Four Pillars Drug Policy Program

Proposed new name for the conferenceProposed new name for the conference

The International Conference for theR d ti f P li R l t d H t P l Reduction of Policy Related Harm to People

Who Use DrugsWho Use Drugs

Deadly Public PolicyDeadly Public Policy

Termed coined by Centre for Excellence in HIV in the 90’s to refer to Termed coined by Centre for Excellence in HIV in the 90 s to refer to all of the social policies that contributed to the HIV epidemic among injection drug users in Vancouver’s Downtown Eastside

No housing programs for drug usersContainment by Police in one area of the cityCo ta e t by o ce o e a ea o t e c tyIncome assistance checks distributed on one dayWorld’s fair cleanup that pushed a cocaine market on top of a heroin World s fair cleanup that pushed a cocaine market on top of a heroin

marketDisplacement of a sex work stroll into the neighourhoodDisplacement of a sex work stroll into the neighourhoodConcentration of alcohol establishments Poor access to syringesPoor access to syringes

Stigmatization of the War on DrugsStigmatization of the War on Drugs

Most policy related harms to people who use drugs flow from the Most policy related harms to people who use drugs flow from the stigmatization caused by the war on drugs.

People who use drugs are the “undeserving poor” and consequently are not recipient of or have access to many of the social programs a e ot ec p e t o o a e access to a y o t e soc a p og a savailable to others

Health servicesHousing programsEmploymentEmploymentTraining Education Education

Change is Hard!Change is Hard!

Our dilemma is that we hate change and love it at the same gtime; what we really want is for

things to remain the same but getthings to remain the same but get better.

Sydney J. Harris

Crisis of ‘80s and ‘90sCrisis of 80s and 90s

1988 17 illicit drug OD deaths1988 - 17 illicit drug OD deaths1993 - 200 illicit drug OD deathsg1993 - 2001: 150 annual average in OD deathsIllicit drug overdose becomes leading cause of

death for men 30-45 in the ninetiesHIV epidemic among injection drugs users - 1996Public Health emergency declared – 1997No emergency response!!No emergency response!!

“We need to recognize that it’s not deviant or pathological for humans to desire to alter their p gconsciousness with psychoactive substances. They’ve been doing it since pre-history… and ey e bee do g t s ce p e sto y a dit can be in a religious context, it can be in a social context, or it can be in the context of social context, or it can be in the context of symptom management.”

P K d ll B iti h C l bi Perry Kendall, British Columbia Provincial Health Officer

Human Development and Learning Human Development and Learning

Conditions that are non negotiableConditions that are non-negotiable1. Sense of belonging – not one that is earned but is an

titl tentitlement2. Once belonging attained then one has the opportunity to

acquire one’s own sense of personal competencies3. Self determination emerges from that sense of 3. Self determination emerges from that sense of

competency4 Criminalization crushes this sense of belonging4. Criminalization crushes this sense of belongingThis is why Harm Reduction is so essential within a context

of criminalization Harm Reduction restores the of criminalization - Harm Reduction restores the opportunity to belong as we have seen here this week

Illicit Drug Portion of Actual Canadian Federal Drug Strategy E di f 2004 200 b CExpenditures for 2004-2005 by Category

Coordination and Research

6%

iPrevention4%

TreatmentEnforcement

Treatment14%

Harm Reduction

73%

Harm Reduction3%

DeBeck et al, DeBeck et al, 20062006. HIV/AIDS Policy & Law Review. HIV/AIDS Policy & Law Review

Canada’s Federal National AntiCanada’s Federal National Anti--Drug Strategy Drug Strategy g gyg gyFunding by CategoryFunding by Category

Coordination and Research

7%

Prevention4%Enforcement

70%

Treatment17%

Harm Reduction

2%%

DeBeck et al, DeBeck et al, 20082008. International Journal of Drug Policy. International Journal of Drug Policy

Auditor General of CanadaAuditor General of Canada

“there have been growing acknowledgements g g gby Canadians and parliamentarians that there are limits on the ability of law there are limits on the ability of law enforcement to reduce the supply of drugs” (2001)(2001)

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Senate Committee ReportSenate Committee Report

Sept 2002Sept 2002“ the available scientific literature …the available scientific literature

establishes no relationship between the severity of legislation and life time severity of legislation and life-time prevalence of cannabis use”

“its criminalization is the principle source of social and economic cost”social and economic cost”

Recommendation of a regulated market for 17

Recommendation of a regulated market for cannabis

Substance Abuse in Canada: Current Challenges and ChoicesChallenges and Choices

This Canadian Centre on Substance Abuse report This Canadian Centre on Substance Abuse report (released April 13th 2005) states:

"... the criminalization of illicit drug users under the current drug control legislation in Canada stands in stark opposition to the objectives of public health, and, in fact,

t ib t t f th d l t d bl th t contributes to many of the drug-related problems that harm reduction tries to alleviate. For example, the prevention of infectious disease transmission or prevention of infectious disease transmission or overdose risk among IDU's is strongly hampered by the criminalization of users"

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criminalization of users

Auditor General of CanadaAuditor General of Canada

“ with drugs as its primary source of “…with drugs as its primary source of revenue, organized crime has intimidated police officers, judges, juries and correctional officers. Such intimidation is a correctional officers. Such intimidation is a direct threat to Canada’s philosophy of peace order and good government ”peace, order, and good government.

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A Vision for PreventionA Vision for Prevention

It is acknowledged that the use of psychoactive It is acknowledged that the use of psychoactive substances is part of human behaviour. Public discourse reflects an understanding that substance use is a reflects an understanding that substance use is a complex social, cultural, health, and economic issue. Social norms promote safety and safer substance use. p yAppropriate regulatory mechanisms exist for all substances. Civic responses to psychoactive substance use focus on preventing and reducing harm. As a result, Vancouver’s individuals, families, neighbourhoods, and communities experience less problem drug use crime communities experience less problem drug use, crime and related harm.

