Amid Canada’s drug toxicity crisis, many advocates, drug policy experts, people with lived/living experience, and public health professionals are focusing their attention on reassessing the 100-year-old prohibitionist approach to substance use. We know there needs to be a change from the criminalization of substance users to supports that are rooted in public health.
What has been put on the back burner as we respond to the current crisis, however, is the ongoing HIV epidemic and its impact on people who inject drugs. The community of people who inject drugs has been forced to arm themselves against two dangerous threats – the toxic drug supply and HIV. Legislation transformation is required immediately to save the lives of those threatened by the drug toxicity crisis. The necessary changes that need to be made to the regulation of substances in Canada have the potential to save lives and reduce the transmission of HIV across the country.
HIV and people who use substances
In addition to being at an increased risk for drug poisoning, people who inject drugs are also at a high risk of contracting HIV. Of the over 11 million people who inject drugs globally, one in eight live with HIV. (1) In Canada, people who inject substances are 59 times more likely to contract HIV than those who do not. Approximately 17 percent of new HIV diagnoses in 2020 were connected to injection drug use. (2)
Furthermore, while incidences of HIV declined globally by 25 percent between 2010-2017, HIV infections among people who inject drugs have continued to rise. People who inject substances and their sexual partners account for approximately 25 percent of all new HIV cases internationally. (3)
Although the sharing of substance use equipment can be connected to this alarming statistic, the stigma associated with using substances also contributes to negative health outcomes related to both HIV prevention and treatment, as people who use substances are less likely to connect to care. (4)
Research shows time and again that the criminalization of substances “demonstrated worse health outcomes among those targeted by [those] laws and their communities at large.” (5) Fear of criminal prosecution and social judgment coerce people who use drugs to do so in secretive, underground spaces, disconnecting them from HIV testing, treatment, and prevention options and forcing them into high-risk environments; combined, this increases vulnerability to the HIV virus. (6)
The case for decriminalization
Those opposed to decriminalizing substances argue that removing this type of legislation will increase the use of substances and create an unnecessary burden on Canada’s health care system through increased substance use-related illness. (7)
The overall health of individuals within our communities should be prioritized, but public health, not punitive laws, should drive health management in Canada. “The evidence that criminalization helps [keep our communities healthy] is weak at best and the vast majority of studies show that criminalization hurts when it comes to health, economics, and society-at-large.“ (5)
Changing to a public health approach through the decriminalization of people who use drugs has proven to be an effective strategy to support those at high risk of contracting HIV, connect them to care, and counter the high rates of HIV among those who inject substances.
The Portuguese model
In July of 2001, Portugal introduced Law 30/2000. Through a health-oriented lens, this law decriminalized drug use and the possession of small amounts of drugs, using administrative consequences, such as community service, for those found carrying drugs. (8) This law also created a referral system for law enforcement authorities to connect people who use drugs with supports and implemented a national framework for harm reduction programming.
The outcomes of this change in legislation resulted in multiple benefits to the country. “Portugal went from having one of the highest rates of problematic drug use in Europe before decriminalization, to having a rate of overall drug consumption that is low in comparison with that of other European countries." (9) In addition, Portugal saw a decrease in drug poisonings by 80 percent, and new HIV cases fell from 52 percent to six percent within the first five years of the new law's launch. (8,9)
Although the Portuguese model may not be fully reflective of what the substance-use community is advocating within the context of decriminalization, Portugal's effort shows the positive aspects of how a public health approach, rather than criminalization, can reduce the transmission of HIV amongst people who use substances while also saving lives.
How to get involved
Over 100 years of criminalizing substances in Canada has proven to be an ineffective strategy for supporting people who use substances, leading to an increase in disease transmission of viruses such as HIV. The criminalization of substances perpetuates stigma for people who use drugs, thus increasing their risk of HIV and other blood-borne infections. Change is needed, and there are many ways to get involved.
