decriminalization of drugs canada essay

Decriminalization failures show half measures are not enough to address drug use problems and the opioid crisis

Professor, Department of Sociology and Anthropology, University of Guelph

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Ottawa’s recent rejection of the City of Toronto’s request to decriminalize possession of controlled drugs is the latest shoe to drop in the resurgence of conservative anti-drug sentiment sweeping the country, and backtracking on reforms achieved in other jurisdictions.

The announcement, citing concern for public safety, follows much the same script as that of the British Columbia government, which — after decriminalizing in 2023 — recently retreated to ban use in public places due to complaints of rampant drug use and continuing high rates of overdose.

In early April, the state of Oregon went further , recriminalizing drug possession, replacing small fines with probation and up to six months in prison. The state was forced to backtrack on decriminalization measures that were passed in 2020 due to backlash over spiking overdoses during the COVID-19 lockdown period.

Continued deaths due to drug use is all the evidence required to curb reform, despite the fact that these spikes occurred mostly during the pandemic.

Research shows that the pandemic exacerbated many of the factors underlying the drug crisis. Health disparities and a lack of resources in underserved communities, social isolation, economic burden, stress, a lack of access to treatment and barriers to care all contribute to acute health effects of drug dependence.

Regardless of these facts, drug policy reform is being blamed for these outcomes.

It’s still all about the politics, of course

In Ontario, predictably, the Ford government’s position on Toronto’s proposal is staunch opposition . Yet there is a sense of new momentum in the same old rhetoric: because drug users continue to die and use drugs in public places, presumably this means the experts and bleeding-heart liberals who supported reform have been soundly proven wrong.

Most concerning, whereas conservatives and liberals may differ in their emphasis on punishment or treatment as solutions to drug problems, neither type of government seems prepared to fully implement a public health approach to substance use. That would mean addressing health disparities and deeper causes of substance use disorders, such as social inequality and social dislocation in Canadian society.

No North American jurisdiction has been able to achieve this, despite the depth of knowledge and increasingly articulate demonstration of progressive public servants. Bureaucrats and politicians speak the language used by experts and other knowledgeable observers, who in turn inform the public of the need for harm reduction and more comprehensive, meaningful social policy reform. Logically, this requires commitment to decriminalization to shift the emphasis from punishing addicts to rehabilitating them.

Increasingly, the discourse has gone further in establishing the need for more coherent public health policies addressing the root causes of addiction. To that end, important progress has been squandered by apparent bewilderment that addicts are still dying in large numbers, despite (and now because of) decriminalization measures that were never claimed to solve the problem of addiction, but rather to reduce known harms of criminalizing drugs .

Decriminalizing drugs is not intended to be a solution to drug problems. Rather, it is a critical first step that’s necessary, but not sufficient, for replacing prohibition with a public health approach.

Although Canada has made this work for regulating cannabis , it still has far to go to implement a more progressive public health approach to other drugs. The dangers of drug use stem not so much from psychoactive substances themselves, but from the toxic and unsafe drug supply that is the result of criminalization. But most of these substances continue to be treated as dangerous enough to ban.

Yet there is scant consideration of the societal and legal circumstances and conditions that make drugs dangerous because they happen to be used in harmful ways by certain people. Whereas opiates , like alcohol , may have higher risk of overdose and adverse health effects due to physical dependence , all drugs can be misused with risk to health and public safety.

Addiction and public health

Decriminalizing drugs can make them safer, but not always, and reduce some harms of using drugs. What cannot be resolved entirely by decriminalization are the societal conditions that make substance use attractive enough to override considerations of concern for the self or others.

Addiction thrives on hopelessness and feelings of despair, abandonment and disconnection, which are caused by homelessness, unemployment and discrimination, among other social problems. Despite the range of local addiction support services and treatment options called for in support of decriminalization proposals, so far decriminalization efforts have failed to go beyond half measures to implement a full array of integrated resources.

Further off course yet, there has been little indication of meaningful commitment to addressing deeper structural root causes of addiction in North American society. Canada’s putative commitment to a public health approach has fared no better than in Oregon.

None of these jurisdictions have gone far enough to remedy the real causes of drug problems. The fate of Portugal’s successful run as a global leader in tackling addiction, as opposed to punishing addicts, helps to clarify new lessons being learned in North America.

Adopted over 20 years ago, decriminalization measures in Portugal have been implemented more successfully because its social safety net is far more comprehensive and better integrated with the criminal justice system. In recent years, as cuts to funding decimated rehabilitation programs, rising rates of overdose soon followed, demonstrating that decriminalization is not a silver bullet ; if you do that and nothing else, things will get worse.

Put otherwise, half measures are ineffective. Until we are prepared to go all in to solve the problem, people who use drugs will keep dying unnecessarily because we have not afforded them real hope.

Sadly, this is news to no one. Not just experts. The Liberal government went on the record years ago by recognizing that decriminalizing drug use is not a panacea. Rather than committing to the next step, then and now, the necessary first step has been taken off the table.

How about try giving it more time?

Another lesson learned in Portugal , that evidently has not been resonating here in North American society, is that the kind of change required takes time. Now that decriminalization has been tried (and deemed a failure) in B.C. and Oregon, the reigning logic appears to be that going back to doing nothing makes more sense than doing something.

Despite great patience shown during a century of misery inflicted on drug users in Canadian society , trying something new is scary. Cue the same old moral panic scapegoating addicts as dangerous people who those in charge prefer should not be seen.

Read more: Won't somebody think of the children? Five reasons why drug panics are counterproductive

Decriminalizing drugs can’t eliminate people’s struggles with addiction. To work well, it requires a considerable level of investment, similar to what has historically been devoted to policing and imprisonment of addicts. Redistributing resources to support the integration of services, housing and employment for more people is not, and has never been, prioritized over punishing drug users.

Until that shift occurs, we will keep falling back on failed policies consistent with a war-on-drugs mentality that has now prevailed for 50 years against all logic. In the meantime, be prepared for a new wave of antiquated arguments proclaiming more liberal policies a failure.

Commitment to half measures creates more problems than it solves.

• War on Drugs
• Psychoactive substances
• Harm reduction
• Opioid crisis
• Drug decriminalization
• drug poisoning

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Decriminalization: Options and Evidence [Policy Brief]

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Publication date: 2018 Publisher: Canadian Centre on Substance Use and Addiction

Examines the various options and evidence on the decriminalization of controlled substances as a means to reduce harms. Based on Canadian and international research, this policy brief notes that recognizing that substance use is a health, rather than a criminal justice, issue is a starting point for reform. Describes how decriminalization covers a range of policies and practices.  

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Canadians’ knowledge and attitudes around drug decriminalization: Results from a public opinion research survey

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Organization: Health Canada

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Background on the exemption in british columbia related to personal possession of certain illegal drugs, approach to monitoring attitudes around drug decriminalization, about the public opinion research (por) survey, key highlights from the por survey results.

At the request of the Government of British Columbia, an exemption related to personal possession of certain illegal drugs has been granted for adults 18 years of age and older in the province. British Columbia (BC) refers to this exemption as a form of decriminalization.

From January 31, 2023 to January 31, 2026, adults are no longer subject to criminal charges or drug seizure if they're found in personal possession of up to 2.5 grams total of any combination of:

• methamphetamine

Instead, they are offered information about health and social supports. This includes support with referrals to local treatment and recovery services, if requested.

Health Canada is collecting data at a national level on Canadians' attitudes towards, and knowledge of, drug decriminalization. To do this, Health Canada has identified a set of indicators to monitor changes related to:

• attitudes towards drug use
• perceptions of public safety

A key source of data for this work will be information gathered from public opinion research (POR).

The POR survey was conducted by the Privy Council Office (PCO). It used 2 separate random samples of 2,000 Canadian adults aged 18 and older. Questions on attitudes towards people who use drugs and decriminalization were run between February 27 and March 12, 2023. Questions on knowledge of decriminalization were run between April 17 and April 30, 2023. Respondents were randomly sampled with proportional representation from across Canada. Unless otherwise noted, results shown in this report are expressed as percentages and may not add up to 100% due to rounding or a "not sure" response to a given question.

Questions focused on both attitudes and knowledge about:

• preferences for approaches to addressing substance use, including a focus on health and social services versus police enforcement
• general attitudes around empathy for people struggling with substance use
• general attitudes around level of comfort in talking to friends and family members about their substance use
• perceived benefits and disadvantages of decriminalization
• This included a focus on improved access to relevant health and social services, reduced stigma, increased harms, and reduced community safety

The POR survey also included 4 true-or-false questions to test respondents' knowledge of the details of BC's exemption for personal possession.

