I'll begin by thanking the committee for the invitation to appear today to discuss this important issue with you.
I have been working in the field of drug policy for over 25 years at the community level and then as the drug policy coordinator for the City of Vancouver as we created and implemented Vancouver's four pillars drug strategy.
Since 2011, I have been the executive director of the Canadian Drug Policy Coalition, a partner project with the Faculty of Health Sciences at Simon Fraser University. Our vision is that of a safe, healthy and just Canada in which drug policy and legislation, as well as related institutional practice, are based on evidence, human rights, social inclusion and public health.
We agree with many of the witnesses you have heard already, including the father who, in quoting Dr. Gabor Maté, laments that there is no war on drugs, that there is only a war on people who use them, which means that we are often warring against the most abused and vulnerable segments of society. We agree that this is counterproductive and harmful.
We agree with the police chief who was exasperated by the lack of health and social services and supports for people who use methamphetamine, and with the several witnesses who testified that responses to substance use related harms across Canada, even in the midst of an overdose death crisis and a growing concern about methamphetamine in various parts of the country, have been inadequate in most regions.
We agree that reducing or eliminating stigma is critical to helping support people as they make decisions about their lives.
There is a tremendous agreement across sectors that stigmatizing people with addictions is not constructive. There is also a significant consensus in Canadian society that addiction issues should be dealt with through a comprehensive health and social approach that considers the social determinants of health, as well as supporting people to manage their substance use through a variety of pathways.
Substance use is one of the most complex issues of our time and will continue to be a part of our public discourse in the future. People have been using substances since the dawn of time, and it will continue, sometimes in beneficial ways and sometimes in ways that cause harm to people who use them.
I've wondered for many years why it has been so difficult to change the way we approach these issues. As some of the committee members have remarked over the weeks, how come we haven't yet even addressed the social determinants of health, as we know we must do to make progress in this area?
I have had similar thoughts over the years. Why is it so hard to change the approach we take? Why is it so hard to shift from what historically has been an overreliance on law and punishment to one that embraces contemporary scientific knowledge of public health interventions and an understanding of how and why people use substances?
We note that the foundations of our current approach were laid in the early 1900s and have resisted fundamental change until quite recently, in response to irrefutable evidence that our historic drug policies have utterly failed to achieve their goals of reducing substance use, stopping the flow of drugs and protecting Canadians.
We saw this with the failure of cannabis prohibition over the past 40 years and are seeing this more starkly with the absolute poisoning of the illegal drug supply in North America through the onset of synthetic fentanyl and its many analogues. This is why we are hearing desperate calls from people who use drugs, those working on the front lines and an increasing number of medical health officers for a safer supply of drugs to be made accessible to people.
The history of Canada's drug policy is that it was in large part created in the early 1900s, imbued with colonial values and fuelled by racism and hysteria about opium use on the west coast and the fear of Asian workers who had worked on building the railway, taking jobs away from British Columbians.
By the late 1920s, Canada's drug policies were some of the most draconian policies in the world. Then, as now, if you were white and had power and resources, you had little fear of being impacted by those drug policies. If you were indigenous, Chinese, Hispanic, black or a poor white person who used drugs, you were very likely to be subjected to very harsh penalties. Penalties for possession were up to seven years in prison and a $1,000 fine, and whipping was at the discretion of the judge. Talk about stigma.
Our current policies sit on this foundation and to this day prescribe criminalization and punishment as a response to possession of an illegal substance, along with these consequences: stigmatization, rejection, shunning and the fear and loathing that society often heaps upon people who use criminalized substances. This is why decriminalization is an important concept to consider as we modernize our drug policies.
We also tend to conflate the worst cases of methamphetamine use with all use, when in fact most people who use methamphetamine are not necessarily problematic users. Imagine if we conflated all alcohol use with the worst, severe problematic use. Our view of having a drink would look very different in our minds.
In the Downtown Eastside where I began working in 1987, the most common homicide in Vancouver at the time involved a fight within blocks of a bar, and alcohol and a knife. There was little hysteria about alcohol-fuelled violence, but there was a local campaign to ban knives from the neighbourhood. With methamphetamine there is a tendency to focus on the drug as the problem rather than the circumstances around it: trauma, poverty, abuse, homelessness, disconnection from family and community and the many other social determinants that contribute to the health of our communities.
In closing, we have a few recommendations for the committee to consider.
We must stop pretending that problematic substance use will disappear if we magically come up with the right set of interventions. We need to accept the fact that substance use will continue to take place in our society along a spectrum of use from beneficial uses to non-problematic uses, problematic uses and, of course, addiction.
We know that most people who use drugs will not become severely addicted to them. That is clear from the evidence. And we know that most people who manage their use, or cease using drugs, do so without the help of professionals or treatment providers. There are multiple trajectories into and out of addiction and multiple non-problematic users of substances.
We must also stop pretending that prohibition of drugs will improve the health and safety of Canadians, In fact, our drug policies are killing Canadians and enriching transnational criminal organizations.
We would acknowledge that at this time in Canada, the illegal drug market is more deadly than it has ever been, and we would prepare for even worse conditions moving forward, meaning that we should scale up harm reduction efforts, not cap them or ignore them as some provinces are doing. Illegal drug markets are dynamic and changing all the time, and we need to be prepared.
We would acknowledge the importance of working with people who use methamphetamine and other drugs to begin to design programs that meet people where they are and support them.
A number of things could be implemented in relatively short order that would go a long way to ending this war on our citizens, some of our most vulnerable, and changing the environment for people who use drugs in their communities.
One, embrace innovation and experimentation. Try new approaches. Review institutional policies and practices that are barriers to engaging people.
Two, support the immediate decriminalization of possession of currently illegal substances for personal use. There is no upside to criminalizing users, given the state of the illegal drug market and the other harms that stem from criminalization, including stigma. We need to maximize connection with people, not push people into the shadows.
Three, it would be good to see more emphasis on harm reduction within the Addictions Foundation of Manitoba recommendations and other provincial strategies, given the toxicity of our drug markets, as well as highlighting the connection between harm reduction, health services and treatment resources. They are not separate. They are a continuum.
The creation of low threshold, welcoming, safe places for people who use methamphetamine where peer workers can help people access supportive services, including help finding secure housing, food, social assistance, help with resumés and job applications, indigenous cultural supports where appropriate, and help build connections to their community, would be an important part of that kind of a plan.
Four, the establishment of supervised consumption services is a powerful message to people who use drugs that we care about them and want to engage people in health services, not back alleys. No one has died of an overdose death in a supervised setting in Canada, by the way.
Five, pharmaceutical-grade methamphetamine would be provided to people addicted to meth as a temporary maintenance regime to give an alternative to the criminalized market and the need to raise the funds to buy meth from unregulated dealers on the street. Methamphetamine under the brand name of Desoxyn is prescribed as a weight loss treatment and for ADHD. Adderall is very similar to methamphetamine and used widely in society, as you heard earlier from David Juurlink.
My final point is that as part of our outreach to people who use drugs, we could also begin to ask people why they are using methamphetamine. This would include non-problematic users as well as those who are clearly addicted. Everyone starts doing something for a reason, and we need to better understand the benefits and the harms that people who use methamphetamine perceive. It would be beneficial to all of us to understand the range of reasons and experiences of people who use methamphetamine.