When British Columbia decriminalizes small amounts of some illicit drugs next year, Canada will join a growing number of countries that have taken strides toward removing penalties for drug use.
But as many Canadian public health experts call on lawmakers to go a step further — and replace black market street drugs with a regulated safe supply — their international counterparts say they are watching to see what their countries can learn from one another.
Ottawa announced last week that from Jan. 31, adults in BC will be allowed to possess up to 2.5 grams of opioids, cocaine, methamphetamine and MDMA — a signal it will treat addiction as a mental health issue rather than a judicial one.
The federal government has not yet made any commitments about a regulated safe supply; in fact, a private member’s bill from the NDP calling for a strategy that would include one was defeated in the House of Commons on Thursday.
But advocates have proposed a number of safe supply models for Canada, with options ranging from prescribing pharmaceutical-grade drugs — as already happens to a very limited degree — to allowing drugs to be sold at licensed entertainment venues or dispensaries.
If adopted, those more liberal models would put Canada in uncharted territory internationally, says Jonathan Caulkins, a professor and drug policy researcher at Carnegie Mellon University in Pittsburgh.
“No country in the world has gone farther, faster than Canada has in that direction with cannabis, and no country in the world has even really seriously thought about doing that for heroin or fentanyl or cocaine.”
So as Ottawa navigates decriminalization, jurisdictions around the world say they’ll be watching to see what, if any, safe drug supply model is adopted.
And CBC News spoke with some of those international drug policy experts to see what Canada might learn from their countries’ experience with decriminalization.
Estonia’s fentanyl crisis
When Estonia decriminalized all drugs in 2005, the black market for illegally manufactured fentanyl was on the rise.
With almost no harm reduction measures or treatment options in place, the country quickly became Europe’s drug overdose capital.
Estonia’s fatal overdose rate began to fall from 2017 after a major fentanyl bust – but it’s still playing catch-up on harm reduction.
“We don’t have a safe supply, and we don’t have safe consumption rooms and we don’t have state-supported drug checking,” says Aljona Kurbatova, the head of the Drug Abuse and Infectious Diseases Prevention Center at Estonia’s National Institute for Health Development.
“Having harm-reduction responses as basic as needle and syringe exchange programs has been quite a challenge for us in the last two decades because of a very strong public opposition to it.”
She said it’s encouraging that Canada already has a strong harm-reduction model ahead of decriminalization, and Kurbatova said she’s hopeful it will have “the courage to try out new things” — including a regulated supply of drugs.
“If Canada will introduce safe supply, it will definitely be an argument even for our politicians to actually listen up and say that perhaps we also, in order to avoid a repetition of previous mistakes, should have something like that.”
The Portuguese model
Back in 2001, faced with a crisis of heroin overdose deaths, Portugal became the first country in the world to decriminalize the possession and use of all illegal drugs. Instead of sending people to court for drug possession, its model focuses on education, treatment and harm reduction.
Portugal’s drug-related death rate is four times lower than the European average, according to the continent’s drug-monitoring agency in 2017.
And those figures are despite all of the country’s drugs coming from a black market.
To date, fentanyl hasn’t emerged as an issue there, though it’s likely only a matter of time, says Dr. João Goulão, the main architect of Portugal’s decriminalization model and head of the country’s General-Directorate for Intervention on Addictive Behaviors and Dependencies.
As a result, a safe supply model is not part of the plan now.
“We are comfortable with what we have,” Goulao said. Of course, we are open to innovate, but this core discussion about the legal framework for drugs is not the primary concern.”
Instead, Goulão is focused on expanding harm reduction services, like drug checking and safe consumption sites, which are in their infancy in Portugal.
“I saw more resources in downtown Vancouver than what we have all over the country,” Goulão told CBC News in an interview from Lisbon, before flying to Canada for a conference this week.
Portugal isn’t looking to export its decriminalization model, he said, but it does hope to inspire other countries to evolve.
“You in Canada, and the Americans, you are living a moment that is similar to our epidemic in heroin in the ’90s … This is, in my view, a window of opportunity to change things.”
A safe supply of heroin
Although Switzerland has yet to decriminalize drugs, it took a groundbreaking step toward safe supply in 1994 by prescribing pharmaceutical-grade heroin to long-term users.
The result was fewer overdose deathsas well as falling rates of HIV and hepatitis C infections and a drop in crime.
“The outcome is: you don’t have people on the street [using drugs]you don’t have people dying from overdoses in the street or in private places… And there is a very good relationship between the people [using drugs] and the health sector,” said Jean-Félix Savary, secretary general of the Romand Group of Addiction Studies (GREA) in Geneva.
During the pandemic, the country allowed people to use prescription heroin at home instead of restricting its use to supervised sites.
“It was a very big success,” Savary said.
Although far fewer people access prescription heroin than other treatments such as methadone, there is now debate in Switzerland about expanding prescription heroin.
“There is still this moral thinking that if you give a drug to somebody, it has to be nasty … so we prefer to give methadone — which is really bad for the body — than to give heroin,” Savary said, noting heroin is much better than methadone from a medical perspective.
“It’s just a medication.”
Decriminalization south of the border
If Canada wants to know what decriminalization looks like without a safe supply of drugs, it only needs to look about 600 kilometers south of the border. Faced with rising opioid-related deaths, Oregon became the first US state to decriminalize drugs in 2020, following a referendum.
Since then, deaths have continued to rise – as they have in Canada – as the drug supply has become more toxic in both countries.
“Just decriminalization isn’t going to stop people from dying from drug overdoses,” said Tera Hurst, executive director of the Oregon Health Justice Recovery Alliance.
She and other drug reform advocates in Oregon are still working to implement safe consumption sites and other harm reduction measures, which they hope will keep people safer over time.
“We’re trying to solve these huge problems with these incremental steps, and incremental steps are sometimes the only thing you can get people to get done.”
As street drugs become increasingly dangerous on both sides of the border, Hurst is watching closely to see if Canada — where she grew up — listens to the calls for some form of a regulated safe supply.
“Safe supply feels like such an important conversation when we’re watching so many people die right now,” she said. “And it feels so far from where most people are when it comes to drugs.”