Mandate The Treatment First
Nowadays, the oldest and most conventional notion needs to be emphasized - there is good and bad in everything. Similarly, not all drugs are good for you, and not all drugs are bad for you.
This notion of seeing the good, the bad, and the ugly in everything is definitely rooted in Natural Law, as it has a lot of truth to it. In any case, when anyone brings up the discussion of modern drug usage, they are not usually talking about people taking their vitamins, we are mainly talking about Hard Drugs, and the people that are addicted to them. So called “Hard Drugs” refer to drugs that are seen as potent or toxic, both in the physical sense (i.e. cardiac arrest, respiratory depression, liver damage, etc.), and the mental sense (i.e. anxiety, paranoia, hallucinations, etc.). Furthermore, some examples of hard drugs include Cocaine, LSD, Marijuana or other Cannabinoid substances, Opioids, Painkillers, and in some cases any large dose of Amphetamines. Obviously, given the complexity surrounding each drug, the term Hard Drugs can refer to many different things, but in simple terms it refers to nonmedical drug usage. Moreover for the purpose of our discussion, let us go through the history of hard drug usage in Canada, and then we will simply focus on Opioids, as it is the current epidemic that is plaguing the country.
Canada's drug usage policy has undergone significant changes over the past century, reflecting shifts in societal attitudes, legal frameworks, and public health priorities. Early policies were focused on strict prohibition and criminalization, driven by moral, social, and racial concerns. Over time, however, Canada's approach began to evolve, with growing recognition of the need for harm reduction, treatment, and public health interventions. From the earliest attempts to control substances like opium, to the legalization of cannabis for recreational use, Canadian drug policy has continually adapted to address both the legal and medical challenges of substance use, while balancing enforcement with emerging health-focused strategies.
The Opium Act of 1908
Canada’s first federal drug law, the Opium Act of 1908, was a response to growing concerns about the opium trade in British Columbia, particularly in Vancouver's Chinatown. The law targeted Chinese immigrants who were associated with the opium trade, marking the beginning of drug prohibition in Canada. This policy reflected a combination of racial prejudice and a desire to control perceived moral and social decay within society (Giffen, Endicott, & Lambert, 1991). It criminalized the import, manufacture, and sale of opium for non-medical purposes, setting the stage for future drug laws that focused on prohibition and criminalization.
The Opium and Drug Act of 1911
Building on the Opium Act of 1908, the Opium and Drug Act of 1911 expanded the scope of drug prohibition to include other substances like cocaine and morphine. This law further entrenched the criminalization approach and broadened the state’s power to regulate substances deemed dangerous (Fischer, 1997). This act was also instrumental in shifting public perception of drug users as deviants rather than individuals requiring medical assistance. Consequently, the 1911 Act represented the government's growing commitment to expanding drug prohibition as a tool to regulate moral behavior in Canada (Giffen et al., 1991).
Narcotic Control Act of 1961
The Narcotic Control Act of 1961 was a significant development in Canadian drug policy, consolidating earlier laws into one act that gave law enforcement broader powers to arrest and prosecute individuals involved in drug offenses. It was primarily concerned with combating narcotic use, including heroin, cannabis, and cocaine (Fischer, 1997). This act increased penalties for drug possession and trafficking, reflecting a zero-tolerance approach that mirrored the global war on drugs led by the United States. The act also further criminalized drug users, steering policy away from harm reduction strategies and emphasizing enforcement and punishment (Giffen et al., 1991).
Le Dain Commission (1969-1972)
A significant shift in thinking about drug policy emerged during the Le Dain Commission, a federal inquiry from 1969 to 1972 that explored the non-medical use of drugs in Canada. The commission recommended decriminalizing cannabis possession and shifting focus toward treatment and harm reduction, rather than criminalization (Giffen et al., 1991). While its recommendations were largely ignored at the time, the Le Dain Commission marked the first serious government effort to explore alternative approaches to drug policy that emphasized public health over law enforcement (Fischer, 1997).
