Should All Drugs Be Decriminalized?

 

Hakique Virani says yes.

Twelve-step addiction recovery programs teach that it is irrational to “do the same thing over and over again expecting different results.” This should be a lesson for legislators too. As the 4,000 Canadian families who lost a loved one to an opioid overdose last year know, our drug laws have been a spectacular failure. It’s long past time to change course and decriminalize drug use.

Let’s first dispense with the straw-man argument that drug decriminalization is about encouraging or condoning drug use. That’s simply untrue. Both sides of this debate argue that people are generally better off not using drugs. But whether or not you believe drugs are bad, everyone in a compassionate society must agree that drug-related problems are bad, and so are preventable deaths. Good drug policy would reduce those outcomes. Our current approach does the opposite.

The threat of jail or a criminal record causes people to hide their drug use. That’s why it’s so common for people to die while using drugs alone at home or in back alleys. “Tough on drugs” talk and policies fuel stigma, keeping people from seeking potentially life-saving medical help.

When people go to jail for possessing drugs, they frequently suffer horrific withdrawal and compulsions to use again at the first opportunity. In jail it’s far easier to get drugs than treatment, and drug use there is far riskier. Needle-sharing and disease transmission are common in jail. So is death. Alberta, BC 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.

For those who survive jail, life is permanently scarred by a criminal record, which worsens unemployment, social exclusion, trauma and family estrangement. These factors, by the way, all increase the risk of drug-related problems and overdose death. In other words, by punishing people who use drugs, the state harms public health.

Besides being ineffective and counterproductive, criminal drug laws are a disturbing departure from how governments should relate to citizens in free societies. If you’re like the vast majority of Canadians who recreationally use a drug (such as cannabis, alcohol, cocaine or heroin), the state should play a limited role in your drug use. That doesn’t mean families or faith communities, for example, can’t still encourage abstinence from drugs in accordance with shared values and beliefs. Health professionals can and should address substance use in their supportive environments. But governments mustn’t strip citizens of their freedom simply for making disagreeable personal choices affecting their own health and well-being.

Instead of spending tremendous resources on draconian measures that achieve the opposite of what they ostensibly intend, we should invest in evidence-based addiction treatment and prevention. Drug decriminalization may be unpopular in some circles, but countries that have taken this step, as Portugal did in 2001, have seen remarkable decreases in drug-related harms. Experts worldwide are clear on this: To reduce drug risks, governments must take some political ones.

Roger Chaffin says no.

In Calgary in 2017, more people died as a result of an opioid overdose (415) than from traffic fatalities (11) and homicides (27) combined. While opioids continue to take a tragic toll at an alarming rate, corresponding drug trends show that methamphetamine use has also increased significantly, along with the acquisitive crime associated with drug use.

There is no doubt that this is a complex social issue requiring collaboration on many fronts. How do you tackle an issue of this magnitude, and where do you start? What are the foundational pieces that are driving harm to the individual, their families and the community?

In the fall of 2017, Calgary welcomed its first supervised consumption service. The Calgary Police Service remains an integral partner in supporting this initiative and acknowledges that the complex social issues of substance abuse cannot be solved in isolation and is the responsibility of many stakeholders, not just police. Our role is not to criminalize addiction, but rather to ensure that vulnerable people are not being preyed upon by those seeking to fund criminal activities.

Research shows that factors such as mental health, trauma and toxic-stress effects on the brain are some of the main drivers for self-medication by way of substance abuse. These are vulnerable people who, first and foremost, need support to address the root causes of their addiction. The role of police is often to be that first point of contact when someone is in a cycle of self harm. Engaging with that person to provide support and services often begins with an interaction with an officer. Decriminalizing possession of drugs would eliminate the authority of the police to have meaningful, purposeful and effective interactions with people who are caught in a cycle of self harm, and who are likely causing subsequent harm to their family, friends and community. For those people, an arrest or charge might just be the key to accessing the resources and services they need. However, those resources need to be in place to effectively interrupt the cycle.

Simple possession charges, unrelated to other criminal offences, are not a focus for our officers. The vast majority of people charged with at least one drug-possession-related offence in the past seven years (86 per cent) have been identified as offenders in more than one criminal incident. Property crime, violent offences and Criminal Code traffic offences are the most frequently associated incidents. These involve victimization of others and impact the sense of safety and security in our communities. While we don’t criminalize addiction, police have a duty to ensure public safety for all.

