Executive Director of the Canadian Drug Policy Coalition, Don MacPherson talks about reducing the harm of drug use, the history of Prohibition and its roots in Vancouver, Canada, and gives evidence-based incentive for why we need to start looking at decriminalization as a new approach to Drug Policy in Canada.
Tracy: Let's open with the Canadian Drug Policy Coalition. From what I understand, your mandate is to raise awareness around harm reduction, and trying to get public policy away from the criminalization and incrimination of drug users. Want to open with a few words on the CDPC?
Don: Yes, the genesis of the group grew out of the harm reduction action in the 90's, shortly after we got together at the end of a UN meeting in 2009. In 1998, there was a UN meeting in New York with the aim of the global eradication of narcotics. The slogan was something like, "A drug free world, we can do it!", because that was where the thinking was back then. It was this sort of fantasy thinking. When they were saying "A drug free world", they weren't talking about tobacco, alcohol, or prescription drugs, they were only talking about illegal drugs. It should've been called, "An illegal drug free world, we can do it." It was a fantasy meeting. So that was when a lot of drug policy reform people stood up and said, "Okay this is ridiculous, countries are actually aspiring for something that's impossible." They were aspiring to literally rid the planet of plants like the coca bush, the cannabis plant, the opium poppy. It was nonsense.
So we had a meeting here in Vancouver afterwards with the North American UN regions. We met people from all over Canada and the US who were doing very interesting work discussing reducing the harm of using these drugs while they were still being consumed here on this planet until we could effectively curb their use. Most of this discussion was based on public health harm reduction, but there were some cannabis activists there as well. The CDPC was tapped more into the harm reduction issue because we realized there was no strong voice, or civil society voice in Canada that was either countering, or working with the government (depending on the policies of the government of the day of course). We wanted to provide a street-level voice through to an academic voice, in order to offer research to the government in terms of putting forward more effective ideas and alternative approaches. Because the notion that prohibition was working had really been questioned throughout the last 30 years. So we decided to form a coalition of organizations that would marshall civil society's organizations and the individuals working on the issue across the country, to put forward a progressive plan for Canada's approach to drugs.
Saying, "Hey these things are bad, let's get rid of them" is an impossibility in a market-based, globalized world. It only increases the profits of gangs and the underground market. The harmful behaviours of people who are addicted to drugs will not be curbed by simply declaring drugs illegal. We see ill-effects from eating too much sugar, from too much drinking, from gambling, or even looking at our iphones all day long. But do we make these things illegal because of the repercussions? Or do we look beyond the substance, and try to understand why certain individuals seek them out to such a destructive degree?
That's exactly right. And as we got into it, we realized a lot of our laws nationally and internationally have stemmed from these very premature discussions among countries: these international drug treaties. The discussion started in 1908 when, in fact we were the first country in the world to make heroine and opium illegal.
Yep! We made it illegal because of the very harsh reality we saw happening with the opium merchants just down the street from where we are [on the Downtown Eastside of Vancouver]. In a way, prohibition started in the DTES just around the corner from Main St and Hastings St in 1908 as a result of a race riot that had nothing to do with drugs. Since then, the notion that drugs are the problem became ingrained into all of our discussions. There was the Shanghai Treaty, and The Hague meeting in 1912. All of these countries were getting together and deciding that drugs were the problem themselves. They ended up with 3 conventions in 1961, 1971, and a 1988 convention on drugs that formed the global infrastructure for drug prohibition.
More to your point, if you look at the work of people we know like Gabor Maté, Bruce Alexander, or Marc Lewis, you suddenly realize you've been duped into thinking that drugs are the problem, let alone something like plants that have been growing alongside people for centuries. It's really hard to go to these big, international drug meetings and put up your hand and say, "Well actually, drugs aren't the problem." You're spending two weeks in these meetings, talking about how to restrict the drugs that have gotten out of control, or how to schedule drugs. Which once you look at the research is the entirely wrong approach. I always use the analogy of the drunk person who lost their keys, and they're only looking for them where a helper is shining a flashlight. Then someone comes up and asks, "What happened?" and the person replies, "I lost my keys". Then the person asks, "Well where did you loose them?" And the drunk person says, "Well I left the bar over there..." pointing to the dark area behind the cars. So they ask, "Well why aren't you looking over there?", and the person replies, "Well because the light is shining right here."
