The injunction request, which has been fought over the last six months, concerned new provincial directives from the abstinence-oriented United Conservative Party, which forms the current provincial government. They require that people who wish to enter supervised consumption sites (SCS) must provide a personal health number (PHN).

“It’s incomprehensible how a court and a government can throw away lives without regard for what that means.”

The plaintiffs behind the injunction, Moms Stop the Harm (MSTH) and the Lethbridge Overdose Prevention Society (LOPS), are struggling to make sense of a judgment that they fear will cost lives.

“For those of us who know what it’s like to lose a loved one, it’s incomprehensible how a court and a government can throw away lives without regard for what that means,” Petra Schulz, co-founder of Moms Stop the Harm, told Filter.

The provincial court ruled that despite the mandate’s potential to cause harm and loss of life, it could proceed as planned. In acknowledging the risks, the court did leave the door open to receiving new information about any harms caused. But the plaintiffs say this has little meaning, as it will be near-impossible to document which deaths occur as a result of a person not being able to access SCS due to lack of a PHN.

“To me, it’s an unfathomable response and I feel that the court made an error to make that kind of interpretation, and people are dying… unless you have a report from someone that states they knew someone who needed an SCS and passed away as a result, it will be really hard to prove exactly who is dying and how,” Schulz said.

“What they’ve said is they don’t know exactly how many people will die, and because of that, they’re going to let the law remain in effect.”

Avnish Nanda, the legal counsel representing the plaintiffs, is equally aghast at the outcome.

“The court defined that harm will happen, people will die, they have accepted that; what they’ve said is they don’t know exactly how many people will die, and because of that, they’re going to let the law remain in effect,” he told Filter. “To me, it’s unprecedented and remarkable because the court is saying the lives of substance users don’t matter.”

In response to the possible harms of the mandate, the court told the plaintiffs that there is a voluntary principle attached to the new regulations, giving SCS the option to not revoke entry rights if a participant’s PHN is currently being processed, or even the discretion to admit those lacking PHNs.

But the plaintiffs find this meaningless, as it is merely a suggestion made by the court. It essentially leaves those overseeing Alberta SCS in a state of regulatory limbo—encouraged to bend the rules at their discretion but liable if they do so.

“It’s not outlined, it’s a recommendation, but at the same time providers are penalized for not following the guideline, so it’s left up to the interpretation of service providers, Schulz said.

“I don’t understand it, I’m at a loss, it doesn’t make sense from a legal perspective,” Nanda said.

However, MSTH and LOPS aren’t backing down yet, as the injunction request is only one piece of a larger human rights lawsuit that the two groups have been working towards since last year. The prospect of further proceedings has been recognized by the provincial court, which granted the plaintiffs grounds to proceed if they wish.

“As part of an injunction determination, the court had to find grounds on whether we can sue, and the court has found that there is a basis to do so,” Nanda explained. “So there’s a constitutional argument to be made. That does allow us to continue on; the problem is some people will die, even some of my clients, people who I talk to daily, as a result of this.”

The Hail Mary of potential federal intervention is not impossible, even if it doesn’t seem imminent.

Schulz has been continuing her search for allies over the course of the hearings and has identified potential champions within the Canadian government, such as Canadian Minister of Mental Health and Addictions Carolyn Bennet.

Bennet has not released any official statement on the matter but has been engaging in open correspondence with Schulz. The Hail Mary of potential federal intervention to intercept the verdict and underline that PHNs are not required under federal regulation is not impossible, even if it doesn’t seem imminent.

“I would like the federal government to step up to the plate,” Schulz said. “The federal government regulates consumption services and could issue a clarification [to state] that … in order to deliver and provide low-barrier access to these services, service providers no longer be instructed to collect PHNs.”

While the fight continues, Schultz fears that with looming border closures, the rise of the Omicron variant and wrathful truckers parked outside of the Canadian capital, this issue and its urgency will be a small blip on the political landscape.

“Unless you’re one of the families like us, who is mourning someone you love or desperately struggling to keep a loved one alive, it’s not on your radar,” she said. “Governments are always focused on what’s strictly important to their voters.”

Correction, February 2: An earlier version of this article suggested that a medical referral is also required to enter SCS under the mandate; this is not the case.

