Keeping the Door Open
Dialogues on Drug Use


Events Resources

Beyond Drug Prohibition: A Public Health Approach (October 2005)

Health Officers Council Paper:

A Public Health Approach to Drug Control in Canada (PDF, 38 pgs - 238K) This groundbreaking discussion paper from the Health Officers Council of British Columbia on a public health approach to dealing with psychoactive substances, which is the inspiration for this symposium.


Abstract: Drug control policies could be crafted to reduce harmful use of substances, minimize negative health effects to the individual, and limit secondary drug-related harms to society. A spectrum of policy approaches exists for drug control. In Canada, tobacco and alcohol exist towards one end of the spectrum in a legal, for profit economy. Illegal drugs such as marijuana, heroin and cocaine exist towards the other end of the spectrum in a criminal-prohibition, black-market economy. The types of harms created by each of these frameworks are reviewed. We argue for a more centrist public health approach to currently illegal drugs, where policies are set to minimize harms. The balance point for determining public health policies for currently illegal drugs would be that which minimizes the prevalence of harmful use and negative health impacts, and also minimizes any indirect or collateral harms to society from regulatory sanctions. Studies support public health harm reduction strategies, but their implementation is hindered by the criminal status of drugs in popular use. Current conditions are right to enter into serious public discussions regarding the creation of a regulatory system for currently illegal drugs in Canada, with better control and reduced harms to be achieved by management in a tightly controlled system. The removal of criminal penalties for drug possession for personal use, and placement of these currently illegal substances in a tight regulatory framework, could both aid implementation of programs to assist those engaged in harmful drug use, and reduce secondary unintended drug-related harms to society that spring from a failed criminal-prohibition approach. This would move individual harmful illegal drug use from being primarily a criminal issue to being primarily a health issue. A review of Canadian reports, articles and poll results on these issues indicates a readiness to explore new approaches. A comprehensive public health approach for drug control should be adopted by the Federal, Provincial, and Municipal governments in Canada.


  • Reform Federal and Provincial laws and international agreements that deal with psychoactive drugs.
  • Devise pan-Canadian, public health based strategies to manage psychoactive drugs.
  • Improve capabilities to closely monitor and provide information about the health and social consequences of psychoactive drugs and drug control strategies.
  • Develop comprehensive services and a balanced investment for prevention, harm reduction, treatment, rehabilitation, and enforcement.

Media Backgrounder for Health Officers Council Paper (PDF, 7pgs)

 This brief backgrounder for MEDIA and others offers a concise summary of the Health Officers Council paper A Public Health Approach to Drug Control in Canada which is available in full above.

Interview with Dr. Rick Mathias examining the HOC paper (web page with link to mp3 file)

This links to a web page for the Redeye Co-op internet radio show in which Dr. Mathias was interviewed about the Health Officers Council paper and talks about the benefits of and the challenges facing harm reduction strategies.


Specific to Canada:

Preventing Harm from Psychoactive Substance Use (draft) (PDF, 108 pgs)

This draft document released June 14, 2005 by the Drug Policy Office of the City of Vancouver lays out a comprehensive strategy for addressing prevention of harms associated with psychoactive substance use.

A Modest Proposal for a Sane Drug Policy (PDF, 33 pgs)

This paper by retired British Columbia Provincial Court Judge Jerome B. Paradis draws on his many years of experience on the bench to make a reasoned and deeply thought proposal for an alternative to prohibition.

The public health and social impacts of drug market enforcement: A review of the evidence (PDF, 11 pgs)

This review paper by Kerr et al published in the International Journal of Drug Policy 16 (2005) 210–220 focuses "on mechanisms through which police activities, occurring in drug markets, intersect with the health and practices of illicit drug users, the delivery of health care, and dynamics within neighbouring communities" and concludes with a discussion of "the benefits and costs associated with policing and alternatives to this particular approach."

Impact of supply-side policies for control of illicit drugs in the face of the AIDS and overdose epidemics: investigation of a massive heroin seizure (PDF, 5 pgs)

This peer reviewed study by Wood et al published in the Canadian Medical Association Journal Jan. 21, 2003; 168 (2) looked at the impact of one of the largest seizures of heroin in Canada on an ongoing prospective cohort of injection drug users. The study observed no beneficial public health effects and concludes with a critique of the wasteful direction of "the overwhelming majority of resources into failing supply-reduction strategies, despite the wealth of scientific evidence demonstrating their ineffectiveness."

Displacement of Canada’s largest public illicit drug market in response to a police crackdown (PDF, 5 pgs)

This peer reviewed study by Wood et al published in the Canadian Medical Association Journal May 11, 2004; 170 (10) "detected no reduction in drug-use frequency or drug price in response to a large-scale police crackdown in Vancouver’s Downtown Eastside" (DTES). Their "results support anecdotal reports of increased public drug use and displacement of drug users, and they probably explain increases in drug-related sex-trade activity and crime in areas outside the DTES. The crackdown also increased the rates of unsafe syringe disposal and significantly reduced the proportion of syringes being returned to the city’s largest needle exchange."


