Pubdate: Tue, 09 Dec 2014
Source: Peterborough Examiner, The (CN ON)
Copyright: 2014 Peterborough Examiner
Contact: http://www.thepeterboroughexaminer.com/letters
Website: http://www.thepeterboroughexaminer.com/
Details: http://www.mapinc.org/media/2616
Author: Rosana Pellizzari
Note: Dr. Rosana Pellizzari is medical officer of health at the 
Peterborough County-City Health Unit.
Page: 4

DRUGS ARE A HEALTH MATTER, NOT A CRIMINAL ISSUE

There is a discussion that is gaining traction in many circles across 
the country and at many levels, and it's about drugs. Not medications 
like antibiotics or blood pressure pills, but psychoactive substances 
that, when ingested, inhaled, injected or absorbed through skin or 
mucous membranes, affect brain chemistry and alter mental functions.

These include legal substances like the highly addictive nicotine in 
tobacco, or the alcohol that is found in beer, wine or spirits. It 
includes prescribed narcotics and stimulants. And it includes a wide 
range of illegal substances like cannabis, methamphetamine, LSD and heroin.

Humans have been consuming these substances for thousands of years. 
We know that about 20% of Ontarians use tobacco, and up to 85% of 
Canadians will consume at least one alcoholic beverage per year. 
Numbers for illegal psycho-active substances are harder to come by. 
The 2012 Canadian Alcohol and Drug Survey found that 10% of 
respondents had used cannabis in the past year and 1% or less 
reported use of cocaine, ecstasy or hallucinogens.

Societies manage these substances in a variety of ways. 
Criminalization and prohibition are options on one extreme end of the 
spectrum, all the way to commercialization on the other, with 
legalization and regulation somewhere in between. There are problems 
with both extremes, with prohibition creating the context for 
institutionalized crime, corruption and violence, and 
commercialization allowing profits to drive sales promotion and 
consumption. Either way, there are harmful consequences.

The idea gaining traction is that we can shift the historical debate 
between criminalization and legalization and reframe it using a 
"public health" approach to prevent these harms, promote the health 
and wellness of all members of a population, and reduce the social 
inequities that are accentuated by these extreme approaches. The 
Medical Officers of Health in British Columbia have started building 
support for this approach with their 2011 paper, "Public Health 
Perspectives for Regulating Psychoactive Substances". The Public 
Health Physicians of Canada endorsed this approach at our 2012 
general meeting in Ottawa. Then, in May of this year, the Canadian 
Public Health Association released a national discussion paper. 
Ontario's Medical Officers of Health have now indicated a desire to 
study the subject as most of our substance misuse work provincially 
has been limited only to preventing infection (through needle 
exchange programs) and unintentional injury.

So, what exactly IS a "public health" approach, and what does it have 
to offer? The approach is grounded in the principles of social 
justice, attention to human rights and equity, evidence-informed 
policy and practice, and addressing the underlying determinants of 
health that often drive behaviour and impact health outcomes. It 
would include the perspective of people who use or are affected by 
the problematic substance use. It would ensure a continuum of 
interventions, policies and programs that address not only the 
substance use but the unintended effects of any policy or law that is 
implemented to manage the harms of substance use. It includes 
strategies such as good data collection to inform decision-making, 
population health assessments, prevention and harm-reduction, and 
health protection efforts. It would also include a full range of 
targeted, effective health promotion activities unlike the 
politically-suspect anti-marijuana PSAs produced by the federal 
government that are currently airing on TV.

It would definitely require research and evaluation to support the 
adoption of evidence-based strategies, with strong leadership in all 
four pillars of a comprehensive drug strategy that acknowledges the 
need for prevention, treatment, harm reduction and enforcement, like 
our local Peterborough Drug Strategy does. A shift to a public health 
approach is not without risk, but jurisdictions like Switzerland, 
Norway, Portugal, Australia and New Zealand can teach us important 
lessons. Perhaps its time has come for Canada.
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MAP posted-by: Jay Bergstrom