UBC Reports | Vol. 49 | No. 2 | Feb. 6, 2003

Preventing Death

A Public Health Approach to Drug Use

By Richard Mathias

Canada’s drug laws kill Canadians.

In 1994, B.C.’s Coroner issued a report on inadvertent overdose deaths in British Columbia, concluding that these deaths were preventable and that a re-thinking of the drug-related laws was necessary and urgent. In the eight years since that report, a further 2,334 deaths have been ascribed to the inadvertent overdose category by the Coroner’s Office. When drug associated deaths are tabulated over the period 1994 to 2001 there were 5,438 deaths, 3,683 directly and 1,756 indirectly attributed to non-therapeutic drugs. Unlike tobacco, these deaths are due to the modes of use rather than direct toxic effects and are mainly preventable, even if use continues, also unlike tobacco.

To draw attention to this issue without a solution would be an empty exercise. The United Nations General Assembly in 2001 called for drug policy that respected human rights, makes treatment available to dependent users and reduces the traffic in illicit substances. Dependency is a relapsing, chronic brain disease and must be treated as such. The ill person should be allowed to use their drug(s) so they can survive their dependency and give time for treatment. A public health approach will do this and will virtually eliminate trafficking, benefiting the individual and the community.

A public health approach has the primary goal of reduction of use of both licit and illicit psychoactive drugs. However, many people will use drugs because of the effects desired by the user, whether tobacco, alcohol, marijuana, ecstasy or other psychoactive drugs. Further goals are to prevent a drug user from becoming either an abuser of or a dependent on the drug. If this fails, the person with a drug dependency will be assisted to use the drug as safely as possible and offered treatment when that person consents to such treatment. When primary prevention and secondary goals fail, the drug user is not stigmatized for their decision and is able to survive through safe use of their chosen drug.

As with alcohol and tobacco, federal, provincial and municipal regulations would be used to control distribution and production. Points of sale would be regulated and would include information on use and possible adverse effects. Places of use would be licensed and would have some responsibility for monitoring use. The drugs sold would either be ingested, smoked or inhaled. These modes would be intended to reduce the risk of overdose and adverse effects.

If the user wished to use a drug by injection, it would be available only through a pharmacist or other professional knowledgeable about handling drugs for intravenous injection. The purity and sterility would be ensured and the syringe and needle could only be used once, thus eliminating sharing. Such syringes are currently available.

There are immediate and predictable effects of putting this public health-care approach in place. The illicit drug trade would be greatly reduced. With a reasonable cost of the drugs, and a reasonable supply of drugs, crime associated with the users would decrease. Drug seeking behaviours occur when a drug is not available. The violence associated with drug trafficking would be reduced as there would no longer be illegal supply networks competing for a lucrative market. The markets would now be legal, regulated and taxed. The monies raised by taxation on drug-related income through legal sources would now be available for use by governments at all levels. Agriculture, manufacturing and hospitality industries would all benefit.

As a society we abolished the death penalty for murder no matter how deliberate or how often repeated, yet we continue to have a de facto ‘death penalty’ for drug use. Governments have a responsibility to all citizens, even stigmatized drug users. The public health approach offers a strategy to prevent drug use within the larger framework of human rights and biomedical ethics. It has the capacity to address current health emergencies and to respond to future needs through program planning and evaluation.

All that is needed is the public and political will to change a failed approach with one more likely to be efficient and effective. The need is urgent. In B.C. alone, there are nearly three deaths per day associated with current drug laws. Each day’s delay results in more infections, risks and deaths. It requires decisive immediate action by our legislators and our public health community to save Canadian lives.

Richard Mathias is a professor of Health Care and Epidemiology in UBC’s Faculty of Medicine.