Canada moving backwards on illegal drugs.

Hyshka, Elaine ; Butler-McPhee, Janet ; Elliott, Richard 等

In Canada and internationally, illegal drug use remains a major public health challenge resulting in significant levels of morbidity and costs comparable to those of other chronic diseases. (1) Historically, the principal response to illegal drug use has been enforcement and incarceration. Yet data from Canada and elsewhere show that this approach fails to meaningfully reduce supply of--or demand for--drugs and results in many unintended negative consequences. (2) Chief among these have been human rights abuses (such as harassment, coercion, compulsory screening, and denial of life-preserving care) often committed in the course of enforcing the 'war on drugs' and even in the name of drug 'treatment.' (3) As a result, calls for evidence-based approaches have grown louder over the past decade, and countries have begun to shift their illegal drug policies away from enforcement and towards public health objectives. For example, harm reduction initiatives can now be found in 93 countries worldwide, and jurisdictions across Australia, Europe, and the Americas have decriminalized the possession of some or all illegal drugs. (2)

This shift towards rational illegal drug policy has been bolstered by two recent events. On June 2, 2011, the Global Commission on Drug Policy released a high-profile report denouncing the war on drugs and recommending that political leaders worldwide adopt drug policies based on "solid empirical and scientific evidence." The 19-member panel, including current and former heads of state and former United Nations Secretary General Kofi Annan among others, called for countries to 1) end the criminalization and stigmatization of people who use drugs but do not harm others, 2) promote alternative sanctions for small-scale and first-time drug traffickers, 3) experiment with models of legal regulation for currently prohibited drugs, and 4) ensure the availability of a variety of harm reduction measures and treatment options. (4) Domestically, on September 30, 2011, the Supreme Court of Canada ruled 9-0 in favour of maintaining legal exemption for Vancouver's Insite, the country's only supervised injection facility. The ruling declared the facility an important health service. (5)

Despite these promising developments, Canada is moving backwards on illegal drugs. Before 2006, the Canadian government participated in the growing movement towards rational illegal drug policy. In the past, Canada explored decriminalizing minor cannabis possession and enabled the establishment and evaluation of a number of innovative harm reduction programs for injection drug users, including Insite. (6) Unfortunately, in recent years, Canada has become one of the last remaining advocates of the failed 'war-on-drugs' approach.

Since first being elected in 2006, the current government has manifested a disregard for the role of evidence in shaping public policy, (7,8) including several attempts to reorient Canadian drug policy away from public health objectives and towards staunch prohibition.

In October 2007, the government excised harm reduction from Canada's four-pillar drug strategy, despite the success of this approach in countries such as Switzerland, Germany, and Australia and its endorsement by the World Health Organization technical guidelines for preventing HIV/AIDS incidence among injection drug users. (9,10)

The Prime Minister and his cabinet also vociferously opposed Insite, despite dozens of peer-reviewed studies demonstrating that Insite prevents overdose deaths, reduces the HIV/AIDs risk, and connects people who inject drugs to detox in the absence of any adverse public safety or health outcomes. (6,8) Canada's federal police force even took the extraordinary measure of commissioning a known anti-harm-reduction advocate to produce a quasi-scientific critique containing unfounded allegations of bias. The critique was subsequently published in a fake academic 'journal' funded by the Drug Free America Foundation. The government cited this analysis as sufficient rationale for appealing provincial court rulings supporting Insite's legal exemption under the Controlled Drugs and Substances Act all the way up to the Supreme Court (8) (although the government has since indicated it will abide by the court's ruling).

In addition to challenging harm reduction efforts, the current government has made several attempts to pass contentious legislation to intensify the 'war on drugs' in Canada. Their proposed mandatory minimums legislation, part of Bill C-10 and currently before the Senate, would see individuals convicted of cultivating six or more cannabis plants, or those selling drugs near a school or other place frequented by minors, receive a minimum of six months' imprisonment. (11) Mandatory minimum sentences for drug offences fulfils one goal, that of punishment and retribution, but fails to meet broader objectives of deterrence of drug use and rehabilitation of offenders. For example, the proposed legislation ignores strong evidence from the United States indicating that mandatory minimum sentences are ineffective and costly, as well as the Canadian Department of Justice's own conclusion that "drug consumption and drug-related crime seem to be unaffected, in any measurable way, by severe [mandatory minimum sentences]." (12) Over 500 Canadian scientists and clinicians have publicly opposed the proposal for mandatory minimum sentences. (13) Past iterations of the proposed legislation failed to achieve opposition support during the government's minority years. However after being reelected with a majority Parliament in May, the government introduced Bill C-10, which includes mandatory minimum sentences legislation alongside 10 other 'tough-on-crime' proposals. The Prime Minister has promised to pass this legislation within 100 days of the start of the fall sitting (i.e., before mid-March 2012). (14) Notably, Canada's Secretary of State for the Americas declared in June that the government's foreign policy on illegal drugs supported a 'war-on-drugs' approach as a "logical extension" of their domestic policy agenda. (15)

Canada's policy of intensifying the 'war on drugs' domestically and internationally is not supported by science or public demand, has been established despite declining crime and substance use rates, and contrasts starkly with the recommendations of the Global Commission on Drug Policy, the Supreme Court of Canada, and international trends. (16,17) Instead, this policy is motivated by ideological principles of punishment and retribution towards drug users. Thus, international observers of Canadian politics would not be faulted for characterizing this revitalized 'war on drugs' as anachronistic and ill advised.

