It’s time to stop opioid prohibition and start regulation

published on April 28, 2017 by JORDAN WESTFALL and THOMAS KERR in The Globe and Mail

Jordan Westfall is president of the Canadian Association of People Who Use Drugs. Thomas Kerr is a professor of medicine at the University of British Columbia

During the era of alcohol prohibition in the 1920s, an average of 1,000 people a year lost their lives from consuming illicitly produced alcohol in North America. The prohibition of alcohol forced its production into underground markets, without regulation or governmental oversight. As a result, the liquor produced was often contaminated, unpredictable in its potency and caused blindness, hallucinations and death.

In 2017, it is estimated that between six and seven Canadians lose their lives to drug overdose every day. In British Columbia, 922 people lost their lives last year, the worst year in its history for overdose deaths, and new data for 2017 shows that the situation is getting worse. Someone in Ontario dies of opioid overdose every 13 hours. Increasingly in both provinces, an unregulated, illicitly produced opioid known as fentanyl is responsible.

How did we get here again almost 100 years after alcohol prohibition? Much of the problem began with the overprescribing of opioid medications and assurances from some in the pharmaceutical industry that these drugs were safe and non-addictive. This spawned an opioid-use epidemic like never seen before in North America.

In response, efforts were made to dramatically curtail the prescribing of opioid medications. Yet research from Vancouver has shown that when denied access to opioid pain medications, many of the most vulnerable people with pain resort to acquiring illegal opioids, such as heroin and fentanyl, through street-based drug markets.

It seems clear that Canada once again has a supply problem related to illegal substances. But what are we doing about it? Although efforts are under way to scale up some evidence-based health interventions, we are risking falling back into a failed war-on-drugs approach focused on controlling the drug supply. Measures such as increased border controls, higher penalties for trafficking and expensive interdiction efforts have all been tried before with limited and often harmful consequences.