tag:theconversation.com,2011:/id/topics/harm-reduction-38831/articlesHarm reduction – The Conversation2023-10-12T12:32:48Ztag:theconversation.com,2011:article/2144392023-10-12T12:32:48Z2023-10-12T12:32:48ZPhiladelphia bans supervised injection sites – evidence suggests keeping drug users on the street could do more harm than good<figure><img src="https://images.theconversation.com/files/552844/original/file-20231009-23-6425vq.jpg?ixlib=rb-1.1.0&rect=0%2C8%2C5991%2C3979&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A registered nurse treats Dominic Rodriguez for a skin injury related to xylazine use in Philadelphia in May 2023. Treatment vans are allowed in the city, but not supervised injection sites. </span> <span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/Drug%20Overdoses%20Animal%20Drug/9c80e074d4e7453380be9404d3bcdd2c?Query=Philadelphia%20drugs&mediaType=photo&sortBy=creationdatetime:desc&dateRange=Anytime&totalCount=592&currentItemNo=21">Matt Rourke/AP Photo</a></span></figcaption></figure><p>The United States remains tightly in the grasp of an ongoing, and escalating, <a href="https://www.cdc.gov/opioids/basics/epidemic.html">crisis of deaths</a> caused by opioid overdoses. </p>
<p>With a record-high <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm">109,000 people dying in 2022</a>, it is clear that something new needs to be done to reverse this trend. </p>
<p>Philadelphia is near the epicenter of the crisis. Some of the country’s <a href="https://www.dailymail.co.uk/news/article-9372555/Philadelphias-Skid-Row-Video-shows-citys-homeless-crisis-dozens-camped-trash-bin-fire.html">largest open-air drug markets</a> can be found in the Kensington neighborhood. Heroin, prescription opioids and fentanyl aren’t the only drugs of concern. Xylazine, a powerful non-opioid also known as tranq, has <a href="https://www.nytimes.com/2023/01/07/health/fentanyl-xylazine-drug.html#">an overwhelming presence</a> on the streets.</p>
<p>We are a group of <a href="https://www.med.uio.no/sustainit/english/people/aca/tjsandse/index.html">Scandinavian</a> <a href="https://www.sv.uio.no/iss/english/people/aca/synovena/index.html">and</a> <a href="https://drexel.edu/coas/faculty-research/faculty-directory/criminology-justice-studies/hyatt-jordan/">American</a> researchers who have studied drug treatment and harm reduction, and we have been watching the situation in Philadelphia from a variety of perspectives.</p>
<h2>A mixed response</h2>
<p>A record 1,413 people died in Philadelphia from <a href="https://www.phila.gov/media/20231002090544/CHARTv8e3.pdf">drug overdoses in 2022</a>. The rate of drug-related deaths for Black residents more than doubled <a href="https://www.phila.gov/2023-10-02-philadelphia-records-more-than-1400-overdose-deaths-in-2022-deaths-among-black-residents-rose-nearly-20/">between 2018 and 2022</a>, mirroring a <a href="https://doi.org/10.1007/s40615-022-01384-6">problematic national trend</a>.</p>
<p>In response, Philadelphia has adopted a multifaceted plan to <a href="https://www.phila.gov/2023-04-26-how-philadelphia-is-responding-to-the-overdose-crisis-in-2023/">stem the tide of overdoses</a>.</p>
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<p>But Philadelphia’s City Council has overwhelmingly rejected the establishment of <a href="https://whyy.org/articles/philadelphia-city-council-passes-near-total-ban-on-future-safe-consumption-overdose-prevention-sites/">supervised injection sites</a> – a potentially impactful, evidence-based tool in this fight. Overriding <a href="https://www.nbcphiladelphia.com/news/local/city-council-overturns-mayors-veto-on-safe-injection-site-ban/3655988/">the mayor’s veto</a> on Sept. 28, 2023, council members have used zoning legislation to essentially prevent the opening of sites where people can take drugs under supervision across most of the city. </p>
<p>In May 2023, the <a href="https://apnews.com/article/opioid-heroin-safe-injection-sites-pennsylvania-drugs-3c94134829464b858e02e3799ac3ae2b">Pennsylvania legislature</a> also overwhelmingly voted to ban supervised injection sites in the entire state.</p>
<p>While much of the political discourse surrounding this decision has focused on <a href="https://doi.org/10.1177/0091450921993821">protecting neighborhoods</a> where drug activity happens in parks and on the streets, ample evidence suggests that banning supervised injection sites may instead jeopardize the people and communities the policy was intended to protect.</p>
<h2>What is harm reduction?</h2>
<p>Supervised injection sites are an example of harm reduction, a general approach to addressing addiction and other public health crises. Ranging from efforts aimed at <a href="https://www.unaids.org/en/resources/presscentre/featurestories/2017/june/20170621_harm_reduction">reducing incidences of HIV</a> to encouraging the <a href="https://depts.washington.edu/harrtlab/wordpress/wp-content/uploads/2018/11/Safer-Use-Alcohol.pdf">safer consumption of alcohol</a>, the concept has become integral to many global public health initiatives. </p>
<p>The goal of <a href="https://espace.curtin.edu.au/bitstream/handle/20.500.11937/17446/18961_downloaded_stream_53.pdf?sequence=2&isAllowed=y">harm reduction</a> is to minimize the negative effects associated with drug use and other risky behaviors rather than solely focusing on eliminating the activity. This approach acknowledges the difficulty in breaking addictive behaviors and the fact that some individuals won’t – or can’t – stop regardless of policy and social efforts. </p>
<p>For drug use, harm reduction takes many forms. These include encouraging nonjudgmental approaches toward people who use drugs among social service workers and health care personnel, needle exchange programs, distribution of drugs that reverse overdoses, testing drugs for safety – and, in many parts of the world, supervised injection sites.</p>
<h2>Limitations in the United States</h2>
<p>Supervised injection sites have been a particularly <a href="https://www.inquirer.com/opinion/commentary/safe-injection-sites-safehouse-philadelphia-20200203.html">controversial approach</a> to harm reduction not just in Philadelphia but across most of the U.S. </p>
<p>Only a few officially sanctioned supervised injection sites have emerged. Two opened in <a href="https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html">Manhattan in 2021</a> with support from <a href="https://www.nytimes.com/2023/08/28/nyregion/safe-injection-sites-drugs-nyc.html">the government of New York City</a>, where research suggests they could <a href="https://doi.org/10.1016/j.jsat.2019.08.010">save both lives and health care dollars</a>. <a href="https://www.wpri.com/target-12/ri-prepares-to-open-first-safe-injection-site-amid-onslaught-of-overdose-deaths/">Rhode Island plans to open</a> a third in Providence in spring 2024, permitted by state legislation. The legality of even these rare sites in the U.S. remains unclear under federal law, according to <a href="https://doi.org/10.2105/AJPH.2006.103747">a 2011 study</a>.</p>
<p>In <a href="https://lira.bc.edu/files/pdf?fileid=f11d3cc8-fb45-4fae-be8c-ee8dcc4e8384">the face of this uncertain legality</a>, scant evidence from the U.S. is available. One unsanctioned site operating in secrecy <a href="https://doi.org/10.1016/j.amepre.2017.06.010">was studied by academics</a>. They found that 90% of users reported they would otherwise have been injecting in parks, streets or public restrooms, meaning the site averted over 2,300 public injections and safely disposed of at least 1,700 needles over two years.</p>
<p>Beyond this, policymakers have limited research in the U.S. to draw upon – and so it is informative to look abroad.</p>
<p>Globally, <a href="https://doi.org/10.1016/j.drugpo.2017.12.005">over 100 supervised injection sites</a> are currently operating in 10 countries, including <a href="https://doi.org/10.1186/s12954-017-0154-1">Canada</a> and across <a href="https://www.emcdda.europa.eu/system/files/publications/2734/POD_Drug%20consumption%20rooms.pdf">Europe</a>. Researchers have looked to experiences in Denmark and Norway, in particular, to study drug consumption rooms. Despite clear differences between Scandinavia and Philadelphia, the research and evidence highlight the potential impact of this form of harm reduction.</p>
<h2>The evidence from Norway</h2>
<p>In Norway, as in the U.S., harm-reduction efforts first began with <a href="http://doi.org/10.18261/issn.2535-2512-2019-06-04">opioid substitution therapy</a>, meaning the provision of less dangerous drugs like methadone for opioid users. </p>
<p>When <a href="http://doi.org/10.1159/000346781">overdose rates</a> kept rising, supervised injection sites where people who use drugs could get clean needles and be <a href="https://www.emcdda.europa.eu/system/files/attachments/6240/Safe%20consumption%20room%202017%20SIF%20and%20overdose%20Oslo%20-%20Thomas%20Clausen%2C%20Norway.pdf">observed while using drugs</a> were piloted in 2005 and made permanent by 2009.</p>
<p>The Norwegian Institute of Public Health collected data on the impact of the supervised injection site in Oslo. Just over 150 people used the site in 2005, the first year it opened. Two years later, demand had almost quadrupled. After just six months of operation, staff were recording over 900 injections per month, each diverted from the street. People using the facility <a href="https://fhi.brage.unit.no/fhi-xmlui/bitstream/handle/11250/275861/sirusrap.7.07.pdf?sequence=3">told researchers</a> their sense of human dignity improved.</p>
<p>Staff reported that the site allowed them to directly connect more people to social and health services. Other data shows that the presence of the site has <a href="http://doi.org/10.1080/08897077.2018.1485130">reduced the use of ambulances</a> and related public services, preserving those resources for the community. </p>
<h2>Striking results in Denmark</h2>
<p>The <a href="https://www.emerald.com/insight/content/doi/10.1108/DAT-03-2015-0007/full/html?utm_campaign=Emerald_Health_PPV_Dec22_RoN">first official Danish supervised injection site</a> opened its doors in Copenhagen in 2012, though underground versions had been operating for a few years.</p>
<p>Since then, several studies have shown the Copenhagen sites not only prevented many drug-related deaths, but <a href="https://sum.dk/nyheder/2015/maj/ny-evaluering-stofindtagelsesrum-har-flyttet-fix-vaek-fra-gaden">improved overall health</a> by successfully connecting people to substance abuse treatment and other health care services. </p>
<p>Staff were also successful at educating people about more hygienic injection techniques, <a href="https://doi.org/10.1186/s12954-016-0109-y">thereby reducing infections and other drug-related complications</a> that often lead to hospitalization. After the sites were opened, <a href="https://doi.org/10.1186/1477-7517-11-29">fewer people openly used drugs</a> in Copenhagen’s parks and streets. <a href="https://doi.org/10.1111/dar.13509">Property values</a> near the injection sites were unaffected.</p>
<p>An evaluation by the Danish Ministry of Health found that the number of needles and syringes discarded in the city’s public spaces was reduced <a href="https://sum.dk/nyheder/2015/maj/ny-evaluering-stofindtagelsesrum-har-flyttet-fix-vaek-fra-gaden">by 70% to 80%</a>, and residents in surrounding neighborhoods said <a href="https://psy.au.dk/fileadmin/CRF/STOF/STOF_pdf_er/STOF_nr._30/STOF_NR_30__S._09_-_Stofmiljoeet_paa_Vesterbro_og_politikken_i_forhold_til_det.pdf">their quality of life improved</a>.</p>
<p>Copenhagen’s experience also highlights the essential fact that supervised injection sites alone aren’t a solution; they are only a part of an effective harm-reduction strategy and must be accompanied by social support and other programming. </p>
<p>For example, the Users’ Academy – or <a href="https://brugernesakademi.dk">Brugernes Akademi</a> in Danish – is a national nonprofit led by people who use drugs that offers a wide range of harm-reduction services directly to their peers. They run a needle exchange program through the mail and raise awareness regarding the legal rights of people who use drugs. They also operate a mobile health clinic that seeks to prevent diseases like <a href="https://bmjopen.bmj.com/content/10/11/e039724">hepatitis C</a> and reduce barriers to health and social services.</p>
<h2>An opportunity to investigate</h2>
<p>Even in the face of the ongoing <a href="https://www.npr.org/sections/health-shots/2021/01/14/956428659/in-philadelphia-judges-rule-against-opening-a-medical-site-to-safely-inject-hero">controversy in Philadelphia</a>, new ideas are emerging.</p>
<p>Using the infusion of <a href="https://whyy.org/articles/philadelphia-opioid-settlement-funds-spending-overdose-preventionwrap-around-services-kensington/">funding from national opioid settlements</a>, Philadelphia could explore more politically acceptable approaches to harm reduction while collecting evidence and building support for a permanent supervised injection site. </p>
<p>In some European cities, mobile supervised injection sites have been adopted first. In Copenhagen, <a href="http://fixerum.dk/">Fixelancen</a>, an old ambulance, has been refurnished as a low-cost supervised injection site. It can service different areas of the city as the drug scene rapidly evolves, avoiding the focus and burden on a particular neighborhood. Such an approach could easily complement <a href="https://www.inquirer.com/health/opioid-addiction/south-philadelphia-upenn-buprenorphine-van-addiction-treatment-opioid-crisis-20191227.html%5D">other mobile</a> <a href="https://doi.org/10.1370/afm.256">harm-reduction efforts</a> already operating in Philadelphia.</p><img src="https://counter.theconversation.com/content/214439/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jannet van der Veen has received income from Brugernes Akademi.</span></em></p><p class="fine-print"><em><span>Synøve Nygaard Andersen received funding from The Research Council of Norway (grant #288083).</span></em></p><p class="fine-print"><em><span>Jordan Hyatt and Tony Joakim Ananiassen Sandset do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>A group of academics look at the global evidence to examine the potential impact of supervised injection sites in Philadelphia and the US.Jordan Hyatt, Associate Professor of Criminology and Justice Studies, Drexel UniversityJannet van der Veen, Visiting Fellow at the Center for Public Policy, Drexel UniversitySynøve Nygaard Andersen, Postdoctoral Fellow in Sociology, University of OsloTony Joakim Ananiassen Sandset, Researcher Fellow at the Centre for Sustainable Healthcare Education, University of OsloLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2124352023-08-30T21:16:09Z2023-08-30T21:16:09ZDecriminalization: How police drug seizure, even without arrest, can create harms<iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/decriminalization-how-police-drug-seizure-even-without-arrest-can-create-harms" width="100%" height="400"></iframe>
<p><a href="https://www.overdoseday.com/">International Overdose Awareness Day</a>, an annual campaign to end overdose and drug poisonings while also remembering those who have died, is Aug. 31. Events are being held in <a href="https://www.momsstoptheharm.com/ioad23">communities across Canada</a>, a sign of a worsening crisis that has taken more than <a href="https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/">36,000 lives since 2016</a>.</p>
<p>The day also represents an opportunity to discuss much-needed policy changes. The <a href="https://drugpolicy.org/issue/decriminalize-drugs-invest-in-health-services/">decriminalization of people who use drugs</a> has long been one of the proposed solutions, an approach that is currently being piloted in British Columbia.</p>
<p>On Jan. 31, 2023, B.C. began a first-in-Canada <a href="https://www.canada.ca/en/health-canada/services/health-concerns/controlled-substances-precursor-chemicals/policy-regulations/policy-documents/exemption-personal-possession-small-amounts-certain-illegal-drugs-british-columbia.html">pilot “decriminalization” policy</a>, in which criminal sanctions for the possession of small amounts of certain illegal drugs for personal use were removed for adults aged 18 or above.</p>
<p>Seven months into this experiment, the impact of this policy remains unclear. Because <a href="https://vancouverisland.ctvnews.ca/data-on-b-c-s-drug-decriminalization-plan-to-be-publicly-available-on-dashboard-1.6252744">a dashboard</a> of policy impact indicator data has not yet been published at the time of writing, it is difficult to weigh <a href="https://vancouversun.com/news/local-news/six-months-into-b-c-s-decriminalization-experiment-whats-working-and-whats-not">the initial effects of the policy</a>.</p>
<p>However, in the city of Vancouver, a policy of <a href="https://doi.org/10.1177/1477370819887514">depenalization</a> (also referred to as de facto decriminalization) has been in place since 2006, providing an opportunity to understand how the provincial pilot may be working — or even improved.</p>
<h2>Depenalization in Vancouver</h2>
<p>Seventeen years ago, the Vancouver Police Department (VPD) launched <a href="https://vpd.ca/wp-content/uploads/2021/06/vpd-policy-drug.pdf">its drug policy</a> to promote <a href="https://doi.org/10.1177/1477370819887514">the depenalization</a> of simple possession offences. Under this policy, VPD officers were encouraged to not arrest or charge people for simple drug possession for personal use except for certain circumstances.</p>
<p>The VPD’s policy differed from B.C.’s pilot decriminalization in several important ways. For example, the VPD’s policy did not specify the class or threshold quantity of drugs to define simple possession. VPD officers were given broad enforcement discretion with respect to drug possession.</p>
<p>Although publicly available VPD data are limited, <a href="https://vpd.ca/wp-content/uploads/2021/06/cleared-drug-charges-january-2014-to-present.pdf">available data</a> indeed indicated low and declining numbers of simple possession charges recommended by the VPD to Crown counsel from 2016 to 2019. These numbers have often <a href="https://vancouversun.com/news/drug-possession-charges-vary-widely-by-police">been cited</a> as the indicator of success of the VPD’s depenalization policy: fewer people are sent to the criminal justice system for the sake of personal drug use.</p>
<p>However, <a href="https://www.straight.com/news/1213101/vancouver-police-stats-suggest-softer-touch-drugs-users-say-its-different-story-streets">anecdotal reports</a> and <a href="https://doi.org/10.1016/j.drugpo.2021.103471">previous qualitative research</a> suggested that police officers might not arrest people for simple possession, but they would still seize drugs. Local communities of people who use drugs and public health advocates in Vancouver expressed concern about the harm created by this policing behaviour.</p>
<p>We undertook <a href="https://doi.org/10.1186/s12954-023-00833-7">surveys involving more than 1,800 people</a> who used drugs on a daily basis in Vancouver to investigate this often undocumented discretionary policing practice.</p>
<h2>Police drug seizures without arrest</h2>
<p>During a 16-month study period in 2019-2021, we found that six per cent of 995 people who used drugs daily in Vancouver (60 per cent residing in the Downtown Eastside neighbourhood that is known for high rates of marginalization and drug use) had had their drugs seized by police without arrest at least once in the past six months. Of those, more than one in four experienced it more than once during the same six-month period.</p>
<p>Of particular concern, 68 per cent of our study participants who had their drugs taken by police without arrest reported having obtained new drugs immediately after the seizure. This portion of the data was collected from the same study population between 2009 and 2012.</p>
<p><a href="https://www.pivotlegal.org/project_inclusion_full">Previous qualitative research</a> documented that acquiring drugs this way could put health and safety at risk in multiple ways. For example, it can put people at a higher risk of drug market violence by creating drug debts.</p>
<p>Some users may also be compelled to acquire new drugs in a rush from an unknown supplier, especially when experiencing painful withdrawal. <a href="https://app.powerbi.com/view?r=eyJrIjoiOGFhMTkwOTktYWQ1My00MzQ4LThlNzItMzVhOWY3NGFmOWQ4IiwidCI6IjZmZGI1MjAwLTNkMGQtNGE4YS1iMDM2LWQzNjg1ZTM1OWFkYyJ9">Amid the ongoing drug toxicity crisis</a>, increasing the frequency of buying drugs in the unregulated drug market, especially through an unknown source, increases risk of drug poisoning.</p>
<p>This is contrary to <a href="https://doi.org/10.1016/j.drugpo.2021.103471%22%22">a belief held among some police officers</a> that seizing drugs would prevent harms, including drug poisoning.</p>
<h2>The role of police in the toxic drug crisis</h2>
<p>A broader question is: Are there any circumstances where police drug seizures are beneficial in preventing drug poisoning? <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307291">A recent study from the United States</a> highlighted that police efforts to reduce the unregulated drug supply may worsen the drug toxicity crisis by showing a consistent pattern. As police seizures of drugs increased, drug poisoning cases also increased.</p>
<p>Several scholars noted that <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307328">police drug seizures would not address the toxic drug supply</a>, that <a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307329">the narrow mission of police may exacerbate drug-related harms</a> and that <a href="https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2023.307320">more harm reduction interventions to address the toxic drug supply are needed</a>.</p>
<p><a href="https://doi.org/10.1186/s12954-023-00833-7">Findings from our study</a> indicate that the VPD’s depenalization policy essentially “<a href="https://d3n8a8pro7vhmx.cloudfront.net/pivotlegal/pages/3494/attachments/original/1639066365/Decriminalization_Report_Final_Revised.pdf">mimics the health and safety harms associated with criminalization</a>” and likely undermines overdose prevention efforts.</p>
<p>Under B.C.’s pilot decriminalization policy, police officers can no longer seize drugs from an adult who possesses up to 2.5 grams of certain illegal drugs. However, the threshold quantity of drugs that defined simple possession has been shown to be <a href="https://doi.org/10.1016/j.drugpo.2023.104126">too low</a> to fulfil the policy objectives. Some people who use drugs, particularly those more marginalized and engaging in high-intensity drug use, may carry more than 2.5 grams of drugs. They may get arrested or experience police drug seizures without arrest.</p>
<p>The annual International Overdose Awareness Day compels us to reckon with ongoing toxic drug deaths and what we can do to reverse this worsening crisis. If decriminalization is going to contribute to positive change, police need to stop seizing drugs from people who use them.</p><img src="https://counter.theconversation.com/content/212435/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kanna Hayashi holds the St. Paul's Hospital Chair in Substance Use Research and is supported in part by a U.S. National Institute on Drug Abuse (NIDA) grant (U01DA038886) and the St. Paul’s Foundation. For the research work presented here, she received funding through a NIDA grant (U01DA038886), a Michael Smith Health Research BC Scholar Award and the William and Ada Isabelle Steel Fund through Simon Fraser University. She also receives funding from the Canadian Institutes of Health Research and the Social Sciences and Humanities Research Council to support her ongoing research in this area. She is also affiliated with the Vancouver Coastal Health Authority as research staff and the Division of Social Medicine, Department of Medicine, University of British Columbia as an affiliate assistant professor. </span></em></p>A police policy of not making arrests for simple possession is a way to essentially decriminalize personal drug use. However, confiscating drugs — even without arrests — can be harmful in many ways.Kanna Hayashi, Research Scientist at the British Columbia Centre on Substance Use & St. Paul's Hospital Chair in Substance Use Research and Associate Professor, Faculty of Health Sciences, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2047832023-07-04T21:51:22Z2023-07-04T21:51:22ZScaling up community drug-checking services in B.C. could help respond to the overdose crisis<figure><img src="https://images.theconversation.com/files/535609/original/file-20230704-27-lyamti.jpg?ixlib=rb-1.1.0&rect=30%2C105%2C4986%2C3083&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Drug checking is a harm reduction practice that provides chemical analysis of substances. Fentanyl test strips help drug users ensure that substances are free of dangerous fentanyl. </span> <span class="attribution"><span class="source">(AP Photo/Carlos Giusti)</span></span></figcaption></figure><p>British Columbia is in the midst of an enduring drug overdose crisis that continues to claim hundreds of people every year with no end in sight. With a <a href="https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf">significant rise in deaths over the last seven years</a>, innovative responses are urgently needed.</p>
<p>Among these responses is community drug checking, which continues to gain traction in both public health practice and research. Drug checking is a harm reduction practice that provides chemical analysis of substances. This is not only to inform harm reduction for people who use, buy and sell drugs (<a href="https://doi.org/10.1186/s12954-021-00545-w">and those who support them</a>), but also to monitor the supply for emerging trends that inform both the community and policymakers about the state of the unregulated supply, <a href="https://doi.org/10.1016/j.drugalcdep.2022.109427">which remains volatile, unpredictable and dangerous</a>. </p>
<p>As researchers providing drug checking on Vancouver Island, we see value in exploring new ways to deliver this service to reach more people who use drugs, at a scale required to address the current crisis.</p>
<h2>Drug checking in global perspective</h2>
<p><a href="https://doi.org/10.1111/add.15734">While drug checking has been around since the 1990s</a>, it remains an underused intervention that is often limited in both scope and scale. However, innovations in <a href="https://doi.org/10.3390/ijerph191911960">how and where the service is provided</a>, as well as <a href="https://doi.org/10.1016/j.drugpo.2022.103611">technological advancements within analytical chemistry and instrumentation</a>, are helping to overcome these limitations.</p>
<p>Internationally, groups like the <a href="https://www.drugs-test.nl/en/about-dims/">Drug Information Monitoring System</a> in the Netherlands have been pioneering drug checking and continuing to inform drug-checking research and practice internationally. </p>
<p>While services in some countries remain beholden by archaic <a href="https://doi.org/10.1016/j.drugalcdep.2022.109425">prohibitory legislative environments that challenge the legality of drug checking</a>, others are finding success in embedding drug checking within novel legal frameworks, <a href="https://doi.org/10.1108/DHS-03-2022-0016">like the legalization of drug checking in New Zealand</a>.</p>
<h2>Drug checking in Canada</h2>
<figure class="align-right ">
<img alt="A person's hand seen using a fentanyl test strip to test a dose of heroin in a small container" src="https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=624&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=624&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=624&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=784&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=784&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535606/original/file-20230704-29-rsezno.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=784&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A drug user places a fentanyl test strip into a mixing container to check for contamination, using a fentanyl test strip.</span>
<span class="attribution"><span class="source">(AP Photo/Bebeto Matthews)</span></span>
</figcaption>
</figure>
<p>In Canada, drug checking has its origins in the festival and rave scene as a grassroots bottom-up response to the harms of an unregulated market. <a href="http://michelow.ca/doc/drug-checking-guide-online-v1.pdf">The oldest drug-checking project has provided critical services at Shambhala Music Festival in Salmo, B.C.</a> for the last two decades. </p>
<p>The success of drug checking in festival settings for <a href="https://doi.org/10.17269/s41997-018-0126-6">lowering potential harms and highlighting broader trends</a> is now <a href="https://doi.org/10.1186/s12889-021-11243-4">increasingly being evaluated as a response to the overdose crisis</a> in B.C. and <a href="https://drugchecking.cdpe.org/">other parts of the country</a>. </p>
<p>Drug checking alone is not enough to curb the dramatic increase in drug toxicity deaths in the province and nationally. However, some of its strengths include <a href="https://doi.org/10.1108/DHS-01-2022-0005">generating evidence of trends</a> within the drug supply, as well as evidence for its effectiveness as a harm-reduction measure. It can also be <a href="https://doi.org/10.1080/09687637.2022.2087487">incorporated into other harm reduction programs and methods</a>, including safe supply.</p>
<h2>Substance: The Vancouver Island drug-checking project</h2>
<p>Our <a href="https://substance.uvic.ca/">research-based service in Victoria, B.C.</a> has spent the last five years developing and evaluating drug-checking service models while conducting robust multi-disciplinary research in the fields of social work, chemistry, computer science and public health. This research provides evidence to support services that <a href="https://doi.org/10.1186/s12954-020-00373-4">respond to the unique needs of people accessing drug-checking services</a>.</p>
<p>On the chemistry side, our research <a href="https://doi.org/10.1002/jrs.6133">evaluates and improves analytical technologies and methods, and boosts their effectiveness in detecting fentanyl and other adulterants</a>. Public health research highlights <a href="https://doi.org/10.1186/s12889-021-11243-4">how drug checking goes beyond individualistic responses to act within community, market and policy arenas</a>. This research supports services that <a href="https://doi.org/10.1186/s12954-020-00373-4">respond to the unique needs of people accessing drug-checking services</a>.</p>