That's where we are today. With all the scientific evidence that has emerged in the last 30 years, since the 60's or 70's let's say, we're finally seeing the shift take place. Author after author is beginning to say, "Look, addiction to drugs has much less to do with drugs and more to do with everything else in our society." So we're trying to change course, but it's like the Titanic - it's a big ship, and it has been on the same course for almost a hundred years. But it's happening faster now: it seems as though almost weekly there are papers coming out in academic journals saying that our drug laws have more harmful effects on people than the drugs do themselves.
Our drug policies actually amplify the harm, they don't reduce the harm. They put people in extreme risk of dying. Overdoses, for example. You don't have to die from an opium overdose. And it's most likely the person is using opium to get out of extreme pain, or away from extreme trauma in the first place - just think of our Vets. They shouldn't have to die because they became addicted to opium, it was not a choice for them. But if you have someone there to take care of them, give them oxygen, or even give them Naloxone, a new drug that reduces the effects of an overdose, then we can save lives. But if they're alone in a room and wind up shooting up, or ingesting too large of a dose, they will die. And why do you think they wont call the ambulance or the police? Well they know how that will end up. So clearly it's our policies that create these consequences.
When you hear people say, "Drugs ruin lives, I see what they do to people on the street," or think, "Well, they're just morally inferior, they just don't know how to use their will power. We must be better than them." How do you educate those people, and dispel or counter that?
Drug use is on a spectrum. Everything from a glass of wine with dinner or cannabis use once a month, to the sacred use of peyote or Ayahausca ceremonies, to more regular but still non-problematic use of these things. The problem occurs when it becomes driving and drinking together. You can have 3 or 4 beers and still be socially acceptable, but if you get into a car after 3 or 4 beers, that's problematic use.
Then, there's dependency. If 10% of us have a real problem with alcohol, tobacco, cannabis, heroine, or whichever else, those are the 10% we should be putting all our resources into to come up with an effective health approach. But if we police 100% of us, including the 90% who don't have a problem with drugs, it becomes a total waste of resources. So why wouldn't we take the resources that we're currently using to police the 90% non-problematic users, and spend it on the 10% to actually help people.
Because the fact of the matter is that people will always get screwed up by drugs. They get screwed from computers, they'll get screwed up from sex, they'll get screwed up from fast food. We need to focus on those people with a problem of substance [over-consumption], and legitimately helping them with their problems. So drugs aren't necessarily the problem just themselves - it's the symptoms from over-use. Let's start asking, "Why are you spending your life sticking a needle in your arm? Let's talk about that." With all the tax payer funds we currently put into trying to catch the flow of these drugs themselves, we could really put a wrap around a bunch of approaches to solve the issue of addiction, rather than policing all of the people that don't have a problem, and that's all been fairly well-documented.
Absolutely. Do you feel more and more people are coming to understand this better despite the fear surrounding drugs that was instilled into us during the 80s and early 90s?
In some ways yes, and some ways not. The biggest challenge is that outside from drug policy circles, people still believe in large part that drugs are the problem. I mean, public money is still going solely to drug 'control': to drug control strategies, or drug control treaties. The irony is that prohibition doesn't control drugs, it actually sets them free into a free market system that is unregulated and uncontrolled. Again, we've fooled ourselves into thinking that our drug control approaches actually control drugs. But they give a free license to organized criminals to develop markets wherever they can, however they can, with whomever they can. That happens 24/7, in every city in the world. There's an illegal, robust drug market that spans this entire globe as a result of prohibition.
So we need to shift our thinking and recognize that A) prohibition does not work period, and that B) drugs aren't the problem but they are a symptom of a different problem. Until we convince people of those two things, we're not going to be able to make any sensible shifts in policy. Harm reduction is a lower level part of that shift, but people actually get it - injection sites are a really good example of the majority of people understanding harm reduction.