Photograph of an overdose prevention center in East Harlem by Helen Redmond

The post Appeal Dismissal Means New Alberta SCS Barriers Now Take Effect appeared first on Filter.

The plaintiffs—Moms Stop the Harm (MSTH) and the Lethbridge Overdose Prevention Society (LOPS)—saw their injunction request for national standard operating rules to apply to Alberta-based SCS swiftly shot down.

The injunction was designed to halt the recent provincial mandate that requires people seeking SCS services to provide a medical referral and a provincial health number. Many who require these services don’t have access to these things, or may be comfortable with sharing their personal data, meaning that the mandate effectively excludes marginalized people from facilities that save lives. Its provisions are due to take effect on January 31.

“The government that we’re dealing with is very punitive with people who don’t fall in line.”

“As the government was rolling out these regulations, it became clear to us that service providers had limited ability to speak out about these regulations without losing funding … the government that we’re dealing with is very punitive with people who don’t fall in line,” Petra Schulz, co-founder of MSTH and a primary representative in the ongoing legal case, told Filter.

The verdict on the injunction was filed on January 10. While the Crown judge overseeing the case expressed sympathy for the plaintiffs, the decision illustrated the heavy odds against Alberta harm reduction advocates under the current provincial administration of the United Conservative Party (UCP).

“We felt immediate harm would come to people if these guidelines were implemented,” said Schulz. “The judge did not grant us the injunction and I really don’t understand why; [the judge] clearly states that irreparable harm will come to people and agreed with us on that point but referred to the case as a Balance of Convenience.”

A Balance of Convenience is generally defined as when the potential relief given to a plaintiff is weighed against the possible injury inflicted on the defendant—interpreted in this case as the prospective disruption to the provincial government’s current SCS guidelines if the demands of MSTH and LOPS were met.

“In essence, the province’s ability to do its job and regulate services outweighs the irreparable harm that will come to individuals,” Schulz said of the decision. “To me, that just means it’s okay for the province to let people die, as long as they get to do their jobs.”

However, the result did not come as a complete shock to Schulz, as she has been monitoring the Alberta government’s rhetoric over the course of the lawsuit.

“We don’t really get the ear of [government] staff, we get their polemic, and they have said that activists in Alberta have taken us to court,” she said. “I wear the label activist with pride, I take it as an acknowledgement that I have achieved something in the eyes of the public. In Alberta, activist is a bit of a swear word, you know—activists are people who come to rob us of our pipelines, and that sort of thing. So to go ahead and take a group of grieving parents and use that kind of divisive language shows you the government’s response.”

Eight years ago, Schulz, like many of the members that make up the bedrock of MSTH, lost her son to an overdose.

“It would be more accurate to say they’re the first provincial government to interfere with federal regulation.”

She also observed how the provincial government has lauded its own accomplishments regarding the regulation of SCS over the course of the case, despite the regulation of these sites falling under the Controlled Drugs and Substances Act—a federal mandate.

“When we work towards the application for a consumption site in say, Edmonton, the process is very arduous, the guidelines that the federal government have are detailed … so for the Alberta government to say they’re the first to take steps to regulate them is an outright lie,” she said. “It would be more accurate to say they’re the first provincial government to interfere with federal regulation.”

A Search for Political Allies

Schulz and her allies reached out to the federal government of Canada—specifically Minister of Mental Health and Addictions Carolyn Bennet—in a January 13 letter that expresses the coalition’s frustrations. The signatories—including the HIV Legal Network and the Canadian Drug Policy Coalition, among others—highlight that while they have adhered to federal policy, the provincial government continues to insist on its restrictive modification of national regulation.

“We are angry, we are confused, we are beyond dismayed and most importantly, we fear for the lives of the people who will now no longer have the low barrier access to supervised consumption services that are so essential to saving lives,” states the letter in reaction to the January 10 decision.

The letter also urges Minister Bennet to reach out to her Alberta counterpart, in order to “clarify that the mandatory collection of personally-identifying information is prohibited within federally exempted supervised consumption services.”

Timothy Slaney, a member of the LOPS board of directors and Schulz’s co-litigant in the legal case, expressed concern that the verdict serves to bolster the abstinence-based doctrine that the Alberta government has been promoting.

“The time is right for them to go for the throat on this, because it’s been such an obvious failure.”