<h2>Vancouver Island’s unique model of drug checking</h2>
<p>In responding to the challenges of scaling up drug-checking services, <a href="https://doi.org/10.1108/DHS-01-2022-0005">we developed a unique distributed drug-checking model</a> to increase the reach of these services. </p>
<p>This model aims to fill in gaps in service delivery for diverse communities that are vulnerable to the unregulated drug supply. It also highlights the importance of multidisciplinary research and service design that draws critical insight from multidisciplinary fields to better inform drug-checking services. </p>
<figure class="align-center ">
<img alt="A window with a logo in a circle reading Substance, est. 2018, surrounded by paper hearts with handwritten messages." src="https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=360&fit=crop&dpr=1 600w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=360&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=360&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/535630/original/file-20230704-21-fkqtxb.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Substance’s distributed model provides a hybrid, easy-to-use drug-checking program that blends immediate portable drug-checking technologies for timely harm reduction with more comprehensive lab-based technologies that provide greater accuracy of drug composition.</span>
<span class="attribution"><span class="source">(Substance)</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Drawing on a network that enables the collection of samples in various locations and communities, our distributed model provides a hybrid, easy-to-use drug-checking program. The program blends immediate portable drug-checking technologies for timely harm reduction with more comprehensive lab-based technologies that provide greater accuracy of drug composition. </p>
<p>Through the use of <a href="https://doi.org/10.1186/s12954-023-00764-3">specialized spectrometers and test</a> strips distributed at various sites and connected to a central server and database, drug analysis can be done remotely within our central hub. These results get looped back to service users distributed across Vancouver Island who also have the opportunity to receive further analysis at a later time using a lab-based method called <a href="https://doi.org/10.1111/dar.13370">paper spray mass spectrometry</a>.</p>
<p>This model responds to the unique challenges of providing critical harm reduction across geographical locations and within different communities. Through the distributed model, we continue to evaluate what works best for whom in <a href="https://theconversation.com/why-the-drug-poisoning-crisis-in-b-c-wont-be-addressed-by-the-new-decriminalization-policy-199239">the context of an ever-changing drug supply and policy landscape</a>. </p>
<p>Most consumables in Canada have quality controls that help inform purchasing and consumption decisions. People who use drugs and those who support them deserve the same. It is long past time that we respond to the enduring crisis to the magnitude it deserves. </p>
<p><a href="https://doi.org/10.1186/s12954-022-00727-0">Drug checking everywhere for everyone</a>: is it possible? It is certainly a worthwhile goal with life-saving potential, and we will continue working to achieve it.</p><img src="https://counter.theconversation.com/content/204783/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bruce Wallace received funding from Health Canada, the Canadian Institutes of Health Research, the Social Sciences and Humanities Research Council, Vancouver Foundation, and the Island Health Authority. </span></em></p><p class="fine-print"><em><span>Dennis Hore received funding from Health Canada, the Natural Sciences and Engineering Research Council of Canada, and the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Piotr Burek does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Most consumables in Canada have quality controls that inform purchasing and consumption decisions. People who use illicit drugs deserve the same. Drug checking provides that harm-reduction service.Piotr Burek, Master of Arts student, Social Dimensions of Health Program, University of VictoriaBruce Wallace, Professor, School of Social Work, University of VictoriaDennis Hore, Professor, Chemistry, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2076792023-06-27T21:21:32Z2023-06-27T21:21:32ZLet evidence, not opinion, guide harm reduction policy and practice in Canada’s drug poisoning crisis<p>The poisoning of the unregulated drug supply, especially in Canada, is a public health crisis that deserves a high priority for the integration of evidence into policy and practice. </p>
<p>The <a href="https://www.cbc.ca/news/health/drug-poisoning-deaths-language-1.6457834">drug poisoning crisis</a> is often referred to as the opioid crisis, but it is all illicit substances, including stimulants, that are tainted with fentanyl, benzodiazepines and other dangerous ingredients, <a href="https://doi.org/10.1111/add.15844">increasing the risk of harm, especially overdose</a>. </p>
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Read more:
<a href="https://theconversation.com/benzo-dope-may-be-replacing-fentanyl-dangerous-substance-turning-up-in-unregulated-opioids-164286">‘Benzo-dope’ may be replacing fentanyl: Dangerous substance turning up in unregulated opioids</a>
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<p>It is still an ongoing battle for those in positions of power to submit to the rigorous evidence supporting harm reduction, despite strategies like <a href="https://doi.org/10.1186/s12954-017-0154-1">supervised consumption sites</a> and the distribution of drug equipment <a href="https://www.phs.ca/insite-an-anniversary-of-hope/">being more than two decades old</a>. </p>
<p>For example, North America’s first formal supervised consumption site, <a href="https://www.phs.ca/program/insite/">Insite</a>, has been in operation for 20 years showcasing what its founding organization, PHS Community Services, calls a “<a href="https://www.phs.ca/insite-an-anniversary-of-hope/">pragmatic and humane approach to the risks of drug use</a>.” </p>
<p>Thorough evaluation of harm reduction strategies has shown they can <a href="https://doi.org/10.1186/s12954-017-0154-1">save money, save lives and promote health</a> at an individual and population level. Furthermore, denial of access to supervised consumption is a <a href="https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/7960/index.do">violation of Section 7 of the Canadian Charter of Rights and Freedoms</a>, which protects an individual’s right to life, liberty and security of the person.</p>
<h2>Stigma and ideology</h2>
<p>Recently, Canada’s leader of the Opposition Pierre Poilievre had his motion to defund safer supply voted down in Parliament. His reference to a “<a href="https://www.ourcommons.ca/DocumentViewer/en/44-1/house/sitting-200/hansard">tax-funded drug supply</a>” as fuelling addiction rather than recovery is not supported by evidence and follows the <a href="https://www.cbc.ca/news/politics/conservative-motion-safe-supply-fails-1.6858551">failed prejudicial ideology of the war on drugs era</a>. </p>
<p>Poilievre’s actions mirror the sentiments of former federal health minister Rona Ambrose, whose opinion also superseded evidence while in a position of influence. In 2013 she attempted to deny access to heroin assisted treatment (HAT) — an <a href="https://doi.org/10.1136/bmj.327.7410.310">opioid substitution treatment using diamorphine/diacetylmorphine (medical grade heroin</a>) — for persons with substance use disorder in Vancouver. </p>
<p><a href="https://www.providencehealthcare.org/sites/default/files/Supreme%20Court%20of%20British%20Columbia%20Decision.pdf">Ambrose publicly stated that</a> “Our policy is to take heroin out of the hands of addicts, not to put it into their arms.”</p>
<p>Ambrose made this public declaration <a href="https://doi.org/10.1016/j.jsat.2006.04.007">despite evidence</a> from both <a href="https://doi.org/10.1056/NEJMoa0810635">Canada</a> and <a href="https://doi.org/10.1136/bmj.317.7150.13">Europe</a> that <a href="https://doi.org/10.1192/bjp.bp.106.026112">showcased the efficacy</a> of HAT in six <a href="https://doi.org/10.1016/S0140-6736(10)60349-2">randomized controlled trials</a> with over 1,500 patients.</p>
<h2>What is evidence?</h2>
<p>What is considered evidence, especially regarding public health? From an epistemological (justified belief, as opposed to opinion) perspective, we may think evidence equals truth. However <a href="https://global.oup.com/academic/product/population-health-science-9780190459376?cc=ca&lang=en&">causation cannot be observed, only inferred</a>. While evidence may be viewed as more of a confirmation, truly <a href="https://doi.org/10.1046/j.1365-2753.2000.00244.x">definitive scientific evidence is rare due to its ever-changing and evolving nature</a>. </p>
<p>Evidence comes in many forms, and although it may not constitute absolute “proof,” it is reliable.</p>
<p>In harm reduction, best practices are grounded in evidence that comes from several facets including peer-reviewed literature, unpublished reports or grey literature, and the experiential knowledge of persons who use drugs themselves. </p>
<p>The way <a href="https://doi.org/10.1016/j.drugpo.2020.103015">harm reduction has progressed in Canada</a> tells us that <a href="https://doi.org/10.1186/s13011-021-00406-6">people who use drugs are key informants at the table</a> as they articulate their own experience of what it is like to use substances from an unregulated supply and to navigate the health and social services system. <a href="https://doi.org/10.1111/add.158441196COMMENTARIES">Their voice in the conversation</a> helps to reduce stigma, support client-centred essential services and policies, and prioritize the needs of people who use substances.</p>
<h2>Barriers to progress</h2>
<p>The question still remains as to why government policies across Canada, public stigma, and ignorance towards the use of substances and the people who use them, are still able to create barriers to the promotion of strategies that fight the current drug poisoning crisis. </p>
<p>During the COVID-19 pandemic, <a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/interactive-timeline">public health strategies were implemented at a rapid pace</a>, but this same urgency is not translating to our community of people who use unregulated drugs. One would think that <a href="https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants">the loss of nearly 40,000 Canadians to opioid overdoses since 2016</a> would be impetus for not just change, but bold action.</p>
<p>Has government not learned its lessons about taking all aspects of evidence into consideration while also considering the urgency of action required in crisis situations? After public health failures during the 2001 SARS crisis, <a href="https://doi.org/10.1098/rsfs.2021.0079">Justice Archie Campbell recommended in his report</a>: </p>
<blockquote>
<p>“Where there is reasonable evidence of an impending threat to public harm, it is inappropriate to require proof of causation beyond a reasonable doubt before taking steps to avert the threat…that reasonable efforts to reduce risk need not await scientific proof.” </p>
</blockquote>
<p>The ultimate question that needs to be asked to those who have the power to move harm reduction forward is: If they want to be a part of ending the drug toxicity crisis, then why and for whom? Is their primary objective more votes? Or is it to value all members of our community, and not just keep people who use drugs alive, but to help them thrive? </p>
<p>If the goal is wanting to be a part of ending this crisis for the betterment of the persons experiencing it, then the approach must include weighing evidence from a variety of sources and triumphing over public and political ideology and stigma. </p>
<p><a href="https://plato.stanford.edu/entries/egalitarianism/#Pri">Prioritarianism</a>, as a principle of justice, puts the focus on the population most in need, whether it be in terms of health, resources, opportunities or access. The moral and ethical values of this approach intend to maximize overall well-being for those who need it the most. </p>
<p>Movement forward requires collaboration that builds on existing strengths and capacities, with the guiding principle being to <a href="https://healthydebate.ca/2021/09/topic/encampments-pandemic-covid/">put the needs of the persons living this experience first</a>. Bioethicist Anita Ho describes epistemic humility — the ability to challenge one’s preconceived and biased assumptions — as “<a href="https://doi.org/10.2979/intjfemappbio.4.2.102">characterized by a commitment to mutual collaboration and trust with those they serve</a>.” </p>
<p>A healthy public includes us all.</p><img src="https://counter.theconversation.com/content/207679/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ross Upshur receives funding from Health Canada, CIHR, Atlas Institute for Veterans and Families</span></em></p><p class="fine-print"><em><span>Karla Ghartey does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Harm reduction is grounded in evidence. But policies, stigma and ignorance about substance use still create barriers in battling Canada’s drug poisoning crisis.Karla Ghartey, Doctor of Public Health (DrPH) student, University of TorontoRoss Upshur, Professor, Dalla Lana School of Public Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2004192023-05-28T11:32:23Z2023-05-28T11:32:23ZDeaths of despair: How income inequality puts Canadian youth at risk<figure><img src="https://images.theconversation.com/files/528639/original/file-20230526-19-j4xo.jpg?ixlib=rb-1.1.0&rect=253%2C176%2C4709%2C3096&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Income inequality is the gap between the highest and lowest earners in a given area. It can contribute to people's risk of poor health, and specifically mental health.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Income inequality has been linked to poor physical and mental health in past research, but more recent evidence suggests the issue of income inequality may be much more severe than previously expected. </p>
<p>While completing my PhD in epidemiology at the University of Alberta, I <a href="http://dx.doi.org/10.1136/jech-2022-219630">published a study</a> highlighting an association between experiencing income inequality in youth and deaths of despair among young Canadians.</p>
<p>Deaths of despair are deaths attributable to suicide, drug overdose and alcohol-related liver disease. These deaths are on the rise in Canada, and finding points of intervention is key to reducing the burden of this crisis.</p>
<p>In collaboration with my doctoral supervisor, <a href="https://www.emergeresearchlab.com">Roman Pabayo</a>, I led a study on a representative sample of Canadian youth and followed them up over a 13-year period to calculate average hazard for deaths of despair. The study sample included 1.5 million Canadians between the ages of 0 and 19 from 2006 to 2018. </p>
<h2>Income inequality and health</h2>
<figure class="align-center ">
<img alt="Tiny human figures standing on coins: a few people on a tall stack, and a lot of people on much smaller stacks" src="https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&rect=75%2C0%2C5513%2C3728&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/528636/original/file-20230526-28817-v1vl9k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Areas where income inequality is higher are less likely to have the type of social programs that are key to improving the health of communities.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Income inequality is the gap between the highest and lowest earners in a given area. It can contribute to people’s risk of poor health, and specifically mental health, in a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1088996/">few key ways</a>. </p>
<p>First, in areas with higher income inequality, people are less likely to relate to their neighbours, regardless of whether they earn more or less income than they do. This can lead to social comparisons, which are detrimental for mental health and self esteem. </p>
<p>Secondly, this lack of connection with those around you — also called “social cohesion” — can cause mistrust and ill feelings about others. This in turn can lead people to become withdrawn or isolate themselves. Lack of social cohesion and isolation are both risk factors for poor mental health and substance use. </p>
<p>Finally, areas where income inequality is higher are less likely to have the type of social programs that are key to improving the health of communities. For example, divesting in mental health services and supports can lead to worsened mental health, and removal or lack of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5685449/">harm reduction services</a> and <a href="https://doi.org/10.1177%2F070674371405901005">mental health services</a> can put people at a higher risk of deaths of despair. </p>
<h2>Income inequality and deaths of despair</h2>
<p>Deaths of despair are on the rise in Canada. Specifically, drug overdose death events have increased so rapidly that the <a href="https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants">drug poisoning crisis</a> has been referred to as an epidemic. This is a major concern, as these deaths have strong <a href="https://doi.org/10.24095%2Fhpcdp.38.6.02">impacts on the well-being of communities, families and friends</a>; but also because this crisis doesn’t appear to be ending anytime soon. </p>
<p>The impact the crisis is having on young Canadians is especially important, considering that unfamiliarity with substances, lower tolerance and risk-taking behaviours may leave them at an increased <a href="https://doi.org/10.1089%2Fcap.2019.0013">risk for drug overdose</a>. Further, suicide is a <a href="https://vizhub.healthdata.org/gbd-compare/">leading cause of death</a> among young people in Canada, indicating a critical need to intervene.</p>
<p>The results of this <a href="http://dx.doi.org/10.1136/jech-2022-219630">new study</a> also showed that higher levels of income inequality in youth are associated with an increased hazard of death from any cause, deaths of despair and drug overdose in young Canadians. </p>
<h2>Urgent need for services</h2>
<p>My colleagues and I are continuing this work by investigating income inequality and deaths of despair in other populations by using other indicators of social equity. We are also investigating more harms we suspect are associated with income inequality, such as hospitalizations owing to despair. </p>
<p>This line of work shows the urgent need for increased access to health services such as counselling and harm reduction, particularly in areas of higher income inequality, to reduce the risk of deaths of despair in these spaces. </p>
<p>The study results should be communicated to policymakers, who inform discussions on reducing income inequality and harms due to drug overdose, suicide and alcohol-related liver disease. Programs to mitigate this problem may include cash transfer programs, increases to minimum wage, or <a href="https://theconversation.com/a-guaranteed-basic-income-could-end-poverty-so-why-isnt-it-happening-182638">universal basic income programs</a> to reduce the gap between the highest and lowest earners.</p><img src="https://counter.theconversation.com/content/200419/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Claire Benny receives funding from the Women and Children's Health Research Institute (WCHRI).</span></em></p>Higher levels of income inequality in youth are associated with increased ‘deaths of despair’ in young Canadians.Claire Benny, PhD Candidate, Epidemiology, University of AlbertaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2007122023-02-28T07:43:46Z2023-02-28T07:43:46ZPill testing is coming to Queensland. Here’s what can we learn from programs overseas<figure><img src="https://images.theconversation.com/files/512579/original/file-20230228-1889-sef6zp.jpg?ixlib=rb-1.1.0&rect=16%2C176%2C5537%2C3549&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/C6ni9uAva5I">Lukas Bato/Unsplash</a></span></figcaption></figure><p>Queensland will become the second Australian jurisdiction to offer pill testing. While the timeline is yet to be announced, once up and running, Queenslanders who use illicit drugs can have them checked to see what they actually contain before taking them. </p>
<p>This is likely to reduce the risk of people overdosing on both unexpected and high potency substances, as well as reducing illness and death from harmful additives and mixtures. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1629286883305099265"}"></div></p>
<p>While making the announcement, Queensland’s health minister acknowledged the groundwork of my colleagues and I in the ACT, where we’ve provided <a href="https://www.harmreductionaustralia.org.au/wp-content/uploads/2018/06/Pill-Testing-Pilot-ACT-June-2018-Final-Report.pdf">successful</a> festival-based testing at the Groovin’ The Moo in 2018 and 2019, and a fixed-site service since 2022. Independent evaluations conducted in Canberra, and unusual in this research space, <a href="https://medicalschool.anu.edu.au/files/ACT%20Pill%20Testing%20Evaluation%20report.pdf">clearly demonstrate</a> a benefit. </p>
<p>Queensland’s move aligns the state with a growing international norm. In fact, the evidence to support such services has existed for decades. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/what-is-drug-checking-and-why-do-we-need-it-in-australia-51578">What is 'drug checking' and why do we need it in Australia?</a>
</strong>
</em>
</p>
<hr>
<h2>What are other countries doing?</h2>
<p>There are as many ways to provide drug checking services as there are countries providing them. They can be broadly divided into:</p>
<ul>
<li><p><strong>onsite or festival-based services</strong>, that generally test at the point of consumption, with lightweight and rapid turnaround equipment</p></li>
<li><p><strong>fixed site services</strong>, to which consumers are usually required to travel. They frequently offer more accurate and detailed analysis, but that takes a little more time.</p></li>
</ul>
<p>Either of these models can be incorporated into broader early warning or monitoring services, where data is collated and emerging trends and novel drugs can be identified. </p>
<p>The Netherlands has been offering a system since the late 1990s. It has now grown to a national monitoring system that <a href="https://www.trimbos.nl/wp-content/uploads/sites/31/2021/09/af1677-the-drugs-information-and-monitoring-system-dims.pdf">extends over 30 sites</a>. Drug checking services have been rolled out in other countries around the world, including <a href="https://kosmicare.org/">Portugal</a>, <a href="https://energycontrol-international.org/">Spain</a>, Mexico, <a href="https://checkit.wien/drug-checking/">Austria</a>, <a href="https://ccsa.ca/drug-checking-working-group">Canada</a>, <a href="https://www.health.govt.nz/our-work/regulation-health-and-disability-system/drug-checking">New Zealand</a> and some parts of the United Kingdom. </p>
<p>Canada offers <a href="https://datac.ca/shambhala-festival-leads-canada-with-drug-checking/">onsite</a> and fixed site testing. The latter is used in Toronto, with samples <a href="https://drugchecking.cdpe.org/about/">transported</a> from collection sites to analytical sites. In British Columbia, in the middle of a deadly fentanyl epidemic, both onsite and fixed site services have <a href="https://drugcheckingbc.ca/">saved lives</a> by identifying <a href="https://www.abc.net.au/news/2022-12-31/deadly-drug-found-during-pill-testing-in-canberra/101819004">samples tainted by</a> not only fentanyls but also products like <a href="https://nida.nih.gov/research-topics/xylazine">xyalzine</a> and <a href="https://www.health.nsw.gov.au/aod/public-drug-alerts/Pages/heroin-found-to-contain-nitazenes.aspx">nitazenes</a>.</p>
<p><a href="https://www.drugfoundation.org.nz/info/being-safer/party-drug-checking/">New Zealand</a> has recently amended legislation to permit both festival testing and pop-up sites.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/after-the-last-summer-of-terrible-drugs-its-time-to-make-nzs-temporary-drug-checking-law-permanent-165612">After the last 'summer of terrible drugs' it's time to make NZ's temporary drug checking law permanent</a>
</strong>
</em>
</p>
<hr>
<p>Ireland <a href="https://www.hse.ie/eng/services/news/media/pressrel/hse-reports-results-ireland-first-back-house-drug-testing-pilot.html">conducted</a> its first pilot at the Electric Picnic festival last year. Meanwhile, I was involved in establishing a <a href="https://www.wedinos.org/about-us">Welsh</a> program which permits the delivery of small samples of drugs to the analytical service from the consumer by ordinary mail. <a href="https://itsnotgov.org/regulation/drug-safety/ecstasydata-dot-org/">Ecstasy Data</a> in the United States does the same.</p>
<p>The combination of onsite testing, fixed site testing and monitoring provides the greatest coverage of drug intelligence, much in the same way that different levels of flu-tracking allows us the best analysis of what lies in store, and is circulating. This allows services to <a href="https://www.emcdda.europa.eu/topics/drug-checking_en">detect</a> and <a href="https://www.independent.co.uk/news/world/europe/superman-ecstasy-pill-fatal-heart-netherlands-trimbos-dutch-holland-a7373086.html">issue warnings</a> about harmful substances that are circulating. </p>
<p>The United States Center for Disease Control (CDC) <a href="https://filtermag.org/cdc-drug-checking/">has recommended drug checking</a> as a way of monitoring the fentanyl crisis in that country. Any future CDC in Australia should strongly consider incorporating such surveillance in its remit.</p>
<figure class="align-center ">
<img alt="Women at a festival at the back of the crowd" src="https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512583/original/file-20230228-1648-110fn1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some pill testing occurs at pop-up festival sites, others have fixed locations.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/pOXHU0UEDcg">Aranxa Esteve/Unsplash</a></span>
</figcaption>
</figure>
<h2>So what system is best?</h2>
<p>In the ACT, we’ve been allowed to design our service around the needs of the patron, and we find face-to-face services are the <a href="https://pilltestingaustralia.com.au/trans-tasman-charter/">best way</a> to engage with consumers. </p>
<p>But other jurisdictions might find that difficult, and may need to modify their service to address external constraints placed upon them, such as not having available equipment on site, or the concerns of local law enforcement in endorsing such an approach. </p>
<p>Some places permit the tests to be conducted by non-chemists. </p>
<p>But in the ACT we use graduate chemists, who are also involved in <a href="https://www.churchilltrust.com.au/project/to-visit-leading-international-drug-checking-services-to-rapidly-improve-the-analytical-chemistry-capabilities-in-australia/">developing and improving</a> the program. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/pill-testing-really-does-reduce-the-risk-of-harm-for-drug-users-181778">Pill testing really does reduce the risk of harm for drug users</a>
</strong>
</em>
</p>
<hr>
<p>The Netherlands has applied the best service possible for the Netherlands, and certainly one of the best in the world, with a process that is proven, and well trusted by the population it serves.</p>
<p>But this is not a service that would necessarily lend itself to the federal structure of Australia, or our historical apprehension to pragmatic discussions about drugs and drug use. </p>
<p>None of these approaches are necessarily better or worse than another – they have been developed to suit the environment in which they operate. The best service for Australia will be an Australian service. And there may well be differences in what that will be, between jurisdictions. </p>
<h2>What do we know about the Queensland system so far?</h2>
<p>While it’s not clear how the Queensland service will work, or how many testing sites there will be, there are some hints it might be a little different to the ACT’s drug checking service, CanTEST. </p>
<p>At the Queensland press conference, health authorities explained the testing process under consideration would take between 45 minutes to an hour. </p>
<p>In Canberra, our analysts conduct a number of tests, including an <a href="https://youtu.be/zWjgsZ4lt-4">FTIR analysis</a> as an initial test, fentanyl test strip analyses where indicated, and UPLC PDA against ten known compounds for quantitative analysis. That all takes around ten minutes – and all in front of the patron. </p>
<p>Times for the patron can vary, depending on the number of attendees at any time, but the analytical time is pretty constant. The patron is encouraged to stay and engage with the process, and even the chemists, who have become very adept science communicators. </p>
<p>The longer time reported might be associated with a different choice of testing equipment, or the use of external analytical facilities, such as private analytical laboratories for offsite testing, like the Toronto model.</p>
<h2>What about other states and territories?</h2>
<p>Queensland’s adoption of pill testing is likely to prompt other states and territories to follow. Queensland played a long political game, never fully ruling out the process, while stating it required further evidence. </p>
<p>With such adamant opposition elsewhere, it is difficult to see what the end-game for other jurisdictions will be. </p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1630167185036288000"}"></div></p>
<p>But there is no future scenario in which pill testing will become less necessary, or less in demand. Twenty years after John Howard’s “tough on drugs” strategy, the appetite of young Australians for illicit drugs seems undiminished, and the nature of those drugs is more dangerous than ever. </p>
<p>The road forward will now necessitate experts and academics alike easing politicians out of the corners they’ve found themselves backed into, as a consequence of adopting the rhetoric of a dated proxy “war on drugs”. It’s a hard road, but one on which the young people, and the parents of young people, across Australia now expect their governments to travel.</p><img src="https://counter.theconversation.com/content/200712/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Caldicott has been the recipient of an NH&MRC Partnership Grant.
