As British Columbia decriminalizes small amounts of some illicit drugs next year, Canada will join a growing number of countries that have taken steps to eliminate sanctions for drug use.
But as many Canadian public health experts urge lawmakers to go one step further and replace black market drugs with a regulated safe supply, their international counterparts say they are looking to see what their countries can learn from each other. .
Ottawa announced last week that as of Jan. 31, BC adults will be able to possess up to 2.5 grams of opioids, cocaine, methamphetamine, and MDMA, a sign that will treat addiction as a mental health problem rather than a legal problem.
The federal government has not yet made any commitments on a regulated secure supply; in fact, a particular NPD bill calling for a strategy that included one was defeated in the House of Commons on Thursday.
But advocates have proposed a number of secure supply models for Canada, with options ranging from prescribing pharmaceutical grade drugs, as already happens to a very limited degree – Allow the sale of drugs in entertainment venues or authorized dispensaries.
If adopted, these more liberal models would put Canada in unexplored territory internationally, says Jonathan Caulkins, a professor and drug policy researcher at Carnegie Mellon University in Pittsburgh.
“No country in the world has gone any further, faster than Canada in this direction with cannabis, and no country in the world has thought so seriously about doing it for heroin, fentanyl or cocaine.”
So while Ottawa is navigating decriminalization, jurisdictions around the world say they will be watching to see what model of safe drug supply, if any, is adopted.
And CBC News spoke with some of these international drug policy experts to see what Canada could learn from its countries’ experience with decriminalization.
Fentanyl crisis in Estonia
When Estonia decriminalized all drugs in 2005, the black market for illegally manufactured fentanyl increased.
With almost no harm reduction measures or treatment options, the country quickly converted The European capital of drug overdose.
Estonia decriminalized drug possession in 2005 amid a fentanyl epidemic. In this photo, Jaan Vaart, coordinator of the damage reduction service in Tallinn, Estonia, is inside a van equipped with syringes and emergency equipment. (Alessandro Rampazzo / AFP / Getty Images)
Estonia’s fatal overdose rate began to fall from 2017 after a major fentanyl crisis, but is still playing catch-up in harm reduction.
“We do not have a secure supply, we do not have safe consumption rooms and we do not have state-backed drug control,” said Aljona Kurbatova, head of the Center for the Prevention of Infectious Diseases and Drug Abuse at the Estonian National Center. Institute for Health Development.
“Having damage reduction responses as basic as needle and syringe exchange programs has been a challenge for us in the last two decades due to very strong public opposition.”
She said it was encouraging that Canada already had a strong model for harm reduction before decriminalization, and Kurbatova said she hoped it would have “the courage to try new things,” including a regulated supply of drugs.
Many countries that have decriminalized drugs are still working to establish places of supervised use. (Andrew Curjata / CBC)
“If Canada introduces a secure supply, it will certainly be an argument even for our politicians to listen and say that maybe also, to avoid the repetition of previous mistakes, we should have something like that.”
The Portuguese model
In 2001, in the face of a heroin overdose crisis, Portugal became the first country in the world to decriminalize the possession and use of all illegal drugs. Instead of sending people to court for drug possession, his model focuses on education, treatment, and harm reduction.
The drug-related mortality rate in Portugal is four times lower than the European one average, according to the continent’s drug control agency in 2017.
And these figures are despite the fact that all the drugs in the country come from a black market.
So far, fentanyl has not emerged as a problem there, although it is probably only a matter of time, says Dr. João Goulão, the main architect of Portugal’s decriminalization model and head of the Directorate-General for Behavior Intervention. Addictive dependencies of the country. .
As a result, a secure supply model is not part of the plan right now.
“We’re comfortable with what we have,” Goulão said. Of course, we are open to innovation, but this basic discussion on the legal framework for drugs is not the main concern. “
Portugal was the first country to decriminalize drugs in 2001. Its model does not include secure supply, but focuses on harm reduction and treatment. In this photo, doses of methadone are being prepared for patients in Lisbon. (Rafael Marchante / Reuters)
Goulão, on the other hand, focuses on expanding harm reduction services, such as drug control and safe places of consumption, which were in his childhood in Portugal.
“I saw more resources in downtown Vancouver than we have across the country,” Goulão told CBC News in an interview from Lisbon, before flying to Canada for a conference this week.
Portugal does not want to export its decriminalization model, he said, but hopes to inspire other countries to evolve.
“You in Canada, and the Americans, are living in a time like our heroin epidemic of the 1990s … This is, in my opinion, a window of opportunity to change things.”
A secure supply of heroin
Although Switzerland has not yet decriminalized drugs, in 1994 it took an innovative step towards a secure supply by prescribing pharmaceutical-grade heroin to long-term users.
Proponents of her case have been working to make the actual transcript of this statement available online. This photo shows heroin and cocaine from a secure supply in Vancouver. (Darryl Dyck / The Canadian Press)
The result was fewer overdose deathsas well as falling rates of HIV infection and hepatitis C and a drop in crime.
“The result is: you don’t have people on the street [using drugs]there are no people who die from overdoses on the street or in private places … And there is a very good relationship between people [using drugs] and the healthcare sector, “said Jean-Felix Savary, secretary general of the Romand Group on Addiction Studies (GREA) in Geneva.
During the pandemic, the country allowed people to use prescription heroin at home instead of restricting its use to supervised places.
“It was a huge success,” Savary said.
Although far fewer people access prescription heroin than other treatments such as methadone, there is now a debate in Switzerland about the expansion of prescription heroin.
Since the pandemic began, Switzerland has begun to allow assisted heroin treatment at home instead of in supervised clinics. This photo shows medical supplies in a safe consumer space in Lausanne, Switzerland. (Denis Balibouse / Reuters)
“There’s still this moral thought that if you give a drug to someone, it must be nasty … so we’d rather give methadone, which is very bad for the body, than give heroin,” Savary said, noting that heroin is very important. better than methadone from a medical perspective.
“It’s just a medicine.”
Decriminalization south of the border
If Canada wants to know what decriminalization is like without a secure supply of drugs, just look at about 600 kilometers south of the border. Faced with an increase in opioid-related deaths, Oregon became the first U.S. state to decriminalize drugs in 2020, following a referendum.
Since then, deaths have continued to rise – as they have done 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 Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance.
She and other advocates for drug reform in Oregon continue to work to implement safe consumption sites and other harm reduction measures, which they hope will keep people safer over time.
“We’re trying to solve these huge problems with these incremental steps, and sometimes incremental steps are the only thing you can get people to do.”
Oregon became the first U.S. state to decriminalize drugs in 2020, but does not have 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 McMinnville, Oregon, on December 9, 2021. (Andrew Selsky / The Associated Press)
As street drugs become more and more dangerous on both sides of the border, Hurst is watching closely to see if Canada, where he grew up, is listening to calls for some form of regulated safe supply.
“Secure supply seems like such an important conversation when we’re seeing so many people die right now,” he said. “And it feels so far from where most people are when it comes to drugs.”