“It’s a full-court press to turn the conversation away from harm reduction and the services that are being shut down,” he told Filter. “I think when you look at what their model of abstinence is, especially when it comes to things like making Sublocade available to the police, the model on how someone gets treatment and becomes sober is a crisis-based one.”

The outcome helps the UCP to maintain its grip on Alberta’s drug policy narrative, he believes.

“I think they are really desperate to delegitimize any group that is not under their direct control, which is why we have seen a lot of defunding and the shutting down of different organizations.”

With Schulz focused on taking the conversation to a federal level, Slaney has looked within Alberta for potential new allies, specifically the New Democratic Party of Alberta (NDP), which formed the previous provincial government and is the UCP’s direct opposition. Whether the federal government or Alberta’s opposition will directly speak on behalf of the rallying organizations remains to be seen.

“I think the time is really right for them to go for the throat on this, because it’s been such an obvious failure,” Slaney said.

A Last-Minute Appeal

In the meantime, the fight continues. Almost a week after the injunction verdict, the provincial court of Alberta accepted an immediate appeal to the decision.

The appeal is slated to be heard on January 27, just four days before the health-number policy is set to take effect, meaning it could hardly be going any closer to the wire.

But Schulz feels that she and her team are ready.

“We are cautiously optimistic that it’s moving forward so quickly,” she said. “Our legal team prepared our argument when the appeal was filed. They could go to court tomorrow and we would feel fully ready, we’ve always been prepared for that because of the looming deadline.”

“The case will be going forward regardless, but of course, we would prefer to not move forward with these regulations in place because they will immediately hurt people.”

With the judicial system bogged down as a result of the COVID-19 pandemic, Schulz and her allies are fully aware that the larger lawsuit case may not be heard for some time, meaning that their appeal could represent the last chance for months to defend SCS participants from new barriers.

“The case will be going forward regardless of the decision, but of course, we would prefer to not move forward with these regulations in place because they will immediately hurt people,” Shultz said. “That’s the whole reason we took this to court in the first place—we don’t want people to be harmed.”

Photograph via Pixabay

The post Alberta Legal Battle Against New SCS Barriers Is Going to the Wire appeared first on Filter.

This development positions Toronto as the second municipality in Canada (after Vancouver) to take such a step. However, even with this momentum, the motion strictly adheres to federal drug policy—the exemption in question would be from the Controlled Drug and Substances Act—leaving a final decision resting precariously in the hands of the Canadian government.

This long-awaited motion has solidified the position of Toronto’s health representatives.

“We will submit the exemption [request] before the end of the month and we will do everything we can to continue to build this united Toronto model, that will not only allow for better health outcomes for our residents but will set the stage for the federal government to say yes,” said Councillor Joe Cressy as the motion passed. “Because we cannot do this on our own, this crisis cannot be solved on our own, but we will roll this rock as far up the hill as we can and work with our federal partners to push it over the ledge.”

Cressy is the chair of the Toronto Board of Health and has been actively overseeing developments surrounding the exemption request.

This long-awaited motion has solidified the position of Toronto’s health representatives. Despite varying public attitudes towards drug use, municipal authorities believe that steps must be taken to change the status quo—which saw 521 overdose deaths in the city in 2020 alone. The motion does not make clear the specific form that decriminalization would take, however.

As it reached its final decision, Toronto Board of Health was adamant that any resulting procedures would be implemented in tandem with local harm reduction organizations, which have been laying the groundwork for decades.

But some within the harm reduction community aren’t convinced, and it will take whatever happens next to persuade them otherwise.

“It will reduce stigma and may reallocate certain resources but what it won’t do is fix toxic drug supply.”

Nick Boyce, director of the Ontario Harm Reduction Network (OHRN), has been monitoring developments in Toronto’s decriminalization push, going as far as advising the working group that helped supply data to inform the final vote.

“There’s a lot of talk about decriminalization, and what that might look like, that is critically important in terms of reframing drug use as a social and health issue and not a criminal or moral one,” Boyce told Filter. “It will reduce stigma and may reallocate certain resources but what it won’t do is fix toxic drug supply.”

Toxic drug supply is one of the many questions that will remain if the federal government plays ball with Toronto. Additional concerns encompass public perspectives around people who use drugs, the role of law enforcement and what treatment would look like under a new model.

