The case for decriminalizing drugs: Dr. David Juurlink in The Toronto Star

Republished from The Toronto Star

From opium to alcohol to tobacco, mind-altering substances have been used for as long as people have preferred pleasant feelings to unpleasant ones. All the while, efforts to eliminate drugs have failed. Like it or not, drug use is here to stay.

The governing Liberals will discuss this issue at their national convention next weekend. In the face of a devastating epidemic of overdose deaths, they will debate a resolution to decriminalize drug use; in other words, to approach it as a health problem rather than a criminal one.

Politicians and the public often oversimplify the decriminalization debate, assuming those who don’t forbid drug use must therefore condone it. But we should all be able to agree on a few things: it’s better if fewer people have drug-related problems, and it’s better if fewer people die.

Let’s reflect on what criminalizing drug use actually accomplishes.

The threat of jail or a criminal record causes people to hide their drug use. It’s why so many Canadians have died while using drugs alone at home, in alleys, and in restroom stalls. In a “tough-on-drug-use” environment, stigma runs rife, and potentially life-saving medical help goes unsought.

When drug use is discovered, the individual is arrested and jailed, often suffering unimaginable withdrawal only to use again at the first opportunity, under even riskier circumstances. In jail, it’s far easier to get drugs than treatment, and needle sharing and disease transmission are common. So is death. Alberta, B.C. and Ontario have all witnessed recent increases in fatal overdoses in jail, and the risk of drug-related death surges eightfold in the weeks following release.

Those lucky enough not to die in jail or shortly thereafter are left with a permanent criminal record and all that goes with it. The things that exacerbate drug problems — unemployment, social exclusion, trauma, family separation — get worse after jail, not better.

The risks are greater today than ever before. Just as alcohol prohibition brought about toxic moonshine in the 1920s, the criminalization of drugs has given rise to cheap and potent (read: lethal) chemicals like fentanyl, which are so easy to synthesize and traffic that interdiction is effectively futile.

But doesn’t the threat of punishment stop people from using drugs in the first place? Unfortunately not, according to both the Global Commission on Drug Policy and five Nobel laureates from the London School of Economics. In truth, we have little to show for the vast societal resources consumed by our current policy, aside from overburdened police, courts and prisons.

Put simply, tough drug laws don’t result in fewer drug-related problems and deaths. They do the opposite. As clinicians with expertise in drugs, health policy, public health and addictions, the situation calls to mind a medical aphorism so simple it hurts: “If what you’re doing isn’t working, stop doing it.”

That’s exactly what Portugal did in 2001. Faced with rising harms related to a cheap, toxic heroin supply, its government adopted policies that replaced handcuffs with help. Drug-related deaths fell, while new cases of HIV declined dramatically. Meanwhile, drug use did not increase; in fact it decreased in some segments of the population. Today in Portugal, if you’re found with a small amount of drugs for personal use, you’re offered professional help. In Portugal, you can tell someone you use drugs without fearing jail or a criminal record. And in Portugal, 6 people per million died from drug overdoses last year. In Canada, that number was 110.

In fact, Canada today has one of the world’s highest rates of drug-related death. With 4,000 of our citizens dying every year, it’s time to acknowledge that our approach isn’t working. In fact, it’s been a spectacular failure.

No compassionate society should treat a health issue as a criminal one, promoting fear and isolation in the process.

And no wise government would continue to expend resources on measures so plainly ineffective and counterproductive as enforcement and interdiction, when evidence-based treatment and prevention measures are at hand.

Yes, decriminalizing drug use will be unpopular in some circles. But the alternative is staying a course clearly shown to have failed, while another Canadian family buries a loved one every two hours.

Dr. David Juurlink (@davidjuurlink) is professor and head of the Division of Clinical Pharmacology and Toxicology at the University of Toronto. Dr. Hakique Virani (@hakique) is a public health and addictions medicine specialist and clinical assistant professor at the University of Alberta.