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  • Du cannabis partout!

    Du cannabis partout!

    Nous passons par une période particulièrement chargée pour toutes les questions liées au cannabis. L’une des questions les plus en vue actuellement est sans doute la légalisation de la consommation de cannabis à des fins récréatives par les états du Colorado et de Washington, aux États-Unis. Ceci a ouvert la voie à un éditorial largement acclamé du New York Times qui proclame fermement que « Le gouvernement fédéral devrait lever l’interdiction sur la marijuana ». En novembre prochain, la légalisation fera l’objet d’un vote en Alaska, en Oregon et à Washington D.C.
    Il en résulte que le président du Mexique Enrique Pena Nieto envisage de libéraliser les lois sur le cannabis, pour permettre à son pays de suivre le rythme de l’évolution de la situation américaine. Tout cela intervient après que le président Nieto et les présidents de la Colombie, du Costa Rica et du Guatémala aient persuadé l’assemblée générale des Nations Unies de convoquer une session extraordinaire (UNGASS) pour explorer d’autres solutions à la guerre inefficace contre les drogues (au Mexique seulement, on estime que 100 000 personnes ont perdu la vie ou ont été portées disparues suite à des cas de violence liés à la drogue). Plus au sud, le retard dans l’application d’un marché du cannabis légal et réglementé remet en question la mise en oeuvre de ce plan.

    Ici au Canada, de nouvelles lois sur le cannabis médicinal ont vu le jour le 1er avril. Ces lois portent à confusion et font actuellement l’objet d’une injonction. Néanmoins, le gouvernement fédéral estime que cette industrie rapportera 1,3 $ milliards en 10 ans. Il n’est donc pas surprenant que les entrepreneurs d’un bout à l’autre du pays tentent de se positionner pour s’approprier une part du marché; demandes de licences, construction de serres et réaffectation de locaux industriels inoccupés, tels qu’une ancienne chocolaterie à l’extérieur d’Ottawa.

    Le gouvernement envisage également d’apporter quelques changements à la Loi réglementant certaines drogues et autres substances qui permettraient aux policiers d’émettre un constat d’infraction pour possession de petites quantités de cannabis, plutôt que de déposer une mise en accusation. Ceci pourrait représenter une avancée positive. Cependant, s’il devient plus facile pour les agents de police de traiter les délits mineurs liés au cannabis, les agents risquent individuellement d’arrêter d’utiliser leur pouvoir discrétionnaire au cas par cas et d’inscrire à leurs dossiers toutes les infractions mineures.

    Il s’agit néanmoins d’une demi-mesure comparativement à ce qui se passe ailleurs en Amérique. Plus particulièrement lorsque l’on considère le nombre de Canadiens qui estiment que la possession simple ne mérite pas l’attention des corps policiers. Même les sondages menés par le gouvernement démontrent que plus de 70 pour cent des Canadiens soutiennent que le cannabis devrait être légalisé ou décriminalisé. Peu importe… Les conservateurs semblent avoir jeté leur dévolu sur les 30 pour cent restants, dénonçant l’approche pro-légalisation de Justin Trudeau et allant jusqu’à prétendre qu’il désire que les enfants d’âge scolaire puissent se procurer du cannabis dans les dépanneurs.

    Pour couronner le tout, les américains contre la légalisation qui n’aiment pas ce qui se passe dans leur pays se sont immiscés dans le débat canadien et ont contribué au lancement du chapitre canadien de Smart Approaches to Marijuana. Il reste à voir si les Canadiens adopteront cette version diluée de la prohibition, c’est-à dire permettre un certain degré de décriminalisation tout en soutenant que le cannabis constitue une menace à la santé publique.

    Quelle sera donc la prochaine démarche? Trudeau continuera-t-il à appuyer la légalisation au moment des élections ? Comment le débat national sera-t-il touché par le retour au Canada de Marc Emery (sans doute le plus célèbre défenseur canadien du cannabis) ? À quoi pouvons-nous nous attendre de la part des groupes s’intéressant au cannabis, tels que Sensible BC, NORML Canada et autres ?

    Il est clair qu’un dialogue émerge au Canada et que l’année à venir promet d’être chargée.

    Nous avons l’intention d’occuper une place de tout premier plan dans ce dialogue. Voici ce que nous envisageons :

    Forum du cannabis médicinal de Mexico – du 22 au 23 septembre 2014
    Dans le cadre de notre programme international, la CCPD appuie les efforts du Mexique visant à introduire le cannabis médicinal dans ce pays. Nous co-parrainerons en septembre, en partenariat avec plusieurs organismes mexicains, un forum sur le cannabis médicinal à Mexico. Des experts américains et canadiens prendront part à deux réunions, l’une parrainée par le Sénat mexicain (qui étudie actuellement une loi concernant la légalisation du cannabis médicinal) et une seconde réunion tenue à l’Université nationale autonome du Mexique, pour discuter de l’état d’avancement de la recherche sur le cannabis médicinal dans les trois pays.