“We got the chiefs of police on board with some model of decriminalization, but what that model looks like I think is where it can get quite contentious,” Boyce said. “A lot of the models that we are seeing are focused on health outcomes and are only looking at it from a medicalized view of substance use—and we know substance use isn’t only a health issue, it’s a social one.”

One issue that a number of Toronto’s harm reductionists point out is that whatever form decriminalization may take, it will likely be lacking in authentic influence from people who use drugs.

“They decided the terms, they decided who sits at the table and they didn’t have the right representation.”

Zoë Dodd has been involved in Toronto’s harm reduction community for many years, and is currently the co-organizer for the Toronto Overdose Prevention Society (TOPS).

“[The City] didn’t come and meet with affected communities first and ask what direction they should go in,” she told Filter. “They decided the terms, they decided who sits at the table and they didn’t have the right representation.”

Dodd also shares Boyce’s concerns over how decriminalization is being pushed strictly as a health issue, ignoring the systemic and social roots of harms. Further reducing the validity of this motion, according to Dodd, is how impacted communities were overlooked by the city leading up to this decision.

“They did not have enough Indigenous representation, they had no youth representation, they don’t want to listen to opposing views when it comes to framing it as a health care issue,” she said, referencing the possibilities of more intrusion into drug users’ lives, including coerced treatment. “There’s reasons to oppose framing it around health care and that is of course the fear of ‘net-widening.’”

Despite decriminalization’s evident potential to reduce harms, the lack of current clarity over what it would look like in practice leaves harm reductionists concerned that crucial strands of the harm reduction DNA may be omitted from the final model.

“If we don’t expunge people’s records, if we don’t see this as a racial and social justice issue, if we don’t change the laws and get rid of criminalization altogether, what difference will it truly make?” asked Dodd.

Photograph by Diego Delso via Wikimedia Commons/Creative Commons 4.0

The post Toronto Will Make Drug Decriminalization Request, But Fears Remain appeared first on Filter.

In response to this, the International Drug Policy Consortium (IDPC), in conjunction with a large coalition of organizations, has announced the Global Drug Policy Index (GDPI)—a massive effort designed to effectively monitor and document international outcomes.

“It has become clear to us that measuring the real impact of drug policies on society on a country-by-country basis has been poorly mapped out—and that’s about to change,” said Marie Noudier, the IDPC’s Head of Research and Communications.

Noudier helmed a November 4 launch briefing covering the goals of the GDPI, the extent of its reach and how it came to be developed. She cited how the current model of documentation made on behalf of world governments and the UN is outdated, still operating based on a “drug-free” society model.

“Most governments continue to employ a repressive approach to drug control based on this skewed data, which means that they cannot be held accountable for the damage that their policies inflict on the lives of so many people,” Noudier told the panel.

In light of this, the IDPC and its allies studied societal measuring tools beyond abstinence in order to form a new framework. Their inspiration came from the Global Hunger Index, Global Peace Index and the World Press Freedom Index.

The current top rankings are held by Norway, New Zealand and Portugal. Brazil, Uganda and Indonesia form the bottom three.

The GDPI in its current state functions as a proof-of-concept, with a pool of 30 countries operating as a testbed. Policies from each country are studied and ranked in conjunction with the UN’s principles of human rights, health and development.

“It’s composed of 75 indicators running across five growth dimensions of drug policy, Noudier explained. “First, the absence of extreme sentences and responses; secondly, the proportionality of criminal justice response; thirdly, health and harm reduction; fourthly, access to controlled medicines; and finally, development.”

These five factors are showcased on the index with a numerical score applied to each. The aggregation of these scores determines where a country falls in an overall ranking. While only 30 countries have been surveyed so far, valuable data has emerged, and countries with high scores in certain areas can see their rankings heavily impacted by failings in others.

The current top rankings are held by Norway, New Zealand and Portugal, which famously decriminalized all drugs back in 2001. Brazil, led by anti-harm reduction President Jair Bolsonaro, holds the bottom spot. Uganda and Indonesia complete the bottom three.

How the Numbers Were Crunched

To formulate this model, the IDPC reached out to experts in large-scale data collection. Matthew Wall, a member of the Global Drug Policy Observatory, and department head of Politics, Philosophy and International Relations at Swansea University in Wales, is one of the leading minds behind the GDPI’s data.

