Dr. Patricia Daly: Decriminalization in Vancouver: a step in the right direction

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Opinion: While people may have different views on the merits of Vancouver’s decriminalization model, it is irrefutable that existing efforts have not been sufficient and that bold action is urgently needed to save money. lives

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In recent weeks, much debate has surrounded the City of Vancouver’s plan to seek a federal exemption to decriminalize personal possession of illegal drugs. On the one hand, organizations representing people who use substances have raised concerns about the proposed amounts of drugs that people might possess under the exemption and the importance of access to a safe supply of drugs. pharmaceuticals for people who will remain at risk of overdose. . Alternatively, others have rejected the basic premise that we should provide a safe supply or even opioid agonist therapy – an evidence-based treatment for opioid addiction – to people struggling with substance use.

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In the past five years, nearly 1,700 people have died from drug overdoses in Vancouver alone. The crisis is not confined to Vancouver – during the same period, toxic drugs killed more than 7,000 people across the province. This is why the government of British Columbia has also announced its intention to seek a federal exemption for the entire province.

While people may have different views on the merits of Vancouver’s decriminalization model, it is irrefutable that existing efforts have not been sufficient and that bold action is urgently needed to save lives.

As the Public Health Officer and Medical Officer of Health for the City of Vancouver, some things are clear to me. First, our continued efforts to address the overdose crisis urgently require that we put in place an integrated system of care for people who use drugs, including expanding opioid agonist therapy and providing a safe supply to people who use drugs. those who are not ready for treatment or for whom addiction treatment is not indicated.

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Second, to complement these ongoing health system efforts, all levels of government must come together to decriminalize personal possession of illegal drugs in order to effectively combat stigma and promote access to life-saving supports.

I am not the only one to have this point of view among public health physicians. The Health Officers Council of BC, which represents the province’s public health physicians and others who practice or are closely related to public health, has called for the decriminalization of possession for personal use so that people who consume drugs are not stigmatized, and called for procedural change from local police to help rather than criminalize people who use drugs. Likewise, the Doctors of BC have officially recognized that decriminalization is essential for treating substance use as a health problem rather than a criminal justice problem, and for promoting access to harm reduction services and treatment. drug addiction.

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As with other psychoactive substances, such as tobacco and alcohol, a public health approach requires a range of policies and programs, including those aimed at improving the social determinants of health. While decriminalization alone is unlikely to improve overdose death rates, when combined with parallel efforts to prevent problematic substance use, reduce harm, and involve people with drug addiction in treatment programs. and secure supply, it represents a change in the right direction.

It is not surprising that this important step forward in drug policy reform is being proposed in Vancouver. This is appropriate, as the city has been disproportionately affected by the overdose crisis, and thousands of our citizens remain at a very high risk of overdose death. There is no time to wait. Vancouver is in a unique position to walk through the door first, with strong support for decriminalization from its mayor and council, the Vancouver Police Department, public health experts on my team, and many residents. who are proud to live in a city that has shown international leadership in human rights in health with programs like InSite, the first supervised consumption site in North America.

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The proposed threshold quantities of drugs that people will be able to possess without fear of being arrested or having their drugs confiscated should be seen as a starting point, open to reassessment over time. The thresholds will be used as a floor and not as a ceiling. People often share their drugs or buy a multi-day supply in order to avoid frequent transactions in the illicit drug market. When police encounter people whose amounts exceed the threshold without any evidence of drug trafficking, discretion can still be used and people will not necessarily face charges or forfeiture. This delicate balance between clarity and flexibility is an integral part of the approach proposed by the city.

When Mayor Kennedy Stewart first approached me about the city’s demand for decriminalization, I advised that unlike jurisdictions like Portugal, the city should not apply administrative sanctions or any form compulsory treatment. Healthcare providers face a daunting task to continue to build a system of integrated substance use services that are patient-centered, trauma-informed and culturally safe. Mandatory treatment would undermine these goals, particularly with respect to our relationships with Indigenous patients who have already had negative experiences in accessing care. Voluntary referrals from police to health services will help build a solid foundation of trust, compassion and commitment between people who use drugs and dedicated health care providers. The mayor, city manager and chief of the Vancouver Police Department have accepted this approach and should be commended for it.

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The advice I have given to the city also applies to the work of the provincial government in seeking a province-wide exemption. Ultimately, all citizens of British Columbia will be better served by a cohesive approach to decriminalization across the province. We will know if this work is successful if drug users tell us. We will also count on researchers to continue to collaborate with people who use drugs to build a strong evidence base to advise other jurisdictions on the strengths and limitations of the model. At this important point in the history of drug policy in Canada, I urge all stakeholders to consider our potential to push our country to fully adopt a public health approach to dealing with the overdose crisis. I am committed to working with the Province, the City of Vancouver and community stakeholders to ensure that we are all doing things right.

Patricia Daly is Vice President of Public Health and Chief Medical Officer of Health for Vancouver Coastal Health. She is also a clinical professor in the School of Population and Public Health, Faculty of Medicine, University of British Columbia.

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