Toronto wants to decriminalize all drugs

The city's medical officer of health says too many people are dying from using drugs contaminated with fentanyl and other toxic substances


Toronto Public Health’s supervised injection site located inside the Works clinic at 277 Victoria Street.

The opioid crisis killed more than 300 people in the GTA in 2017, and it’s getting worse. Toronto’s medical officer of health Dr. Eileen De Villa is advocating for a controversial public health–based approach that includes decriminalization to solve the emergency. She spoke with Post City about the crisis. 

How pervasive has the opioid crisis become in the city?
The number of opioid overdose–related deaths in 2017 was 303, which was a 63 per cent increase from the year prior. 

Is decriminalization directly related to the opioid crisis or is there more to it?
The current situation in the city with regard to opioids is the primary driver. We have a situation here in our city: too many people are dying, taking drugs contaminated with fentanyl and other toxic substances. What we are proposing is to take a public health approach to drug use and drug policy, and that is the premise of the report.

Does endorsing this type of position send a signal that drug use is OK?
No, and in fact, if you had the opportunity to hear my remarks at the board of health meeting you would have heard me say, in fact quite clearly, both written in the report and spoken, that there are potential harms associated with all drugs, whether talking drugs that are legal such as tobacco and alcohol, drugs in medical practice or drugs currently illicit or illegal, all drugs have potential to cause harm. It is also important to demonstrate to people that the potential harms associated with drugs are worsened when people are forced into a position to obtain drugs illegally. 

Dr. Eileen De Villa speaking at Toronto's Board of Health on July 16. 


What is the most compelling evidence to suggest this will work?
The short version of the story is that, as I mentioned, we are in the midst of an opioid emergency in our city. People are dying from taking drugs contaminated with fentanyl and other toxic substances. The current system criminalizes drug use. There is a stigma associated with the criminalization approach to drug use, and the stigma is worsening the situation we are experiencing here on the ground as it pushes people into more unsafe practices. 

Why does it fall to you to do this?
It is our job as the local health unit to work with relevant partners to try to provide what optimizes the health status of our residents. From what we found in the scientific literature and the experience of other jurisdictions, we have found there are other approaches that are more consistent with a public health approach with better results obtained. 

This is just about decriminalizing illicit drugs, then?
We were not, by any stretch of the imagination, advocating a singular focus on decriminalization. What we recommended was a public health approach to drug use and drug policy, to treat it as a health issue and a social issue rather than an issue of criminal behaviour. And there are different elements, including prevention, harm reduction and treatment. A criminalized approach to drug use, when people have a criminal record after using drugs for personal use, it actually worsens their health, and they are less able to access stable housing and stable employment. 

Is it easier to get illegal drugs in Toronto than it is to get the help with addiction?
I can tell you that access to treatment is challenging in our city, for sure. 

Canada is already legalizing cannabis. How much did that move inform the decision to push further?
There is an opportunity to learn from our experiences with a different approach to other drugs, whether alcohol or cannabis. There were lessons that we have learned from tobacco and lessons we will continue to learn as cannabis becomes legal. 

In Portugal, those caught with drugs would be fined and appear before a tribunal and advised of treatment options. Is that the idea?
We weren’t actually specifically advocating for procedures or regimes, but we wanted to raise the conversation. Those details would be worked out in conversation with those that have expertise in the legal realm, expertise in drug laws, with communities, etc. We were not being very prescriptive around the details. I can tell you in a general way, they [Portugal] had among the highest drug rates and very high rates of harm associated with drug use. Now, they have seen significant reductions, both in the harms associated with drug use and in terms of the drug use rates themselves.

Shouldn’t we start with those that are prescribing these opioid painkillers?
I can tell you there is some work already being done within the medical profession by the College of Physicians and Surgeons in terms of better managing prescription medication and opioids in particular. However, we are proposing a more fulsome health approach that covers all aspects. 

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