“Creating a methodology for a project like this is largely an exercise in information compression,” Wall told Filter. “What I mean by that is that you have an extremely complicated policy area in several countries around the world and you need to compress that into a set of numbers.”

To collect this data, the GDPI relied on available assets, such as the United Nations Documentation System; on individual policy data released by each country; and on civil society organizations present within each area of operation.

Attainment of country-specific data was heavily aided by the United Nations Task Team Common Position on drugs—a UN report that holds evidence on rights-based policy surrounding drug use from across the globe.

In the process of converting this mountain of data and documentation into the GDPI’s five factors, Wall contributed to the efficiency of the logistics behind the number crunch, and to making sure nothing got lost in the mix.

“Ultimately, what the index evaluates is the extent to which these policy recommendations from the international system are implemented by these states,” he explained. “So, the 75 indicators we arrived at ended up being compressed into a series of policy clusters, from those clusters we narrowed it down to five dimensions.”

“What that lets us do is uncover and differentiate the lazy narratives about what’s happening in those states, versus what is actually happening on the ground.”

But even with all those resources, the GDPI team was faced with certain gaps in knowledge. To help make up for missing or unavailable information, Wall and his colleagues constructed a survey that was sent out to drug policy experts in the countries of study.

“We received 371 responses to that survey,” he said, “and what you’re seeing on those indicators that were driven by the survey is the aggregate opinion of those expert correspondents. It was a real privilege to be able to process all of that on-the-ground and real-world information.”

According to Wall, additional safety nets were set up throughout the data-collection process, with further surveys being conducted in tandem with policy experts and scientific advisory groups, all to ensure that each indicator on the index was analyzed to its fullest extent.

Wall believes that the potential expansion of the GDPI beyond its current total of 30 countries will benefit the rigor of the project, as well as its scope.

“I think pragmatically, the scale of the project becomes more complex as you increase the number of states,” he said. “So imagine we have served 371 people for these 30 states, we end up looking at 12 to 13 on-the-ground experts per state as a minimum standard. So each state does come with some additional resource implications. What that lets us do, however, is uncover and differentiate the lazy narratives about what’s happening in those states, versus what is actually happening on the ground.”

Reactions From Activists in Impacted Countries

Representatives from the countries involved have been more than interested observers in the GDPI process, with a handful of representatives taking the stand at the launch briefing. They expressed satisfaction and relief at the work the index is doing, while elaborating on where their home countries fall on the ranking.

“As a Brazilian, I wouldn’t say I’m surprised that Brazil is the worst score on the index.”

Julia Lemgruber, coordinator of the Centre for Studies on Public Security and Citizenship in Rio de Janeiro, spoke about her history with drug policy in Brazil and why she isn’t all that shocked by her country’s rating.

“As a Brazilian, I wouldn’t say I’m surprised with the fact that Brazil is the worst score on the index,” she told the panel. “It’s not a surprise, but it makes me feel very comfortable because when I get to talk to media in Brazil, we can emphasize how violent the implementation of drug legislation in Brazil has become. When they translate these numbers from Brazil, they translate what I see every day.”

The emergence of the GDPI is a crucial development, she added. “The criminal justice system does not produce enough data, not enough [so] that we have a clear notion of what’s going on.”

Kenya Cuevas, a renowned trans rights advocate who experienced drug-related incarceration firsthand in Mexico, was able to provide insight into the harms of Mexican drug policy in practice.

“Despite the fact that Mexico has some of the best policies in the world, they are not implemented,” she explained. “We have an important problem of criminalization and people being deprived of freedom. The sentences are really exemplary, are robbery or consumption of substances in my case. I was imprisoned because I consumed drugs and was then accused of selling.”

In the 11 years that Cuevas was imprisoned, she witnessed the Mexican justice system’s approach to drug-related charges, together with how basic human rights and gender freedoms were violated at every turn. “If you have a prison sentence in Mexico for eight years or more, you don’t get [state-funded] legal representation,” she said.

“These decriminalization models are a failure because they are not rooted in human rights … and not created by the people most affected by the drug war.”

Representatives from countries that have higher rankings on the index, such as Canada— currently making international waves in its push for decriminalization—meanwhile shared insight into how even a good scorecard doesn’t mean a country’s system is without faults.