He is the Clinical Lead for Pill Testing Australia and CanTEST.</span></em></p>There’s a lot we don’t know about how Queenslanders will be able to get their pills tested in future. But here’s how other countries do it.David Caldicott, Senior lecturer, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1992392023-02-06T20:53:55Z2023-02-06T20:53:55ZWhy the drug poisoning crisis in B.C. won’t be addressed by the new decriminalization policy<p>On the same day that British Columbia began a new era in drug policy with the <a href="https://www2.gov.bc.ca/gov/content/overdose/decriminalization">decriminalization of simple possession of some drugs</a>, the province’s chief coroner provided a <a href="https://www2.gov.bc.ca/gov/content/life-events/death/coroners-service/statistical-reports">devastating update</a> about the number of lives lost to illicit drugs during the previous year. </p>
<p>On Jan. 31, 2023, B.C. began a <a href="https://www2.gov.bc.ca/assets/gov/overdose-awareness/decriminalization_factsheet.pdf">three-year pilot project</a> under which simple possession of some drugs (opioids, methamphetamine, cocaine and MDMA) can no longer lead to criminal prosecution or even seizure of the drugs by police. The policy applies to possession of up to 2.5 grams of substance for personal use.</p>
<p>While a major step in the right direction, decriminalization does nothing to tackle what is fuelling the drug-poisoning crisis: the makeup of a toxic and unregulated drug supply. </p>
<p>In fact, imposed carry restrictions of 2.5 grams could theoretically lead to unintended consequences as drugs become more potent to fit within legal limits. </p>
<p>The stated goal of the decriminalization policy change is to <a href="https://theconversation.com/decriminalizing-drug-use-is-a-necessary-step-but-it-wont-end-the-opioid-overdose-crisis-162497">remove the stigma associated with drug use</a> to encourage people to seek help when they need it. </p>
<p>While the effects that decriminalization may have on the stigma of drug use remain to be seen, what it won’t affect is the toxicity of the drug supply that is killing thousands of Canadians each year.</p>
<h2>Inconsistent and unreliable drug supply</h2>
<p>Chemical analysis of drugs (such as from <a href="https://drugcheckingbc.ca/video/">drug checking</a> or police investigations) can tell us what is circulating in the supply, but <a href="https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug-type.pdf">toxicology results</a> from those who have died from overdoses tell us what is actually causing death. </p>
<p>These data sources describe how increases in adulteration of drugs with fentanyl analogues, <a href="https://theconversation.com/benzo-dope-may-be-replacing-fentanyl-dangerous-substance-turning-up-in-unregulated-opioids-164286">benzodiazepines</a> and animal tranquilizers like <a href="https://substance.uvic.ca/blog/xylazine/">xylazine</a> are driving the drug poisoning crisis. </p>
<p>Fentanyl has been the main opioid sold on the unregulated market for several years. It is typically sold mixed into other powders like caffeine or sugars to make a final product. </p>
<p>Drug supply monitoring has shown that fentanyl concentration in these powders sold on the street can range from zero to nearly 100 per cent, with a standard sample in B.C. being <a href="https://drugcheckingbc.ca/wp-content/uploads/sites/2/2023/01/Drug_Checking_BC_Nov_20224.pdf">around 10–15 per cent</a>. </p>
<p><a href="https://doi.org/10.1093/aje/kwab129">Research conducted in Vancouver</a> has described how fentanyl concentration in these samples was somewhat consistent between 2018 and early 2020, with variability between samples even decreasing over that period. What that may speak to is producers of fentanyl reaching a sort of “sweet spot” that satisfies their customers. People who sell drugs have described how they <a href="https://doi.org/10.1016/j.drugpo.2020.102845">listen to feedback</a> from their regulars and adjust the product to meet their customers’ needs. </p>
<p>However, following the start of the COVID-19 pandemic, <a href="https://epiresearch.org/wp-content/uploads/2022/06/2022-Abstract-Book.pdf#page=77">variation in potency between fentanyl samples rose dramatically</a>, leading to further unpredictability. These changes to the fentanyl supply around the spring of 2020 coincided with rates of drug poisonings previously not seen in the province. </p>
<p>Under B.C.’s decriminalization framework, possession for personal use caps at 2.5 grams of substance. While 2.5 grams may be more than enough MDMA for a night out, it may not be enough heroin to last a single day for someone who has a high opioid tolerance. People who use drugs say that to abide by these limits, they will be forced to make <a href="https://vancouver.citynews.ca/2022/05/31/bc-decriminalization-drugs/">more frequent, smaller purchases.</a> With the drug supply as volatile and unpredictable as it is, every new purchase puts someone at risk. </p>
<h2>Legal limit may affect potency</h2>
<p>Since we know that the drug supply is dynamic, it raises a question: Will the imposed legal carry limit of 2.5 grams result in increased potency of fentanyl to fit within the new 2.5-gram threshold? </p>
<p>Increases in average potency of fentanyl has been <a href="https://www.inhsu.org/resource/fentanyl-concentration-in-drug-checking-samples-and-risk-of-drug-related-mortality-during-an-illicit-drug-toxicity-crisis-in-vancouver-canada-a-time-series-analysis/">shown to be linked to increased drug poisonings</a> in the same geographic area. If the unregulated fentanyl market adjusts to fit more active ingredient into a smaller package, there will be downstream effects on people lives. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cropped image of a person holding a hand-lettered sign reading 'Every death is a drug policy failure'" src="https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/508487/original/file-20230206-31-5cy44g.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An advocate holds a sign at a demonstration in Victoria in April 2022. Decriminalization alone may have little effect on drug deaths without changes to the addiction treatment system.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>The provincial and federal governments have <a href="https://www.theglobeandmail.com/canada/british-columbia/article-federal-minister-promises-data-on-impact-of-decriminalization/">committed to a data-driven approach</a> to decriminalization. Ongoing drug supply monitoring will help public health professionals characterize what changes occur to the unregulated drug supply as a result of the policy change. Yet the act of decriminalizing drugs for personal use does not have any direct effect on the cause of the ongoing poisoning crisis. </p>
<p>The <a href="https://news.gov.bc.ca/releases/2023PSSG0008-000109">consensus among experts</a> has consistently pointed to unpredictable drugs from an unregulated supply and the absence of a functioning addiction treatment system. For those who want to seek treatment, the lack of available space leaves people waiting, once again left to rely on the toxic drug supply. </p>
<p>If B.C. is serious about confronting the leading cause of unnatural death in the province, it is going to take far more than decriminalizing simple drug possession. People who use drugs require an alternative to the toxic unregulated supply to not be risking their lives every time they use drugs. </p>
<p>Increasing access to a safer supply of drugs through a <a href="https://theconversation.com/safer-supply-of-opioids-saves-lives-providing-alternatives-to-toxic-street-drugs-177925">variety of formats</a> and providing meaningful funding for accessible treatment options are some examples of ways the province can take immediate steps to make an impact. </p>
<p>In the meantime, <a href="https://bc.ctvnews.ca/illicit-drug-death-toll-surpasses-2-000-in-b-c-for-a-2nd-consecutive-year-1.6253605">six more people will die today</a> from a drug poisoning in B.C. And another six will die tomorrow. How many more days can this go on?</p><img src="https://counter.theconversation.com/content/199239/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samuel Tobias does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>As British Columbia begins a new era in drug policy, the drug poisoning crisis continues without an end in sight.Samuel Tobias, PhD Student, School of Population and Public Health, University of British ColumbiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1975932023-01-16T19:45:25Z2023-01-16T19:45:25ZSupervised consumption sites reduce drug overdoses and disease transmission — and deserve government support<figure><img src="https://images.theconversation.com/files/504716/original/file-20230116-22-olk3l0.jpg?ixlib=rb-1.1.0&rect=66%2C41%2C5492%2C3192&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A wall at a supervised consumption site in Ottawa is decorated with notes written in chalk.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Adrian Wyld</span></span></figcaption></figure><p><a href="https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/">Since 2016, more than 32,000 Canadians have died from drug overdoses</a>. In response to this overdose epidemic, several provinces have established <a href="https://www.canada.ca/en/health-canada/services/substance-use/supervised-consumption-sites/explained.html">Supervised Consumption Sites (SCS)</a>, which provide people who use drugs with a safe space to administer drugs under the supervision of trained staff. </p>
<p>The term people who use drugs is used to affirm people’s humanity instead of defining them by their drug use. Person-centred language helps <a href="http://www.globalcommissionondrugs.org/wp-content/uploads/2018/01/GCDP-Report-2017_Perceptions-ENGLISH.pdf">reduce stigma and discrimination</a> which in turn can encourage people who use drugs to seek out harm reduction services. </p>
<p>SCSs have proven to <a href="https://harmreduction.org/issues/supervised-consumption-services/">reduce drug overdoses, disease transmission and public drug use</a>. By 2020, there were <a href="https://health-infobase.canada.ca/datalab/supervised-consumption-sites-blog.html?=undefined&wbdisable=true">39 supervised consumption sites across Canada</a>. Yet despite the evidence, some governments continue to oppose safe consumption on ideological grounds. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/504717/original/file-20230116-16-swbvcu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A man wearing a black jumper standing outside a building next to a large yellow bin labelled: needle drop box." src="https://images.theconversation.com/files/504717/original/file-20230116-16-swbvcu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504717/original/file-20230116-16-swbvcu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=364&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504717/original/file-20230116-16-swbvcu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=364&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504717/original/file-20230116-16-swbvcu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=364&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504717/original/file-20230116-16-swbvcu.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=457&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504717/original/file-20230116-16-swbvcu.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=457&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504717/original/file-20230116-16-swbvcu.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=457&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A man waits to enter the Safeworks supervised consumption site in Calgary.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Jeff McIntosh</span></span>
</figcaption>
</figure>
<p>Alberta is a prime example of how policy shifts away from public health approaches have tangible effects for the well-being of people who use drugs. <a href="https://doi.org/10.1016/j.drugpo.2022.103934">Our research</a> with marginalized drug users in Lethbridge, Alta. demonstrates that the closure of SCSs can increase drug-related harms and negatively impact the safety and welfare of people who use drugs.</p>
<h2>Lethbridge’s SCS</h2>
<p>Prior to the province approving a supervised consumption site in Lethbridge, the city had long contended with <a href="https://www.thestar.com/edmonton/2019/08/18/a-small-alberta-city-is-home-to-the-busiest-drug-consumption-site-in-north-america-we-spent-12-hours-inside.html">high numbers of drug overdoses</a>. Opened in 2018, Lethbridge’s site quickly became the <a href="https://www.thestar.com/edmonton/2019/08/18/a-small-alberta-city-is-home-to-the-busiest-drug-consumption-site-in-north-america-we-spent-12-hours-inside.html">busiest in North America</a>. This was in part because it offered a range of crucial social, mental and health service resources to marginalized community members.</p>
<p>But the site’s success was short-lived. The provincial government <a href="https://lethbridgenewsnow.com/2020/07/16/province-pulling-funding-from-lethbridges-scs/">defunded</a> and replaced it with an <a href="https://lethbridgenewsnow.com/2020/08/17/lethbridges-overdose-prevention-site-now-operating-as-replacement-for-scs/">Overdose Prevention Site (OPS)</a> just two years later. The OPS, while well intentioned, provides limited social, mental and health resources as compared to the SCS. </p>
<p>Moreover, while the former SCS was in the city’s downtown core, the new overdose prevention site was placed in an industrial area, about a 10-minute walk away from where many local people who use drugs spend time. Those interviewed as part of our research experienced this new location as less safe. </p>
<p>In Lethbridge, the SCS’s closure and replacement with an overdose prevention site meant reduced access to harm reduction services. In addition, the site’s closure stripped local people who use drugs of access to essential community connections and services.</p>
<p>Most people we spoke with felt overdoses and drug-related deaths had increased because of the SCS’s closure, with many having lost loved ones. As one of the participants told us: “There’s too many people dying now.” </p>
<p>Supporting participants’ views, <a href="https://healthanalytics.alberta.ca/SASVisualAnalytics/?reportUri=%2Freports%2Freports%2F1bbb695d-14b1-4346-b66e-d401a40f53e6&sectionIndex=0&sso_guest=true&reportViewOnly=true&reportContextBar=false&sas-welcome=false">provincial health data</a> demonstrates that the average number of deaths from drug poisoning doubled in Lethbridge following the site’s dismantling. </p>
<p>If the goal is to extend harm reduction services to as many people as possible, it is imperative to illuminate what prevents some people who use drugs from routinely accessing the OPS. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/504703/original/file-20230116-20-89gt6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Syringes in plastic wrapping." src="https://images.theconversation.com/files/504703/original/file-20230116-20-89gt6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/504703/original/file-20230116-20-89gt6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=404&fit=crop&dpr=1 600w, https://images.theconversation.com/files/504703/original/file-20230116-20-89gt6t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=404&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/504703/original/file-20230116-20-89gt6t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=404&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/504703/original/file-20230116-20-89gt6t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=507&fit=crop&dpr=1 754w, https://images.theconversation.com/files/504703/original/file-20230116-20-89gt6t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=507&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/504703/original/file-20230116-20-89gt6t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=507&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">SCSs provide a safe space to consume drugs. They also offer a range of crucial social, mental and health service resources to marginalized community members.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span>
</figcaption>
</figure>
<h2>How policy change can affect people who use drugs</h2>
<p>In spring 2022, we spent time in downtown Lethbridge, getting to know those who identified as people who use drugs and expressed interest in talking to us. We interviewed 50 houseless people, asking them about their experiences of street life in Lethbridge, whether or not they access the new OPS and why. </p>
<p>Our research provides early evidence that recent provincial policy shifts have negatively impacted people who use drugs in Lethbridge. The majority of those we spoke with who routinely accessed the SCS prior to its closure chose <em>not</em> to access the new OPS. </p>
<p>Participants listed several barriers to accessing the overdose prevention site.</p>
<p>First, the new site does not have a supervised smoking room. This means that those who smoke illicit substances, or who want to replace safe injection with safe smoking, cannot do so in the facility. This is further concerning because, while smoking drugs carries a number of risks, <a href="https://doi.org/10.1016/j.drugalcdep.2021.109003">smoking instead of injecting drugs can decrease skin infections and exposure to blood-borne viruses</a>.</p>
<p>Second, many participants stated that they were fearful of accessing the OPS and spending time in the area. To get from the downtown core to the OPS, they must cross a high-traffic bridge where participants stated people driving by sometimes harass or assault them. There have also been <a href="https://lethbridgeherald.com/news/lethbridge-news/2022/08/04/alpha-house-installs-fencing-at-shelter/">reported concerns over conflict and violence</a> in the vicinity of the overdose prevention site. Accordingly, some people who use drugs often avoided the OPS, opting to consume in “safer,” usually public, areas. </p>
<p>Finally, people who use drugs reported that they often frequented the old SCS because it offered them with wraparound services, social connections and activities beyond supervised consumption. But the OPS lacks these diverse and critical benefits. Because of this, participants felt the OPS was not as responsive to their broader needs. </p>
<p>Undeniably, Lethbridge’s overdose prevention site is providing important health benefits. However, our findings suggest that harm reduction sites that provide marginalized community members with broad community services and connections are more likely to draw local people who use drugs in, encourage uptake and reduce drug-related harms. </p>
<p>Given Lethbridge’s continued challenges with drug-related harms and deaths, it is essential to build safe, accessible and comprehensive harm reduction resources that provide critical care to the city’s most marginalized.</p><img src="https://counter.theconversation.com/content/197593/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carolyn Greene receives funding from the Social Sciences and Humanities Research Council. </span></em></p><p class="fine-print"><em><span>Katharina Maier receives funding from the Social Sciences and Humanities Research Council. </span></em></p><p class="fine-print"><em><span>Marta-Marika Urbanik receives funding from the Social Sciences and Humanities Research Council and Killam Trusts. </span></em></p>Supervised consumption sites provide essential community connections and services for those who use them. By closing them, governments are risking the welfare of people who use drugs.Carolyn Greene, Associate Professor, Criminology, Athabasca UniversityKatharina Maier, Assistant Professor, Criminal Justice, University of WinnipegMarta-Marika Urbanik, Assistant Professor, University of AlbertaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1914062022-10-11T17:02:43Z2022-10-11T17:02:43ZDrug overdoses in public bathrooms are common: new tools could prevent harm and improve response<figure><img src="https://images.theconversation.com/files/488340/original/file-20221005-19-y6wjjn.jpeg?ixlib=rb-1.1.0&rect=38%2C230%2C4272%2C2551&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Bathrooms are common settings for overdose but can be made safer.</span> <span class="attribution"><a class="source" href="https://www.envirotechygieneservices.co.uk/healthcare-waste/">(Envirotec)</a></span></figcaption></figure><p>The drug poisoning crisis in Canada is at its worst in British Columbia, with over <a href="https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf">10,000 lives lost</a> since 2016. A key setting for overdoses in B.C. is bathrooms, though <a href="https://www.straight.com/news/1287391/more-overdoses-are-happening-public-washrooms-and-vancouver-wants-businesses-know-they">this information has not always been readily available</a>. </p>
<p>Every month in B.C., <a href="http://www.saferbathrooms.ca/">more than 50 overdoses happen in bathrooms</a>. This statistic is based on 911 calls where overdose was specifically documented to have occurred in bathrooms. As such, it is likely an undercount of all drug poisonings that take place in bathrooms across the province. </p>
<p>More must be done to prevent and improve how we respond to overdoses in these settings.</p>
<p>There are <a href="https://doi.org/10.1080/08897077.2019.1640834">many reasons for substance use and overdose in bathrooms</a>. </p>
<p>Bathrooms can be private, seemingly safe spaces for people to use substances, especially when they are <a href="https://ohrn.org/resources/safer-washroom-evaluation-healthy-sexuality-harm-reduction-wrha/">unable to access supervised consumption or overdose prevention sites</a>. Even when these services are available, some people will continue to use substances in bathrooms. This is often due to <a href="https://doi.org/10.1186/1477-7517-10-22">stigma as well safety and privacy concerns</a>, including the fear of others knowing about one’s substance use.</p>
<p>There can be <a href="https://doi.org/10.1080/08897077.2019.1640834">serious risks</a> to using substances in bathrooms. Chief among these is the risk of overdosing alone and not receiving lifesaving help in time. Fortunately, there are many ways to make bathrooms safer for people who use substances. </p>
<h2>The Safer Bathroom toolkit</h2>
<p>Our <a href="https://healthresearchbc.ca/award/the-safer-washroom-campaign-disseminating-best-practices-in-the-public-and-private-sectors/">team of substance use and harm reduction researchers</a> has spent the last year identifying best practices and developing a range of tools that people and organizations can use to make bathrooms safer. </p>
<p>Together, we launched a <a href="https://paninbc.ca/2021/11/15/creating-a-safer-washroom-campaign-stakeholder-consultation/">provincewide consultation</a> to ask community members, service providers, city staff and other stakeholders about overdose in bathrooms. </p>
<p>Almost half (44 per cent) of the 237 people surveyed felt their organizations’ bathrooms were not safe for people who use substances, and many others (27 per cent) weren’t sure. They shared common barriers to bathroom safety and highlighted resources they needed to better prevent and respond to overdose in these settings. </p>
<p>We developed the <a href="http://www.saferbathrooms.ca/">Safer Bathroom toolkit</a> based on this consultation. The toolkit provides practical resources related to overdose and bathroom safety, all of which can be adapted to suit individual and organizational needs. </p>
<figure class="align-center ">
<img alt="The architectural blueprints for a single-stall bathroom, overlayed with various design features to promote bathroom safety." src="https://images.theconversation.com/files/487938/original/file-20221004-22-2sr87s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487938/original/file-20221004-22-2sr87s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=359&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487938/original/file-20221004-22-2sr87s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=359&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487938/original/file-20221004-22-2sr87s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=359&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487938/original/file-20221004-22-2sr87s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=452&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487938/original/file-20221004-22-2sr87s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=452&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487938/original/file-20221004-22-2sr87s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=452&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Safer Bathroom toolkit includes an architectural design fact sheet, which identifies safety and overdose prevention features to consider when building or modifying bathrooms.</span>
<span class="attribution"><span class="source">(Hannah Leyland, Intern Architect)</span></span>
</figcaption>
</figure>
<p>These tools include a checklist for evaluating and improving bathroom safety, a guide to inform policy and protocol development, mock overdose scenarios to help with training and support, and examples of signs that convey non-judgmental information to bathroom users. We also created a bathroom design and remodelling fact sheet, working in close collaboration with architects who specialize in harm reduction. </p>
<p>Some of the best practices we share in the toolkit are for organizations to have policies and protocols in place about when and how often to do bathroom safety checks, for staff to complete a monthly mock overdose response exercise, and for bathrooms to be designed in such a way that people can easily and safely respond to overdoses, if they occur. </p>
<p>Incorporating these practices while raising awareness about overdose is one way that communities can come together to save lives.</p>
<h2>Is bathroom safety really the answer?</h2>
<figure class="align-right ">
<img alt="Public restroom lit with uv blue light" src="https://images.theconversation.com/files/489210/original/file-20221011-20-d3o1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/489210/original/file-20221011-20-d3o1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489210/original/file-20221011-20-d3o1p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489210/original/file-20221011-20-d3o1p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489210/original/file-20221011-20-d3o1p.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489210/original/file-20221011-20-d3o1p.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489210/original/file-20221011-20-d3o1p.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Neon-blue lights in bathrooms are used to deter injection drug use by making it more difficult for people to see their veins.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>Existing public health measures are <a href="https://doi.org/10.3389/fcomm.2022.781564">not doing enough</a> to respond to the drug poisoning crisis. What we urgently need is a safer, regulated and accessible <a href="https://doi.org/10.1503%2Fcmaj.201618">drug supply</a>, an <a href="https://www2.gov.bc.ca/gov/content/governments/about-the-bc-government/mental-health-and-addictions-strategy">improved system</a> of voluntary substance use treatment and care and scaled up harm reduction services. As we continue the work of filling gaps in access to these essential supports, making bathrooms safer should be a priority. </p>
<p>This is important because designated, supervised spaces for safer substance use are <a href="https://www.uvic.ca/research/centres/cisur/assets/docs/bulletin-15-every-washroom-overdose-emergency.pdf">scarcely available</a> in many regions in B.C. and across Canada. When these aren’t accessible, public and private bathrooms in our communities can function as <a href="https://www.straight.com/news/1287391/more-overdoses-are-happening-public-washrooms-and-vancouver-wants-businesses-know-they">“de facto” drug consumption sites</a>.</p>
<p>What we must not do is try to prevent or deter access to bathrooms for people who use substances. Some may try measures like installing <a href="https://www.saanichnews.com/news/blue-lit-public-bathrooms-dont-deter-drug-use-says-provincial-authority/">neon-blue lights</a> that make it more difficult to see veins. However, doing so is <a href="https://doi.org/10.1186/1477-7517-10-22">ineffective at preventing substance use in bathrooms</a> and actually <a href="https://doi.org/10.1016/j.healthplace.2010.01.007">increases risks</a>.</p>
<p>From our perspective, making bathrooms safer is part of the solution and one that benefits all bathrooms users. Our hope is that the <a href="http://www.saferbathrooms.ca/">Safer Bathroom toolkit</a> will offer concrete tools to achieve this. </p>
<h2>Access to (safer) bathrooms is a human rights issue</h2>
<figure class="align-center ">
<img alt="A sign, titled 'Crab Park Improvements,' shows an image of and describes a public bathroom that will be piloted in the area." src="https://images.theconversation.com/files/487942/original/file-20221004-467-nuf9ct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/487942/original/file-20221004-467-nuf9ct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/487942/original/file-20221004-467-nuf9ct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/487942/original/file-20221004-467-nuf9ct.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/487942/original/file-20221004-467-nuf9ct.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/487942/original/file-20221004-467-nuf9ct.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/487942/original/file-20221004-467-nuf9ct.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Vancouver Park Board pilots new public bathrooms in CRAB Park, in the heart of Vancouver’s Downtown Eastside neighbourhood.</span>
<span class="attribution"><span class="source">Shannon Riley</span></span>
</figcaption>
</figure>
<p>The COVID-19 pandemic and safety measures have <a href="https://www.cbc.ca/news/canada/british-columbia/where-to-go-what-happens-when-nature-calls-during-a-pandemic-1.5610802">renewed calls</a> for more public bathrooms, especially as people are spending more time outdoors. This is even more so in B.C. and other areas that are hard hit by <a href="https://www.sfchronicle.com/opinion/editorials/article/Editorial-San-Francisco-is-fighting-over-toilets-16234160.php">housing</a> and <a href="https://public.wmo.int/en/media/news/world-toilet-day-sustainable-sanitation-and-climate-change">climate crises</a>. For many people, especially our communities’ most vulnerable, <a href="https://www.cbc.ca/news/canada/british-columbia/about-here-public-bathrooms-1.6404578">finding a bathroom to use can be a very difficult task</a>. </p>
<p>In our view, the safer bathroom conversation ties into the broader conversation about <a href="https://www.hrw.org/report/2017/04/19/going-toilet-when-you-want/sanitation-human-right">access to bathrooms being a human right</a>. As our communities strive to <a href="https://www.macleans.ca/sponsored/future-of-public-washrooms/">improve bathroom access</a>, we must invest in making these spaces safe and accessible for all, including people who use substances.</p><img src="https://counter.theconversation.com/content/191406/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This work is funded by a Reach Award from Michael Smith Health Research BC. Trevor Goodyear receives trainee support through the University of British Columbia and the Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Marilou Gagnon receives funding from Michael Smith Health Research BC, Canadian Institutes of Health Research, and Social Sciences and Humanities Research Council of Canada. </span></em></p>More than 50 overdoses happen in bathrooms every month in British Columbia. Public bathrooms can be made safer for everyone, including people who use substances.Trevor Goodyear, PhD Candidate, School of Nursing, University of British ColumbiaMarilou Gagnon, Professor, School of Nursing, Faculty of Human and Social Development, University of VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1902342022-09-23T01:34:20Z2022-09-23T01:34:20ZShould I give my teen alcohol? Just a sip, the whole can, or none at all?<figure><img src="https://images.theconversation.com/files/484784/original/file-20220915-7253-tne7uf.jpg?ixlib=rb-1.1.0&rect=0%2C2%2C1916%2C1074&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.pexels.com/photo/group-of-friends-clinking-beer-bottles-7148673/">Kindel Media/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>You’re at a barbecue and the adults are enjoying a few drinks. Everyone is relaxed and having a great time. One of your friends has just given their teen a beer. Next thing you know, your 15-year-old is asking for one too.</p>
<p>You don’t really want them drinking alcohol yet, but they’ll probably try it sooner or later. You’d rather they get it from you than somewhere else. But you’re also worried about what trying alcohol now might lead to in the future.</p>
<p>What do you do? </p>
<p>The results of <a href="https://doi.org/10.1016/j.drugalcdep.2022.109533">our study</a> show that not offering your teen alcohol is best. But if you do, a sip is less risky down the track than giving your teen a whole bottle or can.</p>
<h2>Parents play a key role</h2>
<p><a href="https://doi.org/10.1093/eurpub/ckaa193">Fewer teens are drinking alcohol</a> than in previous generations. Nevertheless, alcohol is still one of the <a href="https://doi.org/10.1016/s0140-6736(16)00648-6">biggest contributors</a> to death and illness in young people, including via injuries, accidents and suicide.</p>
<p>Parents play a key role in providing teens with the tools to make healthy life choices. They’re also one of the main sources of alcohol for teenagers. </p>
<p>In fact, many parents give their teens alcohol thinking it’s the <a href="https://doi.org/10.1186/1471-2458-12-491">safest way</a> to introduce it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-are-young-people-drinking-less-than-their-parents-generation-did-172225">Why are young people drinking less than their parents’ generation did?</a>
</strong>
</em>
</p>
<hr>
<h2>No alcohol is best. But is that realistic?</h2>
<p>We set out to understand common patterns of alcohol supply from parents and peers, and whether some patterns increased the chance of binge drinking, alcohol-related harms, and problem drinking as young adults. </p>
<p>So we <a href="https://ndarc.med.unsw.edu.au/project/can-parents-teach-their-children-drink-alcohol-responsibly-or-one-drop-drop-too-many">surveyed</a> the same group of young Australians every year from when they were 13 to 19 years old.</p>
<p>We <a href="https://doi.org/10.1016/j.drugalcdep.2022.109533">found</a> not providing adolescents any alcohol is the least-risky option in terms of preventing later binge drinking, alcohol-related harms (for example, accidents, blackouts, fights) and problem drinking. </p>
<p>Young people who were not supplied alcohol, or only supplied minimal amounts under the age of 18, had the lowest risk of binge drinking, experiencing alcohol-related harms, and reporting symptoms of alcohol abuse, dependence and alcohol use disorder in early adulthood. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/485043/original/file-20220916-18-q3bp3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Three teenagers (two female, one male) standing chatting" src="https://images.theconversation.com/files/485043/original/file-20220916-18-q3bp3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/485043/original/file-20220916-18-q3bp3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/485043/original/file-20220916-18-q3bp3k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/485043/original/file-20220916-18-q3bp3k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/485043/original/file-20220916-18-q3bp3k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/485043/original/file-20220916-18-q3bp3k.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/485043/original/file-20220916-18-q3bp3k.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Adolescence can be a time of experimentation.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/-Xv7k95vOFA">Alexis Brown/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>This aligns with <a href="https://doi.org/10.15288/jsad.2014.75.590">previous research</a> that not allowing any alcohol before the age of 18 is the best way to reduce the chance adolescents will <a href="https://doi.org/10.1111/acer.13525">binge drink</a> and develop <a href="https://doi.org/10.1111/add.16036">physical, psychological, or social problems</a> due to alcohol. It also aligns with
the current <a href="https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol">Australian alcohol guidelines</a>.</p>
