A War on Drugs or a War on People?

By Olivia Mancini, harm reduction worker

Let’s rewind to the 1920s, when Harry Anslinger implemented stringent drug laws that have shaped drug policy for decades. Anslinger introduced alcohol prohibition, which significantly influenced the type of alcohol people were consuming. The drink of choice at the time was beer, but this was difficult to smuggle and conceal. The drink of choice then shifted to spirits because people were able to ship higher amounts of it in smaller containers.

Almost a century later, the government, policymakers, and decision-makers reduced the supply of certain medications (i.e., oxycodone and Percocet). People no longer had access to a safe supply of pharmaceutical drugs prescribed by physicians and had to turn to the illegal drug market for opioids. Today, we still have the exact same issue with opioids, particularly fentanyl. The standard opioid and drug of choice is heroin, but it is a lot easier to smuggle and conceal fentanyl—exactly like the alcohol shift in the 1920s. People switched from taking pills to illegal street-based fentanyl because of drug prohibition and inadequate drug policy.

When people are buying street-based fentanyl, they don’t know how much fentanyl they are going to get. For example, results from samples checked by Toronto’s drug checking service from June 19, 2021, to July 2, 2021, found that 56% of expected fentanyl samples contained at least one benzodiazepine-related drug. People are faced with an evolving dangerous and potent supply of drugs because fentanyl is being cut with different products, such as benzodiazepines.

The increase of benzodiazepines found in fentanyl can be lethal because naloxone (an opioid overdose reversal drug) does not reverse a benzodiazepine overdose, and both opioids and benzodiazepines depress respiration, therefore increasing the risk of overdose-related deaths. As a result, we are now seeing a dual dependency of opioids and benzodiazepines with a drastic increase in accidental drug poisoning overdoses because illegal market drugs are unpredictable and tainted with unknown concentrations of substances. 

Safe Supply Saves Lives

To the critics who oppose evidence-based interventions such as safe supply and safe consumption sites—guess what!? Licensed liquor distributors are already a common example of safe supply, and sites such as bars are examples of safe consumption sites. But because alcohol is legal and regulated, people know exactly how much they are taking and are able to consume accordingly. When people go to the bar, they know how many drinks they will get, and they know their limit. So why are people who use other drugs not provided the same options for purchasing and consuming them?

Physicians who prescribe a safe supply of pharmaceutical drugs to people who use them are not giving people more drugs; they are giving people safer drugs. People have been using drugs for centuries and will continue to do so. Why not remove the barriers and let individuals who use drugs do so in a way that reduces the negative consequences associated with drug use, such as overdose death and transmission of blood-borne infections. It is evident that one solution to the drug poisoning epidemic (created by failed policies) is a medical-grade supply of pharmaceutical drugs.

“Licensed liquor stores and beer stores are the safe supply, and bars are the safe consumption site.”

Safe supply is a revolutionary and innovative approach that humanizes people who use drugs and provides compassionate person-centered care. Avid harm reductionists envision a world where people who use drugs have the agency to develop their own goals and be involved in the decision-making process of their care in collaboration with medical professionals who are supportive and listen to the experiences and expertise of their patients. Medical professionals who provide safe supply—without stigma or judgement—strive to remove systemic barriers to accessing care and improve the quality of life of people who use drugs by their standards.

The Drug Poisoning and Overdose Epidemic Fuelled by Bad Policies

According to the Government of Canada, there have been 21,174 opioid-related deaths from January 2016 to December 2020. This devastating loss of life is predictable due to inadequate drug policies, the war on drugs, and government inaction. Most overdose deaths are accidental due to the toxic drug supply. Every opioid-related death is preventable and a clear policy failure. The COVID-19 pandemic has exposed the inequity of responses to public health emergencies. There has been an outstanding response to the COVID-19 pandemic compared to the obvious insufficient response to the drug poisoning epidemic over the past six years.

The drug poisoning epidemic needs to be tackled with public health interventions instead of criminal justice ones. People who use drugs may not seek support due to the stigma associated with drug use, current drug policies, and the fear of criminalization for illegal drug use. The drug poisoning epidemic is a public health and human rights issue and must be solved by drawing upon proven strategies and policies within a public health and human rights framework. We need the government to understand that the drug poisoning epidemic is a public health issue and not a matter of public opinion.

READ MORE: The history of drug policy in Canada

According to Dr. Charles Atkins, substance use disorder is a chronic health condition with a high rate of relapse, yet we deny or restrict people access to life-saving treatment (i.e., methadone) if their urinalysis comes back positive for drugs. This punitive measure is not practiced in any other medical field. Do we tell people with diabetes that if they consume too much sugar, we will discontinue their medication because we are enabling their unhelpful behaviours? No, we work with the person where they are at by providing psychoeducation and developing treatment goals in collaboration with the person. This is a practical harm reduction approach that reduces the risks associated with diabetes.

Two white tents in a grass field
Moss Park temporary overdose prevention site; Toronto

Why is a safe supply of drugs that keeps people alive and safe, determined by the morals and perspectives of the public? Why do we care what the public thinks? If there is a new diabetes medication, do we have a discussion with the community about whether or not people should have access to life-saving medications, or do we provide it to people who need it? Safe supply is an evidence-based approach that improves the health and well-being of people who use drugs. We need to listen to the evidence to keep people safe and alive. We have already lost over 21,000 lives to the drug poisoning/overdose epidemic in six short years. This is a matter of life or death—no more loss of life due to harmful drug policies. Failure to provide a safe supply of drugs and other essential harm reduction services can only be viewed as negligent and cruel when the evidence shows that safe supply is an effective treatment option. The blood of thousands of lives is on the government’s hands.

Listen to the Experts!

Harm reduction transpired from the minds of people who use drugs. People who use drugs have been relentlessly advocating for safe consumption sites and needle exchange programs for over twenty years. As written in Fighting for Space, by Travis Lupik, a grassroots group of drug users fought for two decades to transform the response to the drug poisoning epidemic and failed drug policy. People who use drugs and activists provided sterile needles and operated safe consumption sites out of rooms and back alleyways in Vancouver’s Downtown Eastside. People who use drugs and activists saved countless lives and reduced the harms associated with drug use to help their most vulnerable community members amidst an ongoing public health crisis.

It is time for the government, policymakers, and decision-makers to listen to the experts. People with lived and living experience of illegal drug use have valuable knowledge and expertise that is vital in developing concrete solutions to the drug poisoning epidemic. They must be meaningfully engaged and consulted in conversations about drug policy reform and harm reduction practices.

Be an Ally

How can you be an effective and supportive ally? Support, listen, empower, and amplify the voices of people who use drugs. Use your privilege and position of power to help overcome the barriers and difficulties many people who use drugs endure such as systemic discrimination and stigma. This can include speaking to your local Member of Provincial Parliament; writing letters to city council, the mayor, or the federal government; or even submitting an opinion article to the newspaper in support of harm reduction and progressive drug policies like legal regulation and decriminalization. If enough people come together to advocate for and collaborate with people who use drugs to fight for drug policy reform and adequate solutions to the drug poisoning epidemic, we will see an impactful social change in our community.

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