top of page
Search
  • Writer's pictureBrayden Sharp-Chrunik
    • Mar 5, 2019
    • 8 min read

The War on Drugs: Who is really Winning?

Updated: Mar 12, 2019


 

For as long as there have been humans with pain, there have been drugs. Drug use, and subsequent abuse, is a major health concern worldwide. Most recent statistics show that in 2015, 250 million people use drugs globally (The United Nations Office on Drugs and Crime, 2017) . But, just because one uses drugs does not necessarily mean it is a problem. Problematic use, in the same study, found that 29.5 million people, or 0.6% of the entire population, suffered from drug use disorders; clinical term for addiction. President Nixon championed the fight against drugs back in 1971. Declaring, “America’s public enemy number one in the United States is Drug Abuse” creating what most of us know today as “The War on Drugs”. After this, and to this day, many countries still fund the ideas and programs first formed back in 1970’s America. In fact, just this year, “Justin Trudeau reaffirmed Canada’s participation in America’s drug war at the United Nations General Assembly on September 24, 2018” as one of 130 nations to re-sign (Lupick, 2018). With over 45 years of data collected and billions of dollars, in the case of America over a Trillion dollars, spent on the War on Drugs, what have been the outcomes?


The results are in, and they are staggering negative. For many countries implementing the War on Drugs strategies centred around drug enforcement, incarceration as punishment and shame for those involved with drug disorders, they have had little effect on the global problem. Any number of different examples could be used, but, for the purpose of this review the focus will be on Canada. Currently, Canada spends more than $2 Billion annually on law enforcement and over $50 Billion annually on drug related enforcement. Over 47,000 people die from addiction every year and hard drug use has increased by more than 89% in the past 10 years (Canadian Centre for Addictions, 2019). Specifically, Canada has seen a large increase in Opioid use, with 11 people each day dying of an opioid overdose (Public Health Agency of Canada, 2018). This has lead to Canada declaring the nationwide “Opioid Crisis”. So, if the methods that have been utilized over the past 4.5 decades are not working to combat the drug problem, what is the solution?


The Opioid Crisis and, to a larger extent, the Drug problem, is a multifaceted issue that requires involvement from all levels of government and the population in order to solve. That said, the Harm Reduction model has shown great success in providing an alternate, successful approach, in combating the negative effects of this problem on a countrywide scale. According to the Government of Canada’s Federal Actions on Opioids (2018), they have taken a multifaceted approach focused on:

  1. Prevention

  2. Treatment

  3. Harm Reduction

  4. Enforcement

The most recent stats suggest that, federally, treatment, prevention, harm reduction, and health promotion efforts around addiction only receive $26.3 million dollars annually (Government of Canada, 2017). While that is a good start, it is far from the $2 Billion spent on law enforcement and small portion of the overall budget to solve what has been deemed a $38.4 Billion dollar a year problem (Canadian Center on Substance Use and Addiction, 2018).


The Harm Reduction Model focuses on 6 main principles, which guide its practices:

  1. Pragmatism: a realistic approach recognizing that, even with the multitude of negative consequences that drug abuse provides, there is a reason people use with some benefits. Use and abuse is on a continuum with no two peoples situations being the same.

  2. Human Rights: Recognizes the right of personal choice and that no judgments are made based on someone’s choices.

  3. Focus on Harm: Places priority on reducing the harm drug use causes to the person and their life rather than stopping the drug use itself. Abstinence can be part of a persons treatment plan however is not used as the final goal or a determining factor of success.

  4. Maximizing interventions options: No one approach will work for everyone. Treatment plans need to be developed around the needs of the person.

  5. Priority of Immediate Goals: Focuses on meeting the person where they are at and working on change as a slow and methodical process, with the most pressing needs being addressed first, and incremental change over time.

  6. Drug User Involvement: Person-centered approach utilizing the person living with drug use as the best source of information and the champion in their own journey.


Harm Reduction comes in many forms and, although it will be addressed in its usefulness to combat drug use disorders for the purpose of this article, has also been utilized to address any number of risky behaviours. For Example, a seat belt, air bag, life jacket, helmet, or sexual protection (condoms, birth control etc.) are all Harm Reduction strategies. Harm Reduction is a mindset, focusing on reducing harm without preventing someone from participating in a risky activity. In 2016, Statistics Canada noted 160,315 injuries from motor vehicle accidents, in comparison to only 1,898 fatalities and 10,322 serious injuries. The uses of seatbelts prevent fatalities, recognizing the high risk associated to driving but not preventing people from completing the activity all together.