<p>However, this is sometimes unrealistic as adolescence can be a time of experimentation. Parents can also feel <a href="https://doi.org/10.1186/1471-2458-12-491">pressure</a> to supply alcohol to their teen if other parents they know are doing so.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/a-parents-guide-to-why-teens-make-bad-decisions-88246">A parent's guide to why teens make bad decisions</a>
</strong>
</em>
</p>
<hr>
<h2>What other options are there?</h2>
<p>We found young people who received whole drinks from their parents earlier in adolescence (aged 14-16) and/or were mainly supplied by their peers drank more heavily during adolescence. They were also much more likely to binge drink, report symptoms of problem drinking and experience alcohol-related harms in early adulthood.</p>
<p><a href="https://doi.org/10.1111/add.15005">Earlier parental supply</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/20649775/">supply from peers</a> have previously been linked with greater alcohol consumption and alcohol-related problems (with the risk increasing for each year earlier supply occurs). Earlier escalation of heavy drinking comes with an increased risk of a range of <a href="https://doi.org/10.1080/10826084.2018.1517172">negative outcomes</a>, including those related to physical and mental health, school or work, and social problems.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/484979/original/file-20220915-47124-hyzs32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Table of food and alcohol, outside" src="https://images.theconversation.com/files/484979/original/file-20220915-47124-hyzs32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/484979/original/file-20220915-47124-hyzs32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/484979/original/file-20220915-47124-hyzs32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/484979/original/file-20220915-47124-hyzs32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/484979/original/file-20220915-47124-hyzs32.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/484979/original/file-20220915-47124-hyzs32.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/484979/original/file-20220915-47124-hyzs32.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">OK then. Just a sip.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/y1XXWct5rBo">Lee Myungseong/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Sitting in the middle of the risk continuum were young people who received sips only from their parents in early to mid-adolescence (14-16 years), and were then supplied whole drinks from around age 17 by their parents, and to a lesser extent, their peers. </p>
<p>These young people were more likely to binge drink or experience alcohol-related harms compared to those not supplied alcohol at all. But they were less likely than teens who received whole drinks during early-mid adolescence and/or who were mostly supplied by peers.</p>
<p>Regardless of the intent, <a href="https://doi.org/10.1016/j.addbeh.2017.07.030">any supply</a> may normalise and signify approval or permissiveness of alcohol use to adolescents. </p>
<p>While it is safest to not supply alcohol in adolescence, if parents do, providing sips only in early to mid-adolescence, and delaying supply of whole drinks for as long as possible is likely to result in less harm than earlier supply of whole drinks, or allowing supply from peers.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/three-ways-to-help-your-teenage-kids-develop-a-healthier-relationship-with-alcohol-80892">Three ways to help your teenage kids develop a healthier relationship with alcohol</a>
</strong>
</em>
</p>
<hr>
<h2>Tips for parents</h2>
<p>Here are some tips for parents of teens to help their child make healthy life choices about alcohol:</p>
<ul>
<li><p>ideally, <a href="https://www.nhmrc.gov.au/about-us/publications/australian-guidelines-reduce-health-risks-drinking-alcohol#block-views-block-file-attachments-content-block-1">do not supply</a> alcohol to anyone under 18; waiting as long as possible to start drinking alcohol is safer</p></li>
<li><p>if you are providing sips, do so <a href="https://adf.org.au/talking-about-drugs/parenting/preventing-aod-uptake/evidence-interventions/family-domain/">under supervision</a>, for example, at home </p></li>
<li><p>know who your teen’s friends are; if they go out make sure you know where they will be and who they will be with; if they will be home late, they should check in with a parent or caregiver. This monitoring reduces the chance of your teen being in an unsafe environment and their friends supplying them with alcohol</p></li>
<li><p>establish some <a href="https://parents.au.reachout.com/common-concerns/everyday-issues/things-to-try-alcohol/set-expectations-with-your-teenager-about-alcohol">alcohol-specific rules</a> (for instance, no alcohol from friends, only allowed to drink if a parent or caregiver is there to supervise)</p></li>
<li><p>limit access to alcohol at home (for instance, keep alcohol in locked cupboards, don’t keep too many drinks in the fridge)</p></li>
<li><p><a href="https://parents.au.reachout.com/common-concerns/everyday-issues/things-to-try-alcohol/make-healthy-choices-about-alcohol">model positive alcohol behaviours</a> (for instance, eating before and while drinking, and sticking to the <a href="https://www.health.gov.au/news/australian-alcohol-guidelines-revised">recommended number</a> of drinks per day or week)</p></li>
<li><p>understand the alcohol <a href="https://adf.org.au/insights/understanding-secondary-supply/">secondary supply laws</a> in your state or territory. These relate to the laws about supplying alcohol for people under 18.</p></li>
</ul>
<hr>
<p><em>If you’re worried about your own or someone else’s use of alcohol or other drugs call the National Alcohol and other Drug Hotline on 1800 250 015, free from anywhere in Australia.</em></p>
<p><em>Evidence-based online resources and services for parents and teenagers include: <a href="https://positivechoices.org.au/parents/should-i-give-my-teenager-alcohol">Positive Choices</a>, <a href="https://parents.au.reachout.com/common-concerns/everyday-issues/alcohol-and-teenagers">ReachOut</a>, <a href="https://adf.org.au/talking-about-drugs/parenting/talking-young-people/">Alcohol and Drug Foundation</a>, <a href="https://kidshelpline.com.au/">Kids Helpline</a> and <a href="https://www.lifeline.org.au/get-help/information-and-support/substance-misuse-and-addiction/">Lifeline</a>.</em></p>
<hr><img src="https://counter.theconversation.com/content/190234/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alexandra Aiken is an Adjunct Associate Lecturer at the National Drug and Alcohol Research Centre. The Australian Parental Supply of Alcohol Longitudinal Study (APSALS) was funded by a 2010–2014 Australian Research Council Discovery Project Grant (DP:1096668), two Australian Rotary Health Mental Health Research Grants, a Research Innovation Grant from the Australian Foundation for Alcohol Research and Education, a 2018-2022 National Health and Medical Research Council project grant (APP1146634), and the National Drug and Alcohol Research Centre, University of New South Wales Sydney,
Australia, which is supported by funding from the Australian Government under the Drug and Alcohol Program.</span></em></p><p class="fine-print"><em><span>Amy Peacock receives funding from the Australian Government Department of Health and Aged Care, the National Health and Medical Research Council, the National Centre for Clinical Research on Emerging Drugs, and ACT Health. She has previously received untied educational funding from Mundipharma and Seqirus for post-marketing surveillance of pharmaceutical opioids; these organisations had no involvement in study design, conduct and reporting, and funding was for work unrelated to that presented here. </span></em></p><p class="fine-print"><em><span>Philip Clare receives funding from the Medical Research Future Fund, and previously received funding from the Australian Government under the Research Training Program. These organisations had no role in the conduct of any studies, and funding was not directly for work presented here.</span></em></p><p class="fine-print"><em><span>Wing See Yuen received funding from the Australian Government under the Research Training Program and the National Drug and Alcohol Research Centre. She works for the National Drug and Alcohol Research Centre at UNSW Sydney. </span></em></p>Should teens drink alcohol? Ideally, no. But in the real world, here are some tips on how to minimise harm.Alexandra Aiken, Adjunct Associate Lecturer, UNSW SydneyAmy Peacock, Senior Research Fellow, UNSW SydneyPhilip Clare, Biostatistician, University of SydneyWing See Yuen, Research fellow, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1861012022-07-19T19:53:24Z2022-07-19T19:53:24ZPush for AI innovation can create dangerous products<figure><img src="https://images.theconversation.com/files/473750/original/file-20220713-16-cnt9m4.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7488%2C4064&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Companies develop AI to gain an advantage over their competition, but this results in flawed products entering the market.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/push-for-ai-innovation-can-create-dangerous-products" width="100%" height="400"></iframe>
<p>This past June, the U.S. National Highway Traffic Safety Administration announced a <a href="https://fortune.com/2022/06/10/elon-musk-tesla-nhtsa-investigation-traffic-safety-autonomous-fsd-fatal-probe/">probe into Tesla’s</a> autopilot software. Data gathered from 16 crashes raised concerns over the possibility that Tesla’s AI may be programmed to quit when a crash is imminent. This way, the car’s driver, not the manufacturer, would be legally liable at the moment of impact.</p>
<p>It echoes the revelation that Uber’s self-driving car, which hit and killed a woman, detected her six seconds before impact. But the <a href="https://www.wired.com/story/ubers-self-driving-car-didnt-know-pedestrians-could-jaywalk/">AI was not programmed</a> to recognize pedestrians outside of designated crosswalks. Why? Because jaywalkers are not legally there.</p>
<p>Some believe these stories are proof that our concept of liability needs to change. To them, unimpeded continuous innovation and widespread adoption of AI is what our society needs most, which means protecting innovative corporations from lawsuits. But what if, in fact, it’s our <a href="https://utorontopress.com/9781487508425/connected-capitalism/">understanding of competition</a> that needs to evolve instead? </p>
<p>If AI is central to our future, we need to pay careful attention to the assumptions around harms and benefits programmed into these products. As it stands, there is a perverse incentive to design AI that is artificially innocent. </p>
<p>A better approach would involve a more extensive harm-reduction strategy. Maybe we should be encouraging industry-wide collaboration on certain classes of life-saving algorithms, designing them for optimal performance rather than proprietary advantage.</p>
<h2>Every fix creates a new problem</h2>
<p>Some of the loudest and most powerful corporate voices want us to trust machines to solve complex societal problems. AI is hailed as a potential solution for the problems of cross-cultural <a href="https://www.fastcompany.com/90753311/google-is-working-on-language-to-text-ar-glasses-its-a-complicated-idea">communication</a>, <a href="https://www2.deloitte.com/us/en/insights/industry/health-care/ai-led-transformations-in-health-care.html">health care</a> and even <a href="https://www.bloomberg.com/news/articles/2022-06-30/new-algorithm-can-predict-crime-in-us-cities-a-week-before-it-happens">crime</a> and social unrest. </p>
<p>Corporations want us to forget that AI innovations reflect the biases of the programmer. There is a false belief that as long as the product design pitch passes through internal legal and policy constraints, the resulting technology is unlikely to be harmful. But harms emerge in all sorts of unexpected ways, as Uber’s design team learned when their vehicle encountered a jaywalker for the first time.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/googles-algorithms-discriminate-against-women-and-people-of-colour-112516">Google's algorithms discriminate against women and people of colour</a>
</strong>
</em>
</p>
<hr>
<p>What happens when the nefarious implications of an AI are not immediately recognized? Or when it is too difficult to take the AI offline when necessary? Which is what happened when Boeing hesitated to <a href="https://www.geekwire.com/2022/downfall-documentary-casts-the-tale-of-boeings-737-max-debacle-as-a-tech-tragedy/">ground the 737 Max jets</a> after a programming glitch was found to cause crashes — and 346 people died as a result.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/09nrrEAScec?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">In 2019, Boeing admitted that its software was the cause of two deadly crashes.</span></figcaption>
</figure>
<p>We must constantly reframe technological discussions in moral terms. The work of technology demands discrete, explicit instructions. Wherever there is no specific moral consensus, individuals simply doing their job will make a call, often without taking the time to consider the full consequences of their actions.</p>
<h2>Moving beyond liability</h2>
<p>At most tech companies, a proposal for a product would be reviewed by an in-house legal team. It would draw attention to the policies the design folks need to consider in their programming. These policies might relate to what data is consumed, where the data comes from, what data is stored or how it is used (for example anonymized, aggregated or filtered). The legal team’s primary concern would be liability, not ethics or social perceptions.</p>
<p>Research has called for taking an approach that considers <a href="https://hbr.org/2021/07/to-spur-growth-in-ai-we-need-a-new-approach-to-legal-liability">insurance and indemnity (responsibility for loss compensation)</a> to shift liability and allow stakeholders to negotiate directly with each other. They also propose moving disputes over algorithms to specialized tribunals. But we need bolder thinking to address these challenges.</p>
<p>Instead of liability, a focus on harm reduction would be more helpful. Unfortunately, our current system doesn’t allow companies to easily co-operate or share knowledge, especially when anti-trust concerns might be raised. This has to change.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/473751/original/file-20220713-26-prkevj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="steering wheel and display screen in the interior of a vehicle" src="https://images.theconversation.com/files/473751/original/file-20220713-26-prkevj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/473751/original/file-20220713-26-prkevj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/473751/original/file-20220713-26-prkevj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/473751/original/file-20220713-26-prkevj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/473751/original/file-20220713-26-prkevj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/473751/original/file-20220713-26-prkevj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/473751/original/file-20220713-26-prkevj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An investigation by the National Highway Traffic Safety Administration found that Tesla’s autopilot function turned off in advance of an imminent collision.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<h2>Re-thinking the limits of competition</h2>
<p>These problems demand large-scale, industry-wide efforts. The misguided pressures of competition pushed Tesla, Uber and Boeing to release their AI too soon. They were overly concerned with the costs of legal liability and lagging behind competitors. </p>
<p>My research proposes the somewhat counter-intuitive idea that the ethical positions a corporation takes should be a source of competitive parity in its industry, not a competitive advantage. In other words, a company should not stand out for finding ethical ways to run its business. Ethical commitments should be the minimum expectation required of all who compete.</p>
<p>Companies should compete on variables like comfort, customer service or product life, not on whose autopilot algorithm is less likely to kill. We need an issues-based exemption to competition, one that is centred around a particular technological challenge, like autonomous driving software, and guided by a shared desire to reduce harm.</p>
<p>What would this look like in practice? The truth is that <a href="https://www.forrester.com/report/The-Benefits-Of-An-Open-Source-Strategy/RES159437?objectid=RES159437">more than 50 per cent of Fortune 500 companies already</a> use open-source software for mission-critical work. And their ability to compete has not been stifled by giving up on proprietary algorithms.</p>
<p>Imagine if the motivation to reduce harm became a core target function of technology leaders. It would end the incentive individual firms currently have to design AI that is artificially innocent. It would shift their strategic priorities away from always preventing imitation and towards encouraging competitors to reduce harm in similar ways. And it would grow the pie for everyone, as customers and governments would be more trusting of technology-driven revolutions if innovators were seen as putting harm reduction first.</p><img src="https://counter.theconversation.com/content/186101/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Weitzner receives funding from SSHRC. </span></em></p>Competition between corporations drives innovation and development. But when it comes to artificial intelligence systems, the prevention of harm should be more important.David Weitzner, Assistant professor, Administrative Studies, York University, CanadaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1849262022-06-19T12:50:48Z2022-06-19T12:50:48ZDecriminalizing hard drugs in B.C. follows decades of public health advocacy<figure><img src="https://images.theconversation.com/files/469560/original/file-20220617-14205-7slb7v.JPG?ixlib=rb-1.1.0&rect=0%2C467%2C5439%2C3853&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">B.C. Minister of Mental Health and Addictions Sheila Malcolmson holds a copy of exemption documents that enable British Columbia to decriminalize possession of small amounts of 'hard' drugs for personal use. B.C.’s bold experiment will be closely watched as a comparator with other progressive jurisdictions.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><iframe style="width: 100%; height: 100px; border: none; position: relative; z-index: 1;" allowtransparency="" allow="clipboard-read; clipboard-write" src="https://narrations.ad-auris.com/widget/the-conversation-canada/decriminalizing-hard-drugs-in-b-c--follows-decades-of-public-health-advocacy" width="100%" height="400"></iframe>
<p><a href="https://globalnews.ca/news/8882290/bc-overdose-crisis-decriminalize-possession/?utm_source=NewsletterNational&utm_medium=Email&utm_campaign=2022">British Columbia has become</a> the first province to be granted an exemption under the <a href="https://laws-lois.justice.gc.ca/eng/acts/c-38.8/">Controlled Drugs and Substances Act</a> to remove criminal penalties for possession of opioids, cocaine, methamphetamine and MDMA for personal use. </p>
<p>This means that police will no longer arrest, charge or seize drugs from adults found with 2.5 grams or less of these substances. Instead, people with drugs will be offered information on available health and social services and assistance with referrals to access treatment if they choose.</p>
<p>B.C.’s bold experiment to decriminalize “hard” drugs will be closely watched as a comparator with other progressive jurisdictions, such as <a href="https://www.pbs.org/newshour/politics/oregon-1st-state-to-decriminalize-possession-of-hard-drugs">Oregon</a> and <a href="https://www.theguardian.com/news/2017/dec/05/portugals-radical-drugs-policy-is-working-why-hasnt-the-world-copied-it">Portugal</a>. Decriminalization in these places has been implemented differently, reflecting the distinctive circumstances and priorities that influence drug policy in different global contexts.</p>
<p>As a sociologist who has been studying drug policy development in Canada for nearly 30 years, it is plainly evident to me that decision-making is a political process that does not rest on facts alone. <a href="https://doi.org/10.1017/S0829320100006566">Drug policy</a> reflects <a href="https://doi.org/10.1080/0959523021000023270">ideological commitments</a> that are influenced by, and in turn influence, prevailing public understandings and opinions about drugs. <a href="https://doi.org/10.1080/09595230500404145">Exposure to the facts</a> — which are also contested — and <a href="https://doi.org/10.1016/S0955-3959(01)00085-8">constructive dialogue about social norms and values</a> is needed to facilitate more meaningful debate. </p>
<figure class="align-center ">
<img alt="Cropped image of a group of people, one of whom is holding a hand-lettered sign reading 'Every death is a drug policy failure'" src="https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469561/original/file-20220617-20-ftu74x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Advocates gather in Victoria to mark the anniversary of the declaration of a public health emergency in opioid-related overdoses in British Columbia on April 14.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>Decriminalizing drug use is the <a href="https://www.oupcanada.com/catalog/9780199007882.html">realization of 50 years of policy discussions</a> advocating for removal of all penalties for small amounts of drugs. The called-for public health perspective is just beginning to materialize, despite extensive evidence that <a href="https://cannabiscoalition.ca/info/HarmReductionHeadway_Resistance_IJDPX2008.pdf">the war on drugs has failed</a>. The research evidence instead supports the view that prohibition of substance use has been ineffective, costly, inhumane and harmful to the user and society.</p>
<h2>Why so little progress for so long?</h2>
<p>Canada has long pursued half-measures by adopting a hybrid model recognizing public health considerations within a legal framework that enforces prohibition. The <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1947221/pdf/canmedaj01573-0103.pdf">LeDain Commission of Inquiry</a> in 1972 proposed a gradual withdrawal from criminal penalties for illicit drug possession, phasing out incarceration in favour of medical treatment. </p>
<p>The LeDain report foreshadowed the emergence of drug policy with the goal of <a href="https://ontario.cmha.ca/harm-reduction/">harm reduction</a> and the need for more attention to the principles that underlie drug policy debates. What is meant by “harm” has been contentious when determining the proper role of law when the police and politicians define harm in ways that justify continued prohibition.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman at a podium in front of a row of flags, and two other women at opposite sides of stage, in front of background with the words 'A pathway to hope'" src="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469565/original/file-20220617-23-jl5q1d.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Minister of Mental Health and Addictions Sheila Malcolmson discusses details about the province’s application for decriminalization at the provincial legislature in Victoria on Nov. 1, 2021, as provincial health officer Dr. Bonnie Henry and chief coroner Lisa Lapointe look on.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Chad Hipolito</span></span>
</figcaption>
</figure>
<p>Ten years after the LeDain report, the enactment of the <a href="https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/">Charter of Rights and Freedoms</a> provided legal tools that complement more scientific evidence-based arguments for drug policy reform. The success of <a href="https://doi.org/10.1017/S0829320100006566">legal challenges on Charter grounds</a>, however, has been largely limited to striking down the most egregious policing practices and penalties for drug crimes.</p>
<p>Sweeping changes in the law might well have been expected with the launch of <a href="https://www.csc-scc.gc.ca/research/forum/e133/133a_e.pdf">Canada’s Drug Strategy</a> in 1987. The language change was monumental: it covered the full spectrum of non-medical drug use, including legal drugs like alcohol, prescription drugs and even solvents; and it signalled an intent to set out in a new direction that dramatically departed from the war-on-drugs approach. </p>
<p>The implementation of the strategy, however, was much less so. Police continued to command the lion’s share of funding, despite the promise of pursuing a “more balanced” and coherent public health approach to substance use. </p>
<p>Thirty-five years later, the situation has changed little. In 2018, after decades of debate, but little action indicating actual commitment to reform, <a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">cannabis was legalized in Canada</a>, transforming its users from pariahs to responsible consumers. Users of more dangerous drugs continue to be treated differently, primarily because such use elicits more concern for crime control than protecting health. </p>
<h2>Lessons from other jurisdictions</h2>
<p>In Oregon, the lack of full commitment to a public health approach explains the <a href="https://abcnews.go.com/Health/wireStory/oregon-decriminalized-drugs-2020-hows-83846382">“mixed results.”</a> U.S.-style decriminalization there has been adopted as a social justice remedy to mitigate the impact of policing on marginalized communities.</p>
<p>In 2020, Oregon voters approved a <a href="https://www.oregonlegislature.gov/lpro/Publications/Background-Brief-Measure-110-(2020).pdf">ballot measure to decriminalize hard drugs</a> as a way to keep addicts out of prison and get them into treatment. Possession of controlled substances is now a “violation” carrying a maximum US$100 fine. The fine is waived if the offender calls a hotline for assessment, which may lead to them receiving treatment. </p>
<p>However, after the first year, just one per cent had used the hotline, and nearly half did not show up to court, prompting criticism that the system is too lenient.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A black wall with colourful handprints and names on it" src="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/469563/original/file-20220617-19-1btqrg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some of the handprints of people recovering from drug addiction are seen on a wall in the parking lot of an addiction recovery centre in McMinnville, Ore., on Dec. 9, 2021.</span>
<span class="attribution"><span class="source">(AP Photo/Andrew Selsky)</span></span>
</figcaption>
</figure>
<p>Portugal’s adoption of decriminalization measures has been <a href="https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight">implemented more successfully</a>, in part because its social safety net is far more comprehensive and better integrated with the criminal justice system. </p>
<p>Portugal’s approach is both more vigorous and nuanced, recognizing that most drug use is “low risk” and requires no intervention. The vast majority of cases referred by the police are deemed non-problematic and the charges are suspended. Those who have a pattern of repeated violations may be issued fines or offered counselling appointments. Substance use dependence and abuse in high-risk cases more often triggers a referral for non-mandatory treatment. </p>
<p>Portugal’s adoption of a graduated system of intervention demonstrates a view that is consistent with coherent harm reduction policy development. Drug use is treated as a health issue. And the proof is in the pudding. Since these measures were enacted in 2001, drug-related deaths and rates of drug use have remained below the European Union average. The rates of HIV infection from injection drug use, and incarceration for committing drug offences, have also been dramatically reduced. </p>
<p>Canada’s adoption of a public health perspective on substance use is hampered by its failure to address the inconsistencies inherent in its hybridized approach. Enacting harm reduction within a prohibition framework perversely criminalizes people recognized as needing help.</p>
<p>B.C.’s bold experiment provides an opportunity to implement more balance in Canadian drug policy, and a more principled withdrawal from the war on drugs. Much can be learned from other places in deciding the path forward, and the world is waiting for new lessons to be learned.</p><img src="https://counter.theconversation.com/content/184926/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Hathaway does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>British Columbia’s bold experiment provides an opportunity to implement more balance in Canadian drug policy, and a more principled withdrawal from the war on drugs.Andrew Hathaway, Professor, Department of Sociology and Anthropology, University of GuelphLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1779252022-03-11T16:31:22Z2022-03-11T16:31:22ZSafer supply of opioids saves lives: Providing alternatives to toxic street drugs<figure><img src="https://images.theconversation.com/files/450317/original/file-20220307-109224-rux7pe.jpg?ixlib=rb-1.1.0&rect=710%2C486%2C5059%2C3288&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Methamphetamine, heroin and cocaine distributed by the Drug User Liberation Front, a grassroots organization proving a safe supply of illicit drugs, in Vancouver, in April 2021.
</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><p>Over 25,000 Canadians have died from opioid overdose since 2016 — with <a href="https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/">6,306 people dying in 2020</a> alone. </p>
<p>The overdose crisis is driven by an unregulated drug supply made up mostly of fentanyl, increasingly potent fentanyl analogues such as carfentanil, and more recently, <a href="https://theconversation.com/benzo-dope-may-be-replacing-fentanyl-dangerous-substance-turning-up-in-unregulated-opioids-164286">unregulated benzodiazepines</a>. Early in the COVID-19 pandemic, fentanyl directly contributed to <a href="https://odprn.ca/research/publications/opioid-related-deaths-and-healthcare-use/">89 per cent of all overdose deaths</a> in Ontario. </p>
<p>The volatility and toxicity in the unregulated drug supply continues to lead to more deaths. The British Columbia coroner’s report shows that <a href="https://news.gov.bc.ca/releases/2022PSSG0010-000188">more people died in 2021</a> from suspected illicit toxic drugs than ever before. In 2021, there was a 26 per cent increase in overdose deaths compared to 2020. </p>
<p>The Public Health Agency of Canada recently estimated that without new interventions, <a href="https://www.canada.ca/en/health-canada/services/opioids/data-surveillance-research/modelling-opioid-overdose-deaths-covid-19.html">another 8,000 overdose deaths will occur in 2022</a>. Addressing this devastating crisis requires bold action that includes expanding current evidence-based harm reduction and treatment services, alongside new interventions to prevent overdose deaths.</p>
<h2>Safer supply</h2>
<p><a href="https://www.canada.ca/en/health-canada/services/opioids/responding-canada-opioid-crisis/safer-supply.html">Safer supply</a>, the practice of providing a medical prescription for pharmaceutical drugs of known quality, is one of those new interventions. In Ontario, safer supply programs are run mostly by community health centres that specialize in providing care to our most marginalized community members. These small pilot programs are a low-barrier first step alternative to the toxic drug supply.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/451089/original/file-20220309-13-14opv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Orange signs with black block lettering instructions on how to pick up safe supply of illicit drugs." src="https://images.theconversation.com/files/451089/original/file-20220309-13-14opv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/451089/original/file-20220309-13-14opv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451089/original/file-20220309-13-14opv3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451089/original/file-20220309-13-14opv3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451089/original/file-20220309-13-14opv3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451089/original/file-20220309-13-14opv3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451089/original/file-20220309-13-14opv3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Safe supply programs are run mostly by community health centres.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>There are several <a href="https://www.canada.ca/en/health-canada/services/substance-use/canadian-drugs-substances-strategy/funding/substance-use-addictions-program.html">research studies funded across Canada</a> to evaluate different parts of these pilot safer supply programs. We are public health researchers involved in some of these studies, and initial results are promising.</p>
<p>At London’s Intercommunity Health Centre, close to 250 clients are prescribed pharmaceutical opioids as a daily-dispensed prescription that they take home and use at their discretion. <a href="https://lihc.on.ca/wp-content/uploads/2022/01/2021-SOS-Evaluation-Full.pdf">A recent evaluation of this program</a> reported decreased use of fentanyl and other street-acquired drugs, reduced hospitalizations and a dramatic decrease in overdoses among clients.</p>
<p>Importantly, clients reported that the program was saving their life and helped them to take steps to improve their health. </p>
<h2>Addiction treatment models</h2>
<p>Unfortunately, there has been <a href="https://www.theglobeandmail.com/opinion/article-as-a-doctor-i-was-taught-first-do-no-harm-thats-why-i-have-a-problem/">opposition to safer supply programs</a> from some in the addiction treatment community. Such opposition has the potential to undermine public support for people who use drugs and the expansion of lifesaving interventions that are urgently needed. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/451093/original/file-20220309-4153-5ecz10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A hand holding a small box labelled 'Ingredients: Cocaine. Please see insert. NOT FOR SALE. Keep away from children and pets.'" src="https://images.theconversation.com/files/451093/original/file-20220309-4153-5ecz10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451093/original/file-20220309-4153-5ecz10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451093/original/file-20220309-4153-5ecz10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451093/original/file-20220309-4153-5ecz10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451093/original/file-20220309-4153-5ecz10.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451093/original/file-20220309-4153-5ecz10.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451093/original/file-20220309-4153-5ecz10.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A client of the Drug User Liberation Front in Vancouver holds safe supply cocaine.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>Current interventions to respond to opioid use don’t work for everyone. Opioid agonist treatments (OAT) like methadone and buprenorphine, are intended to reduce cravings for opioids and manage withdrawal symptoms, but they do not produce euphoria or the high associated with other opioids. </p>
<p>There are issues with both access and retention in OAT. Fewer than <a href="https://doi.org/10.1111/add.14947">70 per cent</a> of people who are diagnosed with an opioid use disorder ever start OAT. And although retention rates vary, an Ontario study found that after one year, <a href="https://doi.org/10.1097/adm.0000000000000156">less than half</a> of people who do start are still using OAT. Although there isn’t a set rule for how long someone should stay on OAT, generally <a href="https://www.camh.ca/-/media/files/professionals/canadian-opioid-use-disorder-guideline2021-pdf.pdf">longer treatment is associated with better outcomes</a>.</p>
<p>Despite low retention rates, addiction medicine has been reluctant to address the barriers to care that people who use drugs have been <a href="https://doi.org/10.1016/j.drugpo.2021.103364">attempting to call attention to for years</a>. </p>