To address substance use, 49% of Canadians preferred a focus on access to health and social services rather than police enforcement, which represented 7% of respondents (Figure 1). However, 35% felt that both approaches were equally appropriate while 6% felt that neither approach was appropriate.

Women, those with higher education and income levels, and Canadian-born respondents were more likely to prefer a focus on access to health and social services to address substance use (Figure 2a).

Although few Canadians prefer a police enforcement approach to address substance use, men and those with lower income and education levels were more likely than others to favour police enforcement (Figure 2b). Men, those with trade or college education, and immigrants were more likely to feel that both approaches were equally appropriate to address substance use (Figure 2c).

88% of Canadians responded that they would like their friends or family members who use drugs to feel comfortable talking to them about it and 81% had empathy for people struggling with substance use (Figure 3). Canadians with lower income and education levels were more likely to think decriminalization would increase harms associated with substance use and make their community less safe. Although 62% of Canadians felt that decriminalization would make it easier to access health and social services, 51% also thought it would increase harms associated with substance use such as overdoses.

Question: Which of the following approaches do you feel is more appropriate to address substance use among people who use drugs?

Source: PCO Survey on Current Issues, February 27 to March 12, 2023

Base: All respondents (Canada: n= 2,000)

Figure 2: Attitudes towards approaches to address substance use among people who use drugs for specific populations

Question: To what extent do you agree or disagree with the following statements?

Questions testing Canadians' knowledge of the exemption in BC focused on:

• differences between the exemption and legalization
• the role of police in enforcing the exemption
• details about which activities involving drugs are covered by the exemption in BC

57% to 62% of Canadians, depending on the question, were able to correctly identify details of BC's exemption (Figure 4). However, 18% to 24% of respondents answered incorrectly and 15% to 19% were unsure of the answer.

Increased knowledge of the details of BC's exemption were shown by (Figure 5):

• BC respondents
• those aged 18 to 34 years
• those with higher education and income levels
• Canadian-born respondents

Question: Based on your understanding of the decriminalization of personal possession of drugs being implemented in British Columbia, are the following statements true or false? (Correct answers are highlighted in darker cells)

Source: PCO Survey on Current Issues, April 17 to 30, 2023

BC's exemption understanding index: Respondents get 25 points for each correct answer. A respondent who answers all four questions correctly gets a score of 100 (range: 0-100)

The results from this survey reflect the knowledge and attitudes of Canadian adults around drug decriminalization and the exemption in BC. These results will serve as a baseline to monitor key outcomes of the exemption, particularly public awareness and understanding of the details of the exemption and substance use. Health Canada's work will continue to compliment monitoring and evaluation work being led by the BC Ministry of Mental Health and Addictions and the Canadian Institutes of Health Research.

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Original research

Impact evaluations of drug decriminalisation and legal regulation on drug use, health and social harms: a systematic review, ayden i scheim.

1 Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA

2 Centre on Drug Policy Evaluation, St Michael's Hospital, Toronto, Ontario, Canada

Nazlee Maghsoudi

3 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada

Zack Marshall

4 Social Work, McGill University, Montreal, Quebec, Canada

Siobhan Churchill

5 Epidemiology and Biostatistics, Western University, London, Ontario, Canada

Carolyn Ziegler

6 Library Services, Unity Health Toronto, Toronto, Ontario, Canada

7 Medicine, University of California San Diego, La Jolla, California, USA

Associated Data

bmjopen-2019-035148supp001.pdf

bmjopen-2019-035148supp002.pdf

bmjopen-2019-035148supp003.pdf

To review the metrics and findings of studies evaluating effects of drug decriminalisation or legal regulation on drug availability, use or related health and social harms globally.

Systematic review with narrative synthesis.

Data sources

We searched MEDLINE, Embase, PsycINFO, Web of Science and six additional databases for publications from 1 January 1970 through 4 October 2018.

Inclusion criteria

Peer-reviewed articles or published abstracts in any language with quantitative data on drug availability, use or related health and social harms collected before and after implementation of de jure drug decriminalisation or legal regulation.

Data extraction and synthesis

Two independent reviewers screened titles, abstracts and articles for inclusion. Extraction and quality appraisal (modified Downs and Black checklist) were performed by one reviewer and checked by a second, with discrepancies resolved by a third. We coded study-level outcome measures into metric groupings and categorised the estimated direction of association between the legal change and outcomes of interest.

We screened 4860 titles and 221 full-texts and included 114 articles. Most (n=104, 91.2%) were from the USA, evaluated cannabis reform (n=109, 95.6%) and focussed on legal regulation (n=96, 84.2%). 224 study outcome measures were categorised into 32 metrics, most commonly prevalence (39.5% of studies), frequency (14.0%) or perceived harmfulness (10.5%) of use of the decriminalised or regulated drug; or use of tobacco, alcohol or other drugs (12.3%). Across all substance use metrics, legal reform was most often not associated with changes in use.

Conclusions

Studies evaluating drug decriminalisation and legal regulation are concentrated in the USA and on cannabis legalisation. Despite the range of outcomes potentially impacted by drug law reform, extant research is narrowly focussed, with a particular emphasis on the prevalence of use. Metrics in drug law reform evaluations require improved alignment with relevant health and social outcomes.

Strengths and limitations of this study

• This is the first study to review all literature on the health and social impacts of decriminalisation or legal regulation of drugs.
• We systematically searched 10 databases over a 38-year period, without language restrictions.
• The review was limited to study designs appropriate for evaluating interventions, nevertheless, most included studies used relatively weak evaluation designs.
• Included outcomes were heterogeneous and not quantitatively synthesised.
• Heterogeneity in the details and implementation of decriminalisation or legal regulation policies was not considered in this review.

Introduction

An estimated 271 million people used an internationally scheduled (‘illicit’) drug in 2017, corresponding to 5.5% of the global population aged 15 to 64. 1 Despite decades of investment, policies aimed at reducing supply and demand have demonstrated limited effectiveness. 2 3 Moreover, prohibitive and punitive drug policies have had counterproductive effects by contributing to HIV and hepatitis C transmission, 4 5 fatal overdose, 6 mass incarceration and other human rights violations 7 8 and drug market violence. 9 As a result, there have been growing calls for drug law reform 10–12 and in 2019, the United Nations Chief Executives Board endorsed decriminalisation of drug use and possession. 13 Against this backdrop, as of 2017 approximately 23 countries had implemented de jure decriminalisation or legal regulation of one or more previously illegal drugs. 14–16

A wide range of health and social outcomes are affected by psychoactive drug production, sales and use, and thus are potentially impacted by drug law reform. Nutt and colleagues have categorised these as physical harms (eg, drug-related morbidity and mortality to users, injury to non-users), psychological harms (eg, dependence) and social harms (eg, loss of tangibles, environmental damage). 17 18 Concomitantly, a diverse and sometimes competing set of goals motivate drug policy development, including ameliorating the poor health and social marginalisation experienced by people who use drugs problematically, shifting patterns of use to less harmful products or modes of administration, curtailing illegal markets and drug-related crime and reducing the economic burden of drug-related harms. 19

Given ongoing interest by states in drug law reform, as well as the recent position statement by the United Nations Chief Executives Board endorsing drug decriminalisation, 13 a comprehensive understanding of their impacts to date is required. However, the scientific literature has not been well-characterised, and thus the state of the evidence related to these heterogeneous policy targets remains largely unclear. Systematic reviews, including two meta-analyses, are narrowly focussed on adolescent cannabis use. Dirisu et al found no conclusive evidence that cannabis legalisation for medical or recreational purposes increases cannabis use by young people. 20 In the two meta-analyses, Sarvet et al found that the implementation of medical cannabis policies in the USA did not lead to increases in the prevalence of past-month cannabis use among adolescents 21 and Melchior et al found a small increase in use following recreational legalisation that was reported only among lower-quality studies. 22

Given increasing interest in quantifying the impact of drug law reform, as well as a lack of systematic assessment of outcomes beyond adolescent cannabis use to date, we conducted a systematic review of original peer-reviewed research evaluating the impacts of (a) legal regulation and (b) drug decriminalisation on drug availability, use or related health and social harms. Our primary aim is to characterise studies with respect to metrics and indicators used. The secondary aim is to summarise the findings and methodological quality of studies to date.

Consistent with our aim of synthesising evidence on the impacts of decriminalisation and legal regulation across the spectrum of potential health and social effects, we conducted a systematic review using narrative synthesis 23 without meta-analysis. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed in preparing this manuscript. 24 The review protocol was registered in PROSPERO (CRD42017079681) and can be found online at https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=79681 .