To simply decriminalize possession of drugs without a robust community support strategy to address the underlying issues will not benefit the person in crisis or the community at large. Focusing on the foundational community responsibility to mental health would go a long way to address the root causes of drug abuse and the subsequent symptoms such as crime and social disorder.

Hakique Virani responds to Roger Chaffin.

Chief Chaffin is right. People with addiction must be supported by communities that prioritize mental health, treatment and social integration. We must protect public safety and social environments. And we must safeguard and enhance the well-being of vulnerable individuals amongst us. Unfortunately, criminalization of drug use doesn’t achieve these ends. It does the opposite.

Calgary opened its first supervised consumption service (SCS) last year, and my colleagues and I are grateful to Chief Chaffin and the Calgary Police for supporting this initiative. Worldwide, no one has ever died of overdose while attending an SCS—effectively a zone of decriminalization. Research shows that people who attend an SCS are more likely to then seek addiction treatment. In other words, providing environments that are medically and legally safer increases the chances that substance users will one day stop.

It’s counterintuitive to some that what appears to be acceptance of substance use actually reduces addiction. But the reason for this association is simple: Harm reduction saves lives, and dead people don’t recover from addiction. Environments that replace handcuffs with helping hands validate lives, reduce stigma and provide less objectionable avenues for people to seek help earlier.

Even if criminalization could somehow help people with drug-use disorders, our blunt legal instruments conflate possession with addiction. Addiction is chronic, relapsing, compulsive substance-use characterized by physical and social dysfunction. The vast majority of people who possess substances for personal use are not addicted to them. Most Canadians use psychoactive substances. There’s no better way for a Canadian politician to prove they are folksy and relatable than being photographed enjoying a cold beer.

Some might scoff at the comparison between a legal drug such as alcohol and illegal ones such as cocaine. And there are indeed differences. Injury, cancer, hospitalization and death are more common from alcohol exposure than from exposure to most illegal drugs. Alcohol is about as addictive as cocaine (and far more addictive than cannabis). And it’s the drug most often associated with violence. Anyone citing the harms of illicit drugs as justification for criminalization would have a hard time explaining why alcohol is legal. (Unless, of course, they’re willing to acknowledge that alcohol is a favourite substance among socially dominant groups.) But here’s one important way alcohol and illicit drugs are the same: Prohibition of alcohol in the 1920s gave rise to toxic moonshine, just as criminalization of drugs has brought about cheap, lethal chemicals such as fentanyl, which are so easy to synthesize and traffic that interdiction is effectively futile.

Using “authority” to impose care is rarely meaningful, purposeful or effective.

Criminalization of drugs doesn’t enable police to protect “vulnerable people” from predatory drug lords. As reports from the Global Commission on Drug Policy and the London School of Economics show, tough drug laws actually benefit organized crime. Low- and mid-level dealers are the ones caught and prosecuted, decreasing competition in the illicit market while demand for drugs remains high. Meanwhile, successful traffickers can charge exorbitant risk premiums despite the market evolving towards cheaper, more toxic drugs. Increased enforcement efforts are also associated with escalations in violence, not reductions. Let’s not forget: Al Capone made millions from bootlegging during alcohol prohibition while almost every US city saw increases in crime. And Capone was only ever indicted for tax evasion.

Since 86 per cent of people charged with drug possession are offenders in more than one criminal incident, it may seem that police are targeting troublemakers, not people with addiction. But criminalizing drugs drives up the cost, so that people with addiction—especially the socially disadvantaged—often resort to other crimes to afford them. Prosecution exacerbates trauma and reduces socioeconomic opportunity, resulting in progression of addiction and dysfunction. So of course there are subsequent crimes.

And what about the remaining 14 per cent whose only crime is drug possession? No one benefits from their arrests, which widen inequity. Despite similarities in substance use across racial groups, Indigenous people in some regions are almost nine times more likely to be arrested for possession, and black Canadians more than five times as likely to be arrested. Our drug laws don’t protect vulnerable people; they harm them the most.

It’s true that decriminalization on its own would not optimize health and social outcomes related to substance use. But decriminalization saved Portugal tremendous resources previously spent on ineffective and counterproductive enforcement. Instead, that country reallocated funds to evidence-based prevention and treatment. Societies that invest in addressing inequity and social factors that influence health not only see reductions in substance-use harms, but improvements in outcomes for virtually every health issue.

