BRAUN: Decriminalizing drugs one step in an ongoing process

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There were 521 fatal opioid overdoses in Toronto last year, a jump of about 80% over 2019.

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The average number of fatal calls attended by paramedics for suspected opioid overdoses has doubled during the pandemic.

As Medical Officer of Health Dr. Eileen de Villa has said, we are in the midst of a drug poisoning crisis.

On Monday, the Board of Health will seek exemptions to the Criminal Code, making personal drug possession within city limits a non-criminal act.

Under the proposal, the simple possession of any drug for personal use would be decriminalized; this has nothing to do with producing or selling drugs, which would remain illegal.

The move to decriminalize simple possession is step one in the overhaul of anti-addiction strategy, which is moving from punishment to public health.

Both Mayor John Tory and Chief of Police James Ramer support decriminalization, but, as the Toronto Sun reported, both say it must be supported by beefed-up harm reduction and treatment services.

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Addiction therapist CK Brand describes decriminalization as a positive change, if those treatment services are in place, such as rehab and counselling.

“But there’s less rehab than ever, and it’s even harder to get into. There are no 28-day programs — a lot is being done around mental health, and far less around addiction. There are good places still in the U.S., but they are private and expensive. Public facilities here — it’s almost impossible,” said Brand.

Fortunately, the agenda for Monday’s Board of Health meeting includes several proposals for funding (federal and provincial) that will improve addiction services and access to them; harm reduction efforts will also include safer drug consumption programs.

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Consider it a work in progress. As Mayor Tory has said, this is not a moral or legal issue: “It is a health issue.”

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What Toronto is going through is not unique. Oregon has dropped criminal penalties for carrying small amounts of hard drugs and, according to a report from nonprofit pewtrusts.org, it’s a change progressive lawmakers are urging other states to make.

For one thing, funds are better spent on addiction recovery services, and, “arresting someone for small amounts has never made sense,” said Brand. “Jail is certainly not the answer.”

Oregon has the fourth-highest rate of substance use disorder in the U.S.

The Centre for Disease Control reports that about 95,000 people died of drug overdoses in America last year. That’s 30% more than in 2019.  Fentanyl abuse increased; treatment options decreased, thanks to the pandemic.

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Since the law changed in Oregon in February, drug arrests have fallen. But access to treatment needs improvement (there are worker shortages because of the pandemic) and work is ongoing to establish more state hospital beds and trained personnel.

The thinking that substance use disorder should be treated as a disease, not a crime, requires a change in perception.

“We’re shifting from a terribly traumatizing system and racist system to a trauma-informed, patient-centred system,” said Tera Hurst, of the Oregon Health Justice Recovery Alliance, in the Pew Trusts report.

“That doesn’t happen overnight.”

Oregon took lessons in this transition from Portugal, the first country to move to decriminalization in 2001. Portugal is often held up as the example of how to do this right.

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Change in Portugal was fuelled by an earlier drug crisis. The country was overwhelmed by heroin use in the 1980s, so bad that one in 100 was fighting addiction.

Susana Ferreira reported in The Guardian that what was required in Portugal was, “an enormous cultural shift” and a complete change in how the country regarded drugs and addiction — again, that move from punishment to individual treatment.

According to the example set by Portugal, instead of arresting people, you let them know what help and services are available to them.

That approach saw a drop in addiction, HIV and hepatitis infections, overdose deaths, and drug-related crime over the first decade following decriminalization.

The Portuguese system works well, although it’s not perfect — activists still want more safe consumption sites, more naloxone, and needle exchange programs in prisons, among other things, according to The Guardian report.

After years of the so-called war on drugs in North America, it’s important to note that among the guiding tenets of Portugal’s policy is this: the eradication of all drugs is an impossible goal.

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