We Need More Than Just Safe Supply. We Need Decriminalization. Now.
Article by: Alexandra Holtom, from Policy Press.
You can read the full article here.
While the COVID-19 pandemic has claimed ten of thousands of lives in Canada and the United States, people who use drugs have also been struggling to survive another public health crisis, one that existed long before COVID-19 — the opioid overdose crisis. Between January 2016 and September 2019, there were over 14,700 apparent opioid-related deaths across Canada. And since March 2020, the number of overdoses and overdose deaths have sharply risen.
Service users, frontline workers, medical health professionals, expert researchers, and drug policy advocates resoundingly agree that the COVID-19 pandemic is exacerbating the overdose crisis. All provinces and territories have been impacted by these intersecting crises, but it appears as though British Columbia (BC) and Ontario have been particularly hard-hit.
In BC, there were 113 preventable overdose deaths in March and 117 in April. Just last week, the most recent BC Coroners Service revealed that there were 170 people who died in May from illicit drug overdoses, which represents a 44% increase over the number of deaths recorded in April 2020.
And in Ontario, the most recent coroner’s report reveals an increase of 25% in fatal overdoses between the months of March and May 2020. Clusters of overdoses and overdose-related deaths have also spiked in numerous cities across the country including in Nova Scotia, Saskatchewan, Yukon, Alberta, and Newfoundland.
There are three main factors that are contributing to the increase of overdoses and overdose deaths throughout the COVID-19 shutdown. The most obvious factor is that physical distancing regulations have ordered people to self-isolate and remain 2 meters apart from people they do not live with. Some people have started using drugs alone in their homes, which for some means confinement in an apartment, and for others, self-isolating in a tent, car, or another isolated space.
In addition to this, many services like supervised consumption sites, mobile harm reduction drop-in centres, drug testing services, and overdose prevention sites have had to close or reduce their hours, often operating at a limited capacity and/or lacking adequate personal protective equipment (PPE). Services that have remained open have reported a drop in the number of service users since the COVID-19 pandemic began, particularly at supervised consumption sites.
A third, and potentially less obvious factor contributing to the increase, is that drug supply chains across national, provincial, and territorial borders have been massively disrupted. This has resulted in drugs becoming less accessible on the streets and the drugs that do circulate often have even higher levels of toxicity. People must resort to buying drugs from sources they are less familiar with, making it more difficult to judge their doses and avoid overdose from a toxic supply.
These three factors combined have resulted in increased preventable overdoses and overdose-related deaths since the beginning of the COVID-19 pandemic. Support for safe supply and decriminalization have long been proposed as alternatives to addressing the overdose crisis. And now, calls for these transformative shifts in drug policy are getting even louder.
Safe supply is a harm reduction strategy that substitutes potentially unsafe drugs with a known quantity of prescribed medication. Safe supply has many evidence-based benefits, namely that it allows people to use drugs without an increased risk of overdose when taken as prescribed. Research shows that safe supply prevents deaths and overdoses and increases access to essential health and social services.
In response to determined and consistent calls for safe supply in the province, the BC Centre on Substance Use and Provincial Government of BC finally released a new model of safe supply in late March. It provides guidelines for physicians and nursing practitioners to prescribe substitute medications for street drugs to eligible patients. New eligible patients receiving substitute medications have been reporting that safe supply has been life saving, especially now during the COVID-19 pandemic.
Safe supply is not without its limitations however. There are a limited number of physicians and nurse practitioners (NPs) who are willing to prescribe substitute medications, and those who are must have dedicated training in addictions medicine. For the people who are unable to find a physician or NP, they must resort to buying illegal street drugs and risk using a potentially toxic substance. This means that street sales will continue, as will arrests for the possession and selling of illegal drugs.
Safe supply cannot address all the disastrous impacts of the War on Drugs and it will be this way for as long as drug criminalization persists. That is why advocates have long been calling for decriminalization as a way of saving thousands of lives and keeping thousands of others out of prison. Simply put, it would mean the elimination of criminal penalties for drug use and possession for personal use.
Drug decriminalization has been proven to lower drug use rates, decrease HIV and Hepatitis C transmission rates, prevent overdose fatalities, and reduce drug-related violence. It also lowers rates of incarceration, decreases the need for law enforcement, reduces social stigma, and fosters acceptance and compassion among citizens.
On May 13th, the Canadian Drug Policy Coalition (CDPC), the Canadian HIV/AIDS Legal Network, and PIVOT Legal Society sent a letter to officials of the federal government calling for the decriminalization of simple drug possession for personal use. It urges that it is “in the public interest” for the government to use exemptions stipulated in the Controlled Drugs and Substances Act (CDSA) to exempt the personal possession of controlled substances. This letter was signed by a range of organizations including advocacy groups lead by people who use drugs, research centres, service providers, human rights organizations, medical professionals, legal clinics, and harm reduction networks.
The CDSA, Canada’s current drug legislation, is counterproductive and rooted in retributive policies that disproportionately impact people who use drugs. Significant amendments to the CDSA or even a whole new piece of legislation are needed to establish a national drug policy that is humane and safe for all. Altering our national approach to drug policy will not happen over night and it requires a strong commitment from provincial and federal policymakers and lobbyists.
Decriminalizing also needs sustainable funding sources that support the wide implementation of alternative models such as safe supply, drug substitution programs, harm reduction services, take-home naloxone kits, and inpatient treatment programs. For drug policy change to be meaningful and just for all, it should be led and informed by people who use drugs and the services who work alongside them.
Dr. Bonnie Henry, the BC Provincial Health Officer, called for decriminalization in late April and recently renewed her call after the latest overdose statistics were released, saying that she would continue lobbying for transformative drug policy change. This is certainly a positive sign, but all provinces and territories need to get on board. Ontario recently announced that it is not even considering safe supply, not to mention decriminalization.
Most importantly, the federal government needs to wake up and respond to these intersecting crises that continue to disproportionately impact people who use drugs. Federal drug policy change is where it all begins and so we must start there.
We need more than just safe supply. We need decriminalization. Now. It is the only logical, ethical, and compassionate thing to do.