<p>People who use drugs have highlighted for a long time how restrictions around take-home doses reduce people’s ability to stay in methadone programs. And they are right — when restrictions on taking home doses of methadone were loosened during the COVID-19 pandemic to facilitate physical distancing, <a href="https://doi.org/10.1001/jama.2022.1271">retention to methadone improved</a> without increased negative outcomes like overdose. </p>
<h2>Listening to drug users</h2>
<p>To address the toxic drug poisonings that are killing Canadians at such an alarming rate, we need to start listening to people who use drugs when they tell us what’s not working with the current system. </p>
<p>The war on drugs has so demonized people who use drugs that they are mostly dismissed by addiction medicine experts when they have tried to say <a href="https://sway.office.com/UjvQx4ZNnXAYxhe7?ref=Link&loc=play">what will help their communities</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/451091/original/file-20220309-25-mrb6e2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People holding signs in support of safer drug supply marching in a street" src="https://images.theconversation.com/files/451091/original/file-20220309-25-mrb6e2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/451091/original/file-20220309-25-mrb6e2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451091/original/file-20220309-25-mrb6e2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451091/original/file-20220309-25-mrb6e2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451091/original/file-20220309-25-mrb6e2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451091/original/file-20220309-25-mrb6e2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451091/original/file-20220309-25-mrb6e2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">People march in the Downtown Eastside to call on the government to provide a safe supply of illicit drugs in April 2021.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>Groundbreaking grassroots work being done by organizations such as the <a href="https://www.dulf.ca/">Drug User Liberation Front</a> (DULF) in Vancouver has highlighted the demand for <a href="https://filtermag.org/compassion-clubs-vancouver/">a non-medicalized model for a safer supply</a> of drugs. </p>
<p>DULF has organized in its community to distribute tested drugs to keep people alive during a crisis; contrast this to prominent members of the addiction medicine community attempting to use their social power to <a href="https://filtermag.org/people-who-use-drugs-safer-supply/">deliberately undermine</a> their efforts. </p>
<p>Opposition to safer supply often misrepresents both the aim and benefits of safer supply. Safer supply is intended to keep people alive — and it works. </p>
<h2>Building new models</h2>
<p>We need new options. Both for people for whom current addiction treatment models have not worked and for those who simply don’t need or want treatment. </p>
<p>People are dying from using a toxic drug supply. Building models of care that listen to the voices of people who use drugs and centre their needs is critical and should not be dismissed based on the fears of doctors who act as gatekeepers of the status quo. The status quo did not prevent, and it will not address, the overdose crisis. </p>
<p>Urgent actions — like decriminalization and access to a regulated drug supply — are part of the policy changes needed to address the toxic drug crisis in Canada. But for the people at risk of drug poisoning today, and for their friends, families and loved ones, safer supply represents a real chance at preventing more tragedy.</p><img src="https://counter.theconversation.com/content/177925/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rose A Schmidt is employed as a research coordinator at the University of Toronto on a project that receives funding from The Ontario HIV Treatment Network about Safer Supply programs in Ontario.</span></em></p><p class="fine-print"><em><span>Gillian Kolla receives funding from a Canadian Institutes of Health Research Banting Postdoctoral Researcher Award and a Canadian Network on Hepatitis C (CanHepC) Postdoctoral Fellowship. She has consulted for Parkdale Queen West Community Health Centre, London Intercommunity Health Centre, The Neighbourhood Group, Street Health, and The Working Centre. </span></em></p><p class="fine-print"><em><span>Nat Kaminski is part of the University of Toronto research project on Safe Supply in Ontario, and is president of The Peel Drug Users Network & Ontario Network of People who use drugs and secretary of the Canadian Association of People who use drugs. They reviewed the guidelines for safe supply in Ontario and advocate for the expansion of services medically prescribed safe supply.</span></em></p>People are dying from using a toxic drug supply. Safer supply and other approaches that listen to the needs of people who use drugs are critical to saving lives and addressing the opioid crisis.Rose A Schmidt, PhD candidate, Dalla Lana School of Public Health, University of TorontoGillian Kolla, Postdoctoral research fellow, Canadian Institute for Substance Use Research, University of VictoriaNat Kaminski, Research assistant, School of Public Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1766572022-02-13T13:13:50Z2022-02-13T13:13:50ZI’m an addiction researcher and therapist. Here’s why promoting sober ‘dry months’ bothers me.<figure><img src="https://images.theconversation.com/files/445990/original/file-20220211-27-1tfs8tr.png?ixlib=rb-1.1.0&rect=128%2C89%2C1790%2C1107&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">'Dry' month campaigns have gained traction with people increasingly taking a time out from alcohol use for one month.</span> <span class="attribution"><span class="source">(Pixabay)</span></span></figcaption></figure><p>Campaigns that challenge people to abstain from alcohol for one month — often in support of a good cause — have emerged across the globe over the past decade. Dry January officially launched in 2013 with a <a href="https://alcoholchange.org.uk/get-involved/campaigns/dry-january/about-dry-january/the-dry-january-story">public health campaign by British charity Alcohol Change</a>.</p>
<p>Other “month of abstinence” campaigns have included <a href="http://au.dryjuly.com/">Dry July</a>, <a href="https://www.goodmorningamerica.com/wellness/story/sober-september-taking-month-off-drinking-body-57595077">Sober September</a>, <a href="https://www.adweek.com/brand-marketing/how-2021-became-the-breakout-year-for-sober-october/">Sober October</a> and “<a href="https://cancer.ca/en/ways-to-give/dry-feb">Dry February</a>” — a few examples of campaigns from Australia, <a href="http://www.dryjuly.co.nz/">New Zealand</a>, the United States, Canada and beyond. Dry campaigns have gained traction with people increasingly taking a time out from drinking alcohol for one month.</p>
<p>Early research suggests alcohol use has <a href="https://doi.org/10.1016/j.ypmed.2021.106422">increased during the COVID-19 pandemic, particularly among individuals who have mental health challenges</a>. The pandemic may be contributing to the greater interest in dry month campaigns. <a href="https://docs.cdn.yougov.com/b9xfo385w1/Dry%20January%20-%20YouGov.pdf">Market research surveys</a> have found <a href="https://morningconsult.com/2022/01/10/dry-january-movement-grows-in-2022/">an estimated one in five people participated in Dry January in 2022</a>. </p>
<p>On the surface, “dry” months are great — individuals set a personal goal to abstain from drinking, are publicly encouraged to achieve it and raise funds for a charity. It can be seen as supportive and positive, and many individuals tout the <a href="https://www.self.com/story/dry-january-health-benefits">health benefits</a> they experience as a result.</p>
<h2>Substance use is complex</h2>
<p>As a substance use researcher and therapist, I certainly do not dispute the potential benefits of avoiding alcohol for a month to meet personal health goals. I also appreciate the peer support received by individuals doing these challenges. </p>
<p>So, why was I so bothered as I listened to someone sharing the life-changing benefits of her four-week sobriety stint on the radio? Why am I irked when people express relief when their four weeks of Dry February are over, and they can get back to “wine time?” </p>
<figure class="align-center ">
<img alt="Glass of whisky in a circle with a line through it with a calendar in the background" src="https://images.theconversation.com/files/445997/original/file-20220211-13-bf7t81.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445997/original/file-20220211-13-bf7t81.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=386&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445997/original/file-20220211-13-bf7t81.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=386&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445997/original/file-20220211-13-bf7t81.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=386&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445997/original/file-20220211-13-bf7t81.jpeg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=485&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445997/original/file-20220211-13-bf7t81.jpeg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=485&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445997/original/file-20220211-13-bf7t81.jpeg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=485&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">While dry month campaigns benefit many, they do not help individuals who struggle with substance issues.</span>
<span class="attribution"><span class="source">(Pixabay)</span></span>
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<p>I’m troubled because while dry drinking campaigns benefit many, they do not help the individuals that I have worked with over the years. These attitudes and campaigns do not contribute to a more nuanced discussion about substance use. Instead, they perpetuate the idea that quitting drinking for a month is a choice, and an easy and positive one at that.</p>
<p>Dry February and other associated campaigns are not intended for individuals struggling with the <a href="https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction/addressing-stigma-health-disparities">systemic inequalities</a>, such as poverty, illness and racism, that lead to substance use issues. You will also note that these campaigns are only about alcohol — <a href="http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.530.385&rep=rep1&type=pdf">a socially acceptable substance</a>. </p>
<p>How would these campaigns be perceived if they were focused on other drugs? Dry campaigns support a <a href="https://scholar.harvard.edu/files/sinha/files/marlatt1996.pdf">harm reduction</a> strategy — not drinking for a month for health benefits with no expectation of ongoing abstinence. However, they continue to separate alcohol as more socially acceptable than other drugs. This negatively affects people who use drugs. </p>
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Read more:
<a href="https://theconversation.com/benzo-dope-may-be-replacing-fentanyl-dangerous-substance-turning-up-in-unregulated-opioids-164286">‘Benzo-dope’ may be replacing fentanyl: Dangerous substance turning up in unregulated opioids</a>
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<p>These attitudes marginalize other substances and only normalize alcohol use, which contributes to the ongoing <a href="https://drugpolicy.org/issues/brief-history-drug-war">War on Drugs</a> and deadly drug supply. Further, these campaigns praise people for not drinking, which plays into the harmful idea that drinking (and using other drugs) is bad or subversive and should be controlled.</p>
<h2>Stigma and inequality</h2>
<figure class="align-center ">
<img alt="A glass of wine tipping over against a blue sky" src="https://images.theconversation.com/files/445998/original/file-20220211-17-wvg0n7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/445998/original/file-20220211-17-wvg0n7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/445998/original/file-20220211-17-wvg0n7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/445998/original/file-20220211-17-wvg0n7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/445998/original/file-20220211-17-wvg0n7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/445998/original/file-20220211-17-wvg0n7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/445998/original/file-20220211-17-wvg0n7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Celebrating predominantly middle/upper class educated women for publicly choosing to quit drinking for one month perpetuates moralistic views of substance use.</span>
<span class="attribution"><span class="source">(Pixabay))</span></span>
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<p>Arguably, these campaigns are directed at predominantly white, educated, middle class individuals who have the luxury of taking a time out from drinking, and the privilege of doing so without the risk of social stigma. </p>
<p>In one <a href="https://doi.org/10.1093/alcalc/agaa025">2020 study comparing individuals who participated in a Dry January with the general population</a>, those who participated in Dry January, were more likely to be younger, women, had a higher income, had completed university education and had “significantly better self-rated physical health.” </p>
<p>Celebrating predominantly middle/upper-class, educated women for publicly choosing to quit drinking for one month is potentially harmful. It perpetuates an all or nothing <a href="https://doi.org/10.1177/002204268701700205">moralistic attitude towards substance use</a>. It reinforces the myth that quitting substance use is a choice that anyone can (and should) make.</p>
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Read more:
<a href="https://theconversation.com/winemom-humour-and-empowerment-or-binge-drinking-and-mental-health-challenges-161338">#WineMom: Humour and empowerment or binge drinking and mental health challenges?</a>
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<p>Dry month campaigns are not directed at my clients who attend therapy for substance use issues. They do not see themselves as welcome participants in these campaigns. Their substance use or sobriety isn’t trendy, or worthy of a hashtag. It’s messy, it’s personal and it is often much more complicated than deciding to “just quit.” For them, drinking can be a needed self-medication tool, an endless obstacle, or an enjoyable friend.</p>
<h2>Policy and privilege</h2>
<p>I continue to appreciate many aspects of dry month campaigns, including raising money for charity and bringing discussions of substance use into the limelight. At the same time, these months are worthy of more critical reflection. </p>
<p>Substance use is complex. People often struggle with their use for reasons directly related to social inequalities, trauma, unsafe supply and poverty. Treating a four-week vacation from alcohol as a moral victory reinforces stigmatizing and negative stereotypes about people who use alcohol and other drugs. Alcohol and other drugs are not inherently bad; the policies we have made around them are what cause harm. </p>
<p>In the midst of Dry February, my hope for dry campaigns would be that they offer not solely a chance to examine and limit one’s own drinking, but an opportunity to broaden the discussion around how privilege and policy impact one’s relationship with alcohol and other drugs.</p><img src="https://counter.theconversation.com/content/176657/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kara Fletcher receives funding from Social Sciences and Humanities Research Council and the Saskatchewan Health Research Fund. </span></em></p>On the surface, sober months like Dry January and Dry February are great. But we need to broaden the discussion around how privilege and policy impact one’s relationship with alcohol and other drugs.Kara Fletcher, Assistant Professor, Faculty of Social Work, University of ReginaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1737992022-01-25T13:25:57Z2022-01-25T13:25:57ZOpioid overdose: A bioethicist explains why restricting supply may not be the right solution<figure><img src="https://images.theconversation.com/files/441839/original/file-20220120-9541-1nz1c60.jpg?ixlib=rb-1.1.0&rect=31%2C12%2C2085%2C1399&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's the best way to solve America's opioid overdose crisis?</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/macro-of-oxycodone-opioid-tablets-with-prescription-royalty-free-image/1162845770?adppopup=true">BackyardProduction/ iStock via Getty images</a></span></figcaption></figure><p>Year after year, America’s drug overdose crisis is worsening.</p>
<p>In the 12-month period ending in June 2021, the most recent period for which there is reliable data, <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm">more than 101,000 people died from drug overdose</a> in the U.S., – an increase of more than 20% from the previous year. </p>
<p>2021 was also an important year for analysis of the overdose crisis, with numerous books and articles shedding light on both the causes and potential solutions to the crisis.</p>
<p>Not all analysis is in agreement, however. As a <a href="https://www.travisrieder.com">bioethicist</a> who has spent much of the past several years researching the ethical and policy issues related to drug use, I’ve become particularly interested in an evolving tension between commentators on the drug crisis. </p>
<p>While many blame today’s crisis on <a href="https://doi.org/10.1093/qje/qjab043">an increase in drug supply</a> over the past 25 years, others suggest that increasing drug supply can <a href="https://doi.org/10.1503/cmaj.201618">actually be a solution</a>. So who is right? And what would ethical policy around drug supply look like? </p>
<h2>Access to drugs can be a problem</h2>
<p>The case against drugs is straightforward. As several experts have shown in recent years, the current drug overdose crisis was sparked by a steep increase in the supply of prescription opioids. </p>
<p>In his meticulously detailed book “<a href="https://www.penguinrandomhouse.com/books/612861/empire-of-pain-by-patrick-radden-keefe/">Empire of Pain</a>,” investigative journalist Patrick Radden Keefe reveals the extent to which Purdue Pharma, and the owning family, the Sacklers, utilized dishonest marketing strategies to drive aggressive prescribing of their extended-release opioid, OxyContin. Sales of the drug soared, and in the following years many <a href="https://www.nytimes.com/2019/08/27/health/johnson-and-johnson-opioids-oklahoma.html">other companies</a> followed similar playbooks.</p>
<p>Public health scientists have now shown that, starting in 1999, the volume of opioids prescribed and the overdose death rate from prescription opioids <a href="https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm">increased in parallel</a> for a decade, with prescription volume quadrupling by 2010 and overdose mortality quadrupling by 2008. </p>
<p>This is not the first time in American history that such a pattern occurred. As I argued in my 2019 book, “<a href="https://www.harpercollins.com/products/in-pain-travis-rieder?variant=32207679684642">In Pain</a>,” the prescription opioid problem of the early 2000s followed a pattern established by the development and marketing of morphine and heroin 100 years before.</p>
<p>When morphine was developed in the 19th century, its widespread use began to lead to addiction – especially among Civil War veterans. Historian <a href="https://vmi.academia.edu/JonathanJones">Jonathan Jones</a> has called this <a href="https://www.washingtonpost.com/history/2021/12/01/opioid-crisis-civil-war-addiction/">America’s first opioid crisis</a>. When heroin was developed by the Bayer AG company and marketed as a more potent, less addictive alternative to morphine that only <a href="https://www.unodc.org/unodc/en/data-and-analysis/bulletin/bulletin_1953-01-01_2_page004.html">exacerbated the crisis</a>. </p>
<p>At least twice in recent history, then, increased access to opioids has resulted in significant public health harms. One could ask, if access to prescription opioids started the crisis, shouldn’t society work to restrict such access?</p>
<h2>Access to drugs isn’t America’s problem</h2>
<p>The problem with attempting to address overdose by restricting access to prescriptions is that the current drug overdose crisis is no longer a prescription opioid crisis. Although opioid prescribing has been dramatically curbed, overdose mortality has <a href="https://www.cdc.gov/opioids/basics/epidemic.html#three-waves">increased dramatically</a>.</p>
<p>Many overdose deaths in recent years have been <a href="https://www.cdc.gov/drugoverdose/deaths/other-drugs.html#anchor_1636146406061">polysubstance</a> deaths, involving multiple drugs. Most commonly, this includes illicit fentanyl, which is approximately <a href="https://www.cdc.gov/drugoverdose/deaths/other-drugs.html#anchor_1636146932580">50 times</a> more potent than heroin. Fentanyl and its chemical analogs – synthetic opioids that are designed to mimic the properties of fentanyl and can be even stronger – make the illicit drug supply unpredictable. When suppliers cut their drugs with varying amounts of fentanyl products, <a href="https://www.drugabuse.gov/publications/drugfacts/fentanyl">the potency differs dramatically</a>, making it difficult to dose. This unpredictability is <a href="https://www.cdc.gov/drugoverdose/featured-topics/overdose-prevention-campaigns.html">driving the striking increase</a> in accidental overdose being seen today.</p>
<p>In recognition of this fact, many scholars <a href="https://ycsg.yale.edu/sites/default/files/files/we_can%27t_go_cold_turkey.pdf">have argued</a> that policies focused on restricting drug access make the drug problem worse, not better. Making prescription opioids harder to get can <a href="https://jamanetwork.com/journals/jamapsychiatry/fullarticle/1874575">push those with a use disorder</a> to the illicit market. And the illicit supply is unpredictable precisely because it is unregulated. Getting clean needles <a href="https://www.networkforphl.org/news-insights/ensuring-access-to-clean-needles-can-save-lives-but-legal-barriers-persist/">can be difficult</a> because of drug paraphernalia laws. And fear of arrest <a href="https://doi.org/10.1016/j.drugalcdep.2010.07.008">increases the risk of drug overdose</a> by leading people to use alone, or by making it risky to call for help if someone does witness an overdose. </p>
<p>In short: punitive drug policy makes using drugs more dangerous.</p>
<p>In her 2021 book “<a href="https://www.hachettego.com/titles/maia-szalavitz/undoing-drugs/9780738285757/">Undoing Drugs</a>,” journalist Maia Szalavitz shows that those advocating for harm reduction have long realized the negative effects of such policies, which is why they resist arguments that focus on restricting drug supply. Instead, they <a href="https://harmreduction.org/about-us/principles-of-harm-reduction/">argue for</a> policies that make using drugs safer.</p>
<p>These policies include <a href="https://www.cdc.gov/ssp/syringe-services-programs-summary.html">syringe exchange programs</a>, which reduce incidence of hepatitis and HIV among people who use drugs by reducing needle-sharing. Another example is distributing <a href="https://www.cdc.gov/stopoverdose/naloxone/index.html">naloxone, a medication that reverses opioid overdoses</a>. In addition, <a href="https://drugpolicy.org/issues/supervised-consumption-services">overdose prevention centers</a> – sometimes called safe injection sites or safe consumption sites – reduce the risk of drug-related harms by allowing people to use drugs in a sterile, supervised setting. </p>
<h2>Can drug supply be the solution?</h2>
<p>Some harm reduction advocates do not, however, stop at strategies to make using contaminated drugs safer. They argue for simply <a href="https://newrepublic.com/article/164531/overdose-deaths-safe-supply?utm_term=Autofeed&utm_campaign=EB_TNR&utm_medium=Social&utm_source=Twitter#Echobox=1638423476">giving people safer drugs</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman holding a bottle of pills in one hand and examining the contents in the palm of another hand." src="https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/441843/original/file-20220120-9024-1xqfpp3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Should people have access to a regulated drug supply?</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/sick-asian-young-lady-holding-pill-take-a-look-royalty-free-image/1320983152?adppopup=true">Tirachard/iStock via Getty Images.</a></span>
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<p>The “safe supply” movement, for example, <a href="https://time.com/6108812/drug-deaths-safe-supply-opioids/">claims that</a> an important way to reduce drug overdose is for people who use drugs to have access to pure, regulated forms that are easy to accurately dose. Although counterintuitive to those who think any drug use is bad, the logic is straightforward: Some people are going to use drugs regardless of how dangerous they are, so it’s better if the drugs they have access to are consistent in potency and so safer. </p>
<p>Taking this logic further yet, some scholars <a href="https://www.nbcnews.com/think/politics-policy/fentanyl-drug-overdose-deaths-are-rising-biden-administration-rcna6384">have argued</a> that because people should have access to a regulated drug supply, all drugs should be legalized. According to this view, since the unpredictability of the drug supply increases overdose risk, making the drug supply predictable should be part of the solution. </p>
<p>Advocates for both safe supply and legalization, then, hold that an increase in drug supply is not only not a problem – it could be a solution.</p>
<h2>Resolving the tension</h2>
<p>The key to resolving this tension is to recognize that drug supply can mean different things. An “increase in supply” can be both a problem and a solution.</p>
<p>The historical cases of morphine and heroin at the end of the 19th century, and then OxyContin a century later, suggest that increased access to badly regulated drugs can lead to harm. As <a href="https://doi.org/10.1080/15265161.2021.1891332">I have argued</a> in the American Journal of Bioethics, these cases pose a serious challenge to the argument for full legalization – especially if legalization implies that all drugs should be accessible to anyone over a certain age, as with alcohol or tobacco. The tension between those concerned about drug supply and those on the pro-legalization side may be unresolvable.</p>
<p>[<em>Over 140,000 readers rely on The Conversation’s newsletters to understand the world.</em> <a href="https://memberservices.theconversation.com/newsletters/?source=inline-140ksignup">Sign up today</a>.]</p>
<p>Providing people who plan to use drugs with a safe supply, however, can be done without making drugs easily accessible to everyone; they just need to be easily accessible to that population. What the public health infrastructure needs is <a href="https://doi.org/10.1016/j.drugpo.2020.102769">a way to prescribe drugs to those committed to using</a> without thereby giving easy access to everyone. </p>
<p>While carefully regulated access to drugs can be harm reduction, unrestricted access can lead to harm expansion. The evidence on drug-related harms therefore supports a carefully regulated safe-supply policy in order to balance the risks and benefits of access to drugs.</p><img src="https://counter.theconversation.com/content/173799/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Travis N. Rieder does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Restricting drug access can make the overdose crisis worse, not better. A bioethicist explains what that means for an ethical drug policy.Travis N. Rieder, Director of the Master of Bioethics degree program at the Berman Institute of Bioethics, Johns Hopkins UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1718692021-11-18T14:00:09Z2021-11-18T14:00:09ZAfrican countries perform badly when it comes to drug policies: a new index shows how<figure><img src="https://images.theconversation.com/files/431977/original/file-20211115-15-1gk0kki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Kenyan police officers display bags of heroin seized in 2011. </span> <span class="attribution"><span class="source">Tony Karumba/AFP via Getty Images</span></span></figcaption></figure><p>Awukye received a 10-year prison sentence in Ghana for cannabis possession. The experience, he <a href="https://globaldrugpolicyindex.net/stories/using-cannabis-to-relax-after-work-landed-me-10-years-in-prison-awukyes-story/">said</a>, shattered his family’s dreams. Michael Anami, a Kenyan, <a href="https://globaldrugpolicyindex.net/stories/my-lived-experience-motivates-me-to-challenge-punitive-and-harmful-policies-anamis-story/">recalled</a> the “multiple arrests, beatings, incarcerations, and untimely deaths” he had witnessed as a drug policy activist and former user.</p>
<p>These were just some of the harrowing stories we heard while developing the recently launched <a href="https://globaldrugpolicyindex.net/">Global Drug Policy Index</a>, a way of comparing countries’ policies on drugs. Such stories suggest that drug policy all too often blights lives. But there are also inspiring individuals and communities working to help people who use drugs. They provide medicine to combat overdoses, needle and syringe exchange programmes to prevent the spread of blood borne diseases, and drug checking services to inform people about the potency and quality of drugs that they might ingest.</p>
<p>It has long been clear that some countries have policies that cause harm and violate human rights, while others have more rational, evidence based and humane policies. But it has been difficult to assess and compare them. </p>
<p>The Global Drug Policy Index aims to fill this gap. It is designed to provide rigorous, transparent and comparative evidence about the quality of countries’ drug policies. It’s a tool to hold governments accountable and ensure that policies are based on health, human rights and development.</p>
<h2>Measure, compare, guide</h2>
<p>The United Nations’ <a href="http://hdr.undp.org/en/content/human-development-index-hdi">Human Development Index</a>, Transparency International’s <a href="https://www.transparency.org/en/cpi/2020/index/nzl">Corruption Perception Index</a> and Freedom House’s <a href="https://freedomhouse.org/countries/freedom-world/scores">Global Freedom Index</a> are just three examples of projects that measure and compare countries in complex areas of policy. Such indices are useful because they crystallise the performance of states and offer clear guidance on how to improve.</p>
<p>The Global Drug Policy Index was driven by <a href="https://idpc.net/policy-advocacy/partnerships/the-harm-reduction-consortium#:%7E:text=The%20Harm%20Reduction%20Consortium%20brings%20together%20seven%20of,European%20Network%20of%20People%20who%20Use%20Drugs%20%28EuroNPUD%29.">the Harm Reduction Consortium</a> and developed by academics at <a href="https://www.swansea.ac.uk/gdpo/">Swansea University’s Global Drug Policy Observatory</a>.</p>
<p>In the sphere of drug policy, academics often collaborate with policymakers, activists and people who use drugs. For the 30 countries covered in this first version of the Global Drug Policy Index, we consulted widely with organisations rooted within the communities affected by drug policies. We also surveyed 371 individuals with “on the ground” knowledge of each state’s drug policy. </p>
<p>The index specifies 75 policy indicators. These are derived from a recent <a href="https://www.unodc.org/documents/commissions/CND/2019/Contributions/UN_Entities/What_we_have_learned_over_the_last_ten_years_-_14_March_2019_-_w_signature.pdf">UN report</a> on best practice in state drug policy.</p>
<p>Based on how they perform on these indicators, states get a score from 0 to 100. One hundred would represent a full implementation of recommended policies across five areas. </p>
<p>The first area is the absence of extreme response, like the death penalty and extrajudicial killing. </p>
<p>Second is the proportionality of the criminal justice response. This looks at levels of violence, discrimination and human rights abuse in states’ policing of drug policy. </p>
<p>Health and harm reduction is the third. This focuses on the funding, availability and accessibility of interventions that reduce the harms arising from problematic drug use. </p>
<p>Access to controlled medicines is fourth. It looks at states’ provision of medicines for pain relief and palliative care. </p>
<p>Finally, there’s development: programmes designed to provide alternative livelihoods to people who grow illicit crops. </p>
<h2>Drug policies in African countries</h2>
<p>Even a quick glance at the <a href="https://globaldrugpolicyindex.net/ranking/">index results</a> for states in Africa reveals a grim truth: African states are among the worst performers in the world in terms of drug policy. </p>
<p><a href="https://globaldrugpolicyindex.net/ranking/">Uganda</a> scores just 28 in the overall index. The country has a perfect storm of punitive, highly violent drug law enforcement combined with minimal availability of basic medical interventions to reduce the harms caused by drug use.</p>
<p>In Kenya, which scores only 32 overall, access to harm reduction interventions is better, although still patchy. Our expert respondents in Kenya described frequent use of violence and torture by police, as well as arbitrary arrest. They said drug law enforcement was particularly harsh on women, certain ethnic groups, and the less wealthy. Such features are common in all low-ranked states in the Global Drug Policy Index.</p>
<p>In other African states evaluated in the index (such as South Africa, Mozambique and Senegal), the picture was more mixed. There were areas of good practice, including less “extreme” responses to drug crimes such as the death sentence. And there were some promising developments in harm reduction. But access to essential medicines is very limited across the continent. And most states are exercising disproportionate force in delivering their drug policies.</p>
<p>These problems aren’t separate. Money spent on police, courts and prisons is money that could be spent on healthcare and harm reduction. Sadly, it seems that Africa’s states are still largely operating from an outdated and discredited “<a href="https://www.bloomsburycollections.com/book/africa-and-the-war-on-drugs/?clearSearch">War on Drugs</a>” perspective. Even South Africa, a <a href="https://www.talkingdrugs.org/drug-decriminalisation">regional leader</a> in decriminalisation policy, has implemented it in a cautious, limited way. Our expert respondents collectively judged that South African decriminalisation has so far been ineffective in reducing contacts between people who use drugs and the criminal justice system. </p>
<p>We hope the information contained in this index will help to develop constructive debates that will lead to more humane and evidenced based policies in the region. To achieve this, states should reorient their approaches to focus on the health and human rights implications of drug use. The index provides a clear guide to the types of policies and actions that will move them towards this goal.</p><img src="https://counter.theconversation.com/content/171869/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Matt Wall receives funding from the Robert Carr foundation for his work as a specialist in social science methodolgy on the Global Drug Policy Index project. </span></em></p><p class="fine-print"><em><span>David Bewley-Taylor received funding from the Robert Carr Fund for his work on the Global Drug Policy Index project. He is a Senior Associate of the International Drug Policy Consortium. </span></em></p>It has long been clear that some countries have drug policies that cause harm and violate human rights.Matt Wall, Associate Professor, Political and Cultural Studies, Swansea UniversityDavid Bewley-Taylor, Personal Chair, Politics, Philosophy and International Relations, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1713032021-11-09T06:06:29Z2021-11-09T06:06:29ZThe police’s new scare campaign won’t stop people from using drugs. But it will increase stigma<figure><img src="https://images.theconversation.com/files/431186/original/file-20211109-19-thpqix.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C7951%2C5304&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>As part of a Halloween-inspired campaign, the Australian Federal Police has released a series of ill-advised memes attempting to highlight the “lesser-known impacts” of illicit drug use.</p>
<p>The campaign demonstrates a skewed and overly simplistic understanding of drug problems. It’s superficial, inaccurate and demonises people who use drugs. </p>
