being rare (Szalavitz, 2021).
The unjust nature of drug laws is described by Nick Boyce, the director of the Ontario Harm Reduction Network:
"Drug laws in Canada are set at a federal level...The rules around which drugs are legal and which are illegal are not based on any science or evidence. They were based on social control and who was using what drugs at the time. Many people might think that drugs like heroin and crystal meth and cocaine are illegal because they are dangerous, but they are actually more dangerous because they are illegal...Think about alcohol coming on as a new drug in the streets – it can be used safely for some people, but criminalization prevents people from truly knowing what they're getting and contributes to stigma / negative perceptions of who uses what drugs. So, we divert resources that could be used to help people into things like policing, which are ineffective” (Poisson, 2021).
Criminalization of drugs makes it so that there is no quality or potency assurance of those drugs. Removing criminal penalties for drug use and possession (not trafficking) would allow for budgeting of safe supply (Poisson, 2021). Safe supply acknowledges that the lives of drug users matter and that their lives are worth saving. Harm reduction is important, but tainted supply makes some of these strategies less effective. For example, naloxone won’t work on an overdose if that supply has been tainted with benzodiazepines (Poisson, 2021).
Police have varying views on drug policy, but many understand that what we are doing right now isn’t working. Chief constable of police Mike Serr in Abbotsford, B.C. acknowledges that arresting someone for simple possession is not making a difference and understands that decriminalization is part of the solution (Poisson, 2021).
The literature has made it clear that decriminalization has only been associated with positive outcomes, or no change, but never negative. This includes decreased suicide rates, unintentional overdoses, drug-related crime rates, and relevant inpatient hospital admissions (acute mental illness episodes or complications of drug use/addiction). It especially makes sense to do so considering the root of the implementation of these laws being based around systemic racism rather than “protection” of the rest of society.
Additionally, decriminalization decreases stigma and creates a culture that promotes increased voluntary seeking of treatment. The evidence demonstrates that decreased criminal penalties allow for easier treatment access for those struggling with addiction. Harm reduction strategies such as syringe service programs contribute to making mental health resources more accessible through referrals. Prison is not in place to acknowledge addiction, and this makes reconviction unsurprisingly common on those with mental illness.
However, decriminalization must be done right to work. This means we need an evidence-informed model for decriminalization with:
Threshold for possession high enough to see positive change
Decreased role of police in enforcement to prevent discrimination in supply checks and more about healthcare providers leading the way instead
Law enforcement should not have so much control over medical and scientific concerns
Sufficient budgeting for safe supply
Expansion of legal protections for those seeking care
Expungement of criminal records for drug-related charges and justice for those currently in prison
Defunding the Police and Health Promotion – Healthy Public Policy
Decriminalization is still not the entire solution. Various interconnected issues relate to one’s likelihood of being affected by addiction and/or what recovery looks like, and thus the implementation of one intervention on its own is not likely to achieve objective success. Decriminalization and safe supply will help prevent deaths and increase access to treatment, but don’t address the trauma that causes people to use drugs in a “problematic manner.” This can be addressed in part by implementing health promotion strategies that address the social determinants of health, which influence the onset and course of addiction, such as eliminating poverty and increasing access to mental health services.
We can work upstream by addressing the social determinants of health that contribute to one's likelihood of experiencing addiction as well as influence one's recovery such as:
Fighting food insecurity
Affordable housing
Employment rates
Ensuring livable wages
Access to education
Access to free healthcare (including free medical prescriptions)
Of course, it must be acknowledged how aspects of one’s identity such as race and gender play a role in these factors, as these are other social determinants of health.
Defunding the police and diverting funds to social services like mental health supports, public education, healthcare, housing, and transportation.
All of the above address the common features of why addiction occurs which include one’s risk for mental illness, past childhood trauma, and being faced with a hopeless future (Szalavitz, 2021). Therefore, improving the accessibility and quality of mental health supports play a significant role in responding to the opioid crisis from a federal perspective.
