Pubdate: Tue, 17 Oct 2017
Source: Record, The (Kitchener, CN ON)
Copyright: 2017 Metroland Media Group Ltd.
Authors: Gabriela Novotna and Tom McIntosh
Page: A7


According to the Canadian Institute of Health Information (CIHI), the
rate of opioid poisoning hospitalizations has been steadily on the
rise with about 13 Canadians a day hospitalized for an opioid overdose
in 2014-2015.

The over-prescription of opioids such as OxyContin, a painkiller
previously thought to have a low potential for addiction, led first to
the diversion of legal drugs to the illegal market, and later, to the
dramatic expansion of the illegal production of fentanyl.

As the horror stories of addiction and death have multiplied, it is
now clear that what was once a medical issue is now a population
health crisis.

To date, we have had little success in dealing with this crisis
because we continue to focus on it in terms that fail to understand it
as something other than a problem with illegal drugs.

Seizing fentanyl shipments as they arrive in Canada has done little to
interrupt the supply on the street. Current harm reduction methods,
while moderately effective, still operate within a framework that
places the illegality of the drug at the centre of our understanding
of the issue.

We supply police and other first responders with the opioid antidote
naloxone and ask it be used to keep the addict/offender alive so that
they can, in all likelihood, be processed into the criminal justice

Supervised consumption sites continue to rely on the police to "turn a
blind-eye" to those entering or leaving the facility likely in
possession of illegal drugs.

The success of both Ottawa and Toronto's "pop-up" safe-use sites in
city parks came entirely from the willingness of the police to pretend
they are not there.

As a first step, this is fine. But it is not a long-term

Situating our harm reduction activities within a criminal justice
framework puts the focus on those populations already more likely to
interact with the criminal justice system - the poor and racialized
groups (especially Indigenous peoples).

Harm reduction's success requires police to let "criminal activity"
such as possession of narcotics slide in certain areas and at certain
times in order for people not to die.

We need to see addiction as, first, a health issue, not a criminal
issue - and, second, as a health issue that primarily preys on those
subpopulations that are already economically or socially

Decades of a "war on drugs" has done nothing to reduce the supply or
the demand for substances that, to some extent, are arbitrarily deemed

We learned this lesson with the failed prohibitions of alcohol and,
increasingly, we seem to be coming to terms with it with marijuana.
And we know we can "de-normalize" harmful substances because we have
done it with tobacco.

In 2001, Portugal decriminalized possession of all drugs in amounts
deemed for personal use. Drug use and addiction (not the same thing)
are a public health issue, it asserted, not a criminal matter.

This freed up resources on the criminal justice side to focus on more
important criminal activity. It also allowed harm reduction methods to
integrate preventive messaging more effectively.

Portugal now averages three overdose deaths per 1 million people every
year. The European Union average is 17.3 and the UK average is 44.6.
Canada has had 2,458 opioid related deaths in the past year.

However squeamish it might make us feel, however much we want to cling
to the notion that "drugs are bad," and "just say no," it is time that
we try something new.

The criminal justice system is not the place to deal with addiction.
It is a social and economic problem that requires more than a
patchwork of public health interventions and treatment services based
on local advocacy efforts.

With the scale of this opioid crisis reaching the middle class and
young recreational drug users, many are being missed. Naloxone peer
distribution programs aimed at street-entrenched chronic drug users
are unlikely to reach suburban neighbourhoods. Strategies to reduce
harms of drug use without criminalizing it first need to be embedded
within a wider health and social policy reform.

We recognize that this is calling for a major policy shift in how we
discuss addiction. But as the fentanyl deaths continue to claim more
and more lives, we cannot continue to pretend that we are on the path
to solving this problem when every indicator says otherwise. The
evidence is strong. It is our mindset that needs changing.

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Gabriela Novotna and Tom McIntosh are expert advisers with and researchers with the Saskatchewan Population 
Health and Evaluation Research Unit at the University of Regina.
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