    Bulletin politique sur le cannabis – automne 2014
    Nous travaillons actuellement à l’élaboration d’un bulletin politique décrivant à quoi pourrait ressembler la réglementation du cannabis dans un contexte de santé publique. Ce bulletin traite de l’histoire de l’interdiction du cannabis, des méfaits possibles en matière de santé et des dommages sociaux et sanitaires des politiques sur le cannabis, suivi d’un examen des mécanismes de régulation susceptibles d’équilibrer l’incidence du cannabis sur la santé des consommateurs et la recherche de profits de la part des intérêts commerciaux.

    UNGASS – en cours
    Tout ceci mène à la session extraordinaire de l’UNGASS en 2016. L’UNGASS est une réunion spéciale des états membres de l’ONU visant à discuter des questions globales importantes, telles que la santé, le genre, la situation des enfants, etc. Le thème central de 2016 sera les priorités du contrôle des drogues au niveau mondial, et nous nous attendons à ce que le forum engendre une nouvelle approche en matière de politiques sur les drogues, soit en parvenant graduellement à un consensus global, ou, plus vraisemblablement, en faisant éclater le concept qu’un consensus à l’échelle internationale est possible.

    En prévision de l’UNGASS, nous demanderons « Quel rôle devrait jouer le Canada à l’échelle mondiale ? ». Appuierons-nous la vieille garde ? Les personnes telles que l’ancien président de l’Organe international de contrôle des stupéfiants de l’ONU, qui a accusé l’Uruguay de faire preuve d’« attitude pirate » en proposant de légaliser le cannabis ? Ou nous rangerons-nous du côté des réformistes progressistes qui soutiennent que les pays devraient être libres de formuler des politiques sur les drogues (cannabis ou autre) qui reflètent les comportements et les intérêts nationaux ? Notre tâche consiste à faire en sorte que cette dernière option prévale.

  • La prévention et la gestion des surdoses d’opiacés au Canada est facile et permet de sauver des vies

    La prévention et la gestion des surdoses d’opiacés au Canada est facile et permet de sauver des vies

    En 2013, 308 personnes ont perdu la vie, en Colombie Britannique seulement, suite à des surdoses causées par la consommation de drogues illicites. Le pire, dans tout cela ? Il est tout à fait possible d’éviter les décès causés par les surdoses d’opiacés.

    Et ce, non seulement du point de vue « si les gens ne consommaient pas de drogues… les surdoses n’existeraient pas ». Parce que bien qu’au sens strict, cette affirmation soit vraie, nous savons bien que les gens consommeront toujours des drogues. Depuis un siècle, les drogues sont interdites et les personnes qui vendent et consomment des stupéfiants sont arrêtées et incarcérées. Cette approche n’a rien changé à la situation.
    Nous devons être réalistes et pragmatiques. La consommation de drogue existe et continuera d’exister. Prévenons donc les décès et les méfaits liés aux surdoses. La Coalition canadienne des politiques sur les drogues collabore avec des experts provenant des quatre coins du pays dans l’élaboration d’un ensemble de changements de politiques permettant de sauver des vies et de rendre le Canada plus sécuritaire, pour tous les citoyens.

    Cliquez ici pour télécharger : La prévention et la gestion des surdoses d’opiacés au Canada

    Au cours de l’élaboration de ce mémoire, nous avons rencontré plusieurs personnes dévouées et compatissantes impliquées dans la mise en oeuvre de programmes de première ligne de prévention des surdoses, d’un bout à l’autre du Canada. L’un des programmes d’intervention les plus pragmatiques et efficaces dans la prévention des méfaits et des décès liés aux surdoses est le programme « Take home naloxone ». Calqué sur le modèle de 180 initiatives similaires aux États-Unis, ce programme prévoit la distribution de trousses d’intervention au surdosage (communément appelées trousse Take home naloxone) à des personnes ayant reçu une formation sur la prévention, l’identification et les mesures à prendre en cas de surdose. La naloxone est un composé chimique qui existe depuis 40 ans et qui permet d’inverser les effets d’une surdose d’opiacés. Ce médicament n’a aucun effet narcotique et ne crée pas de dépendance.

    L’organisme Streetworks d’Edmonton a lancé cette initiative au Canada et des programmes semblables ont été mis en place dans l’ensemble du Canada. Le programme de prévention des surdoses le plus solide au pays (Take home naloxone) est le programme de réduction des méfaits Toward the Heart, du British Columbia Centre for Disease Control (Centre d’épidémiologie de la Colombie Britannique, ou BCCDC)

    Grâce à la participation de plusieurs organismes brittano-colombiens, le programme de naloxone s’étend sur 35 sites, des régions urbaines telles que Vancouver et Surrey, jusqu’aux plus petites villes et collectivités rurales telles que Cranbrook, Campbell River et Fort St. John. Près de 1 000 personnes ont reçu cette formation, y compris le personnel et les bénévoles travaillant dans des centres de santé et de services sociaux, ainsi que les amis et membres des familles de toxicomanes. Plus de 600 trousses ont été distribuées à des clients qui consomment des opiacés, et divers matériels didactiques sont en cours d’élaboration, afin de permettre à nos partenaires communautaires d’élargir la portée du programme. Depuis ses débuts en 2012, les effets de 55 surdoses ont été renversés.

