Harm reduction should drive all drug policy

Harm reduction-based policies are known to reduce the incidence of overdose, lower disease transmission rates and reduce the presence of organized crime, writes Heather Bone.

When the Canadian government introduced legislation to legalize cannabis, the rationale was clear: Canada would abandon a model of prohibition in order to, in the words of Justice Minister Jody Wilson-Raybould, “protect youth from the health and safety risks of cannabis and keep those same criminals from profiting from its production, distribution and sale.” This policy was sensibly guided by a philosophy of harm reduction, which aims to reduce the dangers associated with the use of drugs, without expecting people to quit their habit. Harm reduction-based policies are known to reduce the incidence of overdose, lower disease transmission rates and reduce the presence of organized crime, which is why the approach is promoted by leading health organizations, including the Canadian Mental Health Association. However, politicians at the federal, provincial and municipal levels of government have failed to extend this approach and enact harm reduction-based policies more broadly, and at times have moved in the opposite direction completely.

Take the issue of decriminalization: Liberal party members voted overwhelmingly to support decriminalizing all drugs at their most recent policy convention in April, including hard drugs like cocaine and heroin. This policy has proven to be successful in Portugal, where the annual number of drug-related deaths declined by nearly 28 per cent between 1999 (when drugs were decriminalized) and 2006. Additionally, by treating drug use as a public health issue rather than a crime, Portugal saw HIV rates among drug users plummet by more than 50 per cent. Despite this, Prime Minister Justin Trudeau reiterated his intention to maintain the status quo. As a result of this inaction, the opioid crisis will continue to take its toll on Canadian lives. According to the Public Health Agency of Canada, there were roughly 4,000 apparent opioid-related deaths in 2017 — nearly 1,000 more than the year before. Without a shift in government policy, the number of lives claimed by the opioid epidemic will continue to climb.

Safe injection sites have also been heavily politicized. These facilities provide a hygienic environment for recreational drug users to consume intravenous drugs while supervised by medical professionals. Monitoring drug users is crucial, as the Public Health Agency of Canada estimates 92 per cent of opioid-induced deaths are accidental. Studies show that safe injection sites lower overdose rates, facilitate access to treatment and lower the transmission rates of blood-borne illnesses such as HIV. A site in London, Ont., for instance, has reversed 37 overdoses and referred more than 180 people to treatment since it opened. Unfortunately, in Ontario, the PC government recently increased the red tape associated with operating a site, including subjecting the sites to random audits and increasing reporting requirements. The province capped the number of injection sites at 21 and will not allow pop-up sites to operate. Currently 19 sites are operating, which limits the potential for new locations and introduces the possibility that communities will compete against each other

To make matters worse, the two-sided nature of drug policy in Canada extends far beyond illegal drugs. The use of vaporizers, which are widely regarded as both a harm reduction mechanism and cessation aid, is increasingly under attack. Unlike traditional cigarettes, vaping devices don’t contain tobacco, or any form of combustion, which is what leads to cancer in cigarette smokers. The University of Victoria Centre for Addictions reports that vaping products only have 18 toxicants, as compared to the 79 found in cigarettes. Importantly, vape devices also deliver no tar. For this reason, Public Health England and the British Medical Association have concluded that smokers should be encouraged to make the switch to vaping because it is 95 per cent less harmful than smoking.

Despite this evidence, federal law places restrictions on how vape companies can advertise their products to smokers and bans them from correctly labelling their product as a harm reduction tool or possible aid to quitting smoking. At the provincial level, eight provinces have additional e-cigarette legislation, among which only Ontario allows product promotion. Even some municipal governments, such as the City of Halifax and Town of Port Albert, have targeted e-cigarette use with anti-vaping bylaws that treat vaping products in the same way as traditional cigarettes.

Harm reduction is a pragmatic framework, but it requires a radical change in thinking. It starts with the realistic assumption that criminalization is not an effective deterrent mechanism and rests on the belief that individuals should not be punished for crimes against their own bodies. The evidence is clear: the war on drugs has a body count, and harm reduction approaches are the solution. To reduce the harms associated with drug use, governments should apply the same logic behind cannabis legalization more widely.

Heather Bone is a research fellow at the Consumer Choice Center and an Economics PhD Student at the University of Toronto.

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