Controlled Drugs and Substances Act (1996)
The Controlled Drugs and Substances Act (CDSA), passed in 1996, consolidated Canada’s drug control laws and modernized the legal framework surrounding controlled substances. It emphasized the regulation of possession, trafficking, import, export, and production of various substances, aligning Canada’s drug laws with international treaties (Giffen et al., 1991). The CDSA reflected the continuation of Canada’s prohibitionist approach but also provided a legal structure for medical use of certain drugs, such as cannabis, which would later play a crucial role in shaping the debate around drug decriminalization and legalization (Fischer, 1997).
The Medical Marijuana Access Regulations (2001)
In response to public pressure and legal challenges, the Canadian government introduced the Medical Marijuana Access Regulations (MMAR) in 2001. This policy allowed patients with certain medical conditions to access marijuana with a doctor’s authorization (Giffen et al., 1991). The MMAR marked a significant departure from earlier prohibitionist policies, acknowledging the medicinal benefits of cannabis and opening the door for future discussions on legalization.
Cannabis Act (2018)
The Cannabis Act of 2018 marked a historic shift in Canadian drug policy, legalizing the recreational use of cannabis across the country. This law made Canada the second country in the world to fully legalize cannabis, following Uruguay (Public Health Agency of Canada, 2023). The Cannabis Act was based on a harm reduction model, aiming to reduce the burden on the criminal justice system, prevent youth access, and eliminate the black market for cannabis. It reflected a broader shift toward viewing drug use as a public health issue rather than strictly a criminal matter.
The Current Predicament: Opioid Crisis and Mental Health in Canada
Today, Canada is in the midst of a severe opioid crisis. According to the Public Health Agency of Canada (2023), there were over 7,300 apparent opioid toxicity deaths in 2022, driven largely by the illicit supply of fentanyl, a powerful synthetic opioid. The crisis is exacerbated by the mental health challenges many individuals face, with nearly 20% of Canadians experiencing some form of mental illness each year (Mental Health Commission of Canada, 2022). The interplay between addiction and mental health is complex, as individuals with untreated mental health conditions are more likely to turn to substances as a coping mechanism, which can lead to a vicious cycle of dependency and worsening health.
Another significant issue within Canada’s current opioid crisis is the limited access to addiction treatment due to bureaucratic barriers in the mental health care system. Many individuals struggling with addiction face long wait times to see psychologists, psychiatrists, and other mental health professionals, which exacerbates their conditions and delays critical treatment (Mental Health Commission of Canada, 2022). The demand for treatment services often exceeds capacity, leaving people without timely access to care, particularly in rural and underserved areas (Canadian Centre on Substance Use and Addiction, 2019). Moreover, the complicated referral processes and stringent requirements to qualify for publicly funded services further hinder access, leading many individuals to fall through the cracks of the system (Goering et al., 2015). These barriers contribute to worsening outcomes for people with addiction, highlighting the urgent need for streamlined access to care and increased resources for addiction treatment in Canada.
Root Causes of Mental Health and Addiction
The reasons behind Canada’s rising rates of addiction and mental health issues are multifaceted. Social determinants of health, such as poverty, trauma, and lack of access to healthcare, are well-known factors that contribute to the prevalence of these conditions (Marmot & Wilkinson, 2005). For instance, individuals facing economic hardship are more likely to experience stress, anxiety, and depression, which can push them toward drug use. Furthermore, adverse childhood experiences (ACEs), such as abuse, neglect, and household dysfunction, have been strongly linked to the development of substance abuse disorders later in life (Felitti et al., 1998). Understanding these root causes is crucial for developing effective interventions.
