An appetite for action: Summary of Montreal public health dialogue

Stigma and a lack of knowledge around the social determinants of health were identified as barriers towards taking action.

The Montreal Dialogue was held virtually on October 7, 2020 and attended by 47 participants. The people at the Dialogue represented government, harm reduction organizations, law enforcement, community workers, health care staff, racialized communities, and people with lived and living experience of drug use.

The event brought people together to talk about drug policy in Canada. There was an appetite for action: “We have the scientific data, we know the solution, we [could have] applied it yesterday.” Participants noted that these were “not emotional, but thoughtful requests.”

The Dialogue was planned and delivered by Canadian Drug Policy Coalition, Simon Fraser University’s Wosk Centre for Dialogue, and local partner Association des Intervenants en Dependance du Quebec (AIDQ). The gathering was respectful and emotional, with a great desire on the part of participants to discuss action. Many observed an increase in overdoses, especially during the recent wave of the COVID-19 pandemic. One participant felt that the response to the overdose crisis in Montreal was sorely—and fatally—lacking: “Right now, it’s disastrous. The crisis has not stopped, but increased since COVID-19. In August there were 147 deaths from overdoses.”

In Montreal, a significant number of Dialogue participants worked in law enforcement. One officer noted that collaboration with police is important, even within the context of a broader movement of defunding police forces: “It is absurd to think we can do this without the police.” In another conversation, a participant offered some nuance to this perspective, commenting that the City of Montreal continues to issue tickets to individuals for not adhering to COVID-19 measures related to distancing in public space, which further marginalizes those who use drugs in those spaces, with fewer places they can occupy.

“Right now, it’s disastrous. The crisis has not stopped, but increased since COVID-19. In August there were 147 deaths from overdoses.”

One person felt that police need more education about the issues affecting people who use drugs and the pernicious effects of stigma, especially for those accessing emergency services. Another participant noted that they have observed that police and public health officials have begun working more amicably, while another person added that it was still harmful to issue tickets and seize property during interactions with officers.

READ MORE: Recommendations for change from the Montreal Dialogue

“In 25 years of [drug] consumption, I have never been arrested. I’m afraid I’ll end up in jail without methadone. Heroin was the only drug that helped me with my anxiety and to cope with life. People think we’re junkies (sic.). I want people to understand that there are all kinds of reasons for taking drugs. There are some who take drugs to survive.”

Other topics that surfaced during discussion included the use and distribution of naloxone kits; the needs of women; and the importance of de-stigmatizing perceptions of people who use drugs, emphasizing that people from all walks of life and socioeconomic statuses consume drugs, and will do so for the duration of their lives.

READ MORE: Decriminalization Done Right: A Human Rights and Public Health Vision for Drug Policy Reform

People commented on the need for safe supply, safe consumption sites, and decriminalization, and they revealed how criminalization creates violence, and can create unhelpful contact with police and city bylaw officials. One participant said that drugs should be treated like cannabis and alcohol, while another indicated that the City should decriminalize drugs while also regulating and legalizing them. “Legalization is the only choice…which allows de-stigmatization. As long as there is a law that punishes consumption, there is an inevitable structural stigma.” Stigma and a lack of knowledge about the social determinants of health were identified as barriers towards taking action.

About Canadian Drug Policy Coalition

Advocating for public health- and human rights-based drug policies grounded in evidence, social justice, and compassion. www.drugpolicy.ca