We are witnessing the beginning of a real debate around the wider legally regulated availability of drugs in Canada. The legalization of cannabis has opened peoples’ minds to the idea of responsible regulation, whilst the opioid crisis has forced the debate into new territory. The window of opportunity is now wide open.
Public-health officials in Toronto and Montreal have publicly endorsed ending the criminalization of people who use drugs, as a key part of the public-health response to the opioid crisis. But beyond the immediate emergency, what are the options for dealing with the realities of illegal drug use and criminal-controlled drug markets?
“Legalizing all drugs” may seem a frightening proposition. But considering that prohibition and repression have only made certain products and behaviours more problematic, it is a perfectly reasonable option.
Regulation of risky products and behaviours is a key role of government and is the norm in most policy arenas. Prohibition is the failed and radical experiment here. Nor are legally regulated drugs purely hypothetical. Swiss doctors have been prescribing heroin for the past 25 years to stabilize and treat people with heroin dependency. This “legal” heroin is not associated with any of the criminality, violence, overdose deaths or HIV transmission of the parallel criminal market. The model has already been piloted effectively in Canada’s NAOMI (the North American Opiate Medication Initiative) trials.
The “war on drugs,” as it was named by Nixon, legitimizes the violation of human rights in many countries, represents a major obstacle in reaching public-health objectives, exacerbates violence and criminality, and is costing us billions. The rates of use of an expanding variety of substances are increasing in most countries, at the same time as more effective legal regulation of tobacco is decreasing harmful consumption. Should we continue investing in a strategy that fails so miserably? When decision makers are humble enough to recognize that the hypocrisy of harshly enforced prohibition has only amplified the problems related to drug use, they implement policies that are more efficient to regulate drugs.
Legalization is just the process; strict, responsible legal regulation of drug markets is the end point. This is quite different from the idea that it is liberalization, “relaxing” drug laws, or promoting drugs. We have to choose if we want governments or gangsters to be in control of drug markets. The past half century shows us no third “war on drugs” option in which they magically disappear.
Which drugs would be available, to whom, and where? These are tricky questions, but ones we are able to answer under a legally regulated model where government has taken back control, rather than abdicating all responsibility to criminal market forces. More risky substances could be available only via a medical prescription model with supervised use, like heroin in Switzerland. Certain medium-risk drugs, including certain stimulants and party drugs, could be available on a rationed basis to adults from pharmacies, perhaps with a licensed buyer model, once they have proven they understand the risks. Other lower-risk drugs could be more available through appropriate licensed retailing, as we are about to do with cannabis.
Wider drug regulation would allow redirection of resources into more efficient prevention and targeted treatment, facilitating better access to the most vulnerable individuals. And the forces of commercialization that have been so historically damaging with alcohol and tobacco could be curtailed with appropriate bans on marketing and branding. If done responsibly, drug use would be safer, pressures to increase use can be mitigated and resources for proven public-health responses increased, as criminality and the illegal market contract.
The idea of wider legalization may seem a counterintuitive response to the current crisis, but is in reality a rational, evidence-based, and responsible policy option that policy makers must now seriously explore. Canada has been a pioneer of innovative and successful drug policy reforms. Many seemed controversial at the time, but are now not only accepted, but internationally heralded. The war on drugs has failed. Canada can carry the torch of global leadership to the next level by showing the world how to end it.
— David-Martin Milot is a medical specialist in public health and preventive medicine in Canada and a fellow in research on drug legislation and social norms in France and the United Kingdom. Steve Rolles is Senior Policy Analyst for the Transform Drug Policy Foundation, United Kingdom.