S f S

Chronic DependenceCasual/Non problematic Use

Spectrum of Psychoactive Substance Use

Chronic DependenceCasual/Non-problematic Use• recreational or other use that has

negligible health or social impact• use that has become habitual and

compulsive despite negative health and social impactsp

Beneficial Use Problematic UseProblematic Use• use that has positive health or social

impact

• e.g. medical psychopharmaceuticals;

• use that begins to have negative consequences for individual, friends/family, or societyg p y p ;

coffee to increase alertness; moderate consumption of red wine; sacramental use of ayahuasca or peyote

friends/family, or society

• e.g. impaired driving; binge consumption; harmful routes of administrationadministration

The BoxThe Box

Public Health

2525

Aspect of the Market Under Prohibition (now) With a Regulated Market

Comparison of Unregulated and Regulated Marketsp ( ) g

Price and Profit-government revenue-profit to sellers

fi i i l

uncontrollednoneuncontrolled

controlledpossibility for taxationcould be controlled

-profit supports criminal organizations-laundered profits create instability

yesyes

nono

Purity/Strength uncontrolled controlledPurity/Strength-addition of toxic additives

uncontrolleduncontrolled

controlledno additives

Availability/Access-youth engaged to buy and sell

uncontrolled, openyes

controllednoy g g y y

Conditions of sale-location of sale-appearance of product

i l d t t l b d

uncontrolleduncontrolleduncontrolled

t ll d

controlledcontrolledcontrolledd t -violence used to control buyers and

sellers-health information provided to consumer, including warning labels

uncontrollednonono

does not occuryescontrolledmaybe

-volume purchase restrictions-assessment by a health care worker-location of consumption restricted

no maybe

Policing Costs high lowerPolicing Costs high lower

Production-lab or grow op dangers

uncontrolleduncontrolled

controlledminimal/controlled

Current Regulatory Framework: A Failed Public P liPolicy

Hands over supply of real demand to multinational Hands over supply of real demand to multinational organized criminal organizations P hibiti fl t i i lit d bli h lthProhibition conflates criminality and public healthExample - public health emergency but no p p g yemergency responseNo drug is made safer left in the hands of organized No drug is made safer left in the hands of organized criminals and unregulated dealersP hibiti i t d t t b t liti l Prohibition is not a drug strategy - but a political strategy – United Nations 2008 Drug Free World: We Can Do It!We Can Do It!

Let’s reduce harm from tobacco we can do it!!Let’s reduce harm from tobacco – we can do it!!

“Relatively successful prevention efforts such as “Relatively successful prevention efforts, such as tobacco control in British Columbia are characterized by the alignment of policies and characterized by the alignment of policies and actions across all levels of the community, i l di i ti d di i ti d ti including incentives and disincentives, education, pricing, advertising, regulation and treatment

This has not happened for alcohol and illegal drugs.”drugs.

Perry Kendall BC Provincial Health OfficerPerry Kendall, BC Provincial Health Officer

Regulation of Tobacco - De-normalization

AgeAge

Limited places to useSocially stigmatized

Limited places to use

Illegal dealers

Prevention programs

Illegal dealers pursued by

enforcementTreatment

LitigationWarning labels

TaxedAdvertising and event sponsorships limits

Responses Available for Illegal Drugs

EnforcementEnforcementTreatment and

Harm Reduction

Education and awarenessawareness

Socially stigmatizedthrough criminalizationthrough criminalization

Regulation of Cannabis - Normalization

Age Appearance of retail outletsg

Degree of intoxification

Volume rationing

pp

Taxed

Li i l ti d i Volume rationing

Limited places to use

Required training prior to use

Licensing, location and opening hours of consumption facilities

Socially stigmatizedRequired training prior to use

Maximum volumes for purchase and possession

Socially stigmatized

Prevention programs

TTraining of supplier

Monitoring of use with driving

Treatment

Plain packagingg g

Illegal dealers pursued by enforcement

Retail outlets licensed and limited

Warning labels

No advertising or event Retail outlets licensed and limited sponsorships

Regulation of Heroin - Normalization

Age Appearance of retail outletsDegree of intoxification

Volume rationingLimited places to use

Pharmacy specialist required

Price and profit controls

TaxedpRequired training prior to useRegistration of purchasers

Li i f

TaxedLicensing, location and opening hours of consumption facilities

Socially stigmatizedLicensing of usersTracking of consumption habits

Drug consumed on location of sale

Socially stigmatized

Prevention programs

Treatment availablePrescription only

Maximum volumes for purchase and possession

Plain packagingConcentration of product is

restricted and labeledTraining of supplier

Monitoring of use with drivingIllegal dealers pursued by enforcement

Warning labels

No advertising or event sponsorshipsIllegal dealers pursued by enforcement

Retail outlets licensed and limitedClean needles and health information

provided with purchase

ConclusionConclusionCities have a key leadership role to play in Cities have a key leadership role to play in determining responses to addiction and prohibition in the communityin the communityInformed public discussion criticalBuild on evidence of what works, not ideology or wishful thinkingPolitical and Institutional leadership and courage is necessarynecessaryThere are choices to be made – the status quo or a public health approachpublic health approach

Thanks!! Thanks!!

Donald MacPhersonDonald MacPhersonDrug Policy Coordinatorg y

City of VancouverCanada

Thanks to the Health Officers Council of BC Mark Thanks to the Health Officers Council of BC, Mark Haden, Gillian Maxwell, Keeping the Door Open,

Transform Drug Policy Foundation Transform Drug Policy Foundation donald.macpherson@vancouver.cap @

www.vancouver.ca/fourpillars