The catastrophe of alcohol prohibition<\/a> was an example of all that.<\/p>\n Canada legalized cannabis this time last year and the sky did not fall. There has been no explosion of use<\/a> or sudden spike in highway fatalities<\/a> \u2014 which begs the question: When will Canada take the bull by the horns and launch a concerted public health and education strategy to combat our opioid crisis?<\/p>\n Canadian carnage: 11 lives lost to <\/strong>opioid overdose<\/strong><\/a> per day in 2017<\/strong><\/p>\n The iron law of prohibition holds that as enforcement increases, traffickers migrate to the drugs with the highest potency and toxicity. And that is what has happened. The death rate<\/a> per 100,000 from opioids like fentanyl has increased to 11.6 in the first three months of 2019 from 8.4 in 2016, with the percentage involving fentanyl or fentanyl analogues<\/a> climbing to 79 percent from 50 percent over the same period. British Columbia, Alberta and Ontario are the hot zones.<\/p>\n It does not have to be this way. These deaths are the unintended consequence of a policy zombie called the \u201cwar on drugs,\u201d initiated during a racist moral panic in the late 19th century; it mandated punishment and stigmatization rather than treatment and rehabilitation. Subsequent iterations of the 1908 Opium Act<\/em><\/a> have only exacerbated the foundational intent of the legislation while \u2014 coincidentally<\/a> \u2014 growing the power and resources of Canada\u2019s enforcement agencies. Today, we have the worst of all worlds: powerful and violent drug trafficking organizations benefiting from police enforcement, which has led to high prices, enriching these criminal organizations.<\/p>\n If you doubt this, review the last 20 years of drug-market-related violence tearing Mexico<\/a> apart.<\/p>\n A policy zombie is \u201ca belief that seemingly can\u2019t be killed by evidence<\/a>\u201d but is able to wreak havoc because it is still useful to certain interests. Drug prohibition is the ultimate policy zombie. And this is among the worst kept secrets in the corridors of power. So how do we kill it once and for all?<\/p>\n The first step is to embrace the fact we are experiencing \u201cthe largest health crisis of our generation,\u201d according to Gillian Kolla<\/a> at the University of Toronto\u2019s Dalla Lana School of Public Health. It\u2019s those in the prime of their lives \u2014 25 to 44 years \u2014 who are most deeply affected, accounting for upwards of 11,500 deaths over the past three years, or roughly one person every two hours<\/a>. \u201cCanadian life expectancy at birth has stopped rising for the first time in over four decades,\u201d according to a Statistics Canada<\/a> finding. By contrast, the 2003 SARS public health emergency killed fewer than 50 people<\/a> but provoked an outpouring of money and sympathetic media attention.<\/p>\n One important difference: SARS was not shrouded in the stigmatization that surrounds drug use and users because of 100 years of prohibition propaganda.<\/p>\n What is to be done?<\/strong><\/p>\n Portugal decriminalized \u2014 not depenalized, not legalized \u2014 all drug possession. Use of drugs fell, rates of death by overdose fell, and HIV\/hep C transmission by needle sharing fell. What has spiked upward, according to independent analyses, is demand for treatment<\/a>. How did they do it?<\/p>\n In 2016, I spoke with Jo\u00e3o Castel-Branco Goul\u00e3o<\/a>, a medical doctor and the architect of Portugal\u2019s breakthrough public health policy. He told me that Portugal\u2019s politicians turned to the country\u2019s public health experts and essentially said, \u201cSave us.\u201d<\/p>\n In the late 1990s, Portugal had a public health crisis of addiction<\/a>, with 1 percent of the population addicted to heroin. Crucially, however, that 1 percent included people from every socio-economic class, from richest to poorest. \u201cThere was not a family in Portugal who did not have a member with a heroin problem,\u201d he told me when we spoke in Ottawa, and that is what mitigated the impact of the stigma faced by drug users. The public health experts returned to the politicians with one clear finding: people were afraid to seek treatment because they feared they would be criminalized. When they did seek treatment, they were put on a waiting list for weeks or months. The solution was to decriminalize all drug use, aggressively pursue evidence-based harm reduction and public education strategies, create \u201cdissuasion commissions\u201d and expand treatment options while cutting wait times.<\/p>\n Today, Portugal \u2014 a small and extremely Catholic country \u2014 is leading the world on treating drug-use-related problems.<\/p>\n The challenge of new thinking<\/strong><\/p>\n We urgently need to aggressively destigmatize drugs and drug users. That\u2019s not a small ask in the face of unrelenting propaganda and misinformation, of which the \u201cjust say no\u201d approach was an example, along with political hostility<\/a> to evidence-based safe injection strategies.<\/p>\n Regulating potentially toxic drugs and making them available in a tightly controlled environment where their worst side effects can be mitigated or reversed is not an endorsement of drug use. It\u2019s a policy that seeks to moderate its worst consequences and minimize the social and individual harm that arises from it. It seeks to meet drug users \u201cwhere they are\u201d and create an environment conducive to their safe and healthy reintegration \u2014 including eventual cessation of use.<\/p>\n You can\u2019t rehabilitate people if you can\u2019t keep them alive. Nor can you reintegrate them if you stigmatize their personal health issues.<\/p>\n Safe injection sites in every community would go a long way toward arresting the death rate, reducing expensive emergency room admissions and rehabilitating those who seek treatment. We should not leave our response to this crisis to the small and under-resourced community-based organizations that \u2014 in the vacuum created by political indifference \u2014 have risen to the task. Canadians need to vigorously push our public officials to take the evidence seriously, put the programs in place, fund them for the long term and aggressively expand treatment and rehabilitation options and programs.<\/p>\n We need, in other words, to trade the big problem of escalating opioid deaths for the smaller, more manageable public health problems associated with a regulated supply that prioritizes safe use and opens doors for treatment. We need to give ourselves permission to think anew so that we can say this time next year that we prevented the needless deaths of thousands of opioid users. The sky won\u2019t fall this time, either.<\/p>\n This article is part of the\u00a0<\/strong>The Making of a Cannabis Industry: Year One<\/b><\/span><\/a>\u00a0<\/b><\/span>special feature.<\/strong><\/p>\n Photo: Shutterstock, by\u00a0Lightspring<\/a><\/span><\/p>\n Do you have something to say about the article you just read? Be part of the\u00a0<\/i>Policy Options\u00a0discussion, and send in your own submission.\u00a0Here is a\u00a0<\/i>link<\/i><\/span><\/a>\u00a0on how to do it. |\u00a0Souhaitez-vous r\u00e9agir \u00e0 cet article ? Joignez-vous aux d\u00e9bats d\u2019<\/i>Options politiques\u00a0et soumettez-nous votre texte en suivant ces\u00a0<\/i>directives<\/i><\/span><\/a>.<\/i><\/span><\/p>\n![\"\"](\"https:\/\/policyoptions.irpp.org\/wp-content\/uploads\/2025\/08\/shutterstock_593324582-scaled.jpg\")
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