Seven Chief Public Health Officers Call for Drug Decriminalization, But Justin Trudeau Isn’t Budging

The extraordinary consensus, which has put many cops, doctors, and drug use advocates on the same page, comes amid a deadly summer. In the shadow of the global COVID-19 pandemic, the opioid poisoning crisis is worsening.

Canada has seen roughly 4,000 opioid-related deaths a year since 2017. There is little indication that the deaths are slowing.

Fentanyl and other powerful drugs are now deeply ingrained into the black market heroin trade. Some users even prefer the potent opioids. Many users are overdosing, but thousands more are being poisoned by drugs that are tainted or more powerful than advertised. Supply chains disrupted by the COVID-19 pandemic appear to be causing gluts of cheap and strong drugs, ramping up deaths. Better production is making methamphetamines cheaper and more powerful than before.

There are signs that the crisis is set to spiral out of control, just as Canada tries to contain the COVID-19 pandemic.

While a complete picture of the country won’t be available until next year, preliminary data shows a worrying trend. British Columbia, the hardest-hit part of Canada, has seen more than 900 dead in just the first seven months of 2020, putting it on track to be its deadliest year for overdoses ever. In Toronto, 136 people have died from overdoses from January to July, a 40 percent increase over the year prior. The sparsely-populated Yukon has seen 13 deaths so far this year, more than double 2019. Montreal saw 23 deaths in July alone, many from stimulants such as crack cocaine and meth. Saskatchewan has reported 190 suspected opioid overdose deaths from January to August.

That’s at least 1,262 dead.

With pressure mounting, Prime Minister Justin Trudeau has continued to resist expert calls to decriminalize drug possession, even as he insists he is following the science on the matter.

Do you support the decriminalization of illicit drugs (either for simple possession or in a broader sense) in order to combat the opioid poisoning epidemic? And, irrespective of the question around decriminalization, do you support an expansion in the access to the safe supply of illicit drugs?

Of the 16 health officials across the country who either responded to VICE News’ questionnaire or commented publicly, the chief public health officers for two of Canada’s most populous provinces and one of its territories are in favour of decriminalization, as are the top doctors for its three largest cities.

Dr. Theresa Tam, Canada’s chief public health officer, noted the Trudeau government has consistently resisted a conversation about decriminalization but, she said, “it needs societal debate and discussion.”

Some are more blunt. A spokesperson for Mylène Drouin, the chief public health officer for the Montreal region, responded with a simple “yes” to both questions. Brendan Hanley, chief medical officer for Yukon, was similarly clear: “My answer to both of your 2 questions is yes.”

In a press conference this week, Quebec’s director of public health, Horacio Arruda, said that he was “in favour” of a thoughtful approach to decriminalization, one where “the police, prosecutors, lawyers, everyone accepts it.”

The chief public health officer of British Columbia, Bonnie Henry, published a report last year that carried a single recommendation: “Decriminalization of people who use drugs in B.C.” Her office has also pushed for a significant expansion in safe access to drugs and opioids.

Vancouver’s Chief Medical Health Officer Patricia Daly endorsed decriminalization, but went further in suggesting that “legalization and regulation of all psychoactive substances would reduce people’s dependence on the toxic illegal supply, criminal drug trafficking, and illegal activities that people with addictions must engage in to finance their drug use.”

Toronto’s top doctor wrote in a 2018 report that decriminalization would “facilitate access to much needed health and social services, including treatment and harm reduction services that need to be enhanced.”

Some public health officials were more circumspect.

In an email to VICE News, Deena Hinshaw, the chief medical officer of health for Alberta, referred questions around decriminalization to elected officials. She did underscore, however, that there needs to be “barrier-free access” to “services spanning the continuum from harm reduction, to treatment and recovery, with connections between services that make it as easy as possible for people to get the support that they need.” Alberta recently pulled funding of a safe-injection site, one of the busiest in North America, causing its last day to fall on International Overdose Day.

Saqib Shahab, Saskatchewan’s public health officer, also recently endorsed harm reduction and treatment programs, but stopped short of endorsing decriminalization. Ottawa’s public health department noted “the current impacts of the toxic illegal drug supply require an alternative approach that reaches those whose needs are not currently met by more traditional programming and services,” and highlighted safe supply initiatives already present in Ottawa.

A spokesperson for the Manitoba government, responding on behalf of the chief public health officer, wrote that “drugs trends and related harms vary across the country. Therefore, the appropriate response to these issues may also vary.”

New Brunswick’s chief public health officer declined to comment, while representatives from Ontario, the Northwest Territories, Nunavut, Nova Scotia, P.E.I., and Newfoundland and Labrador failed to provide comment or did not reply.

Medical experts are increasingly lining up behind the idea. But, surprisingly, so are the cops.

In a July report, the Canadian Association of Chiefs of Police also endorsed decriminalization, writing that “merely arresting individuals for simple possession of illicit drugs has proven to be ineffective.” The association of Canada’s top cops specifically recommended legislative changes and a change in approach.

In the interview, Trudeau initially positioned himself as agreeing with the growing public health consensus  around decriminalization. “It’s more of a health issue than a justice issue, and that’s the approach we’ve taken on it,” Trudeau said.

He continued that “the key to decriminalization is making sure that there is a safer supply for people who are struggling with addiction.” But, as he noted a beat later, his government has continued to treat drugs as a criminal law issue. “That is what we’ve moved forward on, without having to take the step of decriminalization.”

