A New Approach to Managing Illegal Psychoactive Substances

1. A New Approach to Managing Illegal Psychoactive Substances CPHA Conference May 27 2014 Brian Emerson and Seema Nagpal Co-chairs

2. - CPHA Resolutions- CPHA Alcohol and Tobacco Papers

3. - Health Officers Council of BC- CPHA Illegal Psychoactive Substances

4. Overview of Paper Purpose: • Review available information • Identify options • Provide recommendations and • Stimulate discussion • Leading to a public health approach to managing currently illegal substances.

5. Overview of paper - continued • Foundational concepts • Public health importance illegal psychoactive substances • Policy Approaches Criminalization and prohibition; State Control; Commercialization; Prescription • Harms of prohibition & criminalization • Public Health Approach – Framework and examples

6. Barriers and Facilitators to Public Health Shift • Values and principles • Economics • Infrastructure • Canadian laws and international conventions • Programs and projects • Leadership • Evaluation • Research

7. Overview of paper - continued • Unintended Consequences of shifting paradigms – risk of commercialization • Vision for 2025 • Framework for Action and Recommendations • Glossary

8. Public Health Approach • Principles based - social justice, equity, human rights, evidence-informed • Addresses determinants of health • Organized, multi-level, mulitsectoral, coherent, comprehensive, efficient, and sustainable

9. Public Health Approach (continued) • Recognizes that people use substances for anticipated and actual beneficial effects • Attentive to the potential harms of the substances, as well as the unintended effects of associated policies

10. Public health framework • Directional Elements • Vision • Assumptions - explicit • Guiding principles/ethics • Goals and objectives

11. Public health framework • Strategies – Universal and Targeted: • Health Promotion • Health Protection • Prevention • Harm-reduction • Health Assessment and Surveillance • Services for people who are at risk or develop problems with substances.

12. Framework for Action and Recommendations Awareness, Information, and Knowledge • Analyze political parties positions • Develop national research agenda • Public awareness campaigns about a public health approach • Encourage research on therapeutic uses i.e. stimulant substitution/maintenance treatment, psychedelic medicine • Monitor and disseminating information about the changes in other countries • Establish a national monitoring capacity

13. Framework for Action and Recommendations Collaboration on Strategies and Initiatives • Collaborate on communications and advocacy • Government of Canada should • Move “Anti-Drug Strategy” lead back to Health Canada • Re-instate harm reduction in federal policy • Undertake consultations to prepare Canada’s input to the 2016 UN General Assembly’s Special Session on Illicit Drugs.

14. Framework for Action and Recommendations Primary Prevention - Children and Youth • Create a national dialogue about child and youth health and prevention of problematic substance use Empowerment, Harm Reduction and Treatment • Broadly implement evidence-based harm reduction measures • Meaningfully involve people who use substances and support development of peer run organizations

15. Framework for Action and Recommendations Stigmatization & Discrimination • Implement anti-stigma and discrimination strategies Evaluation • Review the Controlled Drugs and Substances Act Legislative Change • Support regulatory changes for managing cannabis

16. The Paradox of Prohibition Illegal Market Gangsterism Corporate Profit Heroin Cocaine Methamphetamine Cannabis Tobacco Alcohol Health and Social Problems Public Health Market Regulation Legalize with Few Restrictions Decriminalization Prohibition Prescription Defacto Decriminalization Legalize with Many Restrictions

17. The Paradox of Prohibition Illegal Market Gangsterism Corporate Profit Heroin Cocaine Methamphetamine Cannabis Tobacco Alcohol Health and Social Problems Medical Cannabis Public Health Market Regulation Legalize with Few Restrictions Decriminalization Prohibition Prescription DefactoDepenalization Legalize with Many Restrictions

18. Key Messages • Prohibition & criminalization not working, creating much harm • Public health approach holds much promise • Many lessons to be learned from tobacco and alcohol experience • Much to be learned from other jurisdictions

19. Key Messages • Management of substances - alcohol, tobacco, pharmaceuticals, and currently illegal substances - is a public health challenge. • Public health needs to • step up to the plate to do what it can • advocate for the resources to do more • collaborate with the usual and unusual partners to shift to a public health model.

20. Acknowledgements • CPHA Board and CEO Ian Culbert • Working Group – especially Betsy MacKenzie • Reference Group • Society of Living Illicit Drug Users (SOLID) • Folks at NivaInc., Anton Holland, for writing and production • CPHA Staff – Initially Jim Chauvin, subsequently Frank Welsh, and the dedicated, selfless interns Tasha Shields, ChandniSondagar, Julia Neufeind, Dominique Morneau; and many others at CPHA.