Search strategy and selection criteria

The review team developed, piloted and refined the search strategy in consultation with a research librarian and content experts. We searched MEDLINE, Embase, PsycINFO, Web of Science, Criminal Justice Abstracts, Applied Social Sciences Index & Abstracts, International Bibliography of the Social Sciences, PAIS Index, Policy File Index and Sociological Abstracts for publications from 1 January 1970 through 4 October 2018. We used MeSH (Medical Subject Headings) terms and keywords related to (a) scheduled psychoactive drugs, (b) legal regulation or decriminalisation policies and (c) quantitative study designs. Search terms specific to health and social outcomes were not employed so that the search would capture the broad range of outcomes of interest. See online supplemental appendix A for the final MEDLINE search strategy. For conference abstracts, we contacted authors for additional information on study methods and to identify subsequent relevant publications.

Supplementary data

We included peer-reviewed journal articles or conference abstracts reporting on original quantitative studies that collected data both before and after the implementation of drug decriminalisation or legal regulation. We did not consider as original research studies that reproduced secondary data without conducting original statistical analyses of the data. We defined decriminalisation as the removal of criminal penalties for drug use and/or possession (allowing for civil or administrative sanctions) and legal regulation as the development of a legal regulatory framework for the use, production and sale of formerly illegal psychoactive drugs. Studies were excluded if they evaluated de facto (eg, changes in enforcement practices) rather than de jure decriminalisation or legal regulation (changes to the law). This exclusion applied to studies analysing changes in outcomes following the US Justice Department 2009 memo deprioritising prosecution of cannabis-related offences legal under state medical cannabis laws. Eligible studies included outcome measures pertaining to drug availability, use or related health and social harms. We used the schema developed by Nutt and colleagues to conceptualise health and social harms, including those to users (physical, psychological and social) and to others (injury or social harm). 18

Both observational studies and randomised controlled trials were eligible in principle, but no trials were identified. There were no geographical or language restrictions; titles, abstracts and full-texts were translated on an as-needed basis for screening and data extraction. We excluded cross-sectional studies (unless they were repeated) and studies lacking pre-implementation and post-implementation data collection because such designs are inappropriate for evaluating intervention effects.

Data analysis

Screening and data extraction were conducted in DistillerSR (Evidence Partners, Ottawa, Ontario). We began with title-only screening to identify potentially relevant titles. Two reviewers screened each title. Unless both reviewers independently decided a title should be excluded, it was advanced to the next stage. Next, two reviewers independently screened each potentially eligible abstract. Inter-rater reliability was good (weighted Kappa at the question level=0.75). At this stage, we retrieved full-text copies of all remaining references, which were screened independently by two reviewers. Disagreements on inclusion were resolved through discussion with the first author. Finally, one reviewer extracted data from each included publication using a standardised, pre-piloted form and performed quality appraisal. A second reviewer double-checked data extraction and quality appraisal for every publication, and the first author resolved any discrepancies.

The data extraction form included information on study characteristics (author, title, year, geographical location), type of legal change studied and drug(s) impacted, details and timing of the legal change (eg, medical vs recreational cannabis regulation), study design, sampling approach, sample characteristics (size, age range, proportion female) and quantitative estimates of association. We coded each study-level outcome measure into one metric grouping, using 24 pre-specified categories and a free-text field (see figure 1 for full list). Examples of metrics include: prevalence of use of the decriminalised or regulated drug, overdose or poisoning and non-drug crime.

Metrics examined by included studies. excl., excluding.

We also categorised the estimated direction of association of the legal change on outcome measure(s) of interest (beneficial, harmful, mixed or null). These associations were coded at the outcome (not study) level and classified as beneficial if a statistically significant increase in a positive outcome (eg, educational attainment) or decrease in a negative outcome (eg, substance use disorder) was attributed to implementation of decriminalisation or legal regulation, and vice versa for harmful associations. The association was categorised as mixed if associations were both harmful and beneficial across participant subgroups, exposure definitions (eg, loosely vs tightly regulated medical cannabis access) or timeframes. Although any use of cannabis and other psychoactive drugs need not be problematic at the individual level, we categorised drug use as a negative outcome given that population-level increases in use may correspond to increases in negative consequences; we thought that this cautious approach to categorisation was appropriate given that such increases are generally conceptualised as negative within the scientific literature. For outcomes that are not unambiguously negative or positive, the coding approach was predetermined taking a societal perspective. For example, increased healthcare utilisation (eg, hospital visits due to cannabis use) was coded as negative because of the increased burden placed on healthcare systems. The association was categorised as null if no statistically significant changes following implementation of drug decriminalisation or legal regulation were detected. We set statistical significance at a= 0.05, including in cases where authors used more liberal criteria.

Quality assessment at the study level was conducted for each full-length article using a modified version of the Downs and Black checklist 25 for observational studies ( online supplemental appendix B ), which assesses internal validity (bias), external validity and reporting. Each study could receive up to 18 points, with higher scores indicating more methodologically rigorous studies. Conference abstracts were not subjected to quality assessment due to limited methodological details.

Patient and public involvement

This systematic review of existing studies did not include patient or public involvement.

Study characteristics

As shown in the PRISMA flow diagram ( figure 2 ), we screened 4860 titles and abstracts and 213 full-texts, with 114 articles meeting inclusion criteria ( online supplemental appendix C ). Key reasons for exclusion at the full-text screening stage were that the article did not report on original quantitative research (n=59) or did not evaluate decriminalisation or legal regulation as defined herein (n=23). Details of each included study are presented in online supplemental table 1 . Included studies had final publication dates from 1976 to 2019; 44.7% (n=51) were first published in 2017 to 2018, 43.9% (n=50) were published in 2014 to 2016 and 11.4% (n=13) were published before 2014.

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

Characteristics of included studies are described in table 1 , both overall and stratified by whether they evaluated decriminalisation (n=19) or legalisation (n=96) policies (one study evaluated both policies). Most studies (n=104, 91.2%) were from the USA and examined impacts of liberalising cannabis laws (n=109, 95.6%). Countries represented in non-US studies included Australia, Belgium, China, Czech Republic, Mexico and Portugal. The most common study designs were repeated cross-sectional (n=74, 64.9%) or controlled before-and-after (n=26, 22.8%) studies and the majority of studies (n=87, 76.3%) used population-based sampling methods. Figure 3 illustrates the geographical distribution of studies among countries where national or subnational governments had decriminalised or legally regulated one or more drugs by 2017.

Characteristics of studies evaluating drug decriminalisation or legal regulation, 1970 to 2018

*Combined total exceeds number of studies because some evaluated both decriminalisation and legal regulation.

†One global study and one multi-country European study including Belgium and Portugal.

Number of included studies from countries that implemented decriminalisation or legal regulation by 2017. Note: Policy changes were classified, following the review inclusion criteria, based on the implementation of a change to national or subnational law to decriminalise drug use and/or possession or to legalise at least one class of drugs. We did not evaluate the extent to which legal changes were reflected in policing and criminal justice practice. Implementation of cannabis legalisation for medical purposes only is not reflected in this map.

Study quality

Quality assessment was performed for the 93 full-length articles included in the review, excluding 21 conference abstracts ( online supplemental table 1 ). Scores ranged from 7 to 18 of 18 possible points, with a mean of 14.4 (SD=2.56). Quality scores were similar comparing US to non-US-based studies ( X =14.4 and 13.7, respectively, p=0.386) but higher for studies evaluating legal regulation ( X =14.8) versus decriminalisation ( X =12.8) (p=0.003). Study quality differed significantly (p<0.001) by the direction of the association with the outcome of interest, with higher quality scores among studies estimating mixed ( X =15.4) or beneficial ( X =15.2) versus null ( X =14.2) or harmful ( X =13.1) effects of legal change on the outcome of interest. Study quality did not appear to increase over time (eg, X =14.0 in 2014 and 14.4 in 2018).