Approaches to Solving the Drug Crisis
The opioid drug crisis in Canada has prompted a wide range of approaches aimed at curbing addiction, reducing overdose deaths, and addressing the underlying social, psychological, and physical challenges associated with substance use. From harm reduction strategies like safe supply and supervised injection sites to more traditional institutional approaches, each method offers a different path toward managing the crisis. These approaches vary widely, from the "Hamsterdam" decriminalization model, popularized by The Wire, to historical methods like the psychiatric institution and asylum approaches, which reflect a shift in thinking over time. Additionally, religious and spiritual programs continue to play a significant role in recovery for many, focusing on community and personal transformation. As such, it is important to demystify and explore these diverse approaches, by evaluating their effectiveness in the context of Canada's ongoing efforts to mitigate the devastating effects of opioid addiction.
Several approaches have been proposed to combat the drug crisis in Canada, ranging from harm reduction strategies to full decriminalization of all drugs. One widely controversial method is the establishment of safe consumption sites, where individuals can use drugs in a supervised environment with access to medical care and clean supplies (Kerr et al., 2005). In the United States, similar approaches have been coupled with medication-assisted treatment (MAT) programs, where individuals addicted to opioids receive medications like methadone or buprenorphine to manage withdrawal symptoms and reduce cravings (Volkow et al., 2014).
Safe Supply Approach
The safe supply approach to addressing drug usage in Canada aims to provide individuals with a regulated and safer alternative to illicit drugs. Safe supply programs, which distribute pharmaceutical-grade substances like opioids under medical supervision, are designed to reduce the risks associated with the unpredictable potency of street drugs, particularly those contaminated with fentanyl (Kerr et al., 2020). By providing controlled doses of drugs, proponents argue that these programs can prevent overdoses, reduce the spread of infectious diseases, and enable people to engage with healthcare services without the fear of arrest, with some claiming that these sites have also been shown to reduce overdose deaths and the transmission of diseases such as HIV (Gagnon et al., 2023). Safe supply has been implemented in cities like Vancouver and has shown promise in stabilizing the health of users while reducing emergency hospital visits and deaths (Tyndall, 2020).
Harm Reduction Approach
The harm reduction approach emphasizes minimizing the negative consequences associated with drug use rather than focusing solely on abstinence. This approach includes interventions such as needle exchange programs, supervised injection sites, and the distribution of naloxone to reverse overdoses. Harm reduction has proven to be effective in lowering rates of HIV and hepatitis C transmission, reducing overdose deaths, and increasing engagement with healthcare services (Marshall et al., 2011). Insite, North America’s first legal supervised injection site located in Vancouver, has been widely studied and found to significantly reduce overdose mortality and improve public health outcomes (Wood et al., 2004). This approach prioritizes safety and dignity for people who use drugs while offering them the support needed to eventually seek treatment if desired.
The "Hamsterdam" Approach
The "Hamsterdam" approach, popularized by the TV show The Wire, refers to a policy of de facto drug legalization in a specific area. In the show, law enforcement unofficially designates a neighborhood where drug use and sales are tolerated without intervention, allowing authorities to focus resources elsewhere. This approach reflects a broader argument for decriminalization, positing that removing criminal penalties for drug use can reduce violent crime, improve public health, and free up law enforcement resources for more serious issues (Alexander, 2010). While this model has not been formally adopted in Canada, it echoes the call for decriminalization of personal drug use, which is advocated by public health experts as a way to reduce the harms of the drug trade (Canadian Centre on Substance Use and Addiction, 2019).
Psychiatric Institution Approach
The psychiatric institution approach draws from historical methods where mental institutions were used to treat drug addiction through harsh and often controversial measures. A notorious example is the MKUltra experiment conducted by the CIA in the mid-20th century, which involved unethical testing of LSD and other drugs on unwitting subjects, including some in Canadian institutions (Goliszek, 2003). While these methods are widely condemned today, they highlight the dangers of using coercive or experimental treatments on vulnerable populations. Modern psychiatric treatment for addiction emphasizes ethical standards, evidence-based approaches, and voluntary participation, focusing on therapy, medication-assisted treatment, and holistic care (Volkow et al., 2014).