    Bien que l’efficacité de ces programmes simples de prévention des surdoses ait été démontrée, des défis majeurs font obstacle à leur propagation. La naloxone est vendue uniquement sur ordonnance, elle est coûteuse et ne fait pas partie de la liste de médicaments couverts par les régimes provinciaux d’assurance-médicaments. Un défi encore plus important est l’absence d’une Loi nationale du bon samaritain, qui empêcherait les personnes d’être mises en état d’arrestation et inculpées pour possession de drogues, lorsqu’elles demandent de l’aide en cas d’urgence. Onze états américains ont adopté des Lois du bon samaritain, souvent avec l’appui bipartite des législateurs.

    Nous espérons que cet énoncé de politiques contribuera à éliminer les obstacles aux programmes de prévention des surdoses. Voilà la solution la plus réaliste de prévenir les décès causés par les surdoses d’opiacés.

  • A gift to the drug kingpins: and the need for a North American Drug Policy Agreement

    A gift to the drug kingpins: and the need for a North American Drug Policy Agreement

    This article first appeared as an op-ed in the National Post, April 21, 2014

    We know the stories. Hockey bags that go south full of B.C. bud and return full of Latin American cocaine. Elaborate underground tunnels at both the U.S.-Mexico and U.S.-Canada borders. Canadian mobsters being gunned down in Mexican resort towns. Unlikely Mennonite drug mules crossing North America’s borders with illicit packages concealed in gas tanks and old farm equipment.

    It’s easy to think it’s always been this way, but the reality is we can thank the North American Free Trade Agreement (NAFTA) for much of this activity. So this year, while business leaders and politicians fete the 20th anniversary of NAFTA, drug runners and cartels will be doing the same.

    It shouldn’t come as a surprise. Free traders wax poetically about the interconnected, globalized economy, and the whole point of NAFTA was to strengthen the economic integration of Canada, the U.S. and Mexico by reducing trade barriers.

    How’s this for economic integration, then? Access to legal, regulated medical marijuana in Canada and the U.S. has reduced black market demand across the continent. This phenomenon will become more pronounced with the recent legalization of recreational marijuana in Colorado and Washington, and more states to come. It’s worth noting too that concerns over drug gangs generally, but Canadian gangs in particular, were a key reason Washington voters supported legalization in that state. Regardless, marijuana farmers in Mexico have responded to decreased black market demand by shifting to poppy cultivation. This has resulted in a surge of cheap heroin availability at a time when heroin use is increasing in both the U.S. and Canada.

    Yet despite the predictability of this kind of domino effect in a continental economy, then-U.S. president Bill Clinton forbade U.S. negotiators from discussing the illegal drug trade in NAFTA talks. Years later, U.S. Drug Enforcement Administration official Phil Jordan revealed: “We were prohibited from discussing the effects of NAFTA as it related to narcotics trafficking, yes.” As a result, “For the godfathers of the drug trade in Colombia and Mexico, this was a deal made in narco heaven.”

    Indeed. NAFTA brought a proliferation of maquiladoras — companies operating in duty-free free-trade zones— to the north of Mexico and a massive increase in cross-border commercial traffic. In other words, freer movement of goods in a continent that represents “the world’s largest illicit drug market” according to the UN Office on Drugs and Crime. NAFTA also brought an influx of cheap, subsidized U.S. crops — including corn, soybeans, wheat, cotton and rice — resulting in the collapse of northern Mexico’s agricultural sector. Some farmers shifted to marijuana, which is 1,000 times more lucrative than corn, pound for pound. The rest were in need of work.

    Basically, NAFTA helped create ideal conditions for the rise of a lucrative cross-border drug and gun trade.

    Governments responded by escalating the war on drugs, with devastating impacts on citizens and their communities throughout North America. An estimated 100,000 Mexicans have died or disappeared in drug-related violence, and the U.S. has the highest prison population in the world with over 2 million citizens behind bars. Of these, roughly 500,000 Americans are incarcerated on any given night for a drug law violation. At the same time, death from overdose and HIV/AIDS among injection drug users has taken thousands of lives in the U.S. and Canada. Add to all of that the pain of the families of those directly affected and the communities that have suffered these losses.

    Twenty years after NAFTA’s signing, it’s time to finally acknowledge the drug market is a part of our integrated economy. In turn, we need to negotiate a modern, 21st century drug policy that addresses the health and safety issues across the region and undermines the illegal profiteers.

    The good news is, there’s cause for optimism. The Organization of American States in particular is providing refreshing leadership through member states like Mexico, Colombia and Guatemala calling for a discussion about alternative approaches to the enforcement-heavy war on drugs. And some jurisdictions are implementing bold new paradigms on their own. Similar to the moves in Colorado and Washington, Uruguay became the first country in the world to authorize a legal, regulated market for adult cannabis use.

    The current overemphasis on criminal justice approaches to drug control in North America has sidelined a variety of programs that can minimize the harms related to the drug trade and substance use, including public health promotion and prevention programs. It has also curbed economic and social advancement for drug-producing countries.

