The criminalization of substance use causes demonstrable harms: it isolates people who use drugs, pushes them to use in riskier ways, and deters them from seeking help when they need it.
For a recent episode of the Addiction Practice Pod, we spoke with Dr. Bonnie Henry, BC’s Provincial Health Officer, to discuss the years-long overdose crisis in British Columbia, how the criminalization of substance use negatively impacts lives and health, and what role clinicians can play in reducing these harms in the absence of systemic change.
Note: Interview has been lightly edited for readability.
Q: Dr. Henry, tell us a little bit about why drug policy is a public health issue.
A: When we declared the [overdose] public health emergency, we started looking at what were the root causes that were leading to people using alone. [We heard] people are afraid to talk about their drug use, people are hiding it, people are being stigmatized and shamed. And much of that had to do with criminalization.
One of the most stigmatizing things that we can do people is to call them a criminal and put them in jail. So they’re afraid of losing their family, losing their children, losing their jobs.
Q: What are some of the health concerns that are associated with drugs being illegal rather than the drug itself?
A: Illegal drugs that are on the street, they’re made under conditions that are not regulated. It leads to things like contamination with other chemicals that can cause severe reactions to people and lead to death.
Q: What do clinicians need to know about those harmful effects of criminalization?
A: The toxicity of the street drug supply has just dramatically changed. And that’s where the importance says things like having pharmaceutical alternatives can make a big difference.
I think that the important thing we clinicians need to think about is that harm reduction thinking. It’s not that we’re providing medications to somebody inappropriately, we’re actually protecting them from using of a drug that we know is toxic, giving them what they need, because we know that people have problematic substance use or addiction that it is a medical condition. It’s a chronic, relapsing brain disorder that happens when you become addicted to opioids.
We know that even when we’re prescribing pharmaceutical alternatives — so regulated drugs — that some people will still continue to use street drugs, but their use tends to go down.
And the other thing that I think is incredibly important about a safe supply that we as clinicians need to think about is the very act of connecting with somebody and meeting them where they are – [the importance of] bringing them along and making those connections. We’ve heard people say the opposite of the addiction is connection. If we can make those connections, that increases the probability that people are going to get to that place in their life where recovery is an option. And that’s a positive thing that we need to focus on.
Q: In BC, the majority of fatal overdoses are not from everyday users. What are some strategies that healthcare providers can use to reach this population?
A: The number one thing is to be able to have conversations with our loved ones about drugs. Having those very straightforward, non-judgmental conversations so that people are able to talk about it in a way that can be supportive and help people understand the risks.
We all need to recognize that [people who use substances] are our brothers, our sisters, cousins, our friends, our colleagues. Reaching out and actually sawing it’s okay to talk about this is the most important thing that we can do right now, more than ever.
Q: These sound like pretty basic principles of physicians and nursing practice, listening to people and meeting them where they’re at to get better health outcomes.
If we think about the hierarchy in the medical world, mental health is sort of like the poor sister and addictions medicine is like the poor cousin twice-removed. We have not spent enough time as clinicians learning about addictions and learning about how to talk to people with addictions. But know it is so prevalent in our society.
Q: What would you see as like an ideal future state for how drugs are regulated in Canada?
We’ve had our grand argument with cannabis and the sky didn’t fall. I think that is a good way to move forward. Ideally, in the future, I would like to see all our illegal drugs being regulated in the same way we do with cannabis.
People who use drugs, particularly people who have substance use disorders or addictions, need to be treated like other people with medical conditions. It’s not something different. It’s not [acting like substance use] is illegal, so we can ignore it. We as clinicians can care for people who have these issues and we can help them through these issues. We can support them in making sure that they have what they need to stay safe.
Listen to the full interview and other episodes of the Addiction Practice Pod here.