Canada must treat opioid use as a health issue, not a criminal matter.
The Canadian Mental Health Association calls for care not corrections to relieve opioid crisis
TORONTO (ONTARIO) April 17, 2018 – According to a new national policy paper released today by the Canadian Mental Health Association (CMHA), decriminalization is key to solving the opioid crisis that is killing thousands of people. The paper, developed by a cross-Canada team of mental health policy and research experts in response to escalating rates of opioid-related harms, recommends a bold and effective public health approach to relieving the crisis that focuses on care, not corrections.
“Criminalizing people who use drugs stigmatizes substance use, fosters a climate in which they feel unsafe in accessing life-saving interventions and treatment, and further marginalizes those living in poverty or at social disadvantage,” says Dr. Patrick Smith, national CEO, CMHA. “The war on drugs doesn’t work, and it’s time we lay down our weapons and start getting people help.”
As part of ten evidence-based recommendations, CMHA recommends decriminalizing all illegal substances for personal use with the goal of aligning Canadian drug laws with public health. Decriminalization, which is not the same as legalization, means that the possession, use and acquisition of illegal drugs would no longer be criminal offenses; however, producing, supplying and selling drugs would remain criminal offenses.
The Portuguese model, which decriminalized psychoactive substances for personal use in 2001, increased access to treatment by 60 per cent in the first decade. Portugal also reduced the number of people arrested and incarcerated for drug-related offenses by 60 per cent by 2015.
“To get it right in Canada, decriminalization must be accompanied by significant investment in health promotion, harm reduction and treatment measures,” says Smith. “Social inequalities are a significant and often overlooked root cause of the crisis. If we want to fix the problem, we need to fix the imbalances in our society that are causing problems in the first place.”
Social inequalities cause a significant amount of psychological pain and trauma, which are linked to mental illness and problematic substance use. The opioid crisis disproportionately impacts people who have low incomes, are unemployed or have disabilities as well as Indigenous communities contending with systemic racism, trauma and intergenerational trauma.
In 2016, this public health emergency hospitalized 16 Canadians a day, and is now taking the lives of more Canadians per year than the HIV epidemic did at its height in 1995.
At the same time as decriminalization, CMHA recommends investing in affordable housing, childcare, education and employment—often called the social determinants of health—to address environmental stressors such as poverty and insecure housing, which increase the risk of problematic substance use and mental illness.
This complex and layered problem will require an equally dynamic solution, with a variety of components that add up to a robust and comprehensive public health approach. Other recommendations include researching, funding and improving access to treatment for Opioid Use Disorder, including options such as universal access to psychotherapy, exploring cannabis as a possible alternative form of pain management, recognizing Indigenous healing practices and increasing access to methadone and buprenorphine/naloxone treatment for withdrawal.
“What is clear is that pain is poorly managed and not well understood in Canada—and this is part of the problem. As it stands, veterinarians receive five times more instruction on pain than physicians,” says Smith. “Better training and education are needed, especially for management of chronic pain.”
The paper recommends a National Pain and Addictions Strategy that includes investment in research, education and clinical care targeted toward finding safer pain management approaches. The strategy should recommend treatment options that include both drugs and other approaches; and, if opioids are prescribed, treatment should include an exit plan.
Canada is not starting from scratch, and should increase access to successful overdose prevention sites and supervised consumption sites, like the 20 B.C. overdose prevention sites that reversed almost 500 overdoses between Dec. 2016 and Mar. 2017, by providing public education on their effectiveness. Supervised consumption and overdose prevention sites save lives, reverse accidental poisonings and reduce communicable diseases like HIV and Hepatitis C by providing sterile supplies, but many communities do not have any of these sites. The B.C. Coroners recently reported that up to 94% of deaths from illegal drugs in January 2018 occurred indoors; one innovative solution might be to use video teleconferencing to supervise people who use drugs alone in private residences.
Those who are using illegal drugs and are not seeking treatment are at the highest risk of accidental poisoning from fentanyl and fentanyl analogues. For this group, CMHA recommends researching and supporting innovative pilots that offer prescription-grade drugs as an alternative to the contaminated drug supply.
“Canada is already making great strides in developing and expanding harm reduction programs and initiatives, and we are heading in the right direction. These measures lay the foundation for an even bolder and more effective public health approach to an emergency rooted in suffering, structural inequalities, untreated pain, and mental health and addictions challenges,” says Smith. “It’s not an easy road, but with the right supports, recovery is possible.”
To download the Summary Report of Care not Corrections: Relieving the Opioid Crisis in Canada, or the 53-page Full Report, please visit www.cmha.ca.