Study outcome measures and metrics

Across 114 studies we extracted 224 outcome measures, which were coded into 32 metrics ( figure 1 ). The most common metric employed by studies was the prevalence of use of the decriminalised or legally regulated drug, which was examined in 39.5% of studies (n=45) and represented 22.3% of outcome measures (n=50). Of these studies, 13 (28.9%; 8 full-length articles and 5 abstracts) did not report any other metric 26–38 and an additional 6 studies (13.3%) reported on the prevalence of use in addition to a single drug-related perception metric (either harmfulness or availability). 39–44 The second most common metric was the frequency of use of the decriminalised or legally regulated drug (14.0% of studies, n=16) and the third was the prevalence or frequency of use of tobacco, alcohol or drugs that remained illegal (12.3% of studies, n=14). The fourth most commonly employed metric was any change in the perceived health harmfulness of using the decriminalised or regulated drug (10.5% of studies, n=12), which was assessed among adolescents or young adults in all studies except for one that assessed this metric among parents. 45

All other metrics were assessed in <10% of included studies. Health service utilisation was evaluated in 7.9% of studies (n=9) using 12 outcome measures, primarily related to emergency department visits and/or hospitalisations. Prescribed (primarily opioid) drug use and perceived availability of the decriminalised or legally regulated drug were reported in 7.0% of studies each (n=8). Overdose or poisoning by the decriminalised or regulated drug, and by other drugs (predominantly opioids), were examined in 5.3% (n=6) and 6.1% of studies (n=7), respectively. Driving while under the influence or with detectable concentrations of the decriminalised or regulated drug (cannabis) was examined in seven studies (6.1%) inclusive of eight outcome measures. Notably, one study assessed self-reported impaired driving, 46 while others assessed the proportion of fatally injured drivers screening cannabis-positive or the overall prevalence of driving with detectable tetrahydrocannabinol (THC) concentrations in blood. Remaining metrics were measured in less than 5% of studies ( figure 1 ). Some pre-specified metrics were not represented in any of the articles, including infectious disease incidence (eg, HIV, hepatitis C), environmental impacts (eg, drug production waste, discarded needles) and labour market participation.

Studies outside the US

Of the 10 studies conducted outside the USA, 6 focussed on cannabis decriminalisation. All three studies from Australia examined the prevalence of cannabis use post-decriminalisation, 31 34 47 while one also measured perceived cannabis availability. 47 Following cannabis decriminalisation, one European multi-country study including Belgium and Portugal examined the prevalence of cannabis use and uptake of cannabis-related addictions treatment 48 and one Czech study considered the age of first cannabis use. 49 An international study using United Nations Office on Drugs and Crime data from 102 countries compared availability, as reflected by cannabis seizures and plant eradication, in countries that had decriminalised cannabis versus those that had not. 50 Three non-US studies evaluated decriminalisation of all psychoactive drugs. Two studies from Portugal examined healthcare and non-healthcare costs and psychoactive drug prices, respectively. 51 52 One study from Mexico examined drug-related criminal justice involvement (arrests) and (violent) crimes. 53 Finally, a study of historic opium legalisation in China (1801 to 1902) measured the price and availability (quantity of exports) of opium before and after legalisation. 54

Impacts of decriminalisation and legal regulation

Results of individual studies are provided in online supplemental table 1 . Online supplemental table 2 tallies findings and average quality scores for each of the metrics; here we summarise findings for metrics examined in more than 5% of studies, in descending order based on the number of datapoints. Across all three substance use metrics (prevalence of use, frequency of use and use of other alcohol or drugs), drug law reform was most often not associated with use (with null findings for 48.0% to 52.4% of outcome measures falling under these metrics). With respect to change in perceived harmfulness of the decriminalised or regulated drug, mixed results were found in half of cases, with heterogeneity detected on the basis of age, gender and state. 39 43 55–57 For example, legal regulation of cannabis for medical use was associated with greater perceived harmfulness of cannabis among eighth graders but not older students in an analysis of US Monitoring the Future data 39 while a study employing US National Survey on Drug Use and Health data found greater perceived harmfulness of cannabis among young adults aged 18 to 25 but not adolescents aged 12 to 17. 57

Among nine studies that employed health service utilisation metrics, harmful effects were reported for 6 of 12 outcome measures, with increases in emergency department visits and/or hospitalisations attributed to decriminalisation or legal regulation. 58–63 However, all but one of those studies 58 assessed change over time in one jurisdiction, without a control group. Further, two studies that also examined changes in acute care use for non-cannabis drugs found reductions in those visits or admissions following cannabis decriminalisation or legal regulation. 60 64 In contrast, six of nine prescription drug use associations were beneficial, with reductions observed in rates of opioid 65–69 and other drug prescribing 70 71 attributed to legal regulation of cannabis for medical use; outcomes in this category came from studies of higher average quality ( X =16.3). Perceived availability of the decriminalised or regulated drug appeared largely unaffected by decriminalisation (null associations for five of nine outcome measures) but two studies indicated increased perceived availability of cannabis among Colorado, US, adolescents following legal regulation for adult use 72 and among adults in US states with legal regulation for medical use. 44 Across the subset of seven outcome measures for overdose or poisoning by the decriminalised or regulated drug (cannabis), in all cases an increase in calls to poison control centres or unintentional paediatric exposures was reported. 59 73–77 However, studies assessing the impacts of cannabis regulation on overdose or poisoning by drugs other than cannabis concluded that the effects were either beneficial (four outcome measures 64 76 78 79 ) or mixed/null (three outcome measures 80–82 ). Driving with detectable concentrations of THC was most often found to increase following decriminalisation or legal regulation (five of eight outcome measures; 83–87 ), but these studies were of lower average quality ( X =12.0).

Impacts of decriminalisation

Of the 19 studies evaluating impacts of decriminalisation, six measured the prevalence of use of the decriminalised drug with eight unique outcome measures. No association was detected for all but three outcomes; following cannabis decriminalisation lifetime use increased among adults in South Australia, 31 while past-month use increased among 12 th graders but not younger students in California, 56 relative to the rest of the country in both cases. After peyote use for ceremonial purposes was decriminalised in the USA in 1994, self-reported use increased among American Indians. 88 Three studies evaluated relationships between decriminalisation and drug-related criminal justice involvement in Mexico and the USA. One high-quality study found that decriminalisation positively influenced criminal justice involvement: in five US states, arrests for cannabis possession decreased among youth and adults. 89 When possession of small amounts of cannabis was decriminalised in the 1970s in Nebraska, however, the mean monthly number of arrests did not change, while cannabis-related prosecutions increased among youth. 90 In Tijuana, Mexico, decriminalisation of all drugs had no apparent impact on the number of drug possession arrests. 53 Two historical and one recent study measured healthcare utilisation. US states that decriminalised cannabis in the 1970s saw greater emergency department visits related to cannabis, but decreased visits related to other drugs. 60 In Colorado, US, decriminalisation was associated with increased emergency department visits for cyclic vomiting. 62 Addiction treatment utilisation, healthcare and non-healthcare costs, driving after use, price of drugs, availability of drugs, frequency of use, attitudes towards use and perceived harmfulness were each evaluated in only one or two studies of decriminalisation.

This systematic review identified 114 peer-reviewed publications and conference abstracts evaluating the impacts of drug decriminalisation or legal regulation from 1970 to 2018. Within this search period, 88.6% were published in 2014 or later. This rapid growth in scholarship was driven by the implementation and subsequent evaluation of cannabis legalisation in a number of US states beginning in 2012, and knowledge production will surely continue to accelerate as longer-term data become available and as other jurisdictions (eg, Canada and Uruguay) analyse the effects of recently implemented cannabis legalisation. Indeed, a first study on the impacts of cannabis legalisation on adolescent use in Uruguay was published in May 2020 (finding no impact on risk of use 91 ). The present study provides an overview of the emerging literature based on our systematic review and suggests three key patterns.

First, peer-reviewed longitudinal evaluations of drug decriminalisation and legal regulation are overwhelmingly geographically concentrated in the US and focussed on cannabis legalisation. Importantly, the lack of non-US studies evaluating legal regulation of cannabis for medical use may reflect the more tightly controlled nature of medical cannabis regulation in other countries, and thus the more limited potential for population-level effects. It is notable that decriminalisation in the absence of legal regulation was evaluated in only 18 studies (15.8%), despite being far more common globally than legal regulation. These gaps may hamper evidence-based drug law reform in countries that are less well-developed, that play a substantial role in drug production and transit or that have different baseline levels of substance (mis)use as compared with the US.

Second, prevalence of use was the predominant metric used to assess the impact of drug law reform, despite its limited clinical significance (eg, much cannabis use is non-problematic) and limited responsiveness to drug policy. This is because ecological analyses have indicated little relationship between drug policies and prevalence of use, 52 as have studies assessing within-state change in use related to legal regulation. 21 These findings are supported by the preponderance of evidence synthesised in this review, although some variation is evident in relation to the specific provisions of legal reforms (eg, liberal vs tightly regulated medical markets 92 ). Impacts of legal cannabis regulation on prevalence and frequency of use continue to be evaluated, with recent data suggesting small increases among adults, but not youth. 93 Drug policies may be more able to influence the types of drugs that people use, drug-related risk behaviours and modes of drug consumption. 94 Metrics to assess these outcomes, however, were lacking in the reviewed literature. For example, only one study (0.8%) investigated whether legal regulation of cannabis was associated with changes in the mode of cannabis consumption. 72 Although the prevalence of use was often measured alongside more clinically or socially significant metrics (eg, prevalence of substance use disorders, educational outcomes among young adults), 42.2% of studies assessing substance use prevalence included that metric alone or in combination with a single drug-related attitude metric.

