Our communities’ lives are not fodder for political theatrics!
We are living in deeply troubling and unsettling times. We are seeing a rise in hatred against people who use drugs. We are seeing morality policing and the spread of misinformation. These are eroding hard-fought gains against proven harm reduction measures. Harm reduction is a philosophy that respects the rights of people who use drugs to make choices for themselves. It gave rise to the slogan, Nothing About Us Without Us!
In 2023, British Columbia (B.C.) rolled out a three-year decriminalization pilot. This followed years of activists calling for change. The pilot decriminalized unregulated drugs, meaning those currently deemed illegal under the Controlled Drugs and Substances Act. These include opioids, cocaine, methamphetamine and MDMA. The B.C. pilot does not include benzodiazepines or psilocybin. The city of Toronto applied for a similar pilot, but Health Canada has rejected their request.
The rollout of decriminalization in B.C. has been rife with controversy. It has been widely critiqued by those with harm reduction and drug use expertise. These critiques are that the rollout has lacked political leadership and does not go far enough to make meaningful inroads. As we write this in 2024, the B.C. government has also been chipping away at decriminalization measures. They are not waiting for the evaluation of this three-year pilot project. Additionally, conservative politicians are exploiting our losses from toxic drug deaths and are using the housing crisis to blame decriminalization and attack poor people who use drugs. They are using political cheap shots to garner votes, fundraise, and spread myths and lies.
It has been eight years since B.C. declared the toxic drug death crisis a public health emergency. Across Canada, the toxic drug death crisis continues to rage on—taking the lives of our friends, families, and communities. This has become a generational crisis that could be prevented. Despite efforts from activists, drug users, researchers, policymakers, and a few politicians, we are still witnessing mounting loss. We are also seeing attacks aimed at dismantling and defunding the few forward-thinking, proven, and pragmatic interventions we have available.
Decriminalization has always been part of the liberatory vision in harm reduction. It is the laws and criminalization that fuel stigma and discrimination. They lead to incarceration, violence, overdose, toxic drugs, and deaths. Ideally, decriminalization works to remove police from people’s lives. It could also reduce social stigma and discrimination.
Harm reduction is founded on the principle of bodily autonomy. Bodily autonomy is the right to make decisions for oneself, which may or may not affect the physical body. It is enshrined in human rights, research ethics, medical ethics, and in legal frameworks. People living with HIV have been leaders in the movement to claim bodily autonomy since they drafted The Denver Principles in 1983. These principles assert people’s rights to make active and informed decisions about their health.
In harm reduction, supporting bodily autonomy means supporting drug users’ rights to make choices about what we put into our bodies. Decriminalization is one of many such interventions. These include safe supply, voluntary recovery and legalization of drugs. But harm reduction efforts are under attack, and so are rights to bodily autonomy. These attacks are not new. They are deeply rooted in a conservative and colonial morality. This morality has been embedded in Canadian settler society since Canada’s temperance and moral reform movement pushed for Canada’s first drug law—the Opium Act of 1908. This Act banned the import and use of opium and targeted Chinese workers. It enshrined racism into law to marginalize this community and laid the foundation for the ongoing drug war.
Canada’s drug prohibition is ongoing. Under prohibition, people are dying. Between January 2016 and September 2023, the Health Infobase reported 42,494 apparent opioid toxicity deaths in Canada. Most were in B.C., Ontario and Alberta. Between 2019 and 2021, the Canadian Medical Association Journal reported that the number of annual opioid-related deaths in Canada increased from 3007 to 6022 per year. Twenty-two people are now dying each day. This is an increase from nine just a few years ago.
For their decriminalization pilot, B.C. received a Section 56 class exemption from the Controlled Drugs and Substances Act. This allowed adults over 18 years old to possess up to 2.5 grams of illegal substances for personal use. “Personal use” means they have no intent to traffic, export, or produce the controlled substances. The drugs must not be readily accessible to the driver of a vehicle. The rules also do not apply to drug use in or around schools, playgrounds, airports, watercraft, or for those in the military.
Drug user advocates and harm reduction experts have said that B.C.’s rules were mostly developed with police input, rather than with the expertise of people who use drugs. For example, people who use drugs called for a minimum of four-gram exemption. Nick Boyce, policy director of the Canadian Drug Policy Coalition, explained this recently.1 Instead of taking the advice of people with lived experience, the government and police supported the 2.5 gram threshold. This does not reflect usage or buying patterns, and could result in people buying drugs more frequently from unfamiliar sources. It could incentivize dealers to increase the potency of their drugs. The rules may also worsen regional inequalities. People who live in rural communities sometimes need to stock up and travel while in possession of drugs. This puts them at risk of trafficking charges.
Some say decriminalization is also merely window dressing. It does not go far enough to target the source of the toxic drug supply. Decriminalization is a measure that should be rolled out as a stopgap. It should be used with other measures like safe supply, as we move towards freeing drugs from criminal legal frameworks.
There are also concerns of ‘net-widening’ or ‘up-charging’. This is where B.C. police may start targeting drug users more than before for breaking the new rules (such as carrying over the 2.5 gram limit). Recent research from Tyson Singh and Liam Michaud validated these concerns. They noted that in Vancouver, drug seizures for those carrying over 2.5 grams went up by 34% since decriminalization came into effect.2 Decriminalization will never be effective if the policing of drug users continues. Furthermore, there is no standardized training for police forces who are enforcing the rules. These B.C. rules also do not address people under the age of 18 who use drugs.
