Regulating medications is the way out

Should heroin and cocaine be legally available to those who need and want them? If we’re serious about ending the drug overdose crisis, this is exactly the kind of sweeping change we need. Yes, there needs to be extensive regulation. In fact, the whole point of regulating drug production and sale is so we can better control what gets sold and to whom.

After British Columbia’s provincial health officer, Dr. Bonnie Henry, testified before an all-party health committee in Ottawa in May that regulating these controlled drugs would minimize harm, British Columbia Premier David Eby said he disagreed. He was quoted as saying that “on a real level, in the real world, (it) doesn’t make sense.” But does our current approach to drug prohibition “make sense”?

Since the overdose crisis was declared in 2016, deaths due to illicit drug toxicity have become the leading cause of unnatural deaths in British Columbia and the leading cause of death from all causes among people aged 10 to 59. Since 2016, more than 44,000 people have died from drug toxicity in Canada, and more than a third of those deaths occurred in British Columbia. An average of 22 people die each day in Canada because of the toxicity of the illicit drug supply.

Delivery of toxic drugs

Why is the drug supply so toxic? Because we allow organized crime to produce drugs instead of regulated licensed industries that are required to adhere to health and safety standards.

In the context of drug prohibition, organized crime and drug cartels are motivated to produce very strong products because they are cheaper and therefore more profitable. This is what happened during alcohol prohibition in the 1920s. Organized crime was rife and people were being poisoned because there were no health and safety standards for production.

The failure of alcohol prohibition to meet its key goals of eliminating the supply and demand for alcohol is the same as the failure of drug prohibition. Illegal drugs are easy to find, regardless of their illegal status. A credible estimate is that 225,000 people use illegal substances in British Columbia.

What’s the way out? Our knowledge of the scientific evidence and decades of collective experience—including as a researcher (Kora DeBeck), a provincial health officer in British Columbia (Perry Kendall), and a chief medical examiner (Lisa Lapointe) during an overdose crisis—lead us to drug regulation. When we regulate a substance, we have the most control over its production, distribution, and consumption.

Tobacco Lessons

Some may argue that drug regulation sends the “wrong message” and will encourage drug use, which is most worrying among young people. However, if we look at the lessons from tobacco regulation, we can see that public health-based regulation can actually be a powerful and effective deterrent to substance use.

By strictly controlling tobacco marketing, packaging, purchase prices, purchase age and places of consumption, as well as educating people about the health risks, it has been possible to significantly reduce tobacco consumption and related health damage without the additional risks associated with tobacco prohibition (for example, a criminal black market controlling production and sale).

If we moved from prohibition to regulation, we would have access to the same regulatory tools to control the use of currently illegal drugs.

Addiction treatment is not enough

But what about addiction treatment? Isn’t that what we need? While it’s true that eliminating waiting times and increasing access to effective, evidence-based treatment is incredibly important and much needed, the reality is that many people who use drugs do not have an addiction, and many more are not currently seeking treatment. Yet all people who use drugs face the deadly consequences of an unregulated, toxic drug supply.

It is also important to remember that addiction recovery is complex and relapse is common in the recovery process. In today’s toxic drug environment, those who relapse after a period of abstinence are at significantly higher risk of death due to decreased tolerance. We also know that addiction treatment is not regulated or standardized, and treatment outcomes are not reported.

While supporting people in recovery is important and can save lives, addiction treatment is not the simple solution many believe it should be. Thousands of lives remain at risk every day.

Regulated drug delivery

Taking the production and sale of currently illegal drugs away from organized crime and drug cartels is the most promising way to keep our children and communities safe. With strict health and safety standards for the production of these drugs, and strong public health-based regulations for their distribution and sale, we have the best chance of reversing the carnage of overdose deaths and managing drug-related harm.

Regulating drugs may seem like a radical idea to some, but governments continue to regulate the production and distribution of potentially dangerous goods. Firearms regulation in Canada includes licensing, which requires completing a firearms safety course. Mandatory ingredient lists that disclose the amount of sugar, sodium, and fat in the products we consume are another example of government regulation that aims to protect the public and provide information that can shape consumption patterns and reduce health risks.

Implementing an effective regulatory framework for currently illegal drugs will be a complex undertaking requiring close monitoring and evaluation, and inevitable adjustments and revisions along the way. Although the task may seem daunting, allowing overdose deaths to continue at the current rate is unthinkable.

Transformative and life-saving medicines regulation is urgently needed because – to borrow Prime Minister Eby’s terminology – at a “reality-based, real-world” level, our current approach is a catastrophic failure.

This article was co-authored by Lisa Lapointe. She was British Columbia’s Chief Coroner from 2011 to 2024 and led the Coroners Service to receive its first Premiers Award for Evidence-Based Design for its analysis and timely reporting of drug overdose death data.