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Canadians are increasingly feeling our collective well-being threatened by North American and global turmoil and, with it, the real risk of backsliding on policy and funding for major health and social challenges. No issue is more important in this respect than drug policy.

Take for example British Columbia’s rollback of its decriminalization program, reversals in Ontario and Alberta on safe-consumption sites and safer supply, and a deeply counterproductive move by the latter toward involuntary addiction treatment. Federal Conservative Leader Pierre Poilievre has gone so far as to say all “drug dens” should be shut down.

The onset of fentanyl “border theatre” to appease U.S. President Donald Trump recently led journalist Manisha Krishnan to note that “[t]he adoption of American drug war rhetoric marks a turning point for our relationship with drugs and drug users” and seems to be “the end of a relatively progressive era for drug policy in Canada.”

Given these developments, there may be reason to embrace the Churchillian maxim “never let a good crisis go to waste.” While our leaders are preoccupied with economic and geopolitical challenges, civil-society advocates have the chance to develop progressive drug policies for a future government to take up when a political window presents itself.

Oregon’s decriminalization of drugs has lessons for B.C.

Finding innovative solutions to reduce the cost of substance use on health care

A course-correction on cannabis equity: the moment is now

COVID-19 shows us why Canada needs a federal alcohol act

We must start by looking beyond the current toxic drug crisis to consider how Canada might better regulate all psychoactive substances (tobacco, alcohol, cannabis, opioids and illegal drugs) — namely by giving priority to public health over criminal punishment and over the wide range of commercial enterprises that profit from the use and misuse of psychoactive substances.

This would advance a recommendation made by two independent panels tasked with examining how Canada should respond to the toxic drug crisis. The panels from Health Canada (2021) and the Royal Society of Canada (2024) concluded that the federal government should adopt coherent regulation of all psychoactive substances, grounded on principles of preventing harm and promoting well-being. Doing so, the experts advised, would advance the health of Canadians, contribute to stronger families and communities, bring about savings in public spending to address health and economic impacts of harmful substance use, and reduce law-enforcement expenditures.

The current patchwork approach to regulating psychoactive substances does not make sense from any perspective. Laws that regulate or criminalize alcohol, tobacco, cannabis and illegal drugs reflect distinct histories, social attitudes and commercial interests. But they do not reflect the individual and societal risks these substances bring, or the collective harms and costs incurred.

The Canadian Centre for Substance Use estimates that costs in Canada related to use of legal and illegal substances totalled $49.1 billion in 2020, or $1,291 per capita. Most people might assume that illegal drugs were responsible for the bulk of those costs, but the reality is different. Alcohol was responsible for $518 per capita, tobacco for $293 and cannabis for $63.

These relative risks and costs are not reflected in the ways in which alcohol and tobacco are permitted to be marketed, sold and lobbied for. There should be a total rethinking of how to regulate them, especially in light of some worsening trends. A new Canadian study, for example, shows a rapid two-decade rise in alcohol-related organ damage among youth and young adults in Ontario.

Critics have said for decades that the “war on drugs” approach has failed to achieve public-health goals. Drug trafficking remains extensive as well as a deadlier toxic drug supply. Meanwhile, criminalization of users inflicts further harm on those who are often already highly disadvantaged.

By contrast, public-health experts note that “[w]hen we regulate a substance, we have the most control over its production, distribution and consumption.” Canada has insight from decades of policy and research showing the positive results of applying core public-health principles to control supply, pricing, access to and marketing of legal psychoactive substances. It is time to use this knowledge in bringing commonly used illegal drugs within the sphere of legal regulation.

For well over a decade, policy experts in Canada have been offering proposals to government for how the legal substances of alcohol, tobacco and cannabis should be better regulated in the public interest. Last year, B.C.’s provincial health officer, Dr. Bonnie Henry, delivered a report urging medical and non-medical measures for providing legal, regulated drugs as an alternative to the toxic street supply.

In Europe, the notion of coherently regulating psychoactive substances has been a topic of policy reflection and development since at least 2012. Researchers and national bodies in Switzerland and the Czech Republic have advanced proposals for their countries to adopt regulations for psychoactive substances based on health harms and societal risks. Cities in Europe are endorsing the idea that abandoning prohibition in favour of regulated legalization is the only way to address the harms their communities are facing from illegal drug consumption.

Is it likely that Canada’s federal government — of any political stripe — will act soon? Frankly, no. Doing so would involve much policy analysis, consultation and, above all, the political will to take on commercial interests. It would also mean accepting reduced sales-tax revenues for the sake of long-term public savings on health and other social costs.

Nonetheless, one of the Canadian Public Health Association’s priorities is to lay the groundwork for research, dialogue and policy development that will advance the expert panels’ recommendation for coherent regulation of  psychoactive substances. We envision an advisory group of leading researchers, policy experts and stakeholders who will consult with civil-society groups, including Indigenous substance policy experts. This project would also draw on research into emerging approaches in other countries.

Questions that could be considered would include how to limit the influence of business on coherent regulation; how such regulation would affect tax revenues, health and other social costs; how it would impact black markets; and how to build public awareness and support for change. Ultimately, we hope this effort will produce draft legislation for a future federal government to take forward.

A project this ambitious and disruptive to existing social attitudes may well seem like something of a “moonshot” — and indeed it is. However, many Canadians are intimately familiar with the harms that alcohol, tobacco, cannabis and other drugs have on themselves and their fellow citizens. A federal government with the vision to take a world-leading approach to better regulate these substances could find much popular support. Leadership from policy experts and civil-society stakeholders should begin now to bring that about.