Third, there was a lack of alignment between the stated policy objectives of drug law reform and the metrics used to assess its impact in the scientific literature. For instance, removal of criminal sanctions to prevent their negative sequelae is a key rationale for decriminalisation and legal regulation, 12 13 95 but only four studies (3.5%) evaluated changes in drug-related criminal justice involvement following drug law reform. Similarly. improving the physical and mental health of people who (already) use drugs is a motivation for drug policy reform but no included studies examined mental or physical health outcomes (aside from substance use disorders) in this population. As a result, there is a risk that decisions on drug policy may be informed by inappropriate metrics. Promisingly, in recent months, additional studies assessing legal regulation that employ a range of criminal justice metrics have been published. 96–98 Finally, despite ample evidence of the impact of criminalisation on infectious disease transmission and acquisition risks, 5 we found no studies evaluating the impact of decriminalisation on these outcomes.

Both the included studies and our systematic review have important strengths and limitations. To our knowledge, we conducted the first review of all global literature on decriminalisation and legal regulation and applied no language restrictions. All eligible articles identified were published in English; this may reflect a paucity of evaluation research published in other languages and/or limitations of our search strategy (eg, some non-English journals may not be indexed in the 10 databases searched). In addition, we excluded grey literature, non-original research and study designs that are not suited to evaluating policy effects (eg, cross-sectional studies), but these restrictions narrowed the geographical scope of included studies. For example, two articles on Portugal were excluded as non-original research, but nevertheless provide important insight on impacts of decriminalisation. 99 100 Despite restricting eligibility to more rigorous study designs, most included studies used relatively weaker eligible designs that are known to be vulnerable to pre-existing trends and confounding; only 22.8% and 5.3%, respectively, used controlled before-and-after or interrupted time series designs to address these threats to validity. The use of these study designs may be related to limited resources for prospective drug policy evaluations, with many studies relying on publicly available, routinely collected data. That the US is unique in the extent to which data on drug use and related harms are routinely collected helps to explain its over-representation in our review. Scoping reviews inclusive of grey literature and cross-sectional designs would be valuable for describing the full range of evaluations that have been conducted globally.

While beyond the scope of our high-level synthesis, the implementation and specific provisions of drug policies vary widely. Decriminalisation policies vary in their definitions of quantities for personal use, application of administrative penalties and the extent to which the law ‘on the books’ is reflected in policing and criminal justice practice. Indeed, in some jurisdictions with nominal decriminalisation, arrests for possession of small quantities of the decriminalised drugs remain routine. 53 Legal regulation models for cannabis are also heterogeneous. For example, policies legally regulating cannabis for medical use may or may not allow for legal dispensaries, and this provision has been shown to substantially modify the impact of legal regulation on cannabis use. 101 To the extent that individual studies employed crude exposure measures (eg, presence vs absence of a law), they may have obscured context-dependent effects of drug law liberalisation. Further, the impact of drug laws on drug use and related outcomes may be limited by a lack of public awareness of the details of local laws. 102

Our use of vote-counting in this synthesis (ie, categorising individual outcome measures as indicating beneficial, harmful, mixed/subgroup-specific or no statistically significant associations) is subject to the same limitation. Vote-counting should also be interpreted with caution in light of the heterogeneity of outcome definitions, the inherent arbitrariness of statistical significance thresholds and the key distinction between statistical and clinical significance. In addition, many included studies are evaluating the same policies (eg, cannabis legalisation in western US states), sometimes using overlapping data but drawing different conclusions based on analytical choices and timeframes. The existence of multiple datapoints for a particular outcome does not imply that the outcome has been well-studied across diverse contexts such that scientific consensus on its effects has been reached. Moreover, as illustrated by a recently published extension of the included article by Bachhuber et al , 79 multiple high-quality studies may generate results that are later revealed to be spurious as additional follow-up data become availability. Specifically, Shover et al demonstrated that the positive association reported between medical cannabis legalisation and opioid overdose mortality in 1999 to 2010 reversed direction in later years, suggesting that earlier findings of a protective effect should not be given causal interpretations. 103 This was foreshadowed in the included article by Powell et al , which found that the purportedly positive effect of medical cannabis legalisation was attenuated in 2010 to 2013. 82 This scientific back-and-forth can be expected given that most included articles are evaluating legal changes introduced rather recently, and thus are examining early impacts with limited years of follow-up. Longer-term impacts of non-medical cannabis legalisation, and how they might be influenced by increased commercialisation, are yet to be seen. 104

The findings of this review indicate a need for a broadening of the metrics used to assess the impacts of drug decriminalisation and legal regulation. Given the growing number of jurisdictions considering decriminalisation or legal regulation of psychoactive drugs, 14–16 the disproportionate emphasis on metrics assessing drug use prevalence, as well as the limited geo-cultural diversity in evaluations, are concerning. Experts have called for a more fulsome approach to evaluating drug policies in line with public health and the United Nations Sustainable Development Goals, with attention to the full breath of health and social domains potentially impacted, including human rights and social inclusion (eg, stigma), peace and security (eg, drug market violence), development (eg, labour market participation), drug market regulation (eg, safety of the drug supply) and clinically-significant health metrics (eg, drug-related morbidity). 105 Drawing on methods such as multi-criterion decision analysis, 19 the engagement of both scientists and policymakers in priority-setting may help to produce evidence that provides a more comprehensive understanding of the breadth of impacts that should be anticipated with drug law reform efforts. Funding will also be required to support rigorous prospective evaluations of legal reforms.

Supplementary Material

Acknowledgments.

The authors would like to thank Gelareh Ghaderi for assistance with screening and data extraction.

Twitter: @aydenisaac

Presented at: Presented at the International Society for the Study of Drug Policy (May 22, 2019) and the International Harm Reduction Conference (April 29, 2019).

Contributors: DW and AIS conceptualised and supervised the review. CZ designed and conducted the literature searches. AIS drafted the manuscript. SC, ZM and AIS conducted screening and data extraction. NM contributed to drafting the manuscript and developing figures. All authors contributed to interpretation of findings and revising the manuscript for important intellectual content.

Funding: This review was supported by the Canadian Institutes of Health Research (CIHR) via the Canadian Research Initiative on Substance Misuse (SMN-139150), the MAC AIDS Foundation, and the Open Society Foundations. Ayden Scheim was supported by a Canadian Institutes of Health Research Postdoctoral Fellowship. Nazlee Maghsoudi is supported by a CIHR Vanier Canada Graduate Scholarship. Dan Werb is supported by a US National Institute on Drug Abuse Avenir Award (DP2- {"type":"entrez-nucleotide","attrs":{"text":"DA040256","term_id":"79190989","term_text":"DA040256"}} DA040256 ), a CIHR New Investigator Award, an Early Researcher Award from the Ontario Ministry of Research, Innovation and Science and the St Michael’s Hospital Foundation.

Map disclaimer: The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

Competing interests: None declared.

Patient and public involvement: Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

Patient consent for publication: Not required.

Provenance and peer review: Not commissioned; externally peer reviewed.

Data availability statement: All relevant data are contained within the article and supplementary materials.

LawNow Magazine

relating law to life

Decriminalization of Drugs in Canada: What does it mean and how would it work?

August 9, 2022 By Lee Klippenstein

Drug policy is changing in Canada, with Bill C-5 and requests for exemptions under section 56(1) of the Controlled Drugs and Substances Act .

There is a growing acknowledgement in Canada that drug use is a health issue and not a criminal justice problem. This is an important distinction given the way the opioid crisis is ravaging the Canadian population. John Cooper recently wrote an excellent piece for LawNow , which discusses the changing attitude towards drug use and decriminalization. Hopefully, he has convinced you why governments should pursue decriminalization.

I intend to use this space to explore the what and how of decriminalization in Canada. In the process, I hope the who , when , and where will also become clear.

What Does Decriminalization Mean?

When a drug is decriminalized, it means its possession is no longer a criminal act. It does not mean it is legal and anyone can buy it like a pack of cigarettes from a gas station or a bottle of vodka from a liquor store. It also does not mean the government is promoting or condoning its use. More importantly, decriminalization assists those who use drugs, not those who traffic them.