I do still hear people getting upset over injection sites. But when you ask the question, "Would you rather spend taxes exhausting the healthcare system after a person overdoses and gets rushed to the hospital? Or would you rather spend less money, supervising users in a safe environment with professionals who can direct them to treatment programs, getting them off the street away from their dealers?"
You're right on point there. The most profound thing is when police actually understand these results of having injection sites. The police are there to enforce drug laws, but they know that people are going to get their drugs any way they can. So they see firsthand that if someone uses Insite, versus if they get arrested by the police for doing heroin on the street, of course it's the better outcome for everyone to have then go to Insite rather than get arrested for using. The progressive police force control that contradiction in their hands: their job is to control drugs, stop drugs, and interrupt traffickers, but they know they can't stop drug use and the crime and harm that results from it. People will still find ways to get drugs, so if they have a problem with drugs - any drug - the first thing we should offer them is health services not jail.
With harm reduction, it helps to make the point that drug use will always be with us. Until people have a better path to do down in society, individuals will always seek to use drugs as self-medication, or to feel cool. There's no such thing as a drug free world and if we keep perpetuating that idea we're going to keep starting over and over again on a very false premise. The issue of harm reduction is beginning to help clarify things, but people are still very afraid of anything that looks remotely like legalization.
Many others have talked about this: how the stated aims of the War on Drugs are very different than the unstated aims. It is often pointed out how the stated aims have not been achieved, but the unstated aims certainly have. The stated ones being to rid the globe of drugs, addiction, and crime. The unstated ones being to actually crack down on undesirable people, and increase the prison population, which has been very successful for them.
Yes, we see this when talking about the prison-industrial-complex. The Drug War has been massively profitable in increasing the military budget for policing. So you're right, those unstated aims of the Drug Way are actually doing very well. They're winning the "War on Drugs" if we begin to understand it's not actually a war on drugs, but a war on people. The Drug War started in the early 1900's, but Nixon really ramped it up in '71 and '72. Ironically in 1972 it was the same year that the Royal Commission on the non-medicinal use of drugs was reporting out in Canada. They reported out saying that we should be experimenting with heroin prescription programs, and that we should be decriminalizing cannabis. They were going to suggest implementing Methadone programs as well. And in that same year, just South of the border, Nixon was ramping up the War on Drugs. Nothing happened with that Royal Commission's report, which unfortunately just came and went.
Canada had a choice at that point to go in an entirely different direction than the US but the US approach prevailed internationally. Nixon ramped up the War on Drugs, and just in the last couple of months a former Nixon aid has come out and confessed that the Drug War was more about controlling African-Americans then it was about drugs. So they've admitted it. This was also documented in a book by Michelle Alexander. She's a sociologist in the US who was one of the first to say that the war on drugs is about incarcerating black people and has more to do with social control. The book, The New Jim Crow, succeeded wildly.
We see the same happening here in Canada within our Indigenous communities. When the CDPC put on a talk at SFU Woodward's with Dr. Carl Hart, he spoke on how the Drug War is used as an excuse domestically to get rid of the "undesirables" in our society. Because we're uncomfortable with seeing what addiction can do to people. We haven't been addressing what addiction actually is, so we say, "Okay yes, put them away." It's too ugly for us to handle.
And we're doing our best to get voices like his and that of Dr. Gabor Maté out there to begin to address and discuss this - to agin, try to shift the Titanic. We're living in a historical time, which I view as sort of the Berlin Wall theory. The wall is coming down - global prohibition is starting to crumble. The logic that prohibition was established on is now seen as very illogical. The foundations of it have been exposed to be false. So it's just a matter of time before we can begin to take a much more scientific, medical, health-based approach to the problems we see resulting from drug use and over-use.
