UBC Reports | Vol. 49 | No. 2 | Feb.
A Public Health Approach to Drug Use
By Richard Mathias
Canadas drug laws kill Canadians.
In 1994, B.C.s Coroner issued a report on inadvertent
overdose deaths in British Columbia, concluding that these
deaths were preventable and that a re-thinking of the drug-related
laws was necessary and urgent. In the eight years since that
report, a further 2,334 deaths have been ascribed to the inadvertent
overdose category by the Coroners Office. When drug
associated deaths are tabulated over the period 1994 to 2001
there were 5,438 deaths, 3,683 directly and 1,756 indirectly
attributed to non-therapeutic drugs. Unlike tobacco, these
deaths are due to the modes of use rather than direct toxic
effects and are mainly preventable, even if use continues,
also unlike tobacco.
To draw attention to this issue without a solution would
be an empty exercise. The United Nations General Assembly
in 2001 called for drug policy that respected human rights,
makes treatment available to dependent users and reduces the
traffic in illicit substances. Dependency is a relapsing,
chronic brain disease and must be treated as such. The ill
person should be allowed to use their drug(s) so they can
survive their dependency and give time for treatment. A public
health approach will do this and will virtually eliminate
trafficking, benefiting the individual and the community.
A public health approach has the primary goal of reduction
of use of both licit and illicit psychoactive drugs. However,
many people will use drugs because of the effects desired
by the user, whether tobacco, alcohol, marijuana, ecstasy
or other psychoactive drugs. Further goals are to prevent
a drug user from becoming either an abuser of or a dependent
on the drug. If this fails, the person with a drug dependency
will be assisted to use the drug as safely as possible and
offered treatment when that person consents to such treatment.
When primary prevention and secondary goals fail, the drug
user is not stigmatized for their decision and is able to
survive through safe use of their chosen drug.
As with alcohol and tobacco, federal, provincial and municipal
regulations would be used to control distribution and production.
Points of sale would be regulated and would include information
on use and possible adverse effects. Places of use would be
licensed and would have some responsibility for monitoring
use. The drugs sold would either be ingested, smoked or inhaled.
These modes would be intended to reduce the risk of overdose
and adverse effects.
If the user wished to use a drug by injection, it would be
available only through a pharmacist or other professional
knowledgeable about handling drugs for intravenous injection.
The purity and sterility would be ensured and the syringe
and needle could only be used once, thus eliminating sharing.
Such syringes are currently available.
There are immediate and predictable effects of putting this
public health-care approach in place. The illicit drug trade
would be greatly reduced. With a reasonable cost of the drugs,
and a reasonable supply of drugs, crime associated with the
users would decrease. Drug seeking behaviours occur when a
drug is not available. The violence associated with drug trafficking
would be reduced as there would no longer be illegal supply
networks competing for a lucrative market. The markets would
now be legal, regulated and taxed. The monies raised by taxation
on drug-related income through legal sources would now be
available for use by governments at all levels. Agriculture,
manufacturing and hospitality industries would all benefit.
As a society we abolished the death penalty for murder no
matter how deliberate or how often repeated, yet we continue
to have a de facto death penalty for drug use.
Governments have a responsibility to all citizens, even stigmatized
drug users. The public health approach offers a strategy to
prevent drug use within the larger framework of human rights
and biomedical ethics. It has the capacity to address current
health emergencies and to respond to future needs through
program planning and evaluation.
All that is needed is the public and political will to change
a failed approach with one more likely to be efficient and
effective. The need is urgent. In B.C. alone, there are nearly
three deaths per day associated with current drug laws. Each
days delay results in more infections, risks and deaths.
It requires decisive immediate action by our legislators and
our public health community to save Canadian lives.
Richard Mathias is a professor of Health Care and Epidemiology
in UBCs Faculty of Medicine.