<p>People who use drugs are depicted as <a href="https://www.facebook.com/photo?fbid=248467750652890&set=a.151954043637595">spine-chilling zombies</a> that “bankroll criminals who enslave women and destroy the environment”. <a href="https://www.facebook.com/photo?fbid=249129417253390&set=a.151954043637595">Cocaine use</a> is linked to infertility, jokingly exclaiming “get off the junk to protect your junk”. People who use <a href="https://www.facebook.com/photo?fbid=249764590523206&set=a.151954043637595">heroin</a> are blamed for increasing insurance premiums.</p>
<p>Arguably the worst of the memes is a computer generated image, <em>manufactured</em> by the AFP’s Forensics Facial Recognition team, claiming to be <a href="https://www.facebook.com/100064689998869/posts/250331850466480/?d=n">“before” and “after” methamphetamine use</a>. It seems to be inspired by the infamous American “<a href="https://wjla.com/news/nation-world/before-after-meth-users?photo=4">Faces of Meth</a>” and <a href="https://montanameth.org/">Montana Meth Project</a> campaigns, which have been widely criticised as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4323270/">ineffective</a>, <a href="https://www.oregonlive.com/portland/2014/12/faces_of_meth_10_years_later_a.html">inaccurate and highly stigmatising</a>. In fact, they may have <a href="https://www.news.uwa.edu.au/archive/business-briefing/success-graphic-meth-ads-questioned-uwa-study/">increased risk</a> of use.</p>
<p><a href="https://www.facebook.com/667793613281118/posts/4588998517827255/?d=n">Concerned community organisations</a> are calling on the AFP to remove the posts. </p>
<p>Here’s what the AFP campaign gets wrong.</p>
<p><div data-react-class="InstagramEmbed" data-react-props="{"url":"https://www.instagram.com/p/CVy3f43BlDf","accessToken":"127105130696839|b4b75090c9688d81dfd245afe6052f20"}"></div></p>
<h2>Scare campaigns and distorted ‘facts’ don’t reduce use or harms</h2>
<p>The AFP campaign uses confronting imagery and distorted and exaggerated claims in an attempt to scare people from using drugs.</p>
<p><a href="https://preventionactionalliance.org/wp-content/uploads/2020/09/fear-messages-prevention-efforts.pdf">Decades of evidence</a> show scare tactics don’t work. And <a href="https://bmjopen.bmj.com/content/5/9/e007449">mass media campaigns</a> aren’t very effective in reducing illicit drug use.</p>
<p>The overwhelming majority of the 16.4% of <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data">Australians who currently use illicit drugs</a> do so occasionally and without harmful consequences. So when they see exaggerated images or messages trying to make drugs seem more dangerous or risky than they are, <a href="https://bmjopen.bmj.com/content/5/9/e007449">they switch off</a>. </p>
<p>Scare tactics have been shown to make drugs seem <a href="https://www.tandfonline.com/doi/abs/10.1080/09581590601045220">more alluring</a>, increasing the risk of use, not decreasing it. <a href="https://ifstudies.org/blog/do-scary-statistics-change-peoples-behavior/">Some</a> may see it as a challenge, it can increase awareness of specific drugs, and sometimes young people are attracted to activities that are forbidden.</p>
<h2>It’s best to stick to the facts</h2>
<p>Most people who use methamphetamine don’t look like the “Faces of Meth” images. The typical person who uses methamphetamine is in their 20s, and they use the powdered form of the drug (commonly referred to as “speed”) just once or twice a year.</p>
<p>There are multiple and very complex reasons why people’s appearance might change when they use drugs over a long period. Most of them aren’t to do with the drug itself but are related to a range of other social factors, like poor diet, lack of access to health care and mental health problems that often predate the drug use.</p>
<p>The “Faces of Meth” are really the faces of poverty, trauma and exclusion.</p>
<figure class="align-center ">
<img alt="Person holding small bag of white powder" src="https://images.theconversation.com/files/430951/original/file-20211109-17-12v78cj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430951/original/file-20211109-17-12v78cj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430951/original/file-20211109-17-12v78cj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430951/original/file-20211109-17-12v78cj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430951/original/file-20211109-17-12v78cj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430951/original/file-20211109-17-12v78cj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430951/original/file-20211109-17-12v78cj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Evidence suggests media scare campaigns aren’t very effective in reducing drug use.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The belief that <a href="https://ajp.psychiatryonline.org/doi/full/10.1176/appi.ajp-rj.2017.121204">bugs are crawling under your skin</a> can occur with methamphetamine-related psychosis. But it isn’t very common, and people with other forms of psychosis, unrelated to drug use, also sometimes experience this delusion.</p>
<p>The role of cocaine use on male fertility <a href="https://rbej.biomedcentral.com/articles/10.1186/s12958-018-0320-7">still isn’t clear</a>.</p>
<p>The <a href="https://www.emcdda.europa.eu/attachements.cfm/att_44774_EN_Dif16EN.pdf">link between drug use and crime</a> isn’t straightforward. Most people who use illicit drugs don’t commit crimes, other than the drug use itself.</p>
<p>Even among people who are dependent on drugs, risk of offending actually increases when <a href="https://journals.sagepub.com/doi/abs/10.1177/0887403413499582">they can’t access</a> treatment.</p>
<p>Treatment reduces criminal behaviour. For every A$1 spent on drug treatment, the <a href="https://ndarc.med.unsw.edu.au/resource/new-horizons-review-alcohol-and-other-drug-treatment-services-australia">community saves $7</a> in other costs. This includes a reduction in the costs to society related to crime.</p>
<h2>Demonising people increases problems</h2>
<p>Even if you have a moral objection to drug use, making simplistic links between drug use and physical appearance, offending and other behaviours does nothing to stop people using.</p>
<p>The campaign tagline, “have a conscience”, suggests people who use drugs are morally corrupt. This makes the problem worse by increasing stigma.</p>
<p><a href="https://cdn.adf.org.au/media/documents/ADF_Stigma_background_paper.pdf">Stigma</a> is one of the biggest barriers to seeking help for drug problems. It <a href="https://ndarc.med.unsw.edu.au/sites/default/files/ndarc/resources/Reducing%20stigma%20and%20discrimination%20for%20people%20experiencing%20problematic%20alcohol%20and%20other%20drug%20use.pdf">delays help-seeking</a> and increases the risk of dropout from treatment. </p>
<p>Any public messaging about drugs should follow well-established guidelines for reporting on drug-related issues, including those from <a href="https://mindframe.org.au/alcohol-other-drugs/communicating-about-alcohol-other-drugs">Mindframe</a> and <a href="https://www.aodmediawatch.com.au/guidelines-for-journalists/">AOD Media Watch</a>.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1455841557874024454"}"></div></p>
<h2>Blaming individuals for structural problems doesn’t reduce use or harms</h2>
<p>The AFP’s <a href="https://www.facebook.com/photo?fbid=249129417253390&set=a.151954043637595">cocaine post</a> tries to link individual drug use to large scale structural problems, like organised crime and the global drug trade.</p>
<p>This ignores the key underlying causes of organised crime, which are linked to the massive profits made possible by the <a href="https://globalinitiative.net/analysis/enforcement-of-drug-laws-refocusing-on-organized-crime-elites/">prohibition of drugs</a>. If drugs were regulated, it could <a href="https://ndarc.med.unsw.edu.au/blog/decriminalisation-or-legalisation-injecting-evidence-drug-law-reform-debate">significantly reduce the black market</a> and generate revenue for more treatment.</p>
<p>Drugs are <a href="https://theconversation.com/history-not-harm-dictates-why-some-drugs-are-legal-and-others-arent-110564">more harmful</a> because they’re illegal. They’re manufactured in backyard labs with no quality or dose control.</p>
<p>This is why <a href="https://www.parliament.vic.gov.au/file_uploads/LRRCSC_58-03_Full_Report_Text_WEB_XQB31XDL.pdf">most experts</a> support drug law reform, such as <a href="https://www.thelancet.com/journals/lanhiv/article/PIIS2352-3018(21)00130-2/fulltext">decriminalisation</a> or <a href="https://blogs.bmj.com/bmj/2018/09/24/doctors-support-regulated-markets-illicit-drugs/">legalisation</a>. Public <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/contents/summary">support for legalisation of drugs</a> has been increasing, with more people now supporting the legalisation of cannabis than opposing it.</p>
<p>Some argue that with the massive amount of money spent on drug law enforcement (<a href="https://ndarc.med.unsw.edu.au/news/law-enforcement-takes-lions-share-illicit-drug-spend">66% of the entire spend on drugs</a>) and the <a href="https://www.aic.gov.au/sites/default/files/2020-09/ti602_impact_of_arrest_and_seizure_on_drug_crime_and_harms.pdf">very small long-term impact</a> on the drug market, we need a different approach.</p>
<figure class="align-center ">
<img alt="Person rolling up marijuana joint" src="https://images.theconversation.com/files/430949/original/file-20211109-23-1b5b34h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430949/original/file-20211109-23-1b5b34h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430949/original/file-20211109-23-1b5b34h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430949/original/file-20211109-23-1b5b34h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430949/original/file-20211109-23-1b5b34h.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430949/original/file-20211109-23-1b5b34h.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430949/original/file-20211109-23-1b5b34h.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Regulating drugs could significantly reduce harms.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>What does work?</h2>
<p>What works in preventing uptake is providing <a href="https://positivechoices.org.au/teachers/drug-prevention-what-works">good factual information</a> about drugs from an early age, including evidence-based school drug education.</p>
<p>Harm reduction strategies, like <a href="https://creidu.edu.au/policy_briefs_and_submissions/12-syringe-coverage-and-australian-nsps">needle and syringe programs</a> and medically supervised <a href="https://pubmed.ncbi.nlm.nih.gov/20148794/">injecting facilities</a>, reduce harms from drug use. Often these activities also reduce use, although this isn’t their main aim.</p>
<p><a href="https://www.health.gov.au/resources/publications/study-of-patient-pathways-in-alcohol-and-other-drug-treatment">Treatment is effective</a> in reducing drug use and harms.</p>
<p>There has been a significant shift in Australia and internationally to viewing drug use as a health and human rights issue rather than a criminal justice issue.</p>
<p>Law enforcement should stick to policing. Drug prevention and harm reduction are specialised areas of health science, and public health isn’t served by the AFP acting outside its area of expertise.</p>
<h2>Getting help</h2>
<p>If you’re worried about your own or someone else’s use of alcohol or other drugs call the National Alcohol and other Drug Hotline on 1800 250 015, free from anywhere in Australia.</p>
<p>You can also chat online with a counsellor at Alcohol & Drug <a href="https://www.counsellingonline.org.au">Counselling Online</a>, join an online support group at <a href="https://smartrecoveryaustralia.com.au/online-smart-recovery-meetings-2/">SMART Recovery</a>, or talk to your GP about seeing a psychologist or counsellor. You may be able to access support via telehealth.</p><img src="https://counter.theconversation.com/content/171303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding from Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment. She is a member of the Australian National Advisory Council on Alcohol and other Drugs (ANACAD) and the Board of Directors of Hello Sunday Morning and The Loop Australia.</span></em></p><p class="fine-print"><em><span>Jarryd Bartle works as a consultant in the alcohol and other drug sector</span></em></p>Here’s what the Australian Federal Police’s new campaign gets wrong.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityJarryd Bartle, Sessional Lecturer, RMIT UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1693712021-11-03T19:06:49Z2021-11-03T19:06:49Z‘Just say no’ doesn’t work for teen sex and drug use, so why rely on it for young driver education?<figure><img src="https://images.theconversation.com/files/428706/original/file-20211027-15-iq0893.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4979%2C3309&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Human behaviour is complex. And yet approaches to road safety education are commonly far too simple, especially for young drivers. They are not only inexperienced but also biologically wired to be among those <a href="https://theconversation.com/young-driver-crashes-the-myths-and-facts-49877">most at risk of crashing</a>.</p>
<p>It is time to explore a new, <a href="https://www.sciencedirect.com/science/article/abs/pii/S2214140521002930">more proactive approach to driver education</a>.</p>
<p>Currently, we focus on teaching young people about major crash risks. Then we tell them not to take those risks. Should we really be surprised this does little to reduce the problem?</p>
<p>Common risks for young drivers include speeding and driving while tired. They are also <a href="https://www.infrastructure.gov.au/infrastructure-transport-vehicles/road-transport-infrastructure/safety/publications/2018/community_att_17">more likely to be distracted</a> by mobile phones or an array of other secondary tasks that take their eyes – and minds – away from the road.</p>
<p>Young drivers are <a href="https://www.infrastructure.gov.au/infrastructure-transport-vehicles/road-transport-infrastructure/safety/publications/2018/community_att_17">not alone in taking risks</a>. They see them on the road every day, often among their own family members and social circles, which <a href="https://doi.org/10.1186/s12954-019-0297-3">normalises such behaviour</a>. However, coupled with their lack of experience, such risks are much <a href="https://doi.org/10.1016/S0001-4575(02)00114-8">more likely to result in a crash</a> for the young driver.</p>
<p><strong>Transport accident hospitalisation rates are highest for young drivers</strong></p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/428944/original/file-20211027-13-1cl60jw.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Bar chart showing rates of transport-related hospitalisation by age group and sex" src="https://images.theconversation.com/files/428944/original/file-20211027-13-1cl60jw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/428944/original/file-20211027-13-1cl60jw.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/428944/original/file-20211027-13-1cl60jw.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/428944/original/file-20211027-13-1cl60jw.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/428944/original/file-20211027-13-1cl60jw.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/428944/original/file-20211027-13-1cl60jw.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/428944/original/file-20211027-13-1cl60jw.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Age-specific rates of transport-related hospitalisation (per 100,000) by age group and sex in 2017-18.</span>
<span class="attribution"><a class="source" href="https://www.aihw.gov.au/reports/injury/transport-injuries">Source: Australian Institute of Health and Welfare</a></span>
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Read more:
<a href="https://theconversation.com/despite-lockdowns-1-142-australians-including-66-kids-died-on-our-roads-in-the-past-year-heres-what-we-need-to-do-170021">Despite lockdowns, 1,142 Australians, including 66 kids, died on our roads in the past year. Here's what we need to do</a>
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<p>Is it realistic to expect we can predict and plan ahead to never become fatigued while driving? How many of us refuse all phone use while driving? In today’s highly connected world, why do we expect this of young drivers? </p>
<p>Why then does youth road safety education often simply adopt a “just don’t do it” message?</p>
<h2>Some risks are inevitable</h2>
<p>In other fields of youth health, education has long moved on from such an approach. It has progressed to teaching young people strategies both to avoid taking risks and to reduce harm if the risk does occur. Some risks are even considered inevitable.</p>
<p>An example of such a shift in approach is the move from “just say no” to <a href="https://www.plannedparenthood.org/uploads/filer_public/da/67/da67fd5d-631d-438a-85e8-a446d90fd1e3/20170209_sexed_d04_1.pdf">safe sex education</a> around the 1970s. Some feared this would lead to young people having sex earlier. Not only were these concerns unfounded, but <a href="https://doi.org/10.1371/journal.pone.0024658">research</a> continues to show a link between sex education and lower rates of teenage pregnancies.</p>
<p>This approach is known as risk or harm reduction, or minimisation. It is <a href="https://www.health.gov.au/sites/default/files/national-drug-strategy-2017-2026_1.pdf">well recognised</a> in relation to risky alcohol and other drug use. Think of needle exchange programs, safe injecting rooms and, more recently, pill testing. Initiatives like these <a href="https://www.unodc.org/documents/ungass2016/Contributions/Civil/Dalgarno/30Years_of_HarmMinimisation_FinalUNGASS.pdf">receive mixed support</a> but are <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/adb.12414">shown to reduce</a> harm.</p>
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Read more:
<a href="https://theconversation.com/heres-why-doctors-are-backing-pill-testing-at-music-festivals-across-australia-109430">Here's why doctors are backing pill testing at music festivals across Australia</a>
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<p>Harm-reduction approaches are evident in many other road safety measures that allow for margins of error. These include demerit point systems for offences and vehicle technologies that activate only after a certain threshold is exceeded. These include speed alerts, seatbelt reminders, feedback to stay inside the lane and phone-blocking apps.</p>
<p>In fact, allowing for human-made risks is a <a href="https://www.sciencedirect.com/science/article/pii/B9780081026717106694?via%3Dihub">tenet of systems engineering</a>. If risk can’t be eliminated, then systems are re-engineered to at least transform or reduce the risk of harm to an acceptable level. </p>
<h2>How would harm reduction work for young drivers?</h2>
<p>Many experienced drivers <a href="https://doi.org/10.1016/j.amar.2020.100121">compensate for risky driving conditions</a> by slowing down and leaving a greater gap to the traffic ahead – even if they don’t consciously realise this.</p>
<p>There is clear, <a href="https://doi.org/10.1016/j.aap.2010.05.012">physics-based evidence</a> these compensating behaviours reduce crash risk. The result is a wider view of the road environment so drivers can see any potential hazards early. They also have more time and space to react to any hazards.</p>
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<iframe src="https://player.vimeo.com/video/404436698" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Technology can help alert young drivers to when they need to reduce risk using strategies more experienced drivers automatically use.</span></figcaption>
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<p>A harm-reduction approach to driver education would still emphasise avoiding <a href="https://research.qut.edu.au/carrsq/resources/fact-sheets/">key risks</a>. However, it would also <a href="http://www.racfoundation.org/assets/rac_foundation/content/downloadables/Addressing_Young_And_Novice_Driver_Safety_In_GB_Senserrick_And_Kinnear_November_2017.pdf">challenge young people</a> to reflect on their own “inevitable risks”. Will they never be tempted to speed when running late for work? Will they obey every road rule, even when they see others breaking them? Would any of their answers be different if certain friends or family members were their passengers?</p>
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Read more:
<a href="https://theconversation.com/not-as-simple-as-no-means-no-what-young-people-need-to-know-about-consent-155736">Not as simple as 'no means no': what young people need to know about consent</a>
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<p>If not able to eliminate the risk, young people would be challenged to identify strategies they would be willing and able to apply to reduce potential negative consequences of the risk. Slowing down and increasing following distances are key responses to many risks. </p>
<p>Other more tailored options include interacting with a phone only while stopped at traffic lights rather than when moving – albeit still teaching that <a href="https://doi.org/10.1016/j.aap.2014.10.008">this is not risk-free</a>.</p>
<h2>Time for a fresh approach</h2>
<p>Some might argue harm-reduction approaches to driver education are too risky. We know the casualties in young driver crashes are <a href="https://www.tmr.qld.gov.au/Safety/Transport-and-road-statistics/Road-safety-statistics.aspx">more often their passengers or other road users</a> rather than the young driver. However, we also know <a href="http://dx.doi.org/10.1136/injuryprev-2014-041150">road risks cluster</a> with <a href="https://doi.org/10.1016/j.jth.2021.101024">other youth risks</a> and harm reduction works to reduce negative outcomes from these other risks.</p>
<p>Current approaches <a href="https://www.aihw.gov.au/getmedia/6cef34e2-2422-4f11-a9f3-06e336edac3f/aihw-injcat-204.pdf.aspx?inline=true">are not working</a>, or at least <a href="https://doi.org/10.1136/bmj.m4614">not well enough</a>. Young drivers remain persistently over-represented in road trauma statistics, despite decades of attention. Without any evidenced-based research on harm-reduction approaches to road safety, the potential benefits as well as risks remain unknown.</p><img src="https://counter.theconversation.com/content/169371/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Teresa Senserrick does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We know young drivers will put themselves in risky situations, which is why strategies to minimise harm also need to be part of their education.Teresa Senserrick, Professor, Centre for Accident Research & Road Safety – Queensland (CARRS-Q), Queensland University of TechnologyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1705912021-10-29T14:48:47Z2021-10-29T14:48:47ZBanning large university parties won’t work — students need to be empowered to propose change<figure><img src="https://images.theconversation.com/files/428826/original/file-20211027-25-rhup2c.JPG?ixlib=rb-1.1.0&rect=18%2C0%2C6095%2C4078&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When people are in a group they are more likely to engage in aggressive and risky behaviours they may not normally do on their own. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Lars Hagberg</span></span></figcaption></figure><p>Every year instructors carefully plan what they’re going to teach during the semester. Then something significant happens that makes us pause and we have to resist the temptation to teach what was planned for the next day. </p>
<p>The perfect storm was created over the past two weekends at Queen’s University, with <a href="https://globalnews.ca/news/8322575/police-presence-heavy-during-second-queens-homecoming-weekend/">large student gatherings during homecoming that violated public health regulations</a>, saw excessive drinking, risk taking and misogynistic attitudes and behaviours displayed by some of our students. </p>
<p>Our attempts to teach what we had planned seemed irrelevant. As <a href="https://dbms.queensu.ca/faculty/klodiana-kolomitro">instructors who teach</a> <a href="https://www.researchgate.net/profile/Wendy-Craig-5">and research peer processes</a> in aggression, curriculum transformation and how to leverage curriculum to respond to local and global challenges, we felt the need to respond. </p>
<p>We had deep concerns about the behaviours and attitudes that were demonstrated, and were saddened that this didn’t reflect our experiences with the students as we know them in the classroom. That urged us to have discussions that required critical thinking and reflection about what had happened and the impact it had on the students, the university and the community.</p>
<p>What is teaching for if not to facilitate deep learning, critical thinking and personal growth in moments where we witness the values that we stand for crumble? </p>
<p>We need to have classroom conversations now, and make bold and innovative changes to identify long term solutions. What happened at Queen’s University these past two weekends can’t happen again.</p>
<h2>People behave differently in groups</h2>
<p>These gatherings are not new but there is a heightened sense of urgency to be more effective and intentional in how we address them. These conversations could start by unpacking with students <a href="https://psycnet.apa.org/doi/10.1037/h0057906">why people behave differently in groups than when they are alone</a>. </p>
<p>When people act in groups (<a href="https://ottawa.ctvnews.ca/thousands-pack-kingston-ont-university-district-for-fake-homecoming-1.5635673">like the students that gathered on the streets</a>), they are more likely to see themselves as anonymous and <a href="https://doi.org/10.1093/oxfordhb/9780199859870.001.0001">this reduces their sense of responsibility and accountability</a>. </p>
<p>When people are in a group they are more likely to engage in aggressive and risky behaviours they may not normally do on their own. This is likely because they think <a href="https://doi.org/10.1016/0092-6566(76)90088-X">they won’t be seen or will not be caught</a>. They also behave in ways that conform to the group which may or may not be consistent with their own morals and ethics. </p>
<p>In large groups, there is also a sense of diffusion of responsibility — people are less likely to take action or intervene when in the presence of a large group. All of these processes <a href="https://doi.org/10.1037/0022-3514.34.1.24">are intensified with increases in emotions, alcohol use and crowd size</a>.</p>
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<img alt="A group of students wearing purple walk down a street in London, Ont." src="https://images.theconversation.com/files/428850/original/file-20211027-20185-pyeo9d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/428850/original/file-20211027-20185-pyeo9d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/428850/original/file-20211027-20185-pyeo9d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/428850/original/file-20211027-20185-pyeo9d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/428850/original/file-20211027-20185-pyeo9d.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/428850/original/file-20211027-20185-pyeo9d.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/428850/original/file-20211027-20185-pyeo9d.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Big homecoming parties happen on university campuses across Canada with a total disregard for pandemic restrictions.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Nicole Osborne</span></span>
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<p>The teachable opportunity here is helping students understand why some may have behaved as they did and help them reconnect with their individual sense of identity and values. By shifting the attitudes and behaviours of the majority we can begin to shift the culture.</p>
<p>This requires working together to enhance students’ understanding of their behaviour, help them take responsibility, make amends and have discussions about how they can obtain their goals for connectedness and celebration in a safe and positive way. </p>
<h2>A harm-reduction approach</h2>
<p>The way forward likely involves a <a href="https://harmreduction.org/about-us/principles-of-harm-reduction/">harm-reduction approach</a>. Students will party. A harm reduction approach recognizes this need for young people to gather and socialize but sets up environmental conditions to ensure that it is done with minimal risk. </p>
<p>In this case, it would focus on bringing students together safely in a way that minimizes health and social harms rather than condemning or ignoring them. We need to continue to create safe environments for students on campus where we can manage alcohol consumption and behaviour while still promoting coming together and celebrating — be it homecoming or other important events. </p>
<p>We also need to empower students to stand up. Bystanders play a critical role — by <a href="https://doi.org/10.13189/ujer.2013.010201">being present they are reinforcing the behaviour and inadvertently supporting it</a>. There were students during the homecoming events who had the courage to stand up, intervene and take action. Those are the people we need to empower, the stories we need to tell and the messages we need to amplify. </p>
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<h2>Getting students involved</h2>
<p>Conversations are a good start, but a systemic approach that integrates understanding of these events and taking action through curriculum is essential. </p>
<p>One of these strategies could be creating a university credit based multidisciplinary course that is aimed at proposing solutions for how students could gather and celebrate in a safe — including COVID-19 safe — manner that reflects their own, and community values.</p>
<p>The students would learn (among many things) how to address <a href="https://ethicsunwrapped.utexas.edu/glossary/diffusion-of-responsibility">diffusion of responsibility</a> and <a href="https://gsdrc.org/document-library/addressing-gender-based-violence-a-critical-review-of-interventions/">gender-based violence</a>. It would provide them with opportunities to learn about city bylaws, police costs and potential <a href="https://doi.org/10.1001/jamahealthforum.2020.0839">challenges to the health care system</a> of large student gatherings. </p>
<p>The instructors could be an advisory team of mentors including members from the city, police, first responders and university experts. This initiative would challenge students to research the problem and be an active part of the solution. </p>
<p>Co-creating solutions with students by providing them with opportunities to lead with support and guidance <a href="https://doi.org/10.1177/2047173415597142">will empower them to take ownership and responsibility</a> when it comes to implementing positive change. If they lead the new way forward, students will come and be together in a way that meets their needs.</p>
<p>The behaviours are concerning, but they do in a way reflect large social problems and our ongoing need as humans to be respectful and equitable. As events like this continue to happen, they take on new meaning and heightened urgency. During times like these we need to hold ourselves accountable, engage in courageous conversations, embrace student leadership and make bold curriculum changes.</p><img src="https://counter.theconversation.com/content/170591/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Wendy Craig receives funding from Public Health Agency of Canada. She is the Scientific Director of PREVNet,</span></em></p><p class="fine-print"><em><span>Klodiana Kolomitro does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To make sure what happened at Queen’s University during homecoming weekends doesn’t happen again, we need to have classroom conversations now, and make bold and innovative changes to identify long-term solutions.Wendy Craig, Professor of Psychology, Queen's University, OntarioKlodiana Kolomitro, Associate Vice-Principal (Teaching and Learning), Queen's University, OntarioLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1700072021-10-21T19:16:44Z2021-10-21T19:16:44ZForgotten how to party? Safety tips from a drug and alcohol expert<figure><img src="https://images.theconversation.com/files/427412/original/file-20211020-20-smslqk.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/fun-disco-559484653">Shutterstock</a></span></figcaption></figure><p>Cancelled dance parties, festivals and other events have shaped how Australians use alcohol and other drugs during the pandemic.</p>
<p>Now restrictions are easing, some people who have not used alcohol or other drugs recently may start to use them again, and need to be aware of their reduced tolerance.</p>
<p>Here’s what <a href="https://ndarc.med.unsw.edu.au/program/drug-trends">survey data</a> released today by the National Drug and Alcohol Research Centre, tell us about drug use and drug markets during the pandemic.</p>
<p>And here’s what to think about if your drug use during the pandemic has changed, and you’re about to head off to a party.</p>
<h2>Cocaine up, ecstasy down, alcohol stable</h2>
<p>Of the two yearly surveys released today, one relates to people who inject drugs such as heroin. The other relates to people who use ecstasy and other party drugs, who typically use drugs occasionally.</p>
<p>The group using ecstasy and other party drugs showed significant changes in drug use between 2020 and 2021. This variability is probably because this group tends to use in specific contexts and is more strongly influenced by access and opportunity.</p>
<p>More people used cocaine in 2021 than in 2020, continuing the upward trend in recent years. We don’t know why cocaine use has been increasing. But the frequency of cocaine use was very low at just a few days in the past six months. </p>
<p>Cocaine purity in Australia tends to be fairly low and has been <a href="https://www.acic.gov.au/sites/default/files/2020-09/Illicit%20Drug%20Data%20Report%202018-19_Internals_V10_Cocaine%20CH.pdf">decreasing</a>. So, although other data also show that cocaine has increased in popularity in the past few years, we haven’t seen a big increase in harms. </p>
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Read more:
<a href="https://theconversation.com/weekly-dose-cocaine-the-glamour-drug-of-the-70s-is-making-a-comeback-88639">Weekly Dose: cocaine, the glamour drug of the ’70s, is making a comeback</a>
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<p>Fewer people used ecstasy in 2021; the frequency of use also decreased (from 12 days in the past six months in 2020 to seven days in 2021).</p>
<p>But this was not just because of closed venues or cancelled events. People surveyed said it was also harder to get. The closed international border has restricted importation of ecstasy and the chemicals used to make it. In the past year, ecstasy purity has reportedly decreased and the price increased.</p>
<p>More people said they used “magic mushrooms”, <a href="https://theconversation.com/weekly-dose-anaesthetic-and-recreational-drug-ketamine-could-be-used-to-treat-depression-81468">ketamine</a>, and non-prescribed pharmaceutical stimulants such as <a href="https://www.healthdirect.gov.au/medicines/brand/amt,30571011000036106/dexamphetamine-sulfate-sigma">dexamphetamine</a> and <a href="https://www.healthdirect.gov.au/medicines/brand/amt,17251000168101/ritalin">methylphenidate</a>. The frequency of use of these drugs was very low at just a few days in the past six months.</p>
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Read more:
<a href="https://theconversation.com/weekly-dose-anaesthetic-and-recreational-drug-ketamine-could-be-used-to-treat-depression-81468">Weekly Dose: anaesthetic and recreational drug ketamine could be used to treat depression</a>
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<p>The rate of alcohol use was stable. This is in line with <a href="https://www.aihw.gov.au/reports/alcohol/alcohol-tobacco-other-drugs-australia/contents/impact-of-covid-19-on-alcohol-and-other-drug-use">other data</a> showing that, although alcohol use may have increased slightly in the early months of the pandemic, it stabilised after that. Spending on takeaway alcohol at bottle shops increased, but the opportunities to drink at pubs, bars and restaurants decreased.</p>
<p>The surveys are not intended to represent all people who use drugs, so should be interpreted alongside other sources.</p>
<h2>What might happen as restrictions ease?</h2>
<p>As festivals and dance parties start up again, some people may start to use these drugs again.</p>