US & International:

Effective Drug Control: Toward A New Legal Framework
State-Level Regulation as a Workable Alternative to the “War on Drugs”
(PDF, 149 pgs)

The King County Bar Association, together with a coalition of professional and civic organizations, has been examining a public health approach to the chronic societal problem of substance abuse and encouraging public investment in research, education, prevention and treatment as a more effective alternative to the use of criminal sanctions. This report lays out in detail the findings of this group, which conclude that the establishment of a new legal framework of state-level regulatory control over psychoactive substances, intended to render the illegal markets for such substances unprofitable, to restrict access to psychoactive substances by young persons and to provide prompt health care and essential services to persons suffering from chemical dependency and addiction, will better serve the objectives of reducing crime, improving public order, enhancing public health, protecting children and wisely using scarce public resources, than current drug policies.

The above report is in five parts which also can be obtained individually by clicking on the links below:

State Regulation and Control of Psychoactive Substances - The Vision (PDF, 3 pgs)

This is the vision statement from the King County Bar Association, which, as a result of years of intensive study, recommends the establishment of a state- level system of regulatory control over those psychoactive substances that are currently produced and distributed exclusively in illegal markets.

The Budgetary Implications of Marijuana Prohibition (PDF, 29 pgs)

This report by Jeffrey A. Miron, Visiting Professor of Economics at Harvard University, This report examines the budgetary implications of legalizing marijuana – taxing and regulating it like other goods – in all fifty states and at the federal level.

 TRANSFORM: After the War on Drugs - Options for Control (web page with link to PDF, 43 pgs)

This is a major new report from TRANSFORM Drug Policy Foundation in the UK examining the key themes in the drug policy reform debate, detailing how legal regulation of drug markets will operate, and providing a roadmap and time line for reform. Launched October 12th 2004.

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Drugs, Prison and Disease in our Communities (June 2005)

Specific to Canada:

Harm Reduction Policies and Programs for Persons Involved in the Criminal Justice System (PDF, 12 pgs)

This new CCSA document is the first in a series of documents on harm reduction for special populations in Canada. It describes policies and programs related to drug users and prisons. It details the availablility of drug treatment treatment programs, bleach, sterile injecting equipment and methadone in prisons across Canada.

A Health Care Needs Assessment of Federal Inmates in Canada (PDF, 65pgs)

Canadian Journal of Public Health: Volume 95, Supplement 1, March/April 2005

This comprehensive survey of the health care needs of inmates has several sections of interest which are listed below. Note that both the document's internal page number (pg S##) and the page number within the entire document (pg ## of 65) are indicated for your convenience.

  • See Bloodborne Viral Diseases on pg S30 (pg 32 of 65) for a reference to needle sharing as a common means of transmission.
  • See Table 57 on page s42 (pg 44 of 65) for a breakdown of Axis 1 disorders in psychiatric in-patients in the prisons; note the high numbers for substance-related disorders on the Prairies and in Quebec.
  • The section on Alcohol and Drug Abuse is from page S43 to the top of S46 (pgs 45-48 of 65) is very comprehensive, with alarmingly high prevalence rates of moderate to severe drug abuse identified at intake.
  • The section Substance Abuse in Prisons begins at the bottom of page S44 (pg 46 of 65) and discusses the effectiveness and attitudes towards urine testing, and the results of urine tests.
  • Substance Use Treatment Programs available in prisons are noted on page S45 (pg 47 of 65).
  • Finally the section on Injection Drug Use and Opiate Dependence runs from the bottom of page S45 to the top of page S46 (pages 47-48 of 65)

The Epidemiology of Hepatitis C in Canada

An Educational Event from HepNet, The Hepatitis Information Network

The section HCV in Selected Higher Risk Populations has prevalence rates for Hepatitis C in prison populations.

Reducing the Harm Associated with Injection Drug Use in Canada

Prepared for the meeting of Ministers of Health, St. John’s, Newfoundland in September 2001

The first recommendations of Section 2. Outreach and 3. Treatment and Rehabilitationin Appendix C - Recommendations on document page 37 (pg 51 of 66) make specific reference to prisons.


 International References:

Provision of syringes: the cutting edge of harm reduction in prison? from BMJ 1998;317:270-273 ( 25 July ) published by the British Medical Association

Lost Opportunities? Prison Needle and Syringe Exchange Schemes (PDF, 12pgs) by Rhiadian A. Hughes, in Drugs: Education, Prevention & Policy; February 2000, Vol. 7 Issue 1

WHO Europe: Status Paper on Harm Reduction in Prisons

This Status Paper on Prisons, Drugs and Harm Reduction published May 2005 summarizes the evidence on harm reduction in prisons and aims to provide evidence for action that will reduce the health-related harm associated with drug dependence within the overall objectives of the WHO Health in Prisons Project to protect and promote the health of those imprisoned in the interest of public health.


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