Madhouse Approach
The "madhouse" approach references the grim conditions of early psychiatric facilities, often called madhouses, where individuals with mental health issues, including addiction, were isolated and subjected to inhumane treatment (Porter, 2002). These facilities offered little in terms of actual therapy, with patients frequently restrained, neglected, and abused. While this approach is now discredited, it underscores the importance of humane treatment and the progress that has been made in mental health care. Contemporary addiction treatment rejects such punitive measures in favor of compassionate care that addresses the root causes of substance abuse, including mental health support and trauma-informed care (Substance Abuse and Mental Health Services Administration, 2014).
Asylum Approach
The asylum approach in addiction treatment represents a shift from punitive incarceration to care in institutions designed to rehabilitate individuals. In the 19th and early 20th centuries, asylums were often seen as places of refuge for those suffering from mental illness and addiction (Scull, 2015). While early asylums had their flaws, the idea was to provide a controlled environment where individuals could recover away from the pressures and triggers of daily life. Today, modern inpatient rehabilitation centers echo this concept by offering structured, supportive environments where individuals can detox, receive therapy, and develop skills for long-term recovery. These centers focus on creating a safe space for healing and often integrate a combination of medical treatment, therapy, and social support (McLellan et al., 2000).
Religious and Spiritual Approach
The religious and spiritual approach to addressing drug addiction focuses on healing through faith, community support, and spiritual growth. This approach is exemplified by programs like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), which incorporate spirituality into their recovery frameworks. The 12-step model, which emphasizes surrendering to a higher power, has been used worldwide to help individuals overcome addiction (Kelly et al., 2012). Studies have shown that individuals who engage in spiritually based recovery programs often report higher levels of social support, greater life satisfaction, and better long-term outcomes (Tonigan et al., 2002). Many faith-based rehabilitation programs also integrate traditional therapies with spiritual practices, offering a holistic approach to recovery that addresses both the mind and the soul.
Solutions to the Drug Crisis
From a perspective that views hard drug usage as abnormal and in need of rehabilitation, the most plausible solution to Canada’s drug crisis should emphasize personal responsibility, law enforcement, and support for mandated treatment programs. Canadian Conservatives often advocate for stricter law enforcement on drug trafficking while promoting drug courts that offer individuals the opportunity for rehabilitation rather than incarceration. The goal is to strike a balance between holding individuals accountable for their actions and providing them with the necessary resources to recover (Boyum & Reuter, 2005). Programs such as Alberta’s "Recovery-Oriented Systems of Care" emphasize abstinence-based treatment and rehabilitation (Alberta Health Services, 2020). Dr. Sally Satel, a psychiatrist and lecturer at Yale University, has been a prominent voice in this conversation. In her interview in the documentary created by conservative public intellectual Douglas Murray, Satel stressed the importance of recognizing the diverse motivations behind drug use and the need for tailored treatment approaches. She has consistently argued that addiction is not solely a brain disease but also a behavioral and social condition, requiring multifaceted interventions (Satel, 2019). Her research focuses on addiction prevention and recovery through a framework that combines medical treatment with personal agency and accountability. Satel advocates for drug courts, which offer individuals struggling with addiction an alternative to incarceration through structured rehabilitation programs (Satel & Lilienfeld, 2017). This approach aligns with a rather conservative stance on drug policy, stressing law enforcement in combating traffickers while supporting recovery-oriented treatment, making it a politically conservative yet humane response to Canada’s drug crisis, due to the fact that it mandates treatment primarily and it does not mandate arrest or detention of drug users.
The hard drug crisis in Canada is a multifaceted issue with deep historical roots. Despite evolving drug policies, the current opioid epidemic highlights the limitations of punitive approaches to substance abuse. Addressing this crisis requires an understanding of the relation between mental health and addiction, as well as the social determinants that contribute to these problems. While harm reduction and decriminalization have been effective in certain areas, Solutions focused on primarily mandating treatment, and emphasizing accountability, as well as rehabilitation may also play a role in combating this issue. Ultimately, failing to address Canada’s drug crisis could lead to further social and economic destabilization, making it imperative for policymakers to find a balanced and effective approach.