I think cannabis is the perfect canvas for legalization. Marijuana (as I was saying earlier) was almost decriminalized in Canada as a result of that Royal Commission. If the government had acted on that, they would've decriminalized cannabis in 1972. There's no reason why that couldn't have happened, except that public opinion was not there yet. And when did decriminalization within certain States start to happen in the US? After the Gallup poll when the issue was up by 50%. The Gallup polls that they do every year, have the same questions every year. They don't mess around with it. It's rock solid. You can watch how cannabis got to over 50% just a few years ago. Then, boom. What happened? Those initiatives started happening in Colorado, in Washington. People actually voted themselves on it. There's no better test of public opinion than people coming out to vote to legalize cannabis. Now our politicians are tripping over themselves to put forward bills to legalize it.
In Canada looking at harm reduction, four previous Vancouver mayors and the current mayor all supported Insite. We created a situation long-ago where if you wanted to be the mayor, you have to support harm reduction. But in the other major cities in this country, if you wanted to be mayor, you wouldn't talk about harm reduction, because people didn't understand or like it. It was too dangerous to them. They didn't know what it is. But now, what do you see? You have the mayor of Montreal strongly supporting an application for a safe injection site. In Toronto, the past 5 mayors are getting together and holding a press conference saying that Toronto needs supervised injection sites. The mayor of Edmonton just did a segment for CBC where he spoke very eloquently about harm reduction and the need for a safe injection site. That's all the direct result of the work we've been doing since the 90's in Vancouver. It's the maturing of a concept. Once it has enough support, along with the significant, scientific evidence behind it, some strong public figures are finally saying, "Look, try this out. Believe me, it'll make your city better." Besides it's been going on in Europe for 30 years now.
You helped introduce The Four Pillars Drug Strategy in 2000. Can you talk a bit about that?
The Four Pillars was an attempt to transfer a model that worked in Switzerland to a city like Vancouver. It was an attempt to respond to the death and despair that was happening in the Downtown Eastside of Vancouver, all throughout the 90's. I worked on the corner of Main and Hastings [Streets] at Carnegie Centre which was very connected to the community and all the activism that was going on. People were dying everyday. There were open drug scenes, high HIV among injection drug users. It was a total public policy disaster - very little was being done about it. So people in the community started to look elsewhere - namely to Europe. What happened in Europe in the 80's in places like Switzerland, Holland, and Germany, it was a very similar scenario. They had open drug scenes, high overdose rates, HIV rates among injection drug users. I was [working] at the city at that time, so a number of us from the community borrowed from the Swiss concept that introduced a few new elements to the traditional elements of supportive housing and methodone treatment programs.
The Swiss introduced the concepts of supervised injection sites and heroine prescription programs and they put it into a package that had 4 pillars. Those four pillars included, 1) the police who had their own pillar, 2) the prevention people, 3) the treatment people, and 4) the harm reduction people. It included a comprehensible approach. So even if you don't like the idea of harm reduction, you don't have to spend anytime in that department, you can focus on prevention. So we worked hard to acknowledge that each one of the 4 pillars are needed.
But some critics said that we only needed three pillars and that Harm Reduction should be taken out. The logic behind this was if you prevent drug use in young people, and you treat it when people develop a problem, while the cops take care of the trafficking and crime, everything will work out. But we see that this mode has failed. It left out that really important pillar of harm reduction which is what the Swiss discovered. That was their big innovation to the world in the 90's. In the mid 80's they were going through all of this stuff. So The Four Pillars was our attempt to create a road map for the province and the federal government. The Mayor of Vancouver at the time, Philip Owen was there with us, and he wanted a plan that he could go to the provincial government with and say, "We need your help. Go to the federal government and tell them we have a plan they can help us with." It was a smart move.
What was the response of both the provincial and federal government at that time?
They eventually got it, but it was a huge learning curve. Sitting with senior federal bureaucrats trying to convince them that an injection site was the right thing to do was very difficult, because those were new concepts that people didn't understand, or know enough about. Yes, they had existed in Europe for a good 10, 15 years, but it wasn't talked about over here, so it was scary stuff for those bureaucrats. I remember one day working up at City Hall and writing "safe injection sites" on a white board as part of the discussion, and I remember being impressed that my boss was going to leave it on the white board! It was that sort of an unspeakable, or too radical of an idea. Only people on the street level and some of the NGO people were advocating for this. When Phillip Owen came onto the scene in support of injection rooms it was very radical. Looking back seems strange, we weren't allowed to talk about what we needed to talk about - we could only discuss the approaches that were currently available to address this very dire situation.
