As British Columbia decriminalizes small quantities of some illicit drugs next year, Canada will join the growing number of countries that have taken steps to lift sanctions on drug use.
But as many Canadian public health experts call on lawmakers to go a step further – and replace black market drugs with a regulated safe supply – their international counterparts say they are watching what their countries can learn from each other.
Ottawa announced last week that as of January 31, adults in British Columbia will be allowed to have up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA – a signal that they will treat addiction as a mental health problem, not a judicial one.
The federal government has not yet made any commitments to regulated security of supply; in fact, a private member of the NDP’s bill calling for a strategy that includes one was defeated in the House of Commons on Thursday.
But the defenders suggested a number of models for safe power supply for Canada, with options ranging from prescribing pharmaceutical-grade drugs – as is already the case to a very limited extent – authorizing the sale of drugs in licensed entertainment venues or dispensaries.
If passed, these more liberal models would put Canada in an unexplored territory internationally, said Jonathan Colkins, a professor and researcher in drug policy at Carnegie Mellon University in Pittsburgh.
“No country in the world has gone further than Canada in this direction with cannabis, and no country in the world has even seriously considered doing so for heroin, fentanyl or cocaine.
So as Ottawa turns to decriminalization, jurisdictions around the world say they will monitor what, if any, safe drug model will be adopted.
CBC News spoke with some of these international drug policy experts to see what Canada can learn from its countries’ experience with decriminalization.
The fentanyl crisis in Estonia
When Estonia decriminalized all drugs in 2005, the black market for illicit fentanyl was on the rise.
With almost no harm reduction measures or treatment options, the country quickly rose European Capital of Drug Overdose.
Estonia decriminalized drug possession in 2005 amid an epidemic of fentanyl. In this photo, Jaan Vaart, coordinator of the Harm Reduction Service in Tallinn, Estonia, is in a van equipped with syringes and emergency equipment. (Alessandro Rampaszo / AFP / Getty Images)
The rate of fatal overdoses in Estonia has been declining since 2017 after a large drop in fentanyl – but is still playing to make up for the harm reduction.
“We do not have a safe supply, we do not have safe rooms for consumption and we do not have a state drug inspection,” said Alyona Kurbatova, head of the Center for the Prevention of Drug Abuse and Infectious Diseases at the Estonian National Institute for Health Development.
“Having harm reduction measures as basic as needle and syringe exchange programs has been a great challenge for us over the last two decades because of the very strong public resistance to it.”
She said it was encouraging that Canada already had a strong model for harm reduction before decriminalization, and Kurbatova said she hoped she would have the “courage to try new things” – including a regulated supply of medicines.
Many countries that have decriminalized drugs are still working to create sites for controlled consumption. (Andrew Kurzhat / CBC)
“If Canada introduces safe deliveries, it will definitely be an argument even for our politicians to listen and say that maybe we, in order to avoid repeating previous mistakes, should have something similar.
The Portuguese model
As early as 2001, facing a crisis of heroin overdose deaths, Portugal became the first country in the world to decriminalize the possession and use of all illicit drugs. Instead of sending people to court for drug possession, his model focuses on education, treatment and harm reduction.
The death rate from drugs in Portugal is four times lower than the European one on average, according to the continent’s Drug Monitoring Agency in 2017
And these figures are despite the fact that all drugs in the country come from the black market.
To date, fentanyl has not been a problem there, although it is probably only a matter of time, said Dr. Joao Gulao, chief architect of Portugal’s decriminalization model and head of the Directorate General for Addictive Behavior and Addiction.
As a result, the security of supply model is not part of the plan now.
“We are comfortable with what we have,” Gulao said. Of course, we are open to innovation, but this fundamental discussion on the legal framework for drugs is not a major concern. “
Portugal was the first country to decriminalize drugs in 2001. Its model does not include security of supply, but instead focuses on harm reduction and treatment. This picture shows doses of methadone for patients in Lisbon. (Rafael Marshante / Reuters)
Instead, Goulão is focusing on expanding harm reduction services, such as drug testing and safe use sites, which are in their infancy in Portugal.
“I saw more resources in downtown Vancouver than we have across the country,” Gulao told CBC News in an interview with Lisbon before flying to Canada for a conference this week.
Portugal is not seeking to export its model of decriminalization, he said, but hopes to inspire other countries to develop.
“You in Canada and the Americans, you live in a time that is similar to our heroin epidemic in the 1990s … I think this is a window of opportunity to change things.”
Safe supply of heroin
Although Switzerland has not yet decriminalized drugs, it took a revolutionary step toward secure supply in 1994 by prescribing pharmaceutical-grade heroin to long-term users.
Proponents say prescribing pharmaceutical-grade drugs, as Switzerland does with heroin, is a possible safe supply model for Canada. In this photo, the heroin and cocaine from safe deliveries are shown in Vancouver. (Daryl Dyke / Canadian Press)
The result was fewer deaths from overdoseas well as declining levels of HIV and hepatitis C infections and declining crime.
“The result is: you have no people on the street [using drugs]you don’t have people who die from overdoses on the street or in private … And there are very good relationships between people [using drugs] and the health sector, “said Jean-Felix Savary, Secretary General of the Roma Addiction Research Group (GREA) in Geneva.
During the pandemic, the country allowed people to use prescription heroin at home instead of restricting its use to controlled sites.
“It was a great success,” Savari said.
Although far fewer people have access to prescription heroin than other treatments such as methadone, there is now a debate in Switzerland about expanding prescription heroin.
Since the beginning of the pandemic, Switzerland has started allowing heroin treatment at home instead of in controlled clinics. In this photo, medical supplies are shown in a safe place for consumption in Lausanne, Switzerland. (Denis Balibouz / Reuters)
“There is still this moral thinking that if you give a drug to someone, it must be nasty… so we prefer to give methadone – which is really harmful to the body – than to give heroin,” said Savari, noting that heroin is much better than methadone from a medical point of view.
“It’s just medicine.”
Decriminalization south of the border
If Canada wants to know what decriminalization without a secure drug supply looks like, it only has to look about 600 kilometers south of the border. Faced with rising opioid-related deaths, Oregon became the first state in the United States to decriminalize drugs in 2020, following a referendum.
Since then, deaths continue to rise – as in Canada – as the supply of medicines has become more toxic in both countries.
“Decriminalization alone will not stop people from dying from drug overdoses,” said Terra Hearst, executive director of the Oregon Health Rehabilitation Alliance.
She and other Oregon drug reform advocates are still working to implement safe places to eat and other harm reduction measures that she hopes will keep people safer over time.
“We try to solve these huge problems with these step-by-step steps, and step-by-step steps are sometimes the only thing you can get people to do.”
Oregon became the first state in the United States to decriminalize drugs in 2020, but it lacks some of the harm reduction measures already in place in Canada. In this photo, an addiction recovery worker holds a naloxone kit used to treat an opioid overdose in McMinville, Oregon, on December 9, 2021 (Andrew Rural / Associated Press)
As street drugs become more dangerous on both sides of the border, Hearst is watching closely to see if Canada – where she grew up – listens to calls for some form of regulated security of supply.
“Secure supply feels like such an important conversation when we watch so many people die right now,” she said. “And it feels so far from where most people are when it comes to drugs.”
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