<p>When you use a drug, including alcohol, regularly, your body gets used to having it in your system and you need to use more to get the same effect. This is known as “<a href="https://www1.health.gov.au/internet/publications/publishing.nsf/Content/drugtreat-pubs-front6-fa-toc%7Edrugtreat-pubs-front6-fa-secb%7Edrugtreat-pubs-front6-fa-secb-8%7Edrugtreat-pubs-front6-fa-secb-8-2">tolerance</a>”.</p>
<p>If you haven’t used a drug for a while, your tolerance may have decreased. You’ll need less to get the same effect. So if you start using the same amount as before you might unintentionally use too much and experience unwanted side effects, including overdose.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427416/original/file-20211020-23-yoiztt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Person at home holding small bag containing white powder" src="https://images.theconversation.com/files/427416/original/file-20211020-23-yoiztt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427416/original/file-20211020-23-yoiztt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427416/original/file-20211020-23-yoiztt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427416/original/file-20211020-23-yoiztt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427416/original/file-20211020-23-yoiztt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427416/original/file-20211020-23-yoiztt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427416/original/file-20211020-23-yoiztt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Taking a drug at home can be very different to taking it while dancing all night at a club.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/drug-addict-dealer-closing-bag-cocaine-1019419879">Shutterstock</a></span>
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<p>If you have increased use during the pandemic, your tolerance may have increased, so the effects at your usual dose may be reduced. This can also lead to unintentional overdose because, although you don’t feel the effects, the drug may still be toxic at high enough doses.</p>
<p>The setting you use a drug in also changes the effects you might feel. So if you have been using ecstasy quietly at home during the pandemic you’ll have different effects to using it while dancing all night.</p>
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<strong>
Read more:
<a href="https://theconversation.com/how-does-mdma-kill-109506">How does MDMA kill?</a>
</strong>
</em>
</p>
<hr>
<h2>What can you do to use more safely?</h2>
<p>With changes in the market, the strength and purity of illicit drugs you used before the pandemic might also be different to those you have access to now.</p>
<p>If you can have your drugs checked to see what’s in them you can decide whether to still take them or not. The ACT government has announced funding for a <a href="https://www.canberratimes.com.au/story/6888821/pill-testing-site-could-be-coming-to-the-city-this-summer/">trial of a drug checking service</a>. New Zealand passed interim legislation to <a href="https://theconversation.com/after-the-last-summer-of-terrible-drugs-its-time-to-make-nzs-temporary-drug-checking-law-permanent-165612">make drug checking legal</a> last year. It’s due to finalise the full legislation at the end of this year to <a href="https://www.loc.gov/item/global-legal-monitor/2021-04-14/new-zealand-government-indicates-that-drug-checking-law-will-be-made-permanent/">make it permanent</a>.</p>
<p>If you don’t have access to a drug checking service, you should be extra cautious the first few times you use a drug again after a break:</p>
<ul>
<li><p><strong>“<a href="https://wearetheloop.org/crush-dab-wait">crush/dab/wait</a>”</strong>: take a quarter of a pill or a dab of powder at first then wait an hour or two to see the effects. You can always take more if wanted, but you can’t get it out of your system if you take too much</p></li>
<li><p><strong>avoid mixing drugs</strong>: the more drugs you take at the same time the more likely you are to have problems, like overdose. Some drugs reduce your ability to feel the effects of other drugs. For example stimulants can mask the effects of alcohol, then you can drink too much</p></li>
<li><p><strong>check what’s circulating</strong>: the <a href="https://www.health.nsw.gov.au/aod/public-drug-alerts/Pages/default.aspx">New South Wales</a> and <a href="https://www2.health.vic.gov.au/alcohol-and-drugs/drug-alerts">Victorian</a> governments regularly release alerts to the public about contaminants found in seized drugs or from hospital data. Other states also sometimes release alerts.</p></li>
</ul>
<p>Tolerance also applies to legal drugs like alcohol. If you’ve been drinking more during lockdown, your tolerance might have increased and you might drink more than you intended. You might not feel drunk, but your brain function may still be affected and you can still be over the legal limit for driving.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/427418/original/file-20211020-21-1rg745s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man drinking beer about to grab car keys, friend holding back arm" src="https://images.theconversation.com/files/427418/original/file-20211020-21-1rg745s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/427418/original/file-20211020-21-1rg745s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/427418/original/file-20211020-21-1rg745s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/427418/original/file-20211020-21-1rg745s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/427418/original/file-20211020-21-1rg745s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/427418/original/file-20211020-21-1rg745s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/427418/original/file-20211020-21-1rg745s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">If you’ve been drinking more in lockdown, you might feel OK but be impaired and still be over the limit.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/do-not-drink-drive-cropped-image-572252890">Shutterstock</a></span>
</figcaption>
</figure>
<p>If you have been drinking less, your tolerance may have decreased so a smaller amount of alcohol will affect you more than normal. So, if you drink the same amount as you did before the pandemic you might get drunk more quickly.</p>
<p>Start slowly, monitor the number of drinks you have and pay attention to how drunk you are feeling.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/getting-back-on-the-beers-after-lockdown-heres-what-you-should-know-140454">Getting back on the beers after lockdown? Here's what you should know</a>
</strong>
</em>
</p>
<hr>
<h2>How to get help</h2>
<p>If you’re worried about your own or someone else’s use of alcohol or other drugs call the National Alcohol and other Drug Hotline on 1800 250 015, free from anywhere in Australia.</p>
<p>If you want support to manage your drinking, <a href="https://hellosundaymorning.org/">Hello Sunday Morning</a> offers a free online support community where you can connect and chat with others who are actively changing their alcohol use.</p>
<p>You can also chat online with a counsellor at <a href="https://www.counsellingonline.org.au/">Alcohol & Drug Counselling Online</a>, join an online support group at <a href="https://smartrecoveryaustralia.com.au/">SMART Recovery</a> or talk to your GP about seeing a psychologist. You may be able to access support via <a href="https://www.digitalhealth.gov.au/initiatives-and-programs/telehealth">telehealth</a>.</p><img src="https://counter.theconversation.com/content/170007/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicole Lee works as a consultant in the alcohol and other drug sector and a psychologist in private practice. She has previously been awarded funding by Australian and state governments, NHMRC and other bodies for evaluation and research into drug prevention and treatment. She is a member of the Australian National Advisory Council on Alcohol and other Drugs and the board of directors of Hello Sunday Morning and The Loop Australia.</span></em></p>Now restrictions are easing, some people who have not used alcohol or other drugs recently may start to use them again, and need to be aware of their reduced tolerance.Nicole Lee, Professor at the National Drug Research Institute (Melbourne), Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1695302021-10-14T19:10:12Z2021-10-14T19:10:12ZSex, drugs and TikTok: keeping young people safe needs a mature response, not a moral panic<p>You may have <a href="https://www.wsj.com/articles/tiktok-algorithm-sex-drugs-minors-11631052944">read recently</a> that TikTok allegedly “serves up” sex and drug videos to minors. Media reports have described the video-sharing platform, which is <a href="https://theconversation.com/most-adults-have-never-heard-of-tiktok-thats-by-design-119815">designed predominantly for young people</a>, as an “addiction machine” that promotes harmful content.</p>
<p>In an investigation, reporters at the Wall Street Journal created 31 bot accounts on TikTok, each programmed to interact only with particular themes of content. Many of the bots were registered as being aged 13-15, including one programmed with an interest in “drugs and drug use”, which was ultimately shown 569 videos related to drugs. </p>
<p>The investigation sought to better understand how the app’s algorithm selects videos for users. The workings of these kinds of algorithms are an industry secret, but much has been made of the app’s apparent ability to “know” what users want to see, and whether content creators can <a href="https://dl.acm.org/doi/abs/10.1145/3447535.3462512">game the system</a> and garner more views.</p>
<p>The article concluded that TikTok’s algorithm actively “serves up” drug content to minors, who “may lack the capability to stop watching and don’t have supportive adults around them” to help moderate their opinions. But is this a reasonable conclusion, and if so, should parents be concerned about drug content on TikTok?</p>
<p>The Wall Street Journal article doesn’t provide enough detail to allow us to evaluate the rigour of its methods and the validity of its conclusions. However, there are reasons to suspect the methodology is inherently flawed.</p>
<p>One problem is that a bot designed to engage only with content related to a specific set of interests is not a very realistic model of a typical social media user. Real humans do not have a set list of interests outside which they never stray – they have a diverse range of interests and curiosities.</p>
<h2>Moral panic</h2>
<p>Anxiety and moral panic around technologies popular with young people is nothing new. Fears about the harmful effects of social media have been around for at least a quarter of a century, since the advent of <a href="http://firstmonday.org/ojs/index.php/fm/article/view/2152">MySpace</a> and even earlier platforms in the 1990s. </p>
<p>In turn, these fears about harms to children help fuel calls for greater <a href="https://journals.sagepub.com/doi/full/10.1177/1367877920912257">surveillance and censorship</a>. Several countries such as <a href="https://www.bbc.com/news/technology-53225720">India</a>, <a href="https://www.hindustantimes.com/world-news/pakistan-bans-tiktok-for-4th-time-for-inappropriate-content-101626853759583.html">Pakistan</a> and <a href="https://www.theguardian.com/technology/2020/sep/29/trump-tiktok-wechat-china-us-explainer">the United States</a> have temporarily banned TikTok or considered doing so. Parents have been encouraged to stop their children using it, and the app has been urged to censor drug content entirely.</p>
<p>TikTok offers the perfect recipe for a technopanic. The mysterious workings of its algorithm, and the unprompted nature in which users are served videos in their “For You” feed, has driven fears about the circulation of improper content that facilitates <a href="https://theconversation.com/anorexia-coach-sexual-predators-online-are-targeting-teens-wanting-to-lose-weight-platforms-are-looking-the-other-way-162938">sexual grooming or disordered eating</a>. This is exacerbated by the fact the platform is <a href="https://theconversation.com/most-adults-have-never-heard-of-tiktok-thats-by-design-119815">explicitly designed</a> to attract a young user base.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/most-adults-have-never-heard-of-tiktok-thats-by-design-119815">Most adults have never heard of TikTok. That's by design</a>
</strong>
</em>
</p>
<hr>
<p>Young people, despite being “digital natives” and highly adept at using technology, are often seen as lacking impulse control and being vulnerable to dangerous influences. Yet their voices are largely left out of these conversations. Despite their expertise in navigating these platforms, young people are spoken about, rather than spoken to.</p>
<p>Instead of assuming young people are inherently deficient in their judgement, taking their experiences and expertise seriously could uncover new ways of looking at old problems. One of this article’s authors (Isabelle Volpe) is investigating this in her ongoing PhD research.</p>
<h2>Drug content on social media</h2>
<p>Another problem with the framing of these moral concerns is that not all drug-related content on TikTok necessarily condones drug use. TikTok provides a forum for all sorts of content creators, some of whom openly use drugs and some of whom talk about drug use, its potential harms and risks.</p>
<p>While traditional <a href="https://doi.org/10.1177/0091450917722817">media coverage</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/24882707/">drug education</a> typically focuses on criminality, addiction or distress, these framings often do not resonate with young people, which can lead to intended messages <a href="https://www.tandfonline.com/doi/abs/10.1080/10345329.2011.12035916">not being taken seriously</a>. In comparison, social media platforms give exposure to a wider range of perspectives on drug use.</p>
<p>Some content creators talk about recovery from addiction (including <a href="https://www.tiktok.com/@addictionrecovery?">health professionals</a> describing their work, and people giving <a href="https://www.tiktok.com/@cleanandserene?">first-hand accounts</a>), while some give advice aimed at <a href="https://www.tiktok.com/@harmreductionservices?">reducing potential harms</a> to people who take drugs. </p>
<p>It’s also undeniably true that some creators give accounts of the pleasures of recreational drug use. Drug use is complex, and appraising drug content on TikTok involves painting a complex picture.</p>
<figure class="align-center ">
<img alt="Hand holding a joint" src="https://images.theconversation.com/files/426347/original/file-20211014-26-10zi8b0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/426347/original/file-20211014-26-10zi8b0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=750&fit=crop&dpr=1 600w, https://images.theconversation.com/files/426347/original/file-20211014-26-10zi8b0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=750&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/426347/original/file-20211014-26-10zi8b0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=750&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/426347/original/file-20211014-26-10zi8b0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=943&fit=crop&dpr=1 754w, https://images.theconversation.com/files/426347/original/file-20211014-26-10zi8b0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=943&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/426347/original/file-20211014-26-10zi8b0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=943&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">While some TikTok content creators advocate drug use, others offer constructive health advice.</span>
<span class="attribution"><span class="source">Gras Grun/Unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<h2>What should we do about drugs and TikTok?</h2>
<p>It’s understandable parents might view TikTok as a dangerous place. But it’s important to remember any social media platform can feature drug-related content. Parents and carers can help young people navigate these spaces by having <a href="https://adf.org.au/talking-about-drugs/parenting/talking-young-people/">open and honest conversations about drugs</a>, so young people feel safe and confident to raise any questions or worries about anything they see online.</p>
<p>TikTok also offers an opportunity to deliver evidence-based health information to people who use drugs or are considering doing so. These audiences are often considered “hard to reach”, partly because of the social stigma of seeking out information about drugs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tiktok-can-be-good-for-your-kids-if-you-follow-a-few-tips-to-stay-safe-144002">TikTok can be good for your kids if you follow a few tips to stay safe</a>
</strong>
</em>
</p>
<hr>
<p>An algorithm that can identify people who may benefit from evidence-based information about drugs, and deliver it to them without them explicitly asking for it, could be a powerful tool for public health. Health professionals are <a href="https://ijoc.org/index.php/ijoc/article/view/16900/3498">already using TikTok</a> as a new and engaging way to share public health messaging, and TikTok has already introduced “fact-checking” content warnings to <a href="https://www.tiktok.com/safety/en-us/covid-19/">combat COVID-related misinformation</a>. </p>
<p>A similar approach could be applied to drug-related content, perhaps directing users to reliable health information. There is no quick fix for the complex problem of misinformation; we have to use a range of strategies to offer reliable information to those who need it.</p>
<p>Banning all drug content from TikTok might be a case of throwing the baby out with the bathwater, by also removing content focused on health information and harm reduction. If we are serious about protecting young people online, we need to be driven by evidence, not fear.</p><img src="https://counter.theconversation.com/content/169530/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Isabelle Volpe receives funding from the National Centre for Clinical Research into Emerging Drugs. Her PhD research is funded by the Australian Government and UNSW Arts, Design & Architecture. She is affiliated with not-for-profit organisations The Loop Australia and Students for Sensible Drug Policy.</span></em></p><p class="fine-print"><em><span>Clare Southerton does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Fears that TikTok is “serving up” drug content to impressionable users have prompted calls for all drug content to be censored on the platform. But that would remove useful health advice too.Isabelle Volpe, PhD Candidate, Drug Policy Modelling Program, UNSW SydneyClare Southerton, Postdoctoral Fellow, Vitalities Lab, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1624972021-06-28T19:24:38Z2021-06-28T19:24:38ZDecriminalizing drug use is a necessary step, but it won’t end the opioid overdose crisis<figure><img src="https://images.theconversation.com/files/408451/original/file-20210625-26-1kcq5n5.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C4673%2C3113&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Advocating for decriminalization carries many benefits, including reducing the need for police involvement.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Media, policy-makers, advocates and the public claim that decriminalization will make <a href="https://thetyee.ca/News/2021/05/12/Vancouver-Drug-Decriminalization-Plan-Disaster/">drug use safer</a> and <a href="https://vancouversun.com/opinion/donald-macpherson-federal-government-must-decriminalize-drugs-to-save-lives-and-protect-communities">save lives</a>. But can it?</p>
<p>Decriminalization has been somewhat of a policy buzzword in recent years, with <a href="https://www.theglobeandmail.com/topics/decriminalization/">ample media coverage</a>. It comes with both <a href="https://angusreid.org/opioid-crisis-covid/">public</a> and <a href="https://news.gov.bc.ca/releases/2021MMHA0017-000706">government</a> support.</p>
<p>A 2020 survey of more than 5,000 Canadians showed that <a href="https://angusreid.org/opioid-crisis-covid/">the majority (59 per cent) favour the decriminalization of drugs</a>. The <a href="https://www.cacp.ca/index.html?asst_id=2189">Canadian Association of Chiefs of Police</a> has also publicly supported decriminalization, along with British Columbia’s <a href="https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/reports-publications/special-reports/stopping-the-harm-report.pdf">chief public health officer</a>. </p>
<p>Such support has also come with action. This year, the City of Vancouver submitted an application to Health Canada for an exemption from Canada’s Controlled Drugs and Substances Act — a policy reform referred to as <a href="https://vancouver.ca/people-programs/decriminalizing-simple-possession-of-illicit-drugs-in-vancouver.aspx">the Vancouver Model of decriminalization</a>.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/cKwh_Db8SQE?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Vancouver activists work toward decriminalization.</span></figcaption>
</figure>
<h2>An alternative response</h2>
<p>In the simplest terms, decriminalization is an alternative response to criminal penalties for simple possession. The most recent data shows there were over <a href="https://www150.statcan.gc.ca/n1/pub/85-002-x/2020001/article/00010/tbl/tbl03-eng.htm">48,000 drug-related offences</a> in Canada in 2019, most of which were for possession for personal use. </p>
<p>The criminalization of drugs results in significant <a href="https://www.toronto.ca/wp-content/uploads/2018/05/9888-Harms-Associated-with-Drug-Laws.pdf">health, social and economic harms</a>, particularly to those who are homeless, experiencing mental health issues, racialized or Indigenous. By eliminating a criminalized response to drug possession, drug policy reform efforts can minimize the contact between people who use drugs and the criminal justice system, and may increase their <a href="https://doi.org/10.1177/1477370819887514">connection to health and social systems</a>.</p>
<p>However, alongside recognition of the ineffectiveness of criminalization and support for an alternative model, we need to be realistic with our expectations of what decriminalization can do. </p>
<h2>Decriminalization versus regulation</h2>
<p>Decriminalization does not mean that people can buy cocaine and heroin at the store as they would alcohol and tobacco. Only legal regulation can do that. Legal regulation, which <a href="https://gettingtotomorrow.ca/2020/03/10/considering-alternative-drug-policies-decriminalization-legal-regulation/">drug policy advocates endorse </a>, includes rules to control who can access what drug and when, as opposed to a free market or full legalization. </p>
<p>An example of legalization is Canada’s <em><a href="https://laws-lois.justice.gc.ca/eng/acts/C-24.5/">Cannabis Act</a></em>, which provides a legal framework to control the production, sale and possession of cannabis. </p>
<p>Unlike legal frameworks applied to the supply of drugs, decriminalization does not promote a “safer supply” of drugs. The overdose crisis is driven by an unpredictable, illegal drug supply that is <a href="https://ccsa.ca/sites/default/files/2020-05/CCSA-CCENDU-Adulterants-Contaminants-Co-occurring-Substances-in-Drugs-Canada-Bulletin-2020-en_0.pdf">marked with adulterants, contaminants and other substances</a>. Decriminalization won’t directly impact this supply of drugs, they will continue to be made in unregulated ways and places. </p>
<p>The illegal drug market will continue to be criminalized, unpredictable and precarious, and people will continue to be unsure of what’s in their drugs (in lieu of better <a href="https://doi.org/10.1016/j.drugpo.2018.10.001">drug checking services</a> or how potent they are. Under a decriminalized model, the overdose risk will inevitably remain high.</p>
<p>That said, decriminalization is still a necessary step in addressing the crisis.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/408429/original/file-20210625-23-1srr56v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman holds a sign during a protest reading FOR DECRIM TO WORK WE NEED A SAFE SUPPLY" src="https://images.theconversation.com/files/408429/original/file-20210625-23-1srr56v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/408429/original/file-20210625-23-1srr56v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=405&fit=crop&dpr=1 600w, https://images.theconversation.com/files/408429/original/file-20210625-23-1srr56v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=405&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/408429/original/file-20210625-23-1srr56v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=405&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/408429/original/file-20210625-23-1srr56v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=509&fit=crop&dpr=1 754w, https://images.theconversation.com/files/408429/original/file-20210625-23-1srr56v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=509&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/408429/original/file-20210625-23-1srr56v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=509&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Advocates are calling on the federal government and the City of Vancouver to halt the march toward possible drug decriminalization in the city, saying that addressing the drug supply is also crucial.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<h2>The benefits of decriminalization</h2>
<p><strong>Decriminalization changes the way we think about drugs.</strong>
Drug use will no longer be treated as a criminal issue, but instead a <a href="https://doi.org/10.1016/j.amepre.2019.08.012">health and social one</a>. This means that instead of addressing drugs through handcuffs, the focus will be on the root causes of drug use, including inequities rooted in housing and health care.</p>
<p><strong>Decriminalization saves governments money.</strong>
A large proportion of the justice system — police, courts, prisons — are occupied with <a href="https://www150.statcan.gc.ca/n1/pub/85-002-x/2020001/article/00010-eng.htm">drug-related crimes</a>. As seen in <a href="https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight">other decriminalized jurisdictions such as Portugal</a>, it can reduce the demands and costs to this system. </p>
<p>Considering the demonstrated need for addiction and mental health resources, the money saved could be well spent elsewhere, such as community-led responses, health care, housing and social programs.</p>
<p><strong>Decriminalization positively impacts people’s lives.</strong>
Especially for those targeted by drug law enforcement, namely poor, homeless and racialized people who use drugs, decriminalization can have a <a href="https://www.tni.org/files/publication-downloads/a_quiet_revolution_march_31_2016.pdf">positive impact</a>. </p>
<p>For example, eliminating <a href="https://scholar.harvard.edu/pager/publications/mark-criminal-record">criminal records</a> related to drug possession offences promotes opportunities for people to access employment and housing. Interactions between people who use drugs and police can also be reduced or, better yet, won’t happen at all.</p>
<p><strong>Decriminalization reduces stigma.</strong>
Negative views towards drugs and people who use them is a <a href="https://journalofethics.ama-assn.org/article/how-structural-violence-prohibition-and-stigma-have-paralyzed-north-american-responses-opioid/2020-08">major factor in the overdose crisis</a>. By reshaping the way our family, friends and the medical profession think about drugs, drug use can be talked about more openly and honestly. </p>
<p>Reducing stigma can also encourage people who use drugs to talk to their doctors about prescription-based therapies. At the very least, it will help bring drug use out from isolation, <a href="https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicitdrugoverdosedeathsinbc-findingsofcoronersinvestigations-final.pdf">where fatal overdoses tend to be the highest</a>.</p>
<p><strong>Decriminalization encourages people to call 911 at the scene of an overdose.</strong>
Fear of police is currently a barrier to this. Although people cannot be charged with simple possession at the scene of a drug overdose under <a href="https://www.canada.ca/en/health-canada/services/opioids/about-good-samaritan-drug-overdose-act.html">drug-related Good Samaritan laws</a>, fear of the police is still a <a href="https://doi.org/10.1016/j.drugpo.2020.103039">deterrent</a>. Legislation that decriminalizes drug possession can reassure people that they will not face criminal penalties. And police will no longer need to respond to calls about overdoses.</p>
<p><strong>Decriminalization is harm reduction.</strong>
Although some people fear that decriminalization may increase or encourage drug use, this concern is simply not supported by evidence. We know from dozens of countries, states and cities that have decriminalized drugs that <a href="https://doi.org/10.1093/bjc/azq038">use does not significantly increase</a>. In some places, <a href="https://www.tni.org/files/publication-downloads/a_quiet_revolution_march_31_2016.pdf">it has actually decreased</a>. </p>
<p>Decriminalization also lowers overdose and disease rates, while increasing people’s access to social services and health care. In this way, a decriminalization model is a basic <a href="https://journals.mcmaster.ca/ghar/article/view/2319">harm reduction</a> approach, mitigating the harms experienced by people who use drugs by eliminating or minimizing the source of those harms: criminalization. </p>
<h2>A critical step</h2>
<p>Overall, the notion of decriminalization is not a panacea or a standalone solution to the harms of drug prohibition — but it is a critical step in the right direction. It will have a positive impact on the lives of so many people who are harmed daily from criminalization.</p>
<p>However, in recognizing the <a href="https://doi.org/10.1177/07067437211019656">limitations of decriminalization models</a>, governments and other stakeholders can refocus efforts on what does directly impact the overdose crisis: a safer supply. Decriminalization must be paired with greater access to safer pharmaceutical alternatives to the toxic and illegal drug market. </p>
<p>That’s what will save lives.</p>
<p><em>Caitlin Shane, staff lawyer at Pivot Legal Society, co-authored this article.</em></p><img src="https://counter.theconversation.com/content/162497/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alissa Greer receives funding from Simon Fraser University and the Social Sciences and Humanities Research Council. Dr. Greer is an assistant professor in the School of Criminology at Simon Fraser University, a research affiliate at the Canadian Institute for Substance Use Research, and a senior associate at Bunyaad Public Affairs.</span></em></p>Decriminalization is an important step in addressing the overdose crisis, but it is crucial that other approaches — like regulation — are also in place.Alissa Greer, Assistant Professor in the School of Criminology, Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1573122021-03-18T12:19:55Z2021-03-18T12:19:55Z4 steps to reaching Biden’s goal of a July 4th with much greater freedom from COVID-19<figure><img src="https://images.theconversation.com/files/390193/original/file-20210317-19-1xl7yiz.jpg?ixlib=rb-1.1.0&rect=8%2C33%2C5551%2C3667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Holiday gatherings with family and friends before the pandemic seemed so simple.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/group-of-young-adult-friends-dining-al-fresco-on-a-royalty-free-image/1007278168">FatCamera via Getty Images</a></span></figcaption></figure><p>President Joe Biden <a href="https://www.nytimes.com/live/2021/03/11/us/joe-biden-news">set a goal</a> for the U.S. to have COVID-19 under enough control by summer that Americans can celebrate July 4th with family and friends, at least in small gatherings. Important in achieving this goal is another presidential request: that all U.S. adults be made eligible for <a href="https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/covid-19-vaccines">COVID-19 vaccinations</a> by May 1.</p>
<p>We are <a href="https://scholar.google.com/citations?user=ZxSqdKsAAAAJ&hl=en">public</a> <a href="https://scholar.google.com/citations?user=k5_VseQAAAAJ&hl=en">health</a> <a href="https://nyuscholars.nyu.edu/en/persons/cheryl-healton">deans</a> who lead a variety of COVID-19 response efforts and are involved in public policy discussions. At a time when the nation is weary of hearing “no, you can’t,” we believe that <a href="http://doi.org/10.1001/jamahealthforum.2020.0656">thinking</a> <a href="https://doi.org/10.1007/s10461-014-0789-9">in terms of</a> <a href="https://prevention.nih.gov/about-odp/directors-messages/2020/qa-dr-julia-marcus-2020-odp-early-stage-investigator-lecture-awardee">harm reduction</a> – offering safer but not necessarily risk-free alternatives – is <a href="https://blogs.bmj.com/bmj/2020/12/15/harm-reduction-principles-can-help-us-restore-trust-in-public-health-messaging-on-covid-19/">crucial</a>. </p>
<p>Harm reduction strategies are in use <a href="http://doi.org/10.1056/NEJMp1711991">all around you</a>. Seat belts and air bags are perhaps the most widespread harm reduction strategy for a <a href="https://www.cdc.gov/injury/features/global-road-safety/index.html">leading cause of death in the U.S.</a> Designated driver programs represent a harm reduction technique to reduce alcohol-related traffic fatalities. Another well-known example is the use of <a href="https://www.cdc.gov/ssp/syringe-services-programs-factsheet.html">sterile syringe exchange services</a> to help prevent HIV infection among people who inject drugs while also creating an important pathway for them to access client-centered medical and social services. </p>
<p>Central to harm reduction strategies is meeting someone <a href="https://harmreduction.org/about-us/principles-of-harm-reduction/">where they are</a>, without judgment, yet with support and practical pathways for improving health and wellness. It’s <a href="http://doi.org/10.1007/s10461-020-03006-w">relevant today</a>. </p>
<p>Here are four steps we believe are necessary to achieve the president’s Independence Day goal and a major national population health milestone. </p>
<h2>Get the vaccine and help others get vaccinated</h2>
<p><a href="https://www.euro.who.int/en/health-topics/communicable-diseases/hivaids/policy/policy-guidance-for-areas-of-intervention/harm-reduction">Vaccination is a classic harm reduction measure</a> – it may not eliminate risk, but it vastly reduces it.</p>
<p>People can both commit to getting the <a href="https://www.cdc.gov/vaccines/covid-19/index.html">vaccine</a> and to assisting others in the community to get vaccinated. They can volunteer at vaccination events via the <a href="https://mrc.hhs.gov/HomePage">Medical Reserve Corps</a>. Family members can help each other monitor for available vaccine time slots and navigate the sometimes <a href="https://www.nytimes.com/2021/03/12/technology/vaccine-sites-technology-problems-covid.html">challenging systems to get appointments</a>. Businesses and governmental agencies can allow employees <a href="https://www.nbcnewyork.com/news/coronavirus/new-york-gets-vaccine-boost-to-fight-inequity-cvs-adds-more-hubs/2939938/">paid time off</a> to get vaccinated. <a href="https://www.cdc.gov/coronavirus/2019-ncov/communication/toolkits/community-faith-based.html">Faith communities</a> can also encourage people to get vaccinated and provide welcoming sites for doing so.</p>
<p>Role models can make a difference, too. Recently, <a href="https://www.cnn.com/2021/03/11/politics/former-presidents-vaccine-psa/index.html">four former presidents and first ladies</a> got their vaccine injections on camera and implored U.S. residents to do the same. On March 16, former President <a href="https://www.cnn.com/2021/03/16/politics/donald-trump-covid-19-vaccine/index.html">Donald Trump also urged people to get the vaccine</a> in an interview on Fox. We consider this important at a time when <a href="https://thehill.com/policy/healthcare/542814-49-percent-of-gop-men-say-they-wont-get-vaccinated-pbs-poll">nearly half of Republican men</a> say they will not get vaccinated, according to a PBS News Hour/NPR/Marist poll.</p>