Through the interview, Trudeau blamed “the right” for pushback on his agenda. During the election, the Conservative Party did warn voters in a Chinese-language ad that “Justin Trudeau’s Liberals have a plan to legalize hard drugs just like they legalized marijuana.” It didn’t seem to work.

Trudeau insisted that any further he goes will need to be done “responsibly.”

Finally, Quinn mentioned comments Trudeau made in a VICE News town hall in 2017—Trudeau was pressed by frontline harm reduction worker Zoe Dodd on ending the criminalizing of illicit substances. Trudeau, in response, insisted “I’m not there yet.”

Quinn asked: “Are you there yet?”

“Again, you are putting decriminalization as the silver bullet that is suddenly going to end this crisis,” Trudeau remarked, as Quinn interjected to point out that nobody—not the premier, not the mayor, not the advocates, the researchers, nor the frontline health workers—is suggesting decriminalization is a panacea.

“We are following the science and the best recommendations on what we do, every step of the way,” Trudeau said.

According to Statistics Canada, the courts convicted 4,300 Canadians where drug possession was the most serious offence in 2018. (These numbers include only the lowest-level drug charges, and possession of large quantities of drugs is sometimes prosecuted as a trafficking offence) More than 700 were sentenced to jail time, while another 1,500 were sentenced to a conditional sentence or probation—meaning a violation of their release conditions could mean incarceration.

In August, the Public Prosecution Service—the independent body which manages all federal prosecutions—released new guidelines for prosecuting simple drug possession. As the guidelines spell out, the shift was aimed to “focus upon the most serious cases.”

The new guidelines were heralded by the media as a move away from criminalization. Yet the guidelines themselves are extremely broad. They still encourage charges for possession that presents “harms justifying a criminal prosecution response” including simple possession that occurs “in the vicinity of places frequented by children or young persons” or where the person has kids. It suggests prosecution of drug possession is appropriate where it “poses a heightened risk to a community’s efforts to address consumption of controlled substances in accordance with its own community approaches.”

These guidelines only govern federal Crown attorneys, who generally handle drug prosecutions, but do not affect how police pursue investigations or how provincial Crowns may pursue related charges.

There have been calls in Parliament to fully decriminalize drugs—not just recommend that Crown attorneys pursue charges less often, but to fully remove police from managing drug use and addiction.

NDP Leader Jagmeet Singh has supported wholesale decriminalization since he first ran for leader of his party, while the Green Party has endorsed decriminalization as a temporary solution for the opioid crisis. Backbench Liberal MP Nathaniel Erskine-Smith, too, has endorsed those calls, and actually brought forward legislation to do exactly that. Private member’s bills, however, rarely become law.

Canada wouldn’t be the first state to pursue decriminalization. Portugal dropped criminal prohibitions on drugs two decades ago, and it is considered a success. 

Former health minister Jane Philpott and ex-justice minister Jody Wilson-Raybould have said they lobbied Trudeau to take the same approach, after visiting Lisbon. Trudeau rebuffed their suggestion, the two former ministers said, suggesting that the government’s internal polling proved it unpopular.

Public polling does suggest, however, that Canadians are evenly split on decriminalization in the face of a poisoning epidemic. Ipsos found 47 percent are in favour of decriminalizing drug possession.

A closer look at his government’s work, however, shows the impact is positive but still marginal.

Ottawa’s work in recent years has largely fallen into two categories: Funding safe consumption sites and expanding opioid agonist therapies.

Safe consumption sites have, according to peer-reviewed research, saved scores of lives. They present a safe, monitored space where users can obtain clean needles and where support staff can administer overdose-reversing treatment naloxone when required. They, however, do little to change the supply available in the drug market. And access remains limited: There are no safe consumption sites in Manitoba or Saskatchewan, nor is there a single site east of Montreal.

The second pillar, opioid agonist therapies, works by switching users onto more reliable drugs. Methadone and suboxone are the most well-known alternatives, but Canada has branched out into offering a variety of injectable and tablet alternatives that help users address their addiction while avoiding the threats of street-level heroin and fentanyl. These programs, however, are limited by design.

“It’s really up to doctors to take it up and prescribe,” said Donald MacPherson, director of the Canadian Drug Policy Coalition. These therapies often require patients to show up daily to receive their drugs, and must use under the supervision of a nurse.

Some users have been prescribed heroin itself, sourced through the federal government from a reliable supplier in Switzerland. That program remains small, with just hundreds currently receiving the drug under the supervision of a doctor.

These programs are not available across the country, have limited capacity, and can be cumbersome for users.

A December report from the B.C. Centre for Disease Control reported that less than 1,500 people in the province were undergoing agonist therapies. Other provinces are far behind British Columbia in terms of access. The Trudeau government recently announced $500,000 to fund access to agonist therapies in Toronto.

“If you take methadone and suboxone out of the equation then, yes there are only a few thousand people on what we could call ‘safe supply,’” MacPherson said.

A spokesperson for Health Minister Patty Hajdu admits that Ottawa has no idea how many people in the country have access to these programs, noting it is a provincial responsibility.

Even with new funding and support, it seems virtually impossible that Canada could scale up its agonist therapies to reach enough drug users to end the poisoning epidemic. Many users aren’t interested in switching drugs, while others consider the prescription drugs too weak.

Many drug advocates point to buyers’ co-operatives, whereby users pool their resources to purchase their drug of choice from a trustworthy supplier, as an innovative solution to the problem. While some of these clubs exist in Canada, they must operate in the shadows, as their work is technically trafficking.

As Tam phrased it in a press conference in August, “You cannot arrest your way out of an opioid crisis.”

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Correction: This story has corrected the number of B.C. residents using agonist therapies.