Decriminalization means that users of certain controlled substances will no longer face the criminal penalties they would have before the drug was reclassified. The goal is to reduce the burden on addicts and recreational users, while freeing up scarce justice system resources.

Practically speaking, decriminalization is an exemption from federal laws (those put in place by the Canadian government). The Criminal Code ( CC ) and the Controlled Drugs and Substances Act ( CDSA ) govern drug policy in Canada. Created by the federal government, they apply across Canada but are enforced at the provincial and municipal levels, primarily through policing. Offences under the CC and CDSA are also prosecuted through the provincially-run court systems.

Bill C-5: Proposed Federal Action

Canada is attempting to make modest moves towards reducing the criminal consequences of minor drug possession. In December 2021, the federal government introduced Bill C-5 in the legislature. If passed, Bill C-5 will amend both the CC and the CDSA in significant ways. The bill has passed through the House and is now before the Senate.

None of the changes in Bill C-5 will decriminalize any drug in the manner discussed above. Instead, the changes focus on removing certain mandatory minimum sentences for simple drug possession crimes. The changes also encourage conditional sentences and diversionary measures to address substance abuse in more appropriate ways.

Perhaps the most notable part of Bill C-5 in the context of decriminalization is the “declaration of principles” section ( 10.1 ), which will be added to the CDSA . This section states, in summary, that:

• substance abuse should be addressed primarily as a health and social issue
• interventions should aim to protect the health, dignity, and human rights of drug users
• criminal sanctions for the personal use of drugs increase the stigma of drug use and are not consistent with established public health evidence
• interventions should focus on the root causes of substances abuse, and measures should be directed towards these areas
• judicial resources should focus on offences that pose a greater risk to public safety

This federal bill does not go as far as some provinces and municipalities have requested. The proposed legislation, however, would alleviate some of the potential criminal justice issues that burden those who use these otherwise controlled substances.

How Does Decriminalization Happen?

The levels of government dealing with the immediate impacts of the opioid crisis – people dying daily – want a drug policy that goes further to address the stigma and health issues associated with drug use. Edmonton, Vancouver, and Toronto have all made requests to the federal government to decriminalize small amounts of substances such as cocaine, heroin, and fentanyl. British Columbia also made a request in November of 2021, and it is the first jurisdiction to receive an exemption.

Section 56(1) Exemptions: Municipal and Provincial Actions 

For a city or province to change drug policy in its jurisdiction, it requires an exemption from federal laws under section 56(1) of the CDSA . The Minister of Health and Health Canada grants these exemptions to an individual or a group. They decide on a case-by-case basis. Exemptions have been provided for things like research on the effects of ketamine in treating depression, or as class exemptions to allow pharmacists to provide otherwise controlled substances to their patients. (This was how Methadone was prescribed for a long time, however an exemption is no longer required.)

To receive a section 56(1) exemption, Health Canada considers several factors, including:

• potential benefits
• potential risks or harms
• evidence the substance is necessary for the activity
• safeguards for the use and storage of the substance

B.C. successfully attained an exemption by providing evidence of the severity of the opioid crisis, as well as the province’s capacity to deal with decriminalization. Health Canada accepted B.C.’s plan, which included that:

• adequate social supports would be available to drug users
• law enforcement was properly trained to educate those possessing controlled substances on how to access these resources, and
• B.C. has a comprehensive monitoring system that will allow it to provide ongoing feedback about the impacts of decriminalization in real time.

What Does Decriminalization Look Like on the Ground?

In B.C., adults over the age of 18 will no longer face criminal penalties if police find them with less than 2.5 grams of any opioid, cocaine, methamphetamine, or MDMA (or any combined quantity of these four drugs). These four drugs are the ones deemed most likely to be associated with the ongoing opioid crisis.

The exemption will not apply if there is evidence the adult is using the drugs for more than personal use. It must be stressed that decriminalization in this form does nothing to shield drug traffickers. Law enforcement agents will make these determinations. They will also be trained to provide individual users with information regarding social services and health initiatives to address the underlying issues that cause substance abuse.

No one is suggesting that we turn a blind eye towards the use of controlled substances. Instead, the focus is on acknowledging that drug users are people with health issues that have already upended their lives. Rather than defaulting to prison and punishment, decriminalization initiatives allow drug users to operate with one less fear hovering over their head – that they are going to get “busted” – while also promoting ways for them to recover from their health issues.

It is unclear whether the B.C. model will apply, in its specifics at least, to any of the other jurisdictions that have requested a section 56(1) exemption. It is not even clear whether Edmonton or Toronto will receive this exemption – Health Canada must decide if these locales have met the requirements. The B.C. model does show the potential that decriminalization may hold. And if nothing else, the individuals dependent on these substances in that province will have one less concern.

More to Come

Both Bill C-5 and the requested section 56(1) exemptions suggest Canada may be on its way to a more progressive drug policy, which understands the drug user’s struggle as its starting point. There is likely much more to come on this topic in the coming months and years.

Looking for more information?

• Defending the Defence by Melody Izadi May 14, 2024
• Canada is not yet Ready to Expand its Medical Assistance in Dying Legislation by Myrna El Fakhry Tuttle March 18, 2024
• Accessing the Justice System: Specialized support is critical for sexual violence survivors by Lisa Oracheski February 28, 2024

The information in this article was correct at time of publishing. The law may have changed since then. The views expressed in this article are those of the author and do not necessarily reflect the views of LawNow or the Centre for Public Legal Education Alberta.

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Lee is a law student at the Faculty of Law, University of Alberta and a volunteer with Pro Bono Students Canada.

Drug and Alcohol Testing Association of Canada

1 (866) 324-7093, call us now, understanding decriminalization and the steps to ending the opioid crisis.

Aug 3, 2021

Opinion: Decriminalization is a critical step in curbing the opioid crisis

A recent opinion article published in The Conversation examines the benefits of drug decriminalization, as well as its potential impact in fighting the ongoing opioid crisis. The article, co-authored by Alissa Greer, Assistant Professor in the School of Criminology, Simon Fraser University and Caitlin Shane, staff lawyer at Pivot Legal Society, also critically examines drug decriminalization compared to regulation, as well as its effects on drug-related harms.

According to a survey conducted in 2020, 59% of respondents favour the decriminalization of drugs. The Canadian Association of Chiefs of Police has also recently publicly supported decriminalization, in addition to British Columbia’s chief public health officer.

Earlier in 2021, 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 the Vancouver Model of decriminalization.

What is drug decriminalization?

Drug decriminalization refers to the implementation of an alternative response to criminal penalties for simple possession. It has been shown that criminalization of drugs has resulted in significant health, social and economic harms to vulnerable populations, including individuals who are homeless, have mental health issues, and Indigenous individuals.

In addition, drug decriminalization aims to “minimize the contact between people who use drugs and the criminal justice system and may increase their connection to health and social systems,” according to the authors of the opinion article.

Decriminalization vs. regulation

Legal regulation of drugs involves rules to control access to drugs, in contrast to a free market or full legalization.

Since decriminalization does not promote a “safer supply” of drugs, it will not affect the illegal supply of drugs containing toxic adulterants. Finally, the illegal drug market will continue to be criminalized following the implementation of decriminalization. According to the authors of the opinion article, the overdose risk will, nevertheless, remain high.

Advantages of drug decriminalization

One of the main benefits of drug decriminalization is that it will help to address drug use as a health and social issue in contrast to a criminal one; this would reduce the workload for the legal system, as well as the costs involved. Drug decriminalization also creates a positive impact in people’s lives, promoting their opportunities to access employment and housing. Furthermore, it reduces the stigma associated with drug use, and can serve as an effective harm reduction measure. Finally, implementation of drug decriminalization can encourage people to contact emergency services following an overdose, since fear of police can act as a deterrent in some situations.

Ontario’s mayors have called for decriminalization

Ontario’s Big City Mayors (OBCM) have been calling for the decriminalization of illicit drugs, in addition to continued funding and development of mental health crisis response units.

“While the provincial government is responsible for funding and coordinating mental health and addictions supports, all levels of government have a role to play in improving services for our residents,” OBCM said.

“The war on drugs isn’t working,” said Barrie Mayor Jeff Lehman. “We need to start understanding that this is a public health crisis for people who are addicted and to take a health approach to the people who are using drugs rather than policing.”

Decriminalization as a critical step, but not a solution to opioid crisis

According to the authors of the opinion article, decriminalization is not “a standalone solution to the harms of drug prohibition.” However, it can serve as a critical step in the right direction, since it will exert a positive impact on the lives of numerous people who are harmed daily from criminalization.