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<p>A wide variety of outreach efforts <a href="https://www.nber.org/papers/w25589">for vaccinations</a> are <a href="https://www.nytimes.com/2021/02/07/opinion/covid-black-americans.html">needed to speak to communities</a> with <a href="https://thehill.com/policy/healthcare/542814-49-percent-of-gop-men-say-they-wont-get-vaccinated-pbs-poll">differing outlooks on the pandemic</a>, <a href="http://doi.org/10.1056/NEJMms2025396">differing historical experiences with the medical system</a>, and different experiences in getting access to COVID-19 vaccines. Vaccine delivery strategies must directly address the <a href="https://cph.osu.edu/sites/default/files/docs/covid19inequities/1-Full%20Report.pdf">disparities in racial and ethnic minority communities</a> that are most heavily affected by <a href="http://doi.org/10.1016/j.annepidem.2020.06.010">COVID-related illness</a> but are <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-race-ethnicity/">not being vaccinated at a similar rate</a>.</p>
<p>Above all, vaccines need to be distributed in the communities where people live, with rollouts aided by <a href="https://cph.osu.edu/sites/default/files/docs/covid19inequities/1-Full%20Report.pdf">trusted systems and community partners</a>.</p>
<p>To quickly reach “<a href="https://khn.org/morning-breakout/herd-immunity-are-we-there-yet-sorry-not-even-close/">herd immunity</a>” – when enough people are immune to the virus through vaccination or infection to substantially disrupt viral transmission – the vast majority of Americans, communities and organizations will need to be engaged in these strategies.</p>
<h2>Wear a mask and keep up social distancing</h2>
<p>Think of masks in a context of opening up social activity, not locking down activity. Everyone needs to commit to continuing to wear a mask, practice physical distancing and keep hands sanitized for just a little while longer.</p>
<p>As the nation races to get everyone vaccinated to stay ahead of the very concerning emerging <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/index.html">variants</a>, we need to <a href="https://doi.org/10.1001/jama.2020.21946">use</a> all <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7010e3.htm">evidence-based tools</a> at our disposal. Every shot in an arm is a step forward. And every instance in which other harm reduction measures are kept in place prevents the nation from taking a step backward.</p>
<p>These harm reduction measures are not meant to continue forever, and one can imagine a day when they will not be needed, at least not to the same degree. As social interactions start to resume, now is the time to encourage practical strategies for continuing their use.</p>
<h2>Be strategic in scheduling events</h2>
<p>As more people are vaccinated, the risk of the virus spreading will fall – but that will still take some time, as currently about 12% of the U.S. population has been fully vaccinated, <a href="https://covid.cdc.gov/covid-data-tracker/#vaccinations">according to the CDC</a>. How soon the U.S. could <a href="https://www.nytimes.com/interactive/2021/02/20/us/us-herd-immunity-covid.html">reach herd immunity</a> will depend on the speed of vaccine uptake. </p>
<p>To avoid spreading the virus in another wave, people, universities, schools, businesses, community-based organizations and governmental entities can employ “strategic scheduling” of events. This includes limiting relaxation of mask-wearing and social distancing to private settings with other fully vaccinated people for the time being, as the <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html">CDC’s guidelines</a> suggest.</p>
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<p>People can also postpone events, such as in-person school graduations or Memorial Day community picnics, until later in the summer. A spring vacation this year <a href="https://www.nbcnews.com/politics/meet-the-press/fauci-we-re-not-end-zone-yet-covid-spread-n1261052">could have negative individual and collective consequences</a>. Simply scheduling the same trip later in the summer could be both more enjoyable and much safer. </p>
<p>Many of the life events people might like to experience in 2021 may be possible, but perhaps not to their ideal ordering, or at the scale, they crave.</p>
<h2>Try to be patient</h2>
<p>Public health officials have seldom stressed patience as a tool, but in this circumstance, just a bit more patience regarding higher-risk activities could have great public health benefits.</p>
<p>Thought of in risk reduction terms rather than risk elimination terms, individual, school, business and government planning the next few months might help us all engage in strategic scheduling and have just a bit more patience to benefit everyone.</p>
<p>The nation has <a href="https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6">lost over 530,000</a> family members and friends, many of whom <a href="https://www.statnews.com/2021/01/27/vaccinated-health-care-workers-immunity-spend-time-visiting-covid-19-patients/">died alone</a>. Due to the horrible circumstances of this pandemic, we believe we owe it to their memory to minimize any further loss and to find a pathway to continuing our lives in a way that honors their legacy by urgently employing practical and achievable harm reduction strategies. It may appear small, but a midsummer picnic seems like a great way to start to build upon their legacy.</p>
<p><em>This article has been updated with charts showing vaccine distribution and daily COVID-19 cases</em></p>
<p>[<em>Deep knowledge, daily.</em> <a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=deepknowledge">Sign up for The Conversation’s newsletter</a>.]</p><img src="https://counter.theconversation.com/content/157312/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The president wants Americans to be able to celebrate Independence Day with small gatherings. What will it take to get the virus under control by then? Three public health school deans explain.David R. Holtgrave, Dean and SUNY Distinguished Professor, University at Albany, State University of New YorkAmy Lauren Fairchild, Dean and Professor, College of Public Health, The Ohio State UniversityCheryl Healton, Director of the NYU Global Institute of Public Health (GIPH), Dean of Global Public Health, New York UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1539662021-03-07T14:36:40Z2021-03-07T14:36:40ZCannabis education should aim to normalize — not prevent — safe and legal use<figure><img src="https://images.theconversation.com/files/384939/original/file-20210218-19-1n4fpqc.jpg?ixlib=rb-1.1.0&rect=300%2C56%2C2802%2C2196&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People gather in Trinity Bellwoods park for a weed bubble blowing event in Toronto on Oct. 17, 2018, the day cannabis became legal in Canada. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Christopher Katsarov</span></span></figcaption></figure><p>Many of us grew up in a society that prohibited the use of cannabis. When cannabis was legalized in 2018, it was a major shift for most Canadians. How successful have we been in changing the mindset from it being an illegal and stigmatized drug to one that is legal and socially acceptable?</p>
<p>Education about cannabis has been inconsistent across Canada. <a href="https://doi.org/10.17269/s41997-019-00209-0">Evidence to support the best approach</a> for cannabis education and awareness campaigns is lacking and historically focused on risk-based messages to encourage people to “do not use.” </p>
<p>However, in this new legal environment we need to shift our focus to normalizing, or destigmatizing, cannabis use and educating on how to consume it responsibly and safely. While <a href="https://theconversation.com/why-we-need-better-smarter-panic-free-education-on-cannabis-97641">this shift was identified</a> at the time of legalization, as a society we still have a ways to go to meet these goals. </p>
<p>With the goal of legalization to “<a href="https://www.justice.gc.ca/eng/cj-jp/cannabis/">protect public health and safety</a>,” how do we make sure the public is empowered to make informed choices? </p>
<p><a href="https://www.mun.ca/pharmacy/research/cannabiseval/">Our research team</a> in Newfoundland and Labrador is interested in figuring out how legalization has affected health and safety, and has identified education as a priority. </p>
<h2>Why educate</h2>
<figure class="align-center ">
<img alt="Marijuana joints rolled with Canadian-themed paper" src="https://images.theconversation.com/files/384944/original/file-20210218-18-llz1nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384944/original/file-20210218-18-llz1nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384944/original/file-20210218-18-llz1nf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384944/original/file-20210218-18-llz1nf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384944/original/file-20210218-18-llz1nf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384944/original/file-20210218-18-llz1nf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384944/original/file-20210218-18-llz1nf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Using smoking as the primary mode of cannabis consumption is a higher-risk behaviour, compared to alternatives such as vaping or edibles.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Christopher Katsarov</span></span>
</figcaption>
</figure>
<p><a href="http://cannabisproject.ca/wp-content/uploads/2017/09/Goodman-et-al.-2020-Lower-Risk-Cannabis-Use-Guidelines-Adherence-in-Canada-and-the-U.S..pdf">An international cannabis study survey</a> showed that almost 90 per cent of cannabis consumers partake in some kind of higher-risk consumption behaviour, such as using high-potency products or smoking as the main way of consumption, which is considered high-risk because of its harmful effects on the respiratory system. Vaping or edibles are preferable, although any mode of consumption has risks (for example, because edibles such as cannabis gummies work more slowly, there is a risk of eating too many while waiting for them to take effect). </p>
<p>Canada has dedicated <a href="https://www.cbc.ca/news/health/cannabis-education-health-canada-1.4808291">more than $100 million in federal funds</a> over six years to raise awareness and educate the public on cannabis and how to legally access and safely consume it. However, two years post legalization, <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/research-data/canadian-cannabis-survey-2020-summary.html">22 per cent of Canadians</a> still reported not noticing any campaigns or messages about cannabis. </p>
<h2>What to educate</h2>
<p>Our research team spoke with citizens and with public and private organizations affected by cannabis legalization in Newfoundland and Labrador to identify priority areas of focus.</p>
<p>Our preliminary findings indicate that there is still a lack of education on <a href="https://www.canada.ca/en/campaign/don-t-drive-high.html">rules regarding driving</a>, public use and legal sources, <a href="https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/provinces-territories.html">which vary by province</a>; medicinal benefits and safe use </p>
<p>The content of cannabis education programs often “<a href="https://doi.org/10.17269/s41997-019-00209-0">adopt a narrow view of the ways in which young people may use cannabis</a>,” and must go beyond a mere abstinence focus. For example, <a href="https://dare.org/d-a-r-e-canada/">D.A.R.E. (Drug Abuse Resistance Education)</a> is a common school-based drug prevention program that takes a risk-prevention approach, but <a href="https://doi.org/10.2105/ajph.84.9.1394">the evidence for its effectiveness</a> is questionable.</p>
<p>In addition, <a href="https://www.lifeskillstraining.com/lst-overview/">cannabis education programs</a> have traditionally been lumped together with other illicit substances with a focus on abstinence, emphasizing potential harms. </p>
<p><a href="https://doi.org/10.2105/AJPH.2017.303818">Evidence-based guidelines</a> support a harm-reduction approach and aim to reduce risks for harm both for the individuals and the population. The focus is on encouraging safe and responsible use and enabling people to view cannabis similarly to alcohol. </p>
<h2>Who to educate</h2>
<p>Historically, cannabis education has been directed towards the school-age population, but adults also need to be a key target audience.</p>
<p>There are two problems with solely targeting youth: youth are stigmatized as poor decision-makers and adults — who often include teachers, health professionals, law enforcement — are not equipped with sufficient knowledge on cannabis to engage with youth. </p>
<p>Although underage use of cannabis is not encouraged, it is important to equip adults with the knowledge that enables them to have informed and nonjudgmental conversations with youth. The legal age for cannabis use ranges from 18 to 21, depending on the province.</p>
<figure class="align-center ">
<img alt="A display of different types of cannabis edibles" src="https://images.theconversation.com/files/384947/original/file-20210218-18-107p5qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/384947/original/file-20210218-18-107p5qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=379&fit=crop&dpr=1 600w, https://images.theconversation.com/files/384947/original/file-20210218-18-107p5qo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=379&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/384947/original/file-20210218-18-107p5qo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=379&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/384947/original/file-20210218-18-107p5qo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=476&fit=crop&dpr=1 754w, https://images.theconversation.com/files/384947/original/file-20210218-18-107p5qo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=476&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/384947/original/file-20210218-18-107p5qo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=476&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A variety of soft chews cannabis edibles are displayed at the Ontario Cannabis Store in Toronto on Jan. 3, 2020.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Tijana Martin</span></span>
</figcaption>
</figure>
<p>Studies have shown that <a href="https://doi.org/10.1016/j.ctim.2020.102328">many health professionals do not have sufficient knowledge</a> to even prescribe medicinal cannabis for those who truly need it, let alone enough knowledge to discuss the therapeutic benefits and harms of cannabis. </p>
<p>Teachers are the primary point of contact for youth for educational purposes. If they are not well educated about cannabis, they won’t be able to meaningfully engage with youth and provide them with the knowledge and skills to make informed decisions. </p>
<p>People who use cannabis should be aware of the rules and regulations so that they protect the health and safety of others. We learned from our preliminary findings that without proper education, law enforcement officers may still view cannabis as criminal, and society at large is still prone to <a href="https://doi.org/10.1186/s42238-020-00056-8">stigmatize those who use cannabis</a>. </p>
<h2>How to educate</h2>
<p>Innovative education and awareness strategies need to target youth and the general public to change knowledge, attitudes and behaviour surrounding cannabis. Internet-based education programs that are interactive <a href="https://doi.org/10.3109/10826084.2011.613441">improve knowledge and reduce cannabis use</a>. </p>
<p>Programs that engage youth throughout the process, including the design of the curriculum and the implementation process, will have better long-term outcomes. <a href="https://www.camh.ca/en/health-info/guides-and-publications/lrcug-for-youth">The Blunt Truth</a> was “developed by youth for youth,” as a youth-friendly version of the lower-risk cannabis use guidelines.</p>
<p><a href="https://cssdp.org/">Canadian Students for Sensible Drug Policy (CSSDP)</a> is a network of youth and students who are concerned about the negative impact of drug policies. They support evidence-based information to help youth make informed decisions and developed a <a href="https://cssdp.org/youthtoolkit">Toolkit for Educating Youth</a>. It provides realistic and evidence-based guidance for educators and parents. </p>
<p>Any effective educational campaign will likely need to involve multiple features, tailored to its audience. Education efforts may be more effective if they use different ways to engage people, both inside and outside the school system. These may include interactive tools and games, films that can generate discussion, social media and peer-led discussion. </p>
<p>The legalization of cannabis for non-medical use in Canada has created an opportunity to shift our educational approach in order to make cannabis more acceptable in society. However, this comes with providing education, skills and support to all Canadians. </p>
<p>Whether you are a young person, adult, health professional, teacher, parent, law enforcer or anyone else, everyone should be aware of the health and safety considerations regarding cannabis, and make informed choices. </p>
<p>The goal of cannabis legalization is to protect public health and safety. To do this, we must normalize safe cannabis use, not stop cannabis consumption. </p>
<h2><a href="https://ajph.aphapublications.org/doi/10.2105/AJPH.2017.303818">Safer cannabis choices include</a>:</h2>
<p><strong>Abstain from use</strong>. The most effective way to avoid the risks is to avoid using cannabis.</p>
<p><strong>Avoid use in adolescence</strong>. Cannabis use at a younger age — especially before age 16 — can have negative effects on the developing brain and is associated with adverse health and social effects. Delaying cannabis use at least until after adolescence is recommended.</p>
<p><strong>Choose less risky cannabis products</strong>. High THC (tetrahydrocannabinol) content products are associated with a higher risk for health problems. Choose lower potency cannabis products that have lower levels of THC and higher levels of CBD (cannabidiol).</p>
<p><strong>Avoid synthetic cannabis products</strong>. Synthetic cannabis products, such as K2 and Spice, have much more serious side-effects than natural cannabis.</p>
<p><strong>Choose safer methods of cannabis consumption</strong>. Inhaling cannabis smoke is harmful to the lungs, so choose safer ways to consume such as vaping or edibles. If you do smoke, avoid inhaling deeply or breath-holding, and avoid combining with tobacco.</p>
<p><strong>Reduce the amount or frequency of cannabis use</strong>. Daily or frequent use has higher risks of negative health and social effects, such as mental health problems, cannabis dependence and poor school performance. Limit to using occasionally, such as only one day a week or on weekends.</p>
<p><strong>Don’t drive while impaired</strong>. Do not drive or operate machinery for at least six hours — longer for edibles — after using cannabis. Driving while impaired is against the law, and is associated with increased accidents.</p>
<p><strong>Avoid mixing cannabis with alcohol</strong>. Combining alcohol and cannabis increases impairment.</p>
<p><strong>Consider your risk factors for health problems, and avoid if pregnant</strong>. People with a personal or family history of psychosis or substance use disorders are at higher risk of negative effects and should avoid using cannabis. Use during pregnancy increases the health risk to the mother and baby. Pregnant women should not use cannabis at all.</p>
<p><strong>Avoid combining risky behaviours</strong>. It is likely that the combination of these risk behaviours may increase the likelihood or severity of adverse outcomes.</p><img src="https://counter.theconversation.com/content/153966/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bui K. Petersen works in a position funded by the Canadian Centre on Substance Use and Addiction (CCSA). </span></em></p><p class="fine-print"><em><span>Jennifer Donnan receives funding from the Canadian Centre on Substance Use and Addiction (CCSA) and the Canadian Institutes of Health Research (CIHR)</span></em></p><p class="fine-print"><em><span>Lisa Bishop receives funding from the Canadian Centre on Substance Use and Addiction (CCSA) and the Canadian Institutes of Health Research (CIHR)</span></em></p><p class="fine-print"><em><span>Sandy Brennan works in a position funded by the Canadian Centre on Substance Use and Addiction (CCSA). </span></em></p><p class="fine-print"><em><span>Maisam Najafizada does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If the goal of cannabis legalization was to protect public health and safety, education and awareness campaigns must normalize safe cannabis use, not stop cannabis consumption.Maisam Najafizada, Assistant Professor of Population Health Policy, Memorial University of NewfoundlandBui K. Petersen, Postdoctoral Researcher, Technology and the Future of Work, Memorial University of NewfoundlandJennifer Donnan, Assistant Professor, School of Pharmacy, Memorial University of NewfoundlandLisa Bishop, Associate professor, School of Pharmacy, Memorial University of NewfoundlandSandy Brennan, Research Assistant in Pharmacy, Memorial University of NewfoundlandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1508062020-12-10T13:36:42Z2020-12-10T13:36:42ZOregon just decriminalized all drugs – here’s why voters passed this groundbreaking reform<figure><img src="https://images.theconversation.com/files/374023/original/file-20201209-21-1aik374.jpg?ixlib=rb-1.1.0&rect=30%2C7%2C5111%2C3423&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">According to Oregon law, possessing a small amount of drugs for personal consumption is now a civil – rather than criminal – offense. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/teenage-schoolgirl-reaching-for-cocaine-in-her-back-royalty-free-image/1132980785?adppopup=true">Peter Dazeley via Getty</a></span></figcaption></figure><p>Oregon became the first state in the United States to decriminalize the possession of all drugs on Nov. 3, 2020. </p>
<p><a href="https://ballotpedia.org/Oregon_Measure_110,_Drug_Decriminalization_and_Addiction_Treatment_Initiative_(2020)">Measure 110</a>, a ballot initiative <a href="https://www.klcc.org/post/election-preview-measure-110-would-make-oregon-1st-state-decriminalize-drug-use">funded by the Drug Policy Alliance, a nonprofit advocacy group backed in part by Facebook’s Mark Zuckerberg</a>, passed with more than 58% of the vote. Possessing heroin, cocaine, methamphetamine and other drugs for personal use is no longer a criminal offense in Oregon. </p>
<p>Those drugs are still against the law, as is selling them. But possession is now a civil – not criminal – violation that may result in a fine or court-ordered therapy, not jail. Marijuana, which Oregon legalized in 2014, remains fully legal.</p>
<p>Oregon’s move is radical for the United States, but several European countries <a href="https://www.loc.gov/law/help/decriminalization-of-narcotics/decriminalization-of-narcotics.pdf">have decriminalized drugs to some extent</a>. There are three main arguments for this major drug policy reform. </p>
<h2>#1. Drug prohibition has failed</h2>
<p>In 1971, President Richard Nixon declared drugs to be “public enemy number one” and launched a “<a href="https://www.theatlantic.com/health/archive/2012/03/the-war-on-drugs-how-president-nixon-tied-addiction-to-crime/254319/">war on drugs</a>” that continues today.</p>
<p>The ostensible rationale for harshly punishing drug users is to deter drug use. But decades of research – including <a href="http://tupress.temple.edu/book/20000000009196">our own on marijuana</a> and <a href="https://us.sagepub.com/en-us/nam/drugs-and-drug-policy/book258916">drugs generally</a> – has found the <a href="https://www.vera.org/publications/for-the-record-prison-paradox-incarceration-not-safer">deterrent effect of strict criminal punishment to be small</a>, if it exists at all. This is especially true among young people, who <a href="http://www.monitoringthefuture.org/pubs/monographs/mtf-vol2_2019.pdf">are the majority of drug users</a>. </p>
<p>This is partly due to the nature of addiction, and also because <a href="https://nij.ojp.gov/topics/articles/five-things-about-deterrence">there are simply limits to how much punishment can deter crime</a>. As a result, the U.S. has both <a href="https://www.sentencingproject.org/criminal-justice-facts/">the world’s highest incarceration rate</a> and <a href="http://www.espad.org/sites/espad.org/files/TD0116475ENN.pdf">among the highest rates of illegal drug use</a>. Roughly <a href="https://www.prisonpolicy.org/reports/pie2020.html">1 in 5 incarcerated people in the United States is in for a drug offense</a>. </p>
<p><a href="https://books.google.com/books?hl=en&lr=&id=dNcNUjn4UQEC&oi=fnd&pg=PP9&dq=Crime+in+the+Making:+Pathways+and+Turning+Points+Through+Life.&ots=UfXRYQfehU&sig=jAyUyb68tCm1Bw9dXXtlyUlXPro#v=onepage&q=Crime%20in%20the%20Making%3A%20Pathways%20and%20Turning%20Points%20Through%20Life.&f=false">Criminologists find</a> that other consequences of problematic drug use – such as harm to health, reduced quality of life and strained personal relationships – are more effective deterrents than criminal sanctions. </p>
<p>Because criminalizing drugs does not really prevent drug use, <a href="https://www.jstor.org/stable/3342518?seq=1">decriminalizing does not really increase it</a>. Portugal, <a href="https://time.com/longform/portugal-drug-use-decriminalization/">which decriminalized the personal possession of all drugs in 2001</a> in response to high illicit drug use, has <a href="https://www.emcdda.europa.eu/system/files/publications/11331/portugal-cdr-2019_0.pdf">much lower rates of drug use than the European average</a>. Use of cocaine among young adults age 15 to 34, for example, is 0.3% in Portugal, compared to 2.1% across the EU. <a href="https://www.emcdda.europa.eu/system/files/publications/11331/portugal-cdr-2019_0.pdf">Amphetamine and MDMA consumption is likewise lower in Portugal</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman with a dog waits at a white van while a man drinks from a tiny cup" src="https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=391&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=391&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=391&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=492&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=492&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373956/original/file-20201209-13-1k3fxx5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=492&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A mobile drug-services van in Lisbon gives out methadone, a medication for people with opioid use disorder, in 2017.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/patient-rita-pestana-holds-her-puppy-while-her-husband-news-photo/857614826?adppopup=true">Horacio Villalobos - Corbis/Corbis via Getty Images</a></span>
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</figure>
<h2>2. Decriminalization puts money to better use</h2>
<p>Arresting, prosecuting and imprisoning people for drug-related crimes is expensive. </p>
<p>The Harvard economist Jeffrey Miron estimates that all government drug prohibition-related expenditures <a href="https://www.cato.org/publications/tax-budget-bulletin/budgetary-effects-ending-drug-prohibition">were US$47.8 billion nationally</a> in 2016. Oregon spent about $375 million on drug prohibition in that year. </p>
<p>Oregon will now divert some the money previously used on drug enforcement to pay for <a href="https://www.statesmanjournal.com/story/news/politics/2020/10/16/oregon-2020-election-ballot-measure-110-decriminalize-drug-possession/3620146001/%22%22">about a dozen new drug prevention and treatment centers</a> statewide, which has been <a href="http://www.justicepolicy.org/uploads/justicepolicy/documents/04-01_rep_mdtreatmentorincarceration_ac-dp.pdf">found to be a significantly more cost-effective</a> strategy. Some tax revenue from <a href="https://www.bizjournals.com/portland/news/2019/07/25/oregon-cannabis-tax-revenue-gets-higher-and-higher.html">recreational marijuana sales</a>, which exceeded $100 million in 2019, will also go to addiction and recovery services. </p>
<p>Oregon <a href="https://www.oregonlegislature.gov/citizen_engagement/Reports/2019-OCJC-SB1041-Report.pdf">spent about $470 million on substance abuse treatment</a> between 2017 and 2019.</p>
<p>Not everyone who uses drugs needs treatment. Decriminalization makes help accessible to those who do need it – and keeps both those users and recreational users out of jail.</p>
<h2>3. The drug war targets people of color</h2>
<p>Another aim of decriminalization is to mitigate the significant <a href="https://www.sentencingproject.org/wp-content/uploads/2016/01/Disparity-by-Geography-The-War-on-Drugs-in-Americas-Cities.pdf">racial and ethnic disparities associated with drug enforcement</a>. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Black and whit image of police arresting a Black man in a New York subway station; no faces are seen" src="https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=339&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=339&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=339&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=426&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=426&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373973/original/file-20201209-17-i30jco.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=426&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">New York’s ‘stop and frisk’ policing most often resulted in marijuana possession charges and targeted young Black men. It was declared unconstitutional in 2013.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/saw-this-young-man-being-stopped-in-nyc-subway-by-two-news-photo/185494998?adppopup=true">Third Eye Corporation/Getty</a></span>
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<p>Illegal drug use is <a href="https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf">roughly comparable across race</a> in the U.S. But people of color are significantly more likely to be <a href="https://ag.ny.gov/pdfs/OAG_REPORT_ON_SQF_PRACTICES_NOV_2013.pdf">searched</a>, <a href="https://www.drugabuse.gov/about-nida/noras-blog/2020/06/message-director-racially-motivated-violence">arrested and imprisoned for a drug-related offense</a>. Drug crimes can incur long prison sentences.</p>
<p>Discretion in drug enforcement and sentencing means prohibition is among the <a href="https://newjimcrow.com/">leading causes of incarceration of people of color in the United States</a> – an injustice <a href="https://www.cato.org/multimedia/daily-podcast/bipartisan-drug-policy-reform">many Americans on both sides of the aisle</a> increasingly recognize. </p>
<p>Freed up from policing drug use, departments may redirect their resources toward crime prevention and solving <a href="https://thecrimereport.org/2015/06/24/2015-06-reinventing-american-policing-a-seven-point-blueprin/">violent crimes like homicide and robbery</a>, which are time-consuming to investigate. That could help restore some trust between law enforcement and Oregon’s communities of color. </p>
<h2>Risks of decriminalization</h2>
<p>One common concern among Oregonians <a href="https://www.opb.org/article/2020/10/15/measure-110-oergon-politics-decriminalize-drugs/">who voted against decriminalization</a> was that lessening criminal penalties would endanger children. </p>
<p>“I think it sends a really bad message to them, and influences their perception of the risks,” James O’Rourke, a defense attorney who helped organize the opposition to measure 110, <a href="https://www.opb.org/article/2020/10/15/measure-110-oergon-politics-decriminalize-drugs/">told Oregon Public Broadcasting in October</a>.</p>
<p>But U.S. states that legalized marijuana haven’t seen adolescent use rise significantly. In fact, marijuana consumption among teens – <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/add.14939">though not among college-aged Americans</a> – actually <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2737637">declined in some states with legal marijuana</a>. This may be because legal, regulated marijuana is more difficult for minors to get than black-market drugs. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Woman browses various types of marijuana in glass jars on shelves, in well-lit, upscale setting" src="https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=406&fit=crop&dpr=1 600w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=406&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=406&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=510&fit=crop&dpr=1 754w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=510&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/373955/original/file-20201209-13-pm4j84.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=510&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Customers must be 21 or older to purchase marijuana from dispensaries like Oregon’s Finest, in Portland.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/woman-shops-at-oregons-finest-a-marijuana-dispensary-in-news-photo/491438512?adppopup=true">Josh Edelson/AFP via Getty Images</a></span>
</figcaption>
</figure>
<p>Research also shows that for some people, particularly the young, banning a behavior <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4675534/">makes it more alluring</a>. So defining drugs as a health concern rather than a crime could actually make them less appealing to young Oregonians.</p>
<p>Another worry about decriminalization is that it will attract people looking to use drugs. </p>
<p>So-called “drug tourism” <a href="https://www.economist.com/europe/2009/08/27/treating-not-punishing">hasn’t really been a problem for Portugal</a>, but it happened in Switzerland after officials in the 1980s and 1990s began officially “ignoring” heroin in Zurich’s Platzspitz Park. People came from across the country to <a href="https://theculturetrip.com/europe/switzerland/articles/a-brief-history-of-zurichs-needle-park/">inject heroin in public, leaving discarded needles on the ground</a>. </p>
<p>The local government shut down Platzspitz Park. But rather than chase off or arrest those who frequented it, it began offering methadone and prescription heroin to <a href="https://ssir.org/articles/entry/inside_switzerlands_radical_drug_policy_innovation">help people with opioid use disorder</a>. Public injection, HIV rates and overdoses – which had all become a problem in Zurich – <a href="https://www.northcarolinahealthnews.org/2019/01/21/switzerland-couldnt-stop-drug-users-so-it-started-supporting-them/">plummeted</a>. </p>
<p>Certain parts of Oregon already have higher rates of public drug consumption, namely Portland and Eugene. Because public drug use is still illegal in Oregon, however, we don’t expect a Platzspitz Park-style open drug scene to emerge.
These places should benefit from the expansion of methadone programs and other medication-assisted treatment, which is endorsed by the <a href="https://www.ama-assn.org/delivering-care/opioids/ama-push-better-access-opioid-use-disorder-treatments">American Medical Association</a>.</p>
<p><a href="https://www.theolympian.com/opinion/editorials/article247180921.html">If neighboring Washington state decriminalizes drugs</a>, which it is considering, the chances of drug tourism would drop further. </p>
<p>[<em>The Conversation’s science, health and technology editors pick their favorite stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-favorite">Weekly on Wednesdays</a>.]</p>
<h2>Upside – and downside</h2>
<p>There are risks with any major policy change. The question is whether the new policy results in a net benefit. </p>
<p>In Portugal, full decriminalization has proven more humane and effective than criminalization. Because drug users don’t worry about facing criminal charges, those who need help are more likely to seek it – and <a href="https://www.opensocietyfoundations.org/uploads/52ff6eb9-76c9-44a5-bc37-857fbbfedbdd/drug-policy-in-portugal-english-20120814.pdf">get it</a>. </p>
<p>Portugal’s <a href="https://www.emcdda.europa.eu/system/files/publications/11364/20191724_TDAT19001ENN_PDF.pdf%22%22">overdose death rate is five times lower than the EU average</a> – which is itself <a href="https://www.cdc.gov/nchs/products/databriefs/db356.htm">far lower than the United States’</a>. HIV infection rates among injection drug users also <a href="https://www.emcdda.europa.eu/system/files/publications/11331/portugal-cdr-2019_0.pdf">dropped massively</a> since 2001.</p>
<p>These policies show that problem drug use is a public health challenge to be managed, not a war that can be won.</p><img src="https://counter.theconversation.com/content/150806/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Possessing heroin, cocaine, meth and other drugs for personal use is no longer a criminal offense in Oregon. The idea is to get people with problem drug use help, not punishment.Scott Akins, Professor, Sociology Department, Oregon State UniversityClayton Mosher, Professor, Sociology Department, Washington State UniversityLicensed as Creative Commons – attribution, no derivatives.