“These decriminalization models are a failure because they are not rooted in human rights, ending the legal apparatuses that bring harm to people’s lives, racial justice and they were not created by the people most affected by the drug war,” said Zoe Dodd, co-organizer at the Toronto Overdose Prevention Society.

Although the GDPI is in its infancy, the vast amount of data and conversation that it has already unearthed signals progress in laying the foundation for better knowledge, accountability—and, therefore, policy—worldwide.

Flag-map of the world (2017) by Angelgreat via Wikimedia Commons/Creative Commons 4.0

The post Global Drug Policy Index Shines Light on Harm Reduction, Human Rights appeared first on Filter.

This conversation has provided a shred of hope to Ottawa’s harm reduction community, But with limited supervised consumption capacity and a constantly evolving drug supply, the clock is rapidly ticking on the how and the when.

“Even [since] we opened three years ago, the drug supply changed and the demand for services increased,” Rob Boyd, director of the Oasis Program at the Sandy Hill Community Health Centre in Ottawa, told Filter. “This really outpaced the level of services that we have available in the city.”

“We have seen a shift from crack cocaine to crystal methamphetamine—we have predominantly been a crack cocaine city for decades.”

Boyd has long been following trends of drug consumption in Ottawa, as he oversees the operation of one of its four sanctioned supervised consumption sites (SCS). The unforeseen shifts in drug use that he has witnessed make harm reduction provision more difficult and add urgency to the decriminalization question.

“We’ve had benzodiazepines appear in the drug market,” he explained. “Sites are generally not set up to monitor people who are sleeping off a benzo overdose. Additionally, we have also seen a shift from crack cocaine to crystal methamphetamine—which is new to Ottawa, we have predominantly been a crack cocaine city for decades, even prior to the opioid problem.”

Amid these trends, Ottawa’s SCS have been scrambling to seek ways to reduce harms for people who use drugs in the city. But compared to a raft of options around opioids—including naloxone, referrals to opioid agonist therapy and hydromorphone offered under a safe supply program—they have relatively few resources around meth, say, save for providing safer-use supplies like pipes and foil.

Complicating matters, much drug use involves combinations of substances, rather than people using just one or the other. “When we were consulting and thinking about our service and checking in with sites about what we can do, in the back of our minds it was all about injection, opioids and overdosing,” Boyd said. “We were certainly anticipating a lot of stimulant use, but what we didn’t anticipate was people combining their injecting of a ‘down’ with the smoking of a stimulant.”

Boyd cited instances where large portions of SCS participants have moved directly from an injection tent to a stimulant consumption tent in an effort to balance out the effects of both substances. This phenomenon is boosted by the adulteration of opioid supplies, as in many other parts of North America, with fentanyl and its analogues, he added. The effects of a more potent opioid supply on Ottawans have resulted in a corresponding higher demand for stimulants.

It’s in this context that conversations around harm reduction solutions and general decriminalization have accelerated. Ottawa Public Health’s recent strategy illustrates this, and it was formed after the city communicated with several harm reduction organizations. The Community Addictions Peer Support Association (CAPSA) is one of those organizations.

“In the beginning, we reached out to Ottawa Public Health,” Gord Garner, CAPSA’s president of strategic partnerships, told Filter. “We believe that we have loving wisdom that can help educate, make a change and increase people’s health around substance use. One of the ways to end stigma is taking that knowledge in a measured way and bringing it to health service providers and organizations.”

Garner has a personal stake in the fight for education and solutions, as his own past experience with substance use led him to take on a prominent advocacy role.

“We’ve been very fortunate to be a part of this,” he said. “There have been a couple of action plan meetings that have rolled out, and we’ve had a chance to train our public health nurses on stigma and person-first language. These are pretty critical things because we’re coming in as people with lived experience and educating health service providers.”

“It’s when the oppressors change their minds.”

CAPSA operates with a heavy emphasis on ending the stigmatization of people who use drugs—and the link with decriminalization is clear when persecution and criminalization both result from stigma and increase it, making everyone less safe.

If any governing body wants to address the problem, Garner emphasized, it needs to be all-in. “This is the approach we’re taking with substance use health and discrimination, it’s when the oppressors change their minds, and how to do that is you find people in the oppressing community—who are non-malicious but ignorant of some issues—and change their minds.”