    A North American Drug Policy Agreement could serve as a powerful statement of shared responsibility in addressing the trans-national drug problem. Such an agreement should include provisions for the consuming countries (U.S. and Canada) to reduce demand through social development and improved access to health responses. But it should also map out a legal, regulatory control framework for drugs that are currently illicit. This would reduce the violence within the drug trade, and all of the other prohibition-related harms that are far more destructive to communities and countries than substance use itself.

    Yes, it would mark a departure from 40 years of restrictive, prohibitionist policies, but as Stephen Harper himself has noted, “the current approach is not working.” It’s time to try something else.

  • To ticket or not to ticket – Conservatives take a tiny step on cannabis

    To ticket or not to ticket – Conservatives take a tiny step on cannabis

    For a split second, the door to drug policy reform in Canada opened ever so slightly. But then Justice Minister Peter MacKay was quick to slam it shut: “We’re not talking about decriminalization or legalization.”

    On March 5th, MacKay announced that the federal government is looking at changes to the Controlled Drugs and Substances Act that would make it possible for police to issues tickets for possession of small amounts of cannabis.

    The announcement follows last summer’s resolution from the Canadian Association of Chiefs of Police asking the federal government to consider ticketing options. But it also follows Justin Trudeau’s considerably bolder endorsement of cannabis legalization. So I can’t help but wonder if this is a move to stem the Liberals’ rise in the polls.

    MacKay’s proposal would allow police to issue tickets to people possessing less than 3 grams of cannabis. It’s a positive move in one way, because it means these cases will no longer be sent to criminal court. So otherwise law-abiding citizens will not be burdened with a record of criminal conviction, which can have serious implications for travel and employment.

    But it also comes with the potential of a significant downside. In Australia, for example, similar measures resulted in a “net-widening” effect. That is, because it was easier for police to process minor cannabis offences, individual officers shifted away from using case-by-case discretion in giving informal cautions, to a process of formally recording all minor offences. The result was a significant increase in formal infractions, but no change in the pattern of cannabis use.

    Still even if we assume MacKay’s changes hold promise, we need to be clear that these modest steps are not the endgame to a much needed overhaul to drug laws in this country – especially considering that jurisdictions bordering Canada are moving toward legalization. Is this is best Canada can do given the momentous changes taking place around the world?

    Critics of legalization take pains to point out that cannabis can harm the health of its users. Of course it can! So can alcohol, but the lesson of alcohol prohibition is that an underground market is an unsafe market. The purpose of a legally regulated cannabis market is to ensure that we use the painful mistakes of alcohol and tobacco regulation to create the best possible approach to cannabis. Regulation rather than prohibition will make this substance safer, control its production and distribution, and ensure that at least some of the profits go to the public coffers.

    The other problem with cannabis prohibition is that the effects of drug laws are inequitably applied to poor and Indigenous Canadians. And prohibition doesn’t keep cannabis out of the hands of kids. As Unicef’s 2013 report on the well-being of children in rich countries reveals, Canadian youth use the most marijuana compared to our economic counterparts around the world. Yet they use the third least amount of tobacco. What accounts for this second stat? A solid, legally regulated market that relies on stringent controls and education about the harms of tobacco.

    It’s great that MacKay has taken a first step, but we need to keep moving toward a saner, safer approach to cannabis use. The CDPC is committed to talking with Canadians about the possibilities of cannabis regulation. To that end, in the coming months we’ll unveil proposals to help to build a regulatory framework that takes into consideration what we’ve learned from public health approaches to alcohol and tobacco. Canada can do better.

  • Harm Reduction Comes of Age in Canada, or Does It?

    Harm Reduction Comes of Age in Canada, or Does It?

    This post first appeared in the Centre for Addictions Research of BC’s blog Matters of Substance.

    The Supreme Court of Canada’s September 2011 decision allowing Vancouver’s supervised injection site, Insite, to keep operating was a critical milestone for harm reduction in Canada.

    One only has to look at the list of interveners in the case in support of this innovative service to see that it has become a valued and mainstream service in Canada. Canadian health organizations including the Canadian Medical Association, Canadian Nurses Association, Canadian Public Health Association and 11 others saw fit to come before the court to support Insite. But even with this high level of support, scaling up harm-reduction services in Canada remains a challenge.

    Harm reduction gained traction as a result of the HIV/AIDS crisis in the early 1980s and played a critical role as a strategy to engage injection-drug users in HIV prevention. Harm reduction’s more recent challenges have elevated the critique of policy-related harms – harm caused by policies that criminalize people who use illegal drugs.

    Harm reduction acknowledges that there are significant risks associated with illegal drugs and also attempts to work towards mitigating harms within the criminalized environment where drug use occurs. This often puts the public-health goals of engaging people who use drugs in conflict with traditional public-safety strategies that rely on disruption of illegal drug markets, and in turn disruption of the lives of people who use illegal substances.  Harm-reduction approaches balance these realities and focus on creating safer environments as much as possible within a context of criminalization. Some examples include promoting supervision of consumption or discouraging using drugs while alone, promoting rapid response strategies in the form of peer-delivered naloxone programs and strategies that work towards achieving a kind of détente between health efforts and enforcement practices. Given the context of criminalization, a key goal of harm reduction is to maximize the benefits of public-health interventions and minimize the harm of drug use and the enforcement of drug policy.