Systems Change
Improving education
We must change how we educate youth on drugs and drug use to improve early health literacy
Abstinence-only approaches do not teach kids to take care of themselves; more drug knowledge does not increase likelihood of drug use
Must educate using a harm reduction approach, which includes teaching about the power of drug, set, and setting, when to call 9-1-1, etc
Changing the culture of healthcare
Address those living with untreated chronic pain
Eliminate patient labels of "drug-seeking behavior"
Reforming the criminal justice system and defunding the police
The fight for drug policy reform is aligned with anti-racism efforts and the legal system maintains these injustices
Medical concerns regarding drug use/who needs care should not fall under the responsibilities of the police, need to limit control of law enforcement
Legalization
We must revise or eliminate the federal controlled drugs and substances act to ensure it is based in evidence rather than racism. Legalization would allow for a safe, regulated supply by health-related agency such as Health Canada. We must also ensure there is justice for those serving time for drug-related charges and expungement of criminal records.
I personally don’t know exactly what legalization would like, other than it being based in evidence and following the lead of other countries.
Reparations
BIPOC are disproportionately impacted by the war on drugs as well as other existing systems and these injustices must be corrected with reparations.
Drug laws in Canada are rooted in colonialism, racism, and classism. For these reasons, racialized populations and poor communities are disproportionately affected by these laws and deserve to have these health inequities corrected. Harm reduction involves reducing the harms that colonialism has caused. Justice must be defined by marginalized groups themselves. For example, this includes responding to the TRC calls to action, particularly 31, 33, 34, 36, 38, 42, and 50 relevant to substance use and/or the legal system (Truth and Reconciliation Commission of Canada, 2015).
What Can You Do?
Stay informed
Raise awareness – have conversations with those around you
Call on your MP to take evidence-informed action in responding to the opioid crisis
Support groups already doing the work, like Moms Stop the Harm (MSTH) -- https://www.momsstoptheharm.com/
Attend protests for drug policy reform
Spread kindness to those impacted by problematic drug policies
Everything is interconnected and cannot fight on one front without acknowledging the others.
Until next time,
Raquel
References
Drug Policy Alliance. (2015). Approaches to decriminalizing drug use and possession. Retrieved from https://www.unodc.org/documents/ungass2016/Contributions/Civil/DrugPolicyAlliance/DPA_Fact_Sheet_Approaches_to_Decriminalization_Feb2015_1.pdf
Drug Policy Alliance. (2022). The Drug Policy Alliance’s strategic plan. Retrieved from https://drugpolicy.org/strategic-plan#intro
Gordon, E. (2018). What's the evidence that supervised drug injection sites save lives? National Public Radio. Retrieved from https://www.npr.org/sections/health-shots/2018/09/07/645609248/whats-the-evidence-that-supervised-drug-injection-sites-save-lives
Jesseman, R., & Payer, D. (2018). Decriminalization: Options and evidence. Canadian Centre on Substance Use and Addiction. Retrieved from https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Decriminalization-Controlled-Substances-Policy-Brief-2018-en.pdf
Poisson, J. (2021, October 1). Inside the push to decriminalize drugs in Canada. [Audio podcast episode]. In Front Burner. Google Podcasts. Retrieved from https://podcasts.google.com/feed/aHR0cHM6Ly93d3cuY2JjLmNhL3BvZGNhc3RpbmcvaW5jbHVkZXMvZnJvbnRidXJuZXIueG1s/episode/ZnJvbnRidXJuZXItNWY3NjM4ZjAtNGQ0MC00MGFjLWFkZDctNjEzMjM2ZjE0MGRi?ep=14
Shane, C. (2022). Inadequate threshold quantities will put people who use drugs in harm's way. Retrieved from https://www.pivotlegal.org/inadequate_threshold_quantity
Szalavitz, M. (2021). Undoing drugs: The untold story of harm reduction and the future of addiction. Hachette Go.
Truth and Reconciliation Commission of Canada. (2015). Truth and reconciliation commission of Canada: Calls to action. Retrieved from https://www2.gov.bc.ca/assets/gov/british-columbians-our-governments/indigenous-people/aboriginal-peoples-documents/calls_to_action_english2.pdf
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