Despite concerns from experts and communities of people who use drugs, the rollout has seen some minimal successes. In the first nine months of the pilot, the B.C. government reported a 77% decrease in “offences” for simple possession. Drug checking services also increased by about 60%.3 Overdose prevention sites have been accessed at significantly higher rates. As a result, the First Nations Health Authority and regional health authorities have hired outreach workers to support people who are using drugs and connect them with harm reduction, treatment and recovery services.
While there has been a higher uptake of harm reduction services, overdose deaths have not gone down. People continue to die because decriminalization does nothing to change the toxic supply of drugs. Decriminalization is the absolute bare minimum of what is needed to curb the current crisis.
In March 2024, the current Ontario Medical Officer of Health showed a rare moment of political leadership on the issue. Dr. Kieran Moore—having taken over his predecessor, Dr. David Williams—released the report “Balancing Act: An All-of-Society Approach to Substance Use and Harms”. 4 The report highlights the enormous strains substance use, primarily alcohol, have placed on our healthcare system. It shows Dr. Moore’s strong support for decriminalizing the possession of unregulated drugs for personal use. It also shows his support for supervised consumption services, and for providing a regulated supply of drugs to those in need.5
In the current political climate of fear and division, many politicians are silent on this issue. They are mostly silent while we die. As a result, any minimal inroads that have been made are being eroded. The tepid rollout of decriminalization has also opened up critique from an increasingly extreme conservative agenda. This agenda is setting its sights on bodily autonomy. In this climate, practical and evidence-based policy options have become highly politicized. Politicians, columnists, and those who hold opposing views are spreading misinformation. They are weaponizing this crisis for votes.
Fighting harm reduction has become a conservative talking point. Because of moral panic and scapegoating, the B.C. government is looking to overturn their decriminalization pilot project. There has been rising anti-drug user sentiment. This blames public drug use on decriminalization and harm reduction, when the root of the issue is poverty and people not having access to privacy. People on the streets are just a small subset of those who use drugs. Most people who are dying in the toxic drug death crisis are using at home, alone.
There has also been a surge in morality-driven efforts to control the bodies of drug users. These include involuntary treatment measures, like the recent bills in Alberta and New Brunswick. Fighting for decriminalization means fighting against involuntary treatment. This is an approach which would increase harms and deaths, and is not supported by evidence. People cannot even voluntarily access the help they want and need. The fear that many of us have is an expansion of the use of jails/prisons. Cells/cages would be considered “therapeutic living”, creating “patient prisoners”.
Alberta’s United Conservative Party have been dismantling harm reduction by closing supervised consumption sites and imposing their “recovery-oriented treatment of care”. As a result, deaths in Alberta have escalated at an astonishing rate. The Alberta government want the general public to believe that this is an “addiction crisis” and the only way this can be solved is by forced treatment. However, a summary report published to StatsCan reads, “despite recent rises in substance- related deaths, the presence of substance use disorders did not increase from 2012 to 2022”. 6 This suggests people are dying from unregulated fentanyl and the addition of other unregulated drugs.
To respond to these attacks, and to truly save lives, we need to re-establish our commitment to harm reduction and decriminalization. This needs to be done correctly. Attacks on drug decriminalization efforts that we have seen in B.C. and Ontario, and more broadly, attacks against harm reduction across Canada, are intrinsically linked to a far-right conservative ideology. These conservative attacks against bodily autonomy are happening across the board. For example, some addiction medicine doctors who are against the lifesaving health intervention of safe supply are also against providing gender-affirming care for trans people. The rising conservative push to undo our communities’ rights to bodily auto-nomy and self-determination can be seen in rising hate towards queer people and drag queens. It can be seen in motives to restrict access to trans healthcare, closing supervised consumption services, and in reducing access to reproductive health care and abortion.
All these attacks against bodily auto-nomy are tied together. They are politically coordinated, and are hindering our community’s responses to address HIV and support the health and rights of people who use drugs. If we lose what little we have gained, people will die and suffer at even more unprecedented rates. The way forward is for us to band together in solidarity across our communities around these issues and stop the spread of misinformation and lies. Our communities’ lives are not fodder for political theatrics.
Alexander McClelland is living with HIV and is an Assistant Professor of Criminology at Carleton University. He is a member of the Canadian Coalition to Reform HIV Criminalization.
Zoë Dodd is a Community Scholar at the MAP Centre for Urban Health Solutions, Unity Health, Toronto. She has worked in drug policy, harm reduction, and research for over 20 years. She is currently one of the principal investigators on a CIHR-funded project mapping models of decriminalization—“Alternatives to Criminalization of Drugs: Community-based Systems Mapping of Social and Health Effects”.
1 https://www.youtube.com/watch?v=1OM2FXA6kRU
4 http://www.ontario.ca/page/chief-medical-officer-health-2023-annual-report
5 https://www.cbc.ca/news/canada/toronto/ontario-drugs-alcohol-moore-1.7159701