The authors maintain that it is important to be aware of the limitations of decriminalization models, so that governments and other stakeholders can refocus efforts on creating a safer drug supply. The authors also emphasize the fact that decriminalization must be coupled with greater access to safer pharmaceutical alternatives to the toxic and illegal drug market.

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Should Drugs Be Decriminalized in Canada? Research Paper

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
• As a template for you assignment

In response to serious opioid issues, Canada decided to introduce the decriminalization of the possession of heavy drugs in its particular territories. According to the government, this measure will help release the burden of the justice system and concentrate on health and the ways of its promotion within the framework of the prevention of drug use. Analyzing the rationale of this decision, this work aims to provide arguments against it. In other words, the decriminalization of heavy drugs is an inefficient measure for the prevention of their use as it deals with the consequences of this issue rather than its major causes, such as inadequate health practices, poor education, and economic and social inequities.

The growing rates of opioid use disorder (OUD) and the number of opioid-related deaths have become one of the most disturbing issues in the healthcare system of Canada. According to Belzak and Halverson, “while the opioid crisis has affected every region of the country, western Canada (British Columbia and Alberta) and the northern territories (Yukon and Northwest Territories) have experienced the highest-burden” (224). In British Colombia, probably the most affected province, in 1993, the number of opioid-related deaths did not exceed 330; however, in 2017, there was an increase of 400% with 1473 deaths (Fischer et al. 81). In response to this devastating situation, the government decided to focus on health care excluding opioid-related problem from the competency of the justice system.

Thus, starting January 31, 2023, an exemption from the Controlled Drugs and Substances Act will be implemented in British Colombia for three years. According to it, individuals (18 years and older) “will not be arrested or charged for possessing small amounts of certain illegal drugs for personal use. The total amount of illegal drug(s) must be equal to or less than 2.5 grams” (British Colombia par. 5).

These drugs include opioids, methamphetamine, cocaine, and MDMA; at the same time, their traffic, purchasing, and use in public places remain illegal. According to lawmakers, the criminalization of these drugs’ possession cannot improve the problem associated with opioid misuse. Moreover, it contributes to more negative consequences – the legal punishment of drug users will not prevent them from drug misuse. However, incarceration and its consequences may create additional social issues.

At the same time, the analysis of the situation shows multiple factors that should be addressed in order to minimize the rates of opioid misuse rather than deal with its consequences. Thus, according to Fischer et al., in the 1990s, “overdose deaths were primarily from combined heroin and cocaine injecting” of drug users with HIV (81). However, later, Canada increased the prescription of opioids and other heavy drugs for medical use, implementing and expanding opioid substitution treatment and supervised consumption sites. That is why “since the early 1980s, the volume of opioids sold to hospitals and pharmacies for prescriptions in Canada has increased by more than 3000%” (Belzak and Halverson 225). At the same time, the organization of research and investments in medical science for the identification or creation of safer substituents of opioids for patients with cancer or mental health issues could minimize the prescription of opioids and their potential misuse.

While the decriminalization of opioid use aims to promote safe supply and decrease the popularity of the illegal market, medical prescription does not prevent non-patients from drug abuse. There are multiple routes of opioid supply for non-medical use, including prescription-related fraud and forgery, “double doctoring,” Internet purchases, robberies and thefts, and street drug markets. In addition, according to Health Canada, “the most common source of opioids used without a prescription was a family member” – in other words, prescribed opioids may be shared among relatives (Belzak and Halverson 225). In addition, the mixing of drugs and alcohol consumption is an additional factors in opioid-related deaths. In turn, the education of citizens, along with the spread of awareness related to the negative consequences of drug use, could prevent its potential misuse in non-patients.

Finally, opioid misuse is connected with other serious social issues, such as racism, discrimination, and poverty. As multiple research states, homeless individuals and “First Nations populations across the country are heavily impacted by high rates of problematic substance use” (Belzak and Halverson 226). In addition, adolescents are highly vulnerable to opioid misuse as well. In these cases, addiction and associated consequences are caused by economic, educational, and employment issues, along with the stigmatization of asking for help and the absence of reliable assistance. In other words, due to structural racism connected with unemployment, poverty, unavailability of health care, mental health illnesses, and the absence of culturally competent health care providers, people are involved in drug use and potential misuse. Thus, paying attention to other social issues for the improvement of people’s welfare may prevent opioid issues more efficiently than drug decriminalization.

All in all, it is possible to say that the idea of help as the basis of decriminalization may be regarded as right – the punishment of drug users may create more challenges than solve the problem of drug misuse. However, it is not efficient as it does not address the main factors of drug misuse, including social, educational, health care, and economic issues that exist in society. In turn, the improvement of people’s well-being, the spread of awareness concerning the harmful effects of drugs for non-patients, and the absence of stigmatization of their medical use will genuinely decrease the seriousness of the current situation.

Works Cited

Belzak, Lisa, and Jessica Halverson. “Evidence Synthesis-The Opioid Crisis in Canada: A National Perspective.” Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice , vol. 38, no. 6, 2018, pp. 224-233.

British Colombia. “ Decriminalizing People Who Use Drugs in B.C. ” British Colombia . 2022. Web.

Fischer, Benedikt, et al. “The Opioid Death Crisis in Canada: Crucial Lessons for Public Health.” The Lancet Public Health , vol. 4, no. 2, 2019, pp. 81-82.

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Gov't polling showed many Canadians' drug decriminalization fears

2023 survey suggested canadians are split over whether decriminalization would make communities less safe.

Social Sharing

Months before British Columbia sought to scale back its drug decriminalization pilot project, the federal government's own polling suggested to officials that a majority of Canadians believed the policy would lead to an increase in overdoses. 

The results of the 11-page survey by the Privy Council Office, the wing of federal bureaucracy that supports the Prime Minister's Office, also suggests Canadians were split over whether decriminalization would make their community any less safe. 

"I guess what people are thinking is that [decriminalization] will somehow enable drug use," said Thomas Kerr, a professor and head of the division of social medicine at the University of British Columbia and the director of research at the B.C. Centre on Substance Use. 

Similar opinions were expressed over supervised drug consumption sites and even needle exchanges, Kerr said, adding that fears they would lead to increased use didn't play out "in reality."

"People have really overestimated the impacts of decriminalization, both positive and negative," he said.

• British Columbia to recriminalize use of drugs in public spaces

Decriminalization has grown into a political lightning rod over recent weeks after the B.C. NDP government reversed course and asked that police again be empowered to arrest people or seize illicit drugs when they are being used in public spaces.

The move followed months of concern over public drug use, including inside hospitals. 

The federal Conservatives have seized on the issue and pressed Prime Minister Justin Trudeau's Liberals to rule out granting a federal exemption to any other jurisdictions wishing to pursue decriminalization programs in an effort to curb opioid deaths.

Opposition Leader Pierre Poilievre describes the policy as the legalization of hard drugs. 

Federal Mental Health and Addictions Minister Ya'ara Saks has defended the decision to allow B.C.'s pilot project as one tool to combat the overdose crisis, which she says is being fuelled by an increasingly toxic drug supply. 

She recently rejected Toronto's longstanding application to undertake a similar program, telling The Canadian Press it was because its application lacked limits on the amount of drugs an individual could possess and any age restrictions.

There is currently no new application from the city or from places like Halifax or Montreal, Saks recently told the House of Commons after being pressed by the Tories. 

"People are dying because of street drugs; they are not dying because of decriminalization," Saks said. 

More than 40,000 people have died from opioid-related deaths since 2016, which is when Health Canada started tracking what Kerr called "Canada's worst public health crisis in modern history."

B.C. became the first jurisdiction in Canada to pilot the decriminalization of small quantities of illicit drugs like heroin, fentanyl, cocaine and MDMA, for three years beginning in January 2023. The province has long been ground zero for the country's overdose crisis. 

• Ottawa approves B.C.'s request to recriminalize use of illicit drugs in public spaces

Officials and others promoting decriminalization say it is meant to be a way to reduce stigma for drug users and try to get them connected to help, instead of sitting in jail.

Survey results

In the weeks after the pilot launched, the federal government decided to poll Canadians on their attitudes about decriminalization and drug use in general. 

Health Canada published the survey's findings last fall on a section of the government's website containing infographics, bulletins, advisories and other publications on health-related issues. 

The Privy Council Office surveyed two random samples of 2,000 Canadians early last year. 

It found that 49 per cent of respondents said they preferred focusing on health and social services when it came to addressing substance use among drug users, as opposed to 35 per cent who felt there was also a role for police.