A primary example of this is a recent unofficial shift from the Ottawa Police Service, where according to harm reductionists, officers are opting to avoid arrests for simple drug possession within the municipality.

“They’ve spoken to the fact that they’re not actually charging people with simple possession, they have no interest in doing that at this point,” Boyd said. “They’re not interested particularly in the types of folks who would use harm reduction services [nor do they] want to proceed with simple drug charges, that doesn’t solve the problem of crime or poverty.”

With a number of initiatives working towards decriminalization in all but name, the question still remains: What about decriminalization proper?

Wendy Muckle is the CEO of Ottawa Inner City Health, a harm reduction program that operates in the city’s downtown core and provides services such as a safe supply program. She has been observing the moving pieces of government institutions and harm reductionists in Ottawa.

“I feel like the conversation around decriminalization needs to be separated from what the drug supply is,” she told Filter. “The decriminalization/regulation conversation needs to happen, irrespective of anything that’s happening within the drug supply.”

Muckle is fairly certain that the writing is on the wall.

Muckle additionally pointed to the COVID-19 pandemic’s role in disrupting supply, saying it has added to the shift to methamphetamine use. She has noticed the substance being used both as a substitute for opioids and as a self-administered tool used in the opioid detox process, she said.

As for what the municipal government of Ottawa can do in the face of this crisis, Muckle believes the city’s ability is not as far-reaching as some organizations may hope. “I think at the municipal level there are lots of discussions to be had but they have very limited powers.”

Where all this is likely heading is to Ottawa following other municipalities in eastern Canada, by applying for an exclusion from the federal Controlled Drugs and Substances Act.

Muckle is fairly certain that the writing is on the wall. “[The strategy motion] passed unanimously at the Board of Health in Ottawa, with the recommendation to write to the federal government,” she said. “I think most of the city councillors who are part of the Board of Health participated in the Getting to Tomorrow dialogue, and a lot of them were profoundly impacted by what they heard.”

Decriminalization in Canada’s national capital would have symbolic as well as practical significance. But like many other harm reductionists, Muckle believes that decriminalization without regulation and increased provision of resources would be a very limited positive step.

“I think like anything else, the devil is in the details, so decriminalization on its own is pretty meaningless. It’s what’s behind it that actually helps people’s lives, that’s where that attention needs to go.”

Photograph of Ottawa’s Alexandria Bridge by Intiaz Rahim via Flickr/Creative Commons 2.0

The post Ottawa Decriminalization Moves Accelerate Amid Shift to Meth appeared first on Filter.

While this is a huge development for Canada’s largest metropolis, these ethical intentions now await the final verdict of the federal administration, as the exclusion request is made under Canada’s Controlled Drugs and Substances Act. The timeline for a final decision remains unclear.

“There’s a lot that’s uncertain,” Rhiannon Thomas, program coordinator for the COUNTERfit Harm Reduction Program at Toronto’s South Riverdale Community Health Centre, told Filter. “What is certain is that the conversation is becoming more public and crucial. I don’t need to be convinced anymore that decriminalization is going to be a pillar of improving people’s lives.”

The form any eventual decriminalization would take is also unknown. However, according to Thomas, the city is working with various stakeholders—including harm reductionists, medical professionals and people who use drugs—behind the decriminalization initiative. Their dialogue encompasses issues including how far decriminalization would reach into the greater Toronto area, whether certain areas should be prioritized, and the extent of any police intervention on drug-related emergency calls. 

Toronto isn’t alone: Vancouver developed a similar plan in the spring, and decriminalization bids are likewise underway in Ottawa and Montreal. While the presence of other players on the field is reassuring to those who support Toronto’s effort, people in the local harm reduction community remain cautious and unsure how to interpret the timing.

“The impending arrival of last month’s federal election probably lent impetus.”

“This was just suddenly like, oh, we’re doing this, okay. Why now?” Nick Boyce, director of the Ontario Harm Reduction Network (OHRN), told Filter. “We’ve been talking about this forever. From my perspective, the number one driver of the overdose crisis is criminalization … and there was no movement on this until suddenly a couple of months ago.”

Boyce has long been monitoring whispers of decriminalization in Toronto via the network of harm reduction organizations connected with OHRN. Serