TORONTO — With opioid-related overdoses and deaths reaching record levels in Canada, the top medical official in Toronto is calling for the decriminalization of all drugs as part of a strategy to treat illicit drug use as a public health and social issue, not a criminal one.
In a report released Monday, Eileen de Villa, Toronto’s chief medical officer, urged the city’s board of health to pressure the federal government to eliminate legal penalties for the possession of drugs and to scale up “prevention, harm reduction and treatment services.”
The report also recommended assembling a task force “to explore options for the legal regulation of all drugs in Canada,” which she hopes would destroy an illegal drug market contaminated with fentanyl — a synthetic opioid 100 times more potent than morphine — and other drugs like it.
“When we criminalize people who take drugs, we inadvertently contribute to the overdose emergency,” de Villa said. “It pushes people into unsafe drug use practices and creates barriers for people to seek help.”
People with criminal records are also more likely to have difficulty finding housing and employment, a problem that carries negative health impacts that exacerbate the effects of drug use, she said.
The report comes as Canada battles a worsening opioid overdose crisis. Nearly 4,000 people died of opioid-related overdoses in Canada in 2017, according to the country’s public health agency, a 34 percent increase from the year before. Toronto accounted for 303 of those deaths, a figure that skyrocketed 63 percent from 2016.
In response, Prime Minister Justin Trudeau’s government has embraced a number of “harm reduction” measures, including supervised injection sites, prescription heroin programs for those with severe addictions and even vending machines that dispense prescription opioids.
But de Villa said Canada can do more and should learn from the experiences of other countries.
The report cites Portugal, which was the epicenter of a heroin epidemic in the 1990s and had the highest rate of drug-related AIDS cases in the European Union. It embarked on one of the most ambitious drug experiments in the world by decriminalizing the possession of small amounts of drugs in 2001 and treating drug use as a public health problem.
Under the law, drug trafficking remains a criminal offense. But anyone caught with less than a 10-day supply of any drug is sent to a Commission for the Dissuasion of Drug Addiction, a panel made up of a lawyer, a doctor and a social worker that decides on a specific penalty — usually a warning, a fine or a recommendation to seek treatment for addiction. No one is imprisoned, and possession is treated as an administrative violation.
Since then, there has been a sharp decline in drug overdose deaths and in the number of HIV and AIDS cases associated with injecting drugs. The number of young adults who report using cocaine, MDMA or amphetamines in the past year has also decreased, according to the European Monitoring Center for Drugs and Drug Addiction. Critics of decriminalization had feared a surge in levels of drug use among the general population, but it did not materialize.
But experts caution against drawing a causal link between decriminalization and the positive trends. Some note that decriminalization occurred alongside an increase in harm-reduction measures and methadone maintenance therapy, as well as the introduction of a guaranteed minimum income in the country.
A report from the British Home Office in 2014 concluded, “It is difficult to disentangle the effect of decriminalization from wider improvements in treatment and harm reduction during the same period.” Another study, also in 2014, found that “drug consumption had largely been de-penalized de facto in the 1990s,” so the 2001 law merely “codified the existing practice.”
Canada’s New Democratic Party this year became the first major political party to endorse decriminalization. And at a Liberal Party convention in April, backbenchers and members of the party’s grass roots voted to make decriminalization a top policy priority during the 2019 federal election campaign. (Those votes are nonbinding.)
Trudeau has repeatedly said that he won’t take the approach he took toward recreational marijuana, which will be legal in Canada in October, for other drugs. Ginette Petitpas Taylor, the country’s health minister, told reporters that “decriminalization is not a silver-bullet solution.”