Support harm reduction
Harm reduction is an effective, evidence-based strategy in the fight to end HIV. There are multiple comprehensive harm reduction services that are evidence-based for reducing the transmission of blood-borne infections, such as HIV. These services include, but are not limited to:
- Needle distribution
- Take Home Naloxone
- Supervised consumption services
- Substance use treatment programs
- Accessible testing and treatment options
Like Portugal, areas that have implemented Harm Reduction programming have experienced a substantial decline in HIV infections among people who use substances. (8)
Get educated
Years of criminalization have negatively impacted social attitudes related to substances and people who use substances. Education is key in changing how people understand the world around them and how to address public health issues like substance use disorder, the drug toxicity crisis, and the HIV epidemic. SafeLink Alberta has several free online trainings created with the community which discuss HIV, hepatitis C, and other sexually transmitted infections, harm reduction, and substance use. To learn more or attend these evidence-based and community-informed workshops, please visit: www.safelinkalberta.ca/training-resources/
Get political
On June 1, 2022, the House of Commons vetoed Bill C-216, a Private Member's bill focused on moving substance use from a criminal issue to a public health concern. (9) Decriminalizing substances is a necessary step in our fight against HIV.
At an individual level, decriminalization would give people who use substances living with or at risk of contracting HIV more opportunities to openly connect with support services and care. Furthermore, decriminalization would reallocate tax dollars to focus on prevention strategies that address the factors which lead to people misusing substances and allow Canada to develop a national public health strategy to address problematic substance use.
Individuals interested in human rights, and this cause specifically, can advocate to their local members of parliament and demand legislative change. Remember, according to the Canadian Charter of Rights and Freedoms, “Every individual in Canada is to be treated with the same respect, dignity, and consideration.” (10)
Get involved
Many local not-for-profits and businesses are actively working within the community to decriminalize substance use and reduce the negative impacts generated by such legislation. Learn about these organizations, be patrons at their establishments, or donate your time or money to support their work. To learn more or to get involved, please visit SafeLink Alberta.
References
1. HIV and AIDS. United Nations Office on Drugs and Crime. Published 2022. Accessed June 15, 2022. https://www.unodc.org/lpo-brazil/en/hiv-aids/index.html
2. Challacombe, L. Canadian AIDS Treatment Information Exchange. The Epidemiology of HIV in Canada. Published 2018. Accessed June 15, 2022. https://www.catie.ca/sites/default/files/fs-epi-hiv-canada-EN-2018-09-06.pdf
3. Canada and UNAIDS. UNAIDS. Published 2018. Accessed June 3, 2022. https://open.unaids.org/sites/default/files/documents/DonorProfiles_Canada_low_V9.pdf
4. DeBeck, K., Cheng, T., Montaner, J. S., Elliott, R., Sherman, S., Wood, E., & Baral, S. HIV and the criminalisation of drug use among people who inject drugs: a systematic review. The Lancet HIV. 2017;4(8): 1-9. https://doi.org/10.1016/s2352-3018(17)30073-5. Accessed June 14, 2022.
5. Making Drug Use a Crime Makes HIV Prevention Treatment More Difficult. John Hopkins. Published 2017. Accessed June 15, 2022. https://publichealth.jhu.edu/2017/making-drug-use-a-crime-makes-hiv-prevention-treatment-more-difficult
6. The War on Drugs and HIV: How the Criminalization of Drug Uses Fuels the Global Pandemic. Global Commission on Drug Policy. Published 2012. Accessed June 14, 2022. https://www.opensocietyfoundations.org/publications/war-drugs-and-hivaids-how-criminalization-drug-use-fuels-global-pandemic#publications_download.
7. Carroll, K. Use without consequences? A commentary on Bonn et al. Journal of Studies on Alcohol and Drugs. 2020;81(5):561. https://doi.org/10.15288/jsad.2020.81.561. June 15, 2022.
8. Vale de Andrande, P. & Carapinha, L. Drug decriminalization in Portugal. British Medical Journal. 2010;341:4554. https://doi.org/10.1136/bmj.c4554. Accessed June 15, 2022.
9. Drug Decriminalisation in Portugal: Learning from a Health and Human-Centred Approach. Drug Policy Alliance. Accessed June 15, 2022. https://drugpolicy.org/sites/default/files/dpa-drug-decriminalization-portugal-health-human-centered-approach_0.pdf.
10. Rights and Freedoms in Canada. Government of Canada. Updated May 13, 2022. Accessed June 14, 2022. https://www.justice.gc.ca/eng/rp-pr/cp-pm/just/06.html?wbdisable=true.
