When British Columbia decriminalizes small amounts of certain illicit drugs next year, Canada will join a growing number of countries that have made progress toward removing penalties for drug use.
But while many Canadian public health experts are calling on lawmakers to go further – and replace illicit black market drugs with a safe, regulated supply – their international counterparts say they are watching to see what their countries can learn. one another.
Ottawa announced last week that from January 31, adults in British Columbia will be allowed to possess up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA – a signal that it will treat addiction as a problem of mental health rather than a legal issue.
The federal government has not yet made commitments regarding a secure regulated supply; in fact, an NDP private member’s bill calling for a strategy that would include one was defeated in the House of Commons on Thursday.
But advocates have offered a number of safe power supply patterns for Canada, with options ranging from prescribing pharmaceutical grade drugs – as is already happening to a very limited extent — to authorize the sale of medicinal products in places of amusement or approved dispensaries.
If adopted, these more liberal models would put Canada in uncharted territory internationally, says Jonathan Caulkins, a professor and drug policy researcher at Carnegie Mellon University in Pittsburgh.
“No country in the world has gone further, faster than Canada in this direction with cannabis, and no country in the world has even seriously thought about doing this for heroin, fentanyl or cocaine.”
So as Ottawa navigates decriminalization, jurisdictions around the world say they will be watching to see what, if any, safe drug supply model is adopted.
And CBC News spoke to some of these international drug policy experts to see what Canada could learn from their country’s experience with decriminalization.
The fentanyl crisis in Estonia
When Estonia decriminalized all drugs in 2005, the black market for illegally manufactured fentanyl was on the rise.
With almost no risk reduction measures or treatment options in place, the country has quickly become Drug overdose capital of Europe.
Estonia’s rate of fatal overdoses began to decline from 2017 after a major fentanyl explosion – but it continues to catch up on harm reduction.
“We don’t have a safe supply, and we don’t have safe consumption rooms, and we don’t have state-backed drug control,” says Aljona Kurbatova, head of the Drug Prevention Center. abuse and infectious diseases at the Estonian National Board. Institute for Health Development.
“Having harm reduction responses as basic as needle and syringe programs has been quite a challenge for us over the past two decades because of very strong public opposition to it.”
She said it was encouraging that Canada already had a strong harm reduction model before decriminalization, and Kurbatova said she hoped it would have “the courage to try new things” – including including a regulated drug supply.
“If Canada introduces secure supply, it will certainly be an argument even for our politicians to listen and say that maybe we too, in order to avoid a repeat of previous mistakes, should have something like this.”
The Portuguese model
In 2001, faced with a heroin overdose death crisis, 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 drug-related death rate in Portugal is four times lower than in Europe average, according to the mainland’s drug monitoring agency in 2017.
And these numbers are despite all the drugs in the country coming from a black market.
To date, fentanyl has not emerged as a problem there, although it is probably only a matter of time, says Dr João Goulão, main architect of Portugal’s decriminalization model and head of the Directorate General of the country for the intervention on addictive behaviors and dependencies. .
Therefore, a secure supply model is not part of the plan at this time.
“We are comfortable with what we have,” Goulão said. Of course, we are open to innovation, but this fundamental discussion on the legal framework for drugs is not the main concern.”
Instead, Goulão is focusing on expanding harm reduction services, like drug control and safe consumption sites, which are in their infancy in Portugal.
“I saw more resources in downtown Vancouver than we have in the whole country,” Goulão told CBC News in an interview from Lisbon, before flying to Canada for a conference this week. .
Portugal is not looking to export its decriminalization model, he said, but it hopes to inspire other countries to evolve.
“You in Canada, and Americans, are living in a moment that resembles our heroin epidemic in the 90s… This is, in my opinion, a window of opportunity to change things.”
A safe supply of heroin
Although Switzerland has not yet decriminalized drugs, it took a decisive step towards a safe supply in 1994 by prescribing pharmaceutical-grade heroin to long-term users.
The result was fewer overdose deathsas well as lower rates of HIV and hepatitis C infection and lower crime rates.
“The bottom line is: you don’t have people on the street [using drugs]you don’t have people dying of overdoses on the street or in private places… And there is a very good relationship between people [using drugs] and the health sector,” said Jean-Félix Savary, Secretary General of the Romand Group for 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 sites.
“It was a very big success,” Savary 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.
“There’s always this moral thought that if you give somebody a drug, it has to be mean…so we’d rather give methadone – which is really bad for the body – than give heroin,” said Savary, noting that heroin is much better than methadone from a medical standpoint.
“It’s just medicine.”
Decriminalization south of the border
If Canada wants to know what decriminalization looks like without a safe supply of drugs, it need only look about 600 kilometers south of the border. Faced with rising opioid-related deaths, Oregon became the first US state to decriminalize drugs in 2020, following a referendum.
Since, deaths continued to rise — as they have in Canada — as the drug supply has become more toxic in both countries.
“Just decriminalizing won’t stop people from dying of overdoses,” said Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance.
She and other drug reform advocates in Oregon are still working to implement safe consumption sites and other harm reduction measures, which they hope will keep people safe over time. time.
“We’re trying to solve these huge problems with these incremental steps, and incremental steps are sometimes the only thing you can get people to do.”
As street drugs grow increasingly dangerous on both sides of the border, Hurst is watching closely to see if Canada — where she grew up — is heeding calls for some form of safe and regulated supply.
“Safe supply feels like such an important conversation as we watch so many people die right now,” she said. “And that seems so far off to most people when it comes to drugs.”