In the interest of reducing harms related to substance use and protecting the health and safety of Canadians, the government should abandon regressive policies on illegal drugs that have been shown not only to be ineffective but also damaging to public health. It should instead heed the scientific evidence and learn from the experience of countries that have proactively sought to scale up other approaches (including harm reduction services) and reduce their reliance on law enforcement. It is time to recognize that only policies based on evidence, respect for human rights, and public health can successfully address drug use in Canada.

Acknowledgements: The authors thank Tricia Collingham, Deborah Graham and Peter Vann for their research assistance.

Conflict of Interest: None to declare.

Received: July 7, 2011

Accepted: October 30, 2011

REFERENCES

(1.) US Department of Justice: National Drug Intelligence Centre. The economic impact of illicit drug use on American society. April 2011. Available at: http://www.justice.gov/ndic/pubs44/44731/44731p.pdf (Accessed June 2, 2011).

(2.) Wood E, Tyndall MW, Spittal PM, Li K, Anis AH, Hogg RS, Montaner JSG, O'Shaughnessy MVO, Schechter MT. Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: Investigation of a massive heroin seizure. CMAJ 2003;168(2):165-69.

(3.) Open Society Foundation. At What Cost: HIV and Human Rights Consequences of the War on Drugs. Open Society Foundations, March 2009. Available at: http://www.soros.org/initiatives/health/focus/ihrd/article_publications/ publications/atwhatcost_20090302 (Accessed July 4, 2011).

(4.) Global Commission on Drug Policy. Report of the Global Commission on Drug Policy. Available at: http://www.globalcommissionondrugs.org/Report (Accessed June 2, 2011).

(5.) Makin K, Dhillon S, Peritz I. Supreme Court ruling opens doors to drug injection clinics across Canada. The Globe and Mail 2011 Sept 30. Available at: http://www.theglobeandmail.com/news/national/british-columbia/ bc-druginjection-clinic-can-stay-open-supreme-court-rules/article2186191/ (Accessed October 11, 2011)

(6.) Marshall B, Milloy M-J, Wood E, Montaner JSG, Kerr T. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: A retrospective population-based study. Lancet 2011;377(9775):1429-37.

(7.) Nature. Science in retreat [Editorial]. Nature 2008;451(7181):866.

(8.) Wood E, Kerr T, Tyndall M, Montaner JS. The Canadian government's treatment of scientific process and evidence: Inside the evaluation of North America's first supervised injecting facility. IJDP 2008;19(3):220-25.

(9.) DeBeck K, Wood E, Kerr T, Montaner JS. Canada's new federal "National Anti-Drug Strategy": An informal audit of reported funding allocation. IJDP 2009;20(2):188-91.

(10.) Giesbrecht N, Haydon E. Community-based interventions and alcohol, tobacco and other drugs: Foci, outcomes and implications. Drug Alcohol Rev 2006;25(6):633-46.

(11.) Barnett L, Dupuis T, Kirkby C, MacKay R, Nicol J, Bechard J. Legislative Summary of Bill C-10: An Act to enact the Justice for Victims of Terrorism Act and to amend the State Immunity Act, the Criminal Code, the Controlled Drugs and Substances Act, the Corrections and Conditional Release Act, the Youth Criminal Justice Act, the Immigration and Refugee Protection Act and other Acts. October 5, 2011. Library of Parliament. Available at: http://www.parl.gc.ca/About/Parliament/LegislativeSummaries/ bills_ls.asp?Language=E&ls=c10&Parl=41&Ses=1&source=library_prb (Accessed December 8, 2011).

(12.) Gabor T, Crutcher N. Mandatory minimum penalties: Their effects on crime, sentencing disparities, and justice system expenditures. Ottawa, ON: Justice Canada, Research and Statistics Division, January 2002.

(13.) Shore R. Doctors, scientists want proposed federal drug law scrapped. Vancouver Sun. February 7, 2011. Available at: http://www.vancouversun.com/news/ Doctors+scientists+want+proposed+federal+drug+scrapped/4238150/story.html (Accessed May 25. 2011).

(14.) McGregor, J. Senate in no rush to pass omnibus crime bill. CBCNews. December 7, 2011. Available at: http://www.cbc.ca/news/canada/montreal/story/2011/12/07/pol-crime-senate.html (Accessed December 8, 2011)

(15.) Clark C. Canada pledges $5-million to fight drug crime in the Americas. The Globe and Mail. 2011 7 June. Available at: http://www.theglobeandmail.com/news/politics/canada-pledges-5-million-to- fight-drug-crime-in-the-americas/article2051094/ (Accessed June 9, 2011).

(16.) Health Canada. Canadian Drug and Alcohol Use Monitoring Survey: Summary of Results for 2009. Available at: http://www.hc-sc.gc.ca/hc-ps/drugsdrogues/stat/_2009/summary-sommaire-eng.php (Accessed May 25, 2011).

(17.) Statistics Canada. Police-reported crime statistics in Canada, 2009. Available at: http://www.statcan.gc.ca/pub/85-002-x/2010002/article/11292-eng.htm (Accessed May 25, 2011).

Elaine Hyshka, MA, [1,2] Janet Butler-McPhee, MSc, [3] Richard Elliott, LLM, [3] Evan Wood, PhD, [2,4] Thomas Kerr, PhD [2,4]

Author Affiliations

[1.] Addiction and Mental Health Research Lab, School of Public Health, University of Alberta, Edmonton, AB

[2.] British Columbia Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, BC

[3.] Canadian HIV/AIDS Legal Network, Toronto, ON

[4.] Department of Medicine, University of British Columbia, Vancouver, BC

Correspondence: Dr. Thomas Kerr, Urban Health Research Initiative, BC Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC V6Z 1Y6, Tel: 604-806-9142, Fax: 604-806-9044, E-mail: uhri-tk@cfenet.ubc.ca