public health approach to drugs
Society is beginning to realize that our current approach to drugs, focused on criminalization and prohibition, isn’t working. It has not reduced the availability of drugs and their harms; therefore, there is growing interest in exploring new, evidence-based approaches and alternative strategies.1 Approaches based on public health and human rights, with attention to equity, social justice, evidence, and the underlying determinants of health, would place greater importance on individual and community well-being in policy decisions. This sharply contrasts Canada’s historical approach to substances.2
In practice, a public health and human rights approach to drugs would create policies designed to promote and protect health, as well as prevent disease, injury, and disability. For example, supervised injection and overdose prevention sites accomplish these aims, whereas arrest, prosecution, and jail time for substance use do not. People who spend time in jail are more likely to overdose upon release and suffer destabilizing social and psychological consequences that negatively impact their health and wellness.
The goal of a public health- and human rights-based approach to drugs is to promote the health and wellness of all members of a population and reduce inequities within it. This approach also ensures that the harms associated with policies and laws are not disproportionate to the actual harms of the substances themselves.3 Take for example cannabis: the overall harms of a jail sentence on a person’s health and wellbeing are much greater than the actual harms of consuming the substance, yet low-income and racialized communities have long been targeted by punitive drug laws that have thrown people in jail for possession. In this way, policies based on criminalization are not in line with a public health and human rights approach.
“A public health and human rights approach includes the perspectives of people who use or are affected by problematic substance use, and ensures that a continuum of interventions, policies, and programs are implemented that are attentive to the potential benefits and harms of substances, as well as the unintended effects of the policies and laws implemented to manage them.”~ Canadian Public Health Association
This approach takes into account a whole range of factors determining whether someone is healthy or not throughout their life, and whether they are treated with fairness and equity. It is a holistic, comprehensive approach that includes not only addressing the traditional physical, biological, and psychological factors contributing to wellness, but also the social determinants of health—such as wealth distribution, education, housing, and social inclusion— as well as the determinants of social and health inequities, like power imbalance, racism, classism, ageism, and sexism.
A public health and human rights approach recognizes that problematic substance use is often a sign of underlying issues and inequities; emphasizes evidence-based, pragmatic initiatives; and considers social justice, equity, and respect for human rights.4 It supports evidence-based prevention strategies (especially for children and youth), high-quality mental health services, easy-to-access evidence-based treatment options, recovery and social supports, rehabilitation, harm reduction, and elimination of stigma and discrimination.5 To support human rights, this approach means that access to these services should also be equitable.
[1-5] Canadian Public Health Association