Louise Arbour is a member of the Global Commission on Drug Policy and a former UN high commissioner for human rights. Helen Clark is chair of the Global Commission on Drug Policy and a former prime minister of New Zealand.
Canada pioneered harm reduction in North America with the opening of Vancouver’s Insite, the country’s first legal supervised-consumption site (SCS), in 2003. This was nearly two decades before the first such authorized site opened in the United States. Building on scientific evidence emerging out of European countries such as Switzerland, Canada also introduced the first heroin-assisted treatment programs in North America in 2005. These programs provided a crucial option for people with opioid dependency who were unresponsive to other treatments and medications, such as buprenorphine and methadone.
By moving drug use indoors, supervised-consumption sites reduce public use and prevent the discarding of needles in public spaces. They also play a critical role in preventing the spread of HIV, viral hepatitis and other infections, and they keep people alive – globally, there has never been a fatal overdose recorded inside an SCS. These sites offer a crucial pathway to health care, building trust with those who often avoid traditional care settings owing to stigma and discrimination. They connect participants to essential health and social services, including treatment, housing and employment support.
Despite fears and misinformation, an SCS also benefits its surrounding community. These sites provide medical supervision and compassion to those who might otherwise use drugs alone, risking fatal overdoses. By bringing drug use within a safe space, an SCS can protect both users and the broader community.
In recent years, the North American drug supply has become increasingly toxic, with street heroin being supplanted by unpredictable mixtures of synthetic drugs such as fentanyl and xylazine. Canada has distinguished itself through its bold pursuit of public health and human rights-based policies.
But Canada’s enlightened approach is now facing a troubling backlash. Earlier this year, British Columbia recriminalized the use of drugs in public places, and Ontario will effectively close more than half of its supervised-consumption sites by implementing a ban on any SCS operating within 200 metres of schools and daycare centres, while declining to fund sites that relocate to comply with this rule. The province also plans to block municipalities and organizations from opening new sites or requesting exemptions from federal drug laws.
Opponents of harm reduction argue that it has contributed to overdose deaths, crime and public disorder. Scientific evidence does not support these claims. The surge in deaths across North America has been driven by the rise of fentanyl in the illicit drug supply, not by harm reduction or decriminalization. Indeed, harm-reduction interventions, including supervised-consumption sites, have been an indispensable lifeline in responding to the rise of fentanyl, while punitive policies, stigma and discrimination have only hindered efforts to respond to this crisis effectively.
Decriminalization was never intended to be an isolated policy; even if well-designed, it needs to be paired with interventions that reduce overdose deaths and provide comprehensive health and social support for people who use drugs. Part of the efficacy of decriminalization lies in freeing up public resources, as criminal-justice and enforcement spending can be redirected to public health and social interventions.
Many political opponents of harm reduction advocate for alternatives based on “recovery,” effectively calling for anyone addicted to drugs to be in treatment. While evidence-based treatment is a crucial pillar of well-balanced drug policies, some provinces are moving toward implementing or expanding involuntary treatment. Proponents of mandatory treatment present it as a compassionate, tough-love approach for individuals whose substance use has severely harmed their health and safety, as well as that of their families and communities.
This perspective oversimplifies complex issues, contradicting UN recommendations that drug treatment should be voluntary. Research shows that mandatory treatment is no more effective than voluntary treatment and often results in human-rights violations and additional harms, including fatal overdose after release. The short-term benefits of compulsory treatment are unsustainable, with higher risks of relapse, overdose and death. Substance-use disorder is multifaceted, with recovery often involving multiple relapses before finding lasting recovery. Abstinence should not be the only measure of success.
Importantly, Ottawa has announced an $86.8-million commitment to 96 new addiction and overdose prevention projects across Quebec, including crucial support for community organizations. This four-year agreement, double the length of previous programs, addresses both clinical research and community-based interventions – vital resources for overdose prevention.
This step forward underscores that harm reduction must expand, not retract. Canada’s drug policies must stay comprehensive. Rather than pursuing punitive approaches, we need to support prevention, voluntary treatment and harm reduction, especially for marginalized groups, including women, youth, racialized communities, and Indigenous peoples. Now is not the time to reverse course, but rather to build on Canada’s commitment to saving lives.
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Publish date : 2024-10-28 21:00:00
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