The Global Commission on Drug Policy has issued recommendations on tackling North America’s opioid crisis, calling for the immediate expansion of harm-reduction services, the decriminalization and regulation of currently illicit drugs and an initiative to allow interested cities to de facto decriminalize as federal debates over drug policy continue.
The position paper, to be released on Monday, comes in advance of the final report of the White House opioid commission, led by New Jersey Governor Chris Christie, due out in November.
An interim report of the White House commission released in late July cited as its top recommendation the declaration of a national emergency as the number of overdoses continues to rise.
Michel Kazatchkine – a physician, professor of medicine, former executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria and a member of the Global Commission – said he was favourably impressed with the White House commission’s interim report.
“It is going in the right direction – but these steps will fall short in the next few months,” said Dr. Kazatchkine in a telephone interview from Geneva, Switzerland.
The Global Commission has called for drug decriminalization and regulation since its creation in 2011. Faced with the mounting death toll in North America’s opioid crisis, it is now recommending a “sanctuary city” initiative under which cities that wish to do so can de facto decriminalize petty drug use and possession.
The Global Commission is chaired by former Switzerland president Ruth Dreifuss. Its members include Richard Branson, former United Nations secretary-general Kofi Annan, former U.S. secretary of state George Schultz, former chairman of the U.S. Federal Reserve Paul Volcker and 10 former heads of state.
“Repression is harmful,” Dr. Kazatchkine said. “Wherever repressive policies are in place, people will not be in the best condition to access services. There is no way decriminalization will happen at the federal level soon in the U.S., but states or cities can sometimes make decisions for which they do not need federal approval, or for which they will enter into a battle with the federal process, but they still can continue to do things.”
He cited as examples the legalization of marijuana in some U.S. states and Seattle’s Law Enforcement Assisted Diversion (LEAD) program, which sees police officers redirecting those involved in lower-level drug or sex-work offences to community-based services rather than jail.
In Canada, health officials including British Columbia’s provincial health officer and the head of the BC Centre for Disease Control have called for decriminalization. Jagmeet Singh, elected head of the federal NDP on Sunday, has also pledged to decriminalize petty drug use. The reigning Liberal government, which has pledged to legalize recreational marijuana by Canada Day, 2018, says there are no plans to decriminalize or legalize any other drugs.
Both commissions agree on the need to expand access to substitution therapies such as methadone and buprenorphine-naloxone (Suboxone); they are offered in only about 10 per cent of conventional drug-treatment facilities in the United States. However, the Global Commission also notes the efficacy of treatments with pharmaceutical-grade heroin and hydromorphone – both currently offered in Canada, but to only a few hundred people. It has also called for supervised-consumption sites.
Canada has approved a total of 18 federally sanctioned sites, a dozen of which are in operation. B.C. is home to several other provincially sanctioned “overdose prevention sites” and activists have set up various other unsanctioned sites.
The United States has not approved a single site, although various cities have expressed interest and a “secret” site is said to have monitored some 2,500 injections over three years with no fatal overdoses.
Clean needles also need to be available to prevent the spread of blood-borne illnesses, the Global Commission says.
“The U.S. has a very ambiguous position on needle and syringe exchange,” Dr. Kazatchkine said. “It is forbidden, for example, at the federal level in any foreign programs that the U.S. funds, including harm reduction abroad.”
Other recommendations from the White House commission include the development of fentanyl-detection sensors – but only for use of law-enforcement agencies to stanch the flow of the illicit opioid into the country.
The Global Commission would like to see drug checking be available to drug users – something that also has been available on a small scale in B.C.
Approximately 64,000 people died from drug overdoses in the United States last year. In Canada, there were at least 2,816 opioid-related deaths, with preliminary data suggesting another 3,000 dead by the end of 2017.
We need a “carrot & stick” approach. The “carrot” will be easy access to well-trained buprenorphine prescribers (as well as prescribers for other medications use to treat addiction to other classes of drugs), the “stick” would be punitive actions–not necessarily incarceration, although “work camps” where skills are taught could be a good option. Instruction in “life skills” and instrumental activities of daily living as well as recovery skills would also be a good idea. These could all be incorporated into public service as well. It worked during the “great depression” with the Civilian Conservation Corps, why not try an approach like that again?