    So what should Canada be doing to facilitate the development of a more robust harm reduction approach as a part of a comprehensive response to drug use? We urge governments to begin with a review of current drug policies to determine the benefits and harms to individuals and communities that accrue from the criminalization of drugs and the people who use them.

    Other countries have done such an analysis and have decided to eliminate criminalization as a response to possession of drugs for personal use in an effort to maximize the benefit of a public-health approach to drug problems. Portugal (2001) and the Czech Republic (2009), are two examples of jurisdictions that have taken this step. Both have decriminalized all drugs that are deemed to be for personal use. Portugal decriminalized drugs as part of a response to an HIV epidemic and high rates of drug overdose. The Czech Republic did the same as a result of an extensive evaluation of the previous policy of criminalization. Evaluation of the experience in Portugal has shown that results have been positive overall – HIV incidence and overdose deaths have been reduced, police are supportive of the new law as it has given them more meaningful and helpful involvement in steering individuals towards health services, more people are accessing treatment and other health services which were improved as a part of the decriminalization policy. Additionally no negative trends have been seen in terms of increased harms attributed to this policy change.

    Achieving a policy shift as significant as decriminalization will take some time. In the meantime, the Canadian Drug Policy Report, Getting to Tomorrow, outlines some possibilities for improving the development of harm reduction in Canada in the short term:

    • Acknowledge that harm reduction is much more than supply distribution and is an essential component of a comprehensive public health response to problematic substance use that offers client-centred strategies with health engagement at their core.
    • Acknowledge that harm reduction values the human rights of people who use drugs and affirms that they are the primary agents of change for reducing the harms of their drug use.
    • Provincial governments can commit to articulating harm reduction strategies across mental health, addictions and infectious disease policy frameworks.
    • Where harm reduction language is present within policy frameworks ensure implementation at the community level.
    • Support innovation at all levels. An ethic of experimentation will help create an environment where new ideas and novel approaches can be developed and explored.
    • Provide leadership to bring health and policing agencies together to get “on the same page” with regard to harm reduction. Opposition by some in the policing community is unfortunate and an unnecessary barrier to scaling up harm reduction programs.

    Developing a robust and equitable harm-reduction approach for Canadians will necessitate new thinking about old strategies — thinking that exposes the harms that flow directly from our current policy frameworks and will open the door to new ideas and approaches that are emerging around the world.

  • The Road to 2016 – Drug Policy Consensus Shattered

    The Road to 2016 – Drug Policy Consensus Shattered

    There’s a Crack in Everything – That’s How the Light Gets In (with thanks to Leonard Cohen)

    I couldn’t help it. Sometimes my mind would wander while attending the Commission on Narcotic Drugs (CND) meeting in Vienna – the annual drug policy palooza where UN member states gather to shore up the failed prohibitionist policies of the past. Even an unanticipated Russell Brand appearance could do only so much to enliven the sessions.

    In those mind-wandering moments, I found myself humming Leonard Cohen’s famous song “Anthem,” especially the beautiful line: “There’s a crack in everything, that’s how the light gets in.”

    I suppose my mind wasn’t so much wandering, as it was synthesizing the stark disconnect between the evidence presented at the outset of the meeting – in fact, the science at the heart of the enterprise – and the actual decisions arrived at by CND delegates.

    There is unquestionably a crack in the consensus in these global discussions, a crack that may well end up being a chasm as wide as the Grand Canyon by the time the UN Special Session on Drugs (UNGASS) takes place in 2016 in New York.

    Decriminalization

    As for the light, that came in part from the two stellar UN-appointed scientific panels that reported out at the beginning of the meeting. Michel Kazatchkine, UN Envoy to Eastern Europe and Asia on HIV, and Nora Volkow, Director of the US National Institute on Drug Abuse, chaired panels that delivered strong statements on the need for problematic drug use to be dealt with as a public health issue not a criminal issue. Kazatchkine’s group noted: “Criminalization of drug use, restrictive drug policies and aggressive law enforcement practices are key drivers of HIV and Hepatitis C epidemics.” Volkow’s group added: “We consider that criminal sanctions are not beneficial in addressing substance use disorders and discourage their use.”

    The divide between the above statements and the content of the negotiations at the CND was vast – the overwhelming majority of delegates clung to the status quo and refused to even consider language on decriminalization. Clearly we’ve made very little progress since Portugal (2001) and the Czech Republic (2009) decriminalized all drugs for personal use, on their own without fanfare or bringing it up at the CND.

    Harm Reduction

    In a somewhat Orwellian turn of language control, a number of countries including Canada demanded the words ‘harm’ and ‘reduction’ not appear side by side, but they could endorse “measures aimed at minimizing the negative public health and social impacts of drug abuse that are outlined in the WHO, UNODC, UNAIDS Technical Guide.”