People should never be so afraid of disclosing a personal health behaviour that it progresses to such dysfunction that a police officer is the “first point of contact.” Using “authority” to impose care rarely results in “meaningful, purposeful and effective” interactions for any health condition, let alone complex ones where trauma and psychosocial stressors play a role. In addressing Canada’s drug crisis, police leaders have commonly said, “We can’t arrest our way out of this problem.” But it’s time they and lawmakers recognize that we keep arresting our way further into it.

Roger Chaffin responds to Hakique Virani.

I happen to agree with Dr. Virani in many ways. Our current approach to the rapid increase in the number of addicted individuals in our communities is merely a band-aid solution to the complex social and health problems at the core of the problem. Jail is certainly not a place where individuals get the help they truly need to address core issues such as mental health and trauma.

That being said, the law enforcement community is not in the business of criminalizing addictions. The vast majority of individuals who are arrested and charged with offences serious enough to require jail time are not there because of simple possession of drugs. They are there because they have committed more serious crimes, often in the pursuit of fuelling their addiction, and have further victimized other members of our community.

We need solutions that will provide frontline responders—be they police, paramedics or social workers—with the tools to assist in the moment of interaction with that individual. Models such as Seattle’s Law Enforcement Assisted Diversion (LEAD) pilot program give officers the ability during their immediate interaction with low-level offenders engaged in drug-related or other illegal activity to redirect these people to community-based treatment and support services—including housing, healthcare, job training, treatment and mental health support—instead of processing them through traditional criminal justice system avenues.

The LEAD program is a coordinated approach with Seattle’s municipal government, prosecuting and defending attorneys, police, the Washington Department of Corrections and the American Civil Liberties Union. This client-centred, case-management approach has demonstrated much success. Clients were 60 per cent less likely than people in the control group to be arrested in the first six months after entry into the program, and had both 58 per cent lower odds of arrest and 39 per cent lower odds of being charged with a felony over the longer term. The program has also demonstrated statistically significant reductions in average yearly criminal justice and legal system utilization and associated costs.

LEAD is inspired by similar “arrest-referral” programs in the UK whose pilot projects proved so effective that they were eventually implemented in nearly every police department in the country. Programs such as LEAD provide relief for communities experiencing drug-related crime and social disorder, and offer opportunities for solutions and support for people with addictions. They allow police to use the power of the law to help guide a vulnerable population to an outcome that’s better for them and for the community. It’s about harm reduction working hand-in-hand with law enforcement.

Frontline responders, including police, can redirect people to community-based treatment.

Here in Alberta, the Calgary Police Service is a proud partner of the Calgary Drug Treatment Court. The CDTC, which has been in operation since 2007, provides a pre-sentence justice alternative for drug-addicted non-violent offenders through the integration of justice, health services and treatment options, including court interventions, addiction counselling, employment assistance and skills upgrading. Its philosophy: “…When drug-addicted offenders are provided with the right type and intensity of services, they can change their lives, and often in remarkable and transformative ways.” Indeed, 7 out of 10 CDTC graduates have no new charges or convictions, and overall the program demonstrates an 82 per cent reduction in recidivism.

The CDTC also takes other factors into consideration, such as research showing that over 90 per cent of women who experience serious addictions have known a history of abuse or trauma. The court offers programming led by women and uniquely tailored to women, and can provide referrals to women’s services in the community. A woman suffering severe addictions might not otherwise encounter these services were it not for justice system interventions such as those offered at Calgary’s Drug Treatment Court.

Both the LEAD program and the CDTC offer potential solutions to this complex social issue. Ultimately it comes down to resources. Our communities, municipalities and provinces must come together to make mental health and addictions a focus. We must all work together to acknowledge the harm caused not just to the individual and their families but to our communities by these chronic health issues.

In the meantime, police officers will continue to do what they can on the frontlines. We have a duty to care with compassion and fairness, ensuring impartial and just treatment to all. Our officers are currently undergoing training for trauma-informed approaches to working with our vulnerable populations. Toxic stress effects on the brain, trauma and mental-health conditions impact self-treatment decisions. Understanding this guides us in our daily interactions with individuals.

We will continue to work with our partners to address the complex social and health issues facing our city today and into the future.

Hakique Virani is an assistant clinical professor of preventive medicine at the University of Alberta. Roger Chaffin is the chief of the Calgary Police Service and a board member of the Calgary Homeless Foundation.

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