It's a slow process. With effective policy, we might not see results for 10 or 20 years, but politicians don't like that because they only have a 4 year term, so you can imagine why they say, "There's a problem? Okay, here's law enforcement. Here are things you can see us doing." But does it actually halt the problem into the long term? No.
That's exactly right. Part of the failure of our Four Pillars program--and I say failure even though the 4 pillars accomplished a lot in terms of public education--was that it wasn't anti-drug enough at a time when we didn't know much about drugs. It wasn't an anti-drug charge. It was a pro-housing, pro-prevention, pro-harm reduction. All positive things. But slowly after, the province and the federal government came along. So finally in 2003, Insite got its permit to open. But when I say failure, I mean that we started down a road and then stopped. That was partly because Owen left politics. Larry Campbell came in after him and helped progress the issues a bit, but then left after one term. When Sam Sullivan was elected he was supportive but he had his own plan moving forward. So simply put, we lost momentum and we didn't scale up the response to meet the challenge. We scaled it up at the beginning to meet the challenge, which resulted in the city having only one, overwhelmed injection room and one small heroin program that was eventually put to a halt because of the change in government at the federal level. In Switzerland they scaled up their Four Pillar Strategy across the entire country let alone just one city - all the major cities had one to five injection sites. I remember Zurich implementing five, so of course their scale was much larger and their Four Pillars program had massive benefits into the long term.
But the dissemination of the results from Insite are known everywhere today. I often say that because of The Four Pillars process and the massive globalization of this information, along with residents of Vancouver who became quite proud of Insite, we created a context where suddenly you couldn't stand up in a meeting and say stupid things--either from the floor or as a politician--because a doctor or a scientist would stand up from the audience and say, "Actually, that's not what the evidence says". By engaging the scientific community, people came down from their towers, they got their hands dirty, and they were a part of the public process. So I'm very proud of the Four Pillars.
Let's talk about the roots of addiction. The research shows that it's 3-fold: 1) is simply conditioning of a behaviour - the "cue, routine, reward circuity" becomes much stronger the more an act is repeated. 2) is looking at childhood trauma - our nervous system and the most basic structure of our brain develops in response to our early childhood environment. And 3) is an increasingly isolated society focused on anxiety-inducing competition.
Without the right support and educational tools for stress reduction, of course people reach for substances that reduce stress.
Certainly. Gabor Maté does extensive work on childhood trauma but gets a lot of flack for being so categorical, so this combination of things is right on point. Affordable housing, job competition, lack of social services when people are going through stressful life events, people being disconnected from supportive families or communities. Dr. Carl Hart talks about these societal impacts - specifically looking at police targeting, poor and marginalized neighbourhoods, the prison system ... Trauma plays a role in the biological, psycho-social sphere and again we have the science to prove that too. UBC's Bruce Alexander would say, "We're like the canaries in the capitalist mine." The stresses are becoming so immense that addiction is expanding, and drugs are just a symptom of this stress. Materialistically, we may have access to everything we need, but we're not connected in a way that we evolved under. Marc Lewis writes about addiction as a developmental issue, so that goes to your point 1). Brain plasticity plays a huge role. You learn to do different things, but we can unlearn them as well with the right information. People can even age out of drug addiction. They stop using drugs because they fall in love, they create a family, or they get a job they like. All those sorts of things.
Right, the stresses get reduced. It's cheesy but love can halt addiction, because addiction partly results from a lack of secure connection to another human. The journalist Johan Hari does a lot of work on this topic.