When addressing Harm Reduction strategies in combating the opioid crisis, Canada, and specifically Alberta's policies are still in its infancy; as demonstrated through comparison to some European countries programs and the Alberta Governments web page around Harm Reduction Strategies. The most successful example of Harm Reduction from a Canadian perspective comes from Vancouver’s Safe Injection Site, opened in 2003. A study demonstrated that, within 12 weeks of opening the facility, there was a decrease in daily drug users in public from 4.3% to 2.4%; as well as average publicly discarded syringes fell from 11.5 to 5.4, both statistically significant decreases (Wood et al, 2004). Another study found evidenc, despite common misconceptions around harm reduction practices bringing more crime to the surrounding area, a year after opening the safe injection site, that it was contribute to an increase in any drug related criminal activity in the surrounding area. In fact, the study saw a statistically significant decrease in vehicle thefts/break-ins since its opening (Wood et al, 2006). Other research, coming out of Europe (Harm Reduction strategies have been prevalent in many European countries for over a decade so they have access to more useful data) found that the effects of Safe Consumption sites lead to “Increased contact with health and social services; Decreased drug-related litter; Decreased high-risk injection practice (e.g., re-using or sharing injection equipment); and Decreased injection in public. (EMCDAA, 2018).


Although Canada’s Harm Reduction approaches are centred on safe injection sites, naloxone training, needle distribution programs and peer support groups, they should be taking steps to further their efforts based on work done in Europe. Portugal, a leader in Harm Reduction, became the first country to decriminalize all drugs in 2001. This policy move was accompanied by diverting government funding from drug enforcement instead to social programs who’s target was to connect addicts and provide person centred, follow up care along with programs such as job grants, employment programs, syringe exchange programs, safe injection sites, medical drug facilities etc. The results were decreases in drug use, HIV, drug related deaths, homicides, and crime (Transform, 2019). Canada took a large first step in legalizing Marijuana (the difference between Legalization and Decriminalization is shown in Figure 2.).


Harm Reduction is a strategy not only the federal government needs to promote and fund but also from a provincial level and, more importantly, from a community level. Lethbridge (my place of residence) has been the centre of attention for the opioid crisis in Alberta. In 2017, the Opioid death rate was the 3rd highest of any Alberta city. A survey done by ARCHES in 2017 stated that 67% of people injected in public, 47% witnessed needle sharing (a main concern in contracting HIV) and 24% of people surveyed had witnessed an overdose (ARCHES, 2017). The increase in fentanyl and other opioid drugs within the community has been a contributing factor to the municipality contributing money towards Harm Reduction. Lethbridge opened the first safe injection site in Alberta and the first one in Canada to offer inhalation rooms. A needle distribution, and subsequently a needle pick up program, was started, along with Naloxone training being offered in many locations and a Medical Detox centre was opened. The safe injection site has seen over 90,000 visits (most of any site) and responded to prevent over 850 overdoses in the first 8 months. The Alberta government also contributed $12.6 million dollars toward opening supportive housing complex for those homeless or struggling with addiction.


This has not come without backlash from the community. Harm Reduction in Lethbridge, as well as many places where it is not familiar, has elicited negative responses. People claim these strategies: Help people experiment with drugs that would not regularly, promote drug paraphernalia in communities, increase crime and cost tax payers more money; all of which have been proven wrong through studies. In case of Lethbridge, we do not need to get rid of these strategies, in fact, we should be implementing more. Although the safe injection site has seen many positive benefits, it currently neglects very important follow up care when working with people with drug use disorders. Like two sides to a coin, taking the risk and uncertainty of drug use out of the equation is the first step, providing rapport based and medically researched and tailored follow up care and resources is the second step to fighting the crisis we face worldwide.


The Harm Reduction Model and its effects are new to Canada. Although there is plenty research in Europe and around the world of its successes as an alternative to combating the drug problem it does need to be studied and implemented more in depth in Canada. Over 45 year of the War on Drugs has shown us that what we are doing is not working and new approaches should be entertained. Implementing a successful plan utilizing the Harm Reduction model will require all levels of the Canadian population; from the federal and provincial governments deciding to provide increases in funding suitable to carry out necessary programs and develop new ones, to the clinicians educating people and providing follow up care, to the general populations willingness to entertain a different approach and learn about its methods, and the researchers willingness to track its progress. Harm Reduction in Canada is in its infancy and, as research shows, it will only benefit us as a country to be rid of the "War on Drugs" and help parent Harm Reduction as a crucial component to combating the drug and opioid crisis into the future.

Video 1. End the Stigma Canadian Campaign to spread awareness to the National Opioid Crisis.

 

References:

23 views0 comments

Comments

bottom of page