References
Alberta Health Services. (2020). Recovery-oriented systems of care: Transforming Alberta’s addiction and mental health system. Alberta Health Services.
Alexander, M. (2010). The new Jim Crow: Mass incarceration in the age of colorblindness. The New Press.
Boyum, D., & Reuter, P. (2005). An analytical assessment of U.S. drug policy. AEI Press.
Canadian Centre on Substance Use and Addiction. (2019). Decriminalization: Options and evidence. Ottawa, ON: CCSA.
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., ... & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. American Journal of Preventive Medicine, 14(4), 245-258.
Fischer, B. (1997). The battle for a new Canadian drug law: A legal basis for harm reduction or a new rhetoric for prohibition? Canadian Journal of Criminology, 39(4), 311-330.
Gagnon, M., Rudzinski, K., Guta, A., Schmidt, R. A., Kryszajtys, D. T., Kolla, G., & Strike, C. (2023). Impact of safer supply programs on injection practices: Client and provider experiences in Ontario, Canada. Harm Reduction Journal, 20(1), 81. https://doi.org/10.1186/s12954-023-00817-7
Giffen, P. J., Endicott, S., & Lambert, S. (1991). Panic and indifference: The politics of Canada's drug laws. Canadian Centre on Substance Abuse.
Goering, P., Wasylenki, D., & Lindsay, S. (2015). Reducing barriers to access to care. Canadian Journal of Psychiatry, 60(11), 517-521.
Goliszek, A. (2003). In the name of science: A history of secret programs, medical research, and human experimentation. St. Martin's Press.
Kelly, J. F., Stout, R. L., Greene, M. C., & Slaymaker, V. (2012). Young adults, spirituality, and 12-step programs: A typological and longitudinal comparison. Alcoholism: Clinical and Experimental Research, 36(3), 539-546.
Kerr, T., Mitra, S., Kennedy, M. C., & McNeil, R. (2020). Supervised drug consumption rooms in Canada: Past, present, and future. Harm Reduction Journal, 17(1), 1-11.
Kerr, T., Tyndall, M., Li, K., Montaner, J., & Wood, E. (2005). Safer injection facility use and syringe sharing in injection drug users. The Lancet, 366(9482), 316-318.
Marshall, B. D., Milloy, M. J., Wood, E., Montaner, J. S., & Kerr, T. (2011). Reduction in overdose mortality after the opening of North America’s first medically supervised safer injecting facility: A retrospective population-based study. The Lancet, 377(9775), 1429-1437.
Marmot, M., & Wilkinson, R. G. (2005). Social determinants of health. Oxford University Press.
McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689-1695.
Mental Health Commission of Canada. (2022). Mental health in Canada: Statistics. Retrieved from
https://mentalhealthcommission.ca
Porter, R. (2002). Madness: A brief history. Oxford University Press.
Public Health Agency of Canada. (2023). Opioid- and stimulant-related harms in Canada. Government of Canada.
Satel, S. (2019). Interview in The madness of crowds. Directed by Douglas Murray.
Satel, S., & Lilienfeld, S. O. (2017). Brainwashed: The seductive appeal of mindless neuroscience. Basic Books.
Scull, A. (2015). Madness in civilization: A cultural history of insanity. Princeton University Press.
Substance Abuse and Mental Health Services Administration. (2014). Trauma-informed care in behavioral health services. U.S. Department of Health and Human Services.
Tonigan, J. S., Connors, G. J., & Miller, W. R. (2002). Participation and involvement in Alcoholics Anonymous. In J. S. Tonigan, G. J. Connors, & W. R. Miller (Eds.), Project MATCH Monograph Series.
Tyndall, M. (2020). An emergency response to the opioid overdose crisis in Canada: A regulated opioid distribution program. CMAJ, 192(34), E986-E988.
Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-assisted therapies—tackling the opioid-overdose epidemic. New England Journal of Medicine, 370(22), 2063-2066.