    Harm reduction, in other words.

    These programs are the most cost effective way to engage people who use drugs and often the only bridge to more mainstream public health services. The scientific panel offered clear statements on the benefits and cost-effectiveness: “Harm reduction interventions are good value for money, with average costs per HIV infection averted ranging from $100 to $1,000.”

    Apparently scientists can use the words, but not the members of the CND.

    Death Penalty

    Switzerland, with support from others, pushed hard at the meeting for the Joint Ministerial Statement to clearly state the death penalty was not an appropriate response to drug offenses of any kind. In the end they failed, being blocked by countries like Iran, China and a number of other Middle Eastern and Asian countries. Canada’s silence on this discussion was deafening.

    The Swiss allowed the “consensus” document to go forward but not without delivering the following statement at the end of the meeting:

    “The death penalty is in opposition to our position with regard to all offences. The International Covenant on Civil and Political Rights says that it should only be applied for very serious crimes and therefore very rarely. The human rights committee says we should very much limit the use of the death penalty. The International Narcotics Control Board (INCB) said that its application was never in the spirit of the (drug) conventions. The INCB encourages countries to consider its abolition. In this background, the silence of the Joint Ministerial Statement (JMS) on the death penalty is regrettable. It does not take into account our position and that of other (UN) bodies. We will continue to promote the abolition of the death penalty. We ask that our agreement with the JMS is on this understanding – capital punishment is not in line with our commitment to combat the world drug problem. International cooperation on drug law enforcement is contingent to respect for all human rights – as well as the right to life.”

    2016 UN General Assembly Special Session on Drugs (UNGASS)

    If there’s one thing that we learned while attending the CND it’s that any meaningful consensus on new approaches to addressing drug problems globally will be near impossible to attain when the biggest international drug policy meeting in 20 years – UNGASS 2016 – takes place in two years at the UN General Assembly in New York.

    This meeting was called in response to the pleas from the presidents of Mexico, Colombia and Guatemala a little over a year ago, calling on the UN to facilitate real dialogue on alternative approaches to the global drug problems.

    UNGASS is huge because it will undoubtedly precipitate a new approach to drug policy – either through the development of a more progressive global consensus, or, more likely, because it will shatter the distorted idea that a global consensus is possible.

    Either way, countries should be free to chart their own appropriate path forward to address drug problems, grounded in the public health and human rights imperatives enshrined in various UN conventions, without the shackles of the misguided and restrictive drug control treaties.

    “Ring the bells that still can ring
    Forget your perfect offering
    There is a crack in everything
    That’s how the light gets in.”
    – Leonard Cohen, Anthem

  • Treat drug use as a public health issue, not criminal issue, say UN agencies

    Treat drug use as a public health issue, not criminal issue, say UN agencies

    Criminal activity and drug trafficking. Distressingly, those are dominant discussion points at this week’s annual UN drug policy conference – the Commission on Narcotic Drugs (CND).

    As a result, public health considerations have been somewhat sidelined, but not, thankfully, among UN agencies, where a number of key representatives called for the removal of criminal sanctions associated with drug use, and the realignment of drug use as a public health issue.

    Back in Canada, the federal government is considering changing Canada’s marijuana laws to allow ticketing by police instead of arrest, but Justice Minister Peter MacKay has insisted that even if that’s the case, “Criminal Code offences would still be available to police…. It’s not decriminalization. It’s not legalization.” What’s more, the move could be a step backwards if police begin issuing tickets, where in the past they might have turned a blind eye.

    Regardless, under the current regime, simple cannabis possession charges in Canada numbered 61,406, a rate of 178 per 100,000 people as recently as 2011. This represented a 16% increase of such incidents since 2001. In BC alone, the arrest and prosecution of personal marijuana use costs taxpayers $10.5 million a year.

    Contrast that criminalization framework with comments from UN agencies this week at the CND:

