Pubdate: Wed, 10 Dec 2014
Source: Standard, The (St. Catharines, CN ON)
Copyright: 2014 St. Catharines Standard
Contact: http://www.stcatharinesstandard.ca/letters
Website: http://www.stcatharinesstandard.ca/
Details: http://www.mapinc.org/media/676
Author: Rosana Pellizzari
Page: 8

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 tha! t 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.

Dr. Rosana Pellizzari is medical officer of health at the Peterborough
County-City Health Unit.
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MAP posted-by: Matt