Pubdate: Thu, 19 Oct 2017
Source: Victoria Times-Colonist (CN BC)
Copyright: 2017 Times Colonist
Authors: Gabriela Novotna and Tom McIntosh
Page: A10


Thirteen Canadians a day were hospitalized for an opioid overdose in
2014-2015, according to the Canadian Institute of Health Information,
and the rate of opioid poisoning hospitalizations has been steadily

What began with the over-prescription of opioids such as OxyContin, a
painkiller once thought to have a low potential for addiction, led 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 multiply, it is clear
that what was once a medical issue is now a population-health crisis.

We have had little success in dealing with this crisis because we
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. 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
system. Supervised-consumption sites 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's 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 so people won't die.

We need to see addiction as, first, a health issue, not a criminal
issue, and, second, as an issue that primarily preys on populations
that are economically or socially marginalized.

Decades of a "war on drugs" have done nothing to reduce the supply or
the demand for substances that are, to some extent, arbitrarily deemed
illegal. We learned this lesson with the failed prohibitions of
alcohol and, increasingly, we seem to be coming to terms with it with
marijuana. We also 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 public-health issues, it asserted, not criminal matters. This
freed resources on the criminal-justice side and allowed
harm-reduction methods to be integrated with preventative messaging
more effectively.

Portugal now averages three overdose deaths per million people every
year. The European Union average is 17.3 and the U.K. average is 44.6.
Canada had 2,458 opioid-related deaths in the past year, for a rate of
14.8 per million people.

However much we want to cling to the notion that "drugs are bad," it
is time to 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 the opioid crisis reaching the middle class and
young recreational drug users, many are being missed. Naloxone
peer-distribution programs aimed at streetentrenched chronic drug
users are unlikely to reach suburban neighbourhoods.

Strategies to reduce harms of drug use without criminalizing it first
have to be embedded within a wider health and social-policy reform.

This would mean a major policy shift in how we discuss addiction. But
as the fentanyl deaths claim more and more lives, we cannot continue
to pretend that we are on the path to solving this problem. 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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