    • UN Deputy Secretary Jan Eliasson tried to set a positive tone early by emphasizing the “public health imperative” in addressing drug use, and called for a “comprehensive and open-minded exchange” that included civil society input and that didn’t shy away from “discussing innovative ideas and perspectives.” He concluded by stressing that it is not enough to say no to drugs, “we are also saying yes… to human rights.”
    • Gilberto Gerra, Chief of Drug Prevention and Health Branch for the UN’s drug control agency (UNODC) insisted that criminal sanctions are ineffective and counter-productive because they do nothing to address problematic drug use. He argued that drug policies should be based on health and not on punishment, and that nowhere do international drug conventions require that personal use should be criminalized.
    •  Two Scientific Working groups convened by the UNODC to advise the CND criticized criminal sanctions and implored delegates to base their policy decisions on science.The first – headed by Nora Volkow (Director of the United States National Institute on Drug Abuse) – insisted that “substance use disorders should be treated as medical and public health issue rather than a criminal justice and/or moral issue.” Imprisonment does not equate with treatment, and the group discouraged the use of “criminal sanctions” given that they “are not beneficial in addressing substance use disorders.”
      The second group – headed by Michel Kazatchkine (UN Secretary General’s Special Envoy on HIV/AIDS for Eastern Europe and Central Asia) – concluded that “we need to stop incarceration of people who use drugs for minor drug related offenses.” Its members highlighted the legal and regulatory impediments to implementing harm reduction initiatives and noted that the “criminalization of drug use, restrictive drug policies and aggressive law enforcement practices are key drivers of HIV and hepatitis C epidemics among people who inject drugs.” Basically, people are dying because they are treated as criminals rather than patients.
    • UNAIDS director Michel Sidibe echoed calls to understand drug use as a public health and human rights issue, stating: “The criminalization of millions of people for minor drug offences exacerbates vulnerability to HIV infection, and does little to protect society from the health and social harms caused by drug dependence.” He added, “We must work towards transforming laws and law enforcement officials to become bridges to connect people who use drugs to life saving health services.”
    • The UN High Commissioner for Human Rights Navi Pillay’s statement drew attention to “the intense focus of law enforcement against drug use” which “has resulted in large numbers of persons being arrested and held in prolonged periods of pre-trial detention for minor drug offences.” She condemned the “so-called ‘treatment’ in such centres” which “is frequently not based on individualized assessment and evidence-based medical practice, but rather in mass treatment with a focus on disciplinary-type interventions.”

    These comments represent a striking scientific consensus on the harm created by the criminalization of drugs and those who use them. Clearly the language of public health is beginning to inform the deliberations at this forum. The real challenge for countries to put teeth into these recommendations by implementing concrete and comprehensive public health approaches to drug related harm.

  • Quel rôle jouera le Canada dans l’orientation d’une politique mondiale sur les drogues?

    Quel rôle jouera le Canada dans l’orientation d’une politique mondiale sur les drogues?

    (Les liens aux sites externes sont disponibles en anglais seulement.)

    Les Canadiens s’enorgueillissent de recevoir un accueil favorable à-travers le monde. Non seulement parce que nous avons des paysages majestueux ou de braves athlètes olympiques, mais également pour nos contributions en matière de diplomatie internationale.

    La Commission annuelle des stupéfiants (CS) de l’Organisation des Nations Unies qui se réunira à Vienne les 13 et 14 mars 2014 nous offre la possibilité d’ajouter une page à cette riche histoire. À cette occasion, la communauté internationale se réunira pour discuter de la façon d’améliorer la réponse mondiale face aux problèmes liés à la consommation et au trafic de stupéfiants.

    Historiquement, le Canada a joué un rôle important dans ces débats et a prôné un large éventail d’approches en matière de santé publique, ainsi que des mesures coercitives fondées sur des données factuelles contre les groupes criminels organisés qui produisent et vendent les drogues illicites. Notre influence est décuplée par le fait que nous contribuons financièrement, de manière significative, au Programme des Nations Unies pour le contrôle international des drogues.

    Mais certains observateurs internationaux s’inquiètent de ce que nous communiquerons cette année à la Commission des stupéfiants.

    Dans un article publié récemment par l’Ottawa Citizen, Michel Kazatchkine, envoyé spécial du Secrétaire général des Nations Unies pour le sida en Europe de l’est et en Asie centrale, a fait remarquer: « Le Canada est depuis longtemps un chef de file mondial dans la mise en oeuvre de politiques de réduction des méfaits en matière de consommation de médicaments à usage domiciliaire. Voilà pourquoi il est presque choquant de voir ce pays s’aligner sur des pays tels que la Russie et la Chine, qui s’opposent à ce que la «réduction des méfaits» fasse partie des nouveaux principes élaborés par les Nations Unies pour guider les négociations lors de la session extraordinaire de 2016. »

    Kazatchkine a ensuite décrit la hausse alarmante de nouveaux cas d’infections par le VIH en Russie, attribuable au manque de services de réduction des méfaits disponibles aux usagers de drogues injectables. En fait, le gouvernement russe s’oppose généralement aux services tels que l’échange de seringues et les programmes de traitement à la méthadone, qui sont des services éprouvés permettant de sauver des vies.

    En tant qu’ancien Directeur exécutif du Fonds mondial de lutte contre le sida, la tuberculose et le paludisme, et membre de la Commission  mondiale des politiques sur les drogues, Kazatchkine sait de quoi il parle. En effet, la Commission mondiale a sonné l’alarme en 2012 sur la relation continue entre les politiques répressives de contrôle des drogues et la propagation du VIH. Le message à retenir est donc simple : le refus d’offrir des services de réduction des méfaits aux consommateurs de drogues, jumelé à la criminalisation de la possession de drogues, oblige les individus à chercher refuge aux endroits où la propagation du VIH est beaucoup plus probable, en raison de l’utilisation commune de matériel d’injection de drogues.