While women and those with higher incomes tended to favour a health-focused approach, the findings suggested men and lower-income earners were more likely to prefer a police response. 

It noted that "Canadian born respondents" were also more likely to favour a health approach, while immigrants were more likely to see room for police. 

• Toronto decriminalization pitch left addictions minister with 'deep concerns'

When it comes to the issue of decriminalization, the survey found that 51 per cent of respondents agreed with the statement, "I believe decriminalizing drugs would increase harms associated with drug use such as overdoses." 

That is compared to 38 per cent who said they disagreed and seven per cent who said they neither agreed nor disagreed. 

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Polling said Canadians worried about drug decriminalization, UBC prof. says it’s ‘overestimated’

By Stephanie Taylor, The Canadian Press

Posted May 31, 2024 1:00 am.

Last Updated May 31, 2024 6:40 am.

Months before British Columbia sought to scale back its drug decriminalization pilot project, the federal government’s own polling suggested to officials that a majority of Canadians believed the policy would lead to an increase in overdoses.

The results of the 11-page survey by the Privy Council Office, the wing of the federal bureaucracy that supports the Prime Minister’s Office, also suggests Canadians were split over whether decriminalization would make their community any less safe.

“I guess what people are thinking is that (decriminalization) will somehow enable drug use,” said Thomas Kerr, a professor and head of the division of social medicine at the University of British Columbia and the director of research at the B.C. Centre on Substance Use.

Similar opinions were expressed over supervised drug consumption sites and even needle exchanges, Kerr says, adding that fears they would lead to increased use didn’t play out “in reality.”

He also said: “People have really overestimated the impacts of decriminalization, both positive and negative.”

Decriminalization has grown into a political lightning rod over recent weeks after the B.C. NDP government reversed course and asked that police again be empowered to arrest people or seize illicit drugs when they are being used in public spaces.

The move followed months of concern over public drug use, including inside hospitals.

The federal Conservatives have seized on the issue and pressed Prime Minister Justin Trudeau’s Liberals to rule out granting a federal exemption to any other jurisdictions wishing to pursue decriminalization programs in an effort to curb opioid deaths.

Opposition Leader Pierre Poilievre describes the policy as the legalization of hard drugs.

Federal Mental Health and Addictions Minister Ya’ara Saks has defended the decision to allow B.C.’s pilot project as one tool to combat the overdose crisis, which she says is being fuelled by an increasingly toxic drug supply.

She recently rejected Toronto’s longstanding application to undertake a similar program, telling The Canadian Press it was because its application lacked limits on the amount of drugs an individual could possess and any age restrictions.

There is currently no new application from the city or from places like Halifax or Montreal, Saks recently told the House of Commons after being pressed by the Tories.

“People are dying because of street drugs; they are not dying because of decriminalization,” Saks said.

More than 40,000 people have died from opioid-related deaths since 2016, which is when Health Canada started tracking what Kerr called “Canada’s worst public health crisis in modern history.”

B.C. became the first jurisdiction in Canada to pilot the decriminalization of small quantities of illicit drugs like heroin, fentanyl, cocaine and MDMA, for three years beginning in January 2023. The province has long been ground zero for the country’s overdose crisis.

Officials and others promoting decriminalization say it is meant to be a way to reduce stigma for drug users and try to get them connected to help, instead of sitting in jail.

In the weeks after the pilot launched, the federal government decided to poll Canadians on their attitudes about decriminalization and drug use in general.

Health Canada published the survey’s findings last fall on a section of the government’s website containing infographics, bulletins, advisories and other publications on health-related issues.

The Privy Council Office surveyed two random samples of 2,000 Canadians early last year.

It found that 49 per cent of respondents said they preferred focusing on health and social services when it came to addressing substance use among drug users, as opposed to 35 per cent who felt there was also a role for police.

While women and those with higher incomes tended to favour a health-focused approach, the findings suggested men and lower-income earners were more likely to prefer a police response.

It noted that “Canadian born respondents” were also more likely to favour a health approach, while immigrants were more likely to see room for police.

When it comes to the issue of decriminalization, the survey found that 51 per cent of respondents agreed with the statement, “I believe decriminalizing drugs would increase harms associated with drug use such as overdoses.”

That is compared to 38 per cent who said they disagreed and seven per cent who said they neither agreed nor disagreed.

The survey results suggest a majority believe decriminalization would make accessing services like recovery and treatment easier. A majority also said they have empathy for those struggling with drug addiction.

Still, 43 per cent of respondents said they agreed it would make their community less safe, compared to 46 per cent who disagreed. Another eight per cent didn’t answer.

Saks’s office highlighted the finding that suggests people empathize with those struggling and believe decriminalization will make supports easier to access.

“From the outset we’ve been clear, the exemption would be rigorously monitored, evaluated and adapted as needed, guided by the dual objectives of public health and public safety,” it said in an email.

“We are focused on ensuring people who use drugs can be moved from the criminal justice system to the healthcare system.”

Kerr said while he believes there is room for public education when it comes to specific harm-reduction policies, it would be “highly irresponsible” for policy-makers to base decisions around public sentiment.

Nonetheless, he said it appears “the pendulum is swinging” and the country is experiencing a “right-wing” backlash against certain drug policies.

That includes not just decriminalization of possession but also the provision of pharmaceutical alternatives for drug users in an effort to keep them away from toxic drugs — an approach known as safe supply.

Poilievre has taken specific aim at such programs, promising that a future Conservative government would place greater focus on treatment and recovery options.

“The question always becomes, what do you do for people when they’re not in treatment, or whether they’ve just left a treatment program and have relapsed,” Kerr said.

“We need to keep these people alive and disease free, and living with some dignity.”

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Ford calls drug decriminalization a ‘nightmare’ that will ‘never’ happen in Ontario

Drug decriminalization is an “absolute nightmare” that will “never” happen under Ontario's Progressive-Conservative government, Premier Doug Ford says.

Ford made the comments to reporters on Friday amid a national debate over the policy, which was recently rejected in Toronto by the federal government.

“It's an absolute nightmare. It would be a disaster,” Ford said.

“As long as I'm premier, we're never going to decriminalize hardcore drugs.”

Ford cited British Columbia as an example, which recently recriminalized the use of drugs in public places following a pilot project that sparked public and political blowback.

British Columbia’s pilot project began in January 2023, but this spring's reversal came after B.C. Premier David Eby expressed concerns about an “escalating situation” regarding public safety. This January, B.C. chief coroner reported a new record high in overdose deaths for 2023, the first year of decriminalization: at least 2,511 lives lost.

Eby said that escalating situation included concerns about drug use in hospitals, and public places like restaurants. He concluded the changes were needed after the attorney general said a legal battle over the province’s own attempt to legislate restrictions on public drug use could be tied up in court for at least a year.

“Addiction is a health issue, it is not a criminal law issue, and that principle is what the entire decriminalization project was about,” Eby said.

“But that compassion, that concern for people who are struggling does not mean that anything goes. We still have expectations around safety, public spaces, in the coffee shop, on the bus, in the park, on the beach.”

Ford praised Eby on Friday, saying he was “so proud” of the premier for reversing that “big mistake.”

He also thanked Ottawa for “giving the jurisdiction of that into the hands of the province.” The federal government recently rejected a request from Toronto to decriminalize the possession of small quantities of drugs for personal use.

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“What I believe in: we need more detox centres (and) we need more rehabilitation centres,” Ford said.

“But we sure the heck don't need people shooting up and doing drugs in neighbourhoods like Etobicoke, Mississauga or anywhere in that case in Ontario.”

The Canadian Press reported Friday that Federal Addictions Minister Ya’ara Saks had “deep concerns” about the lack of limits Toronto put on its now-rejected pitch to decriminalize the possession of illegal drugs.

Saks said the proposal did not include age restrictions or limits on the amount of drugs a person could have in their possession.

Saks added she made the decision to refuse the pitch after she received word Toronto would not amend its plans to address the concerns raised earlier by department officials.

Video: Opioid crisis: Are Canada’s ‘safe supply’ drugs being used in organized crime?

A Toronto Public Health spokesperson did not answer questions about the minister’s description of her objections, or the timeline of events, but added decriminalization is but one “evidence-informed policy tool to help remove barriers to care.”

Ontario did not support Toronto’s pitch; it warned Toronto Public Health to drop its more than two-year-old decriminalization application.

Ford also wrote a letter recently to Prime Minister Justin Trudeau asking Ottawa to stop approving new sites that supply safe opioids, while seeking a review of the Health Canada-approved sites across the country.

-- with files from Global News’ Sean Boynton , Simon Little and The Canadian Press