It's a fascinating field. Something I've always wanted to do would be to put on a series of events discussing all this research behind the causes of addiction. Having Dr. Carl Hart come speak was part of that idea. We also had Marc Lewis come speak last summer too. Maia Szalavitz also writes a lot about this stuff. She has her own work with researching addiction which covers the learning and connection aspects of addiction too. It's interesting to me to look at the question of, 'Why are they so focused on drugs?' The mysterious thing for me is this: we have global infrastructure, and trillions of dollars being spent on fighting the war on drugs. But in fact sugar is just as, if not more problematic than drugs. I read once that there is a diabetes related amputation around once an hour in Mexico. Sugar is ravaging countries all over the globe. The drug thing is interesting because we're a drug gobbling society. Individuals all the way up the chain of command love drugs in our society. You have to wonder why all the fuss about drugs and no fuss about sugar?
Dr. David Kessler wrote a great book about this, The End of Overeating. He was part of the FDA under Bill Clinton, and is now taking on the Big Food and Big Sugar industries. A great documentary called Fed Up also looks at this.
Where is the criminalization of corporations who are forcing this upon us? Or throwing people in jail for having a cake shop? Why aren't we doing that? If you look at it, it's the same thing. Medical offices of BC, would say sugar is British Columbia's biggest drug problem. It goes back to the point of how we got it wrong from the get-go. For 100 years we've had it all wrong. Certainly there are very potential harms with drugs, but putting all the focus on trying to get rid of them sucks all the energy and all the money out of the real issue.
Correct. Let's end with decriminalization. Aside from harm reduction advocacy work, the CDPC is pushing for decriminalization of all drugs?
Yes, the Canadian Drug Policy Coalition focuses on major policy tasks, one of which is definitely harm reduction which will always be an uphill battle. But we also say that decriminalization needs to happen for all drugs. We're interested in, and looking at, what happened in Portugal. They have decriminalized drugs for personal use. There's no upside to criminalizing drugs for personal possession or use. You can't criminalize trafficking, because the sell, trade, or flow of drugs should all be regulated. For those who feel that it should still be illegal to produce drugs, then that's fine. But a crucial step is that you or I should never be criminalized for using drugs, period.
Ultimately, our organization understands that we must move towards regulation. Trying to rid our society of the fear that the sky will fall if drugs are regulated is a lot of work. But it would be much better if young people were getting drugs from publicly open places we can check-up on, not from an underground market we can't see - which is where it becomes dangerous and deadly. This way, they know the quality and the dosage of what they are taking because we can regulate that, just like we do with food. We must stop forcing our young people to only have the option of the black market. We also have to get over the fear that people are going to line up around the corner to go buy heroin. First of all they're just not going to. And second of all we can then start having public awareness campaigns like we do with cigarettes on the consequences of heroin. If most people have meaningful work, meaningful activities in their days, they have loved ones and friends, they're not going to get caught up in heroin use.
Kids are drawn to drugs because of the risk factor. As a teenager you're in that rebellious stage, so anything your parents don't want you to do, you're going to do. A friend once said, "What if we grew up with pot as the thing grandmas used for arthritis? It'd take the cool-factor out of drugs."
That's a very effective analogy. In fact, very few young people living in the DTES are moving into the use of heroin, because through heroin programs, the image of the heroine user is very sick person. The more we nail that into people, the more use goes down. Regarding clinics, the last place a kid wants to do is see a doctor at the clinic. It becomes much less "cool". The Swiss argue the same thing, they've made heroine use incredibly uncool for young people. Seeing the harms reduces the salience of these things. We need to get there with cannabis as well, which is a bit of a challenge. I would argue that we should legalize cannabis so that we can create different social norms. If it's no longer edgy or cool to smoke pot before you go into class on Monday morning, we can reduce it's role in society, and those who are concerned about the effects of drugs will start to see results.
Dr. Kessler talks about this as well, "If you take cigarettes out of the hands of the movie stars, look what happens: there's a huge decline in smokers." Now it's the person on the carton with burnt lungs who smokes. The psychology is empowering.
And when we reach legalization with all other drugs, we can start to do that too. It's looking up.
Well thank you and keep up the wonderful work Don, I'll look forward to more events put on by the CDPC!