    Kazatchkine n’est pas le seul expert international à exprimer ses inquiétudes face à la position du Canada. Selon un article publié dans le Journal de l’Association médicale canadienne, au cours d’une récente session de négociation menant à la CS, le « Canada se trouve encore une fois aux premiers rangs de la bataille » contre l’appui de l’ONU envers « des mesures d’atténuation et de réduction des méfaits », selon les dires du Consortium International des Politiques liées à la Drogue (IDPC), un groupe britannique témoin aux négociations. Dans unrapport publié après la session, un observateur de l’IDPC a déclaré que le Canada « s’est exprimé haut et fort tout au long » de la session et s’est opposé à toute référence au terme « réduction des méfaits ».

    Nous ne savons pas exactement quelle sera l’approche de la délégation du Canada au CS cette année, mais nous avons élaboré certaines recommandations, conjointement avec le Réseau juridique canadien VIH/sida.

    Vous pouvez lire l’ensemble de notre proposition ici.

    Nous y invitons la délégation à mettre l’accent sur les éléments suivants, lors de leurs discussions avec les autres États membres :

    1. Encourager tous les pays à adopter une démarche globale en matière de santé publique envers la consommation de drogues, y compris la décriminalisation.

    2. Encourager les pays à mettre à l’essai de nouvelles idées et politiques sur les drogues axées sur la santé.

    3. Respecter, protéger et promouvoir les droits de la personne (plus particulièrement en ce qui concerne l’opposition à la torture dans les centres de détention pour toxicomanes et l’opposition à la peine capitale pour les crimes liés à la drogue).

    4. Assurer le plein accès aux médicaments essentiels.

    5. Promouvoir le plein engagement de la société civile aux débats concernant la politique à adopter en matière de drogues.

    6. Remettre en cause l’utilité des termes associés aux efforts mis en oeuvre d’un « monde sans drogues »

    7. Reconnaître le mandat confié à l’OMS dans le cadre des Conventions de 1961 et de 1971, de formuler des recommandations en matière de classement des substances.

    Même si nos recommandations ne sont pas adoptées au cours de cette CS, nous disposons de 2 ans pour poursuivre cette conversation, avant la Session extraordinaire de l’Assemblée générale des Nations Unies (UNGASS) en 2016. Cette assemblée est d’importance capitale en matière de politique internationale  sur les drogues, et présente une occasion unique de démontrer les dysfonctionnements du présent système de contrôle des drogues. Elle représente une excellente occasion de réorienter l’approche mondiale en faveur de mesures globales de santé publique, pour faire face aux problèmes liés aux drogues.

    Le Canada est bien placé pour jouer un rôle de premier plan pour mettre de l’avant ce changement. La collectivité internationale n’attend rien de moins.

  • Measuring lives saved: the facts about safer consumption services

    Measuring lives saved: the facts about safer consumption services

    This post first appeared in the Centre for Addictions Research of BC’s blog Matters of Substance.

    Despite the pragmatic nature of harm reduction programs, and their demonstrated ability to save lives, controversy still dogs efforts to scale-up harm reduction. One of the most misunderstood and controversial initiatives are safer consumption services (SCS).

    In the last 20 years, SCS services (sometimes also known as safer injection services (SIS) have been integrated into drug treatment and harm reduction programs in Western Europe, Australia, and Canada. The focus of these services is facilitating people to safely consume pre-obtained drugs with sterile equipment. These services can be offered using a number of models including under the supervision of health professionals or as autonomous services operated by groups of people who use drugs.

    The objectives of SCS include preventing the transmission of blood-borne infections such as HIV and hepatitis C; improving access to health care services for the most marginalized groups of people who use drugs; improving basic health and well-being; contributing to the safety and quality of communities; and reducing the impact of open drug scenes on communities.

    Safer consumption services grew out of the recognition that low-threshold, easily accessible programs to reduce the incidence of blood-borne pathogens were effective and cost-effective. This was the conclusion of over 30 research studies on Vancouver’s own supervised injection site known as Insite.

    Research has found that SIS services:

    • are actively used by people who inject drugs including people at higher risk of harm;
    • reduce overdose deaths — no deaths have occurred at Insite since its inception;
    • reduce behaviours such as the use of shared needles which can lead to HIV and Hep C infection;
    • reduce other unsafe injection practices and encourage the use of sterile swabs, water and safe needle disposal. Users of these services are more likely to report changes to their injecting practices such as less rushed injecting;
    • increase the use of detox and other treatment services. For example, the opening of Insite in Vancouver was associated with a 30% increase in the use of detoxification services and in Sydney, Australia, more than 9500 referrals to health and social services have been made since the service opened, half of which were for addiction treatment;
    • are cost-effective. Insite prevents 35 new cases of HIV and 3 deaths a year providing a societal benefit of approximately $6 million per year. Research estimates that in Sydney, Australia, only 0.8 of a life per year would need to be saved for the service to be cost-neutral;
    • reduce public drug use; and reduce the amount of publically discarded injection equipment; and
    • do not cause an increase in crime.

    Professional groups such as the Canadian Medical Association, the Canadian Nurses Association, the Public Health Physicians of Canada, the Registered Nurses Association of Ontario, and the Urban Public Health Network have expressed their support for SCS.

    Clearly it’s time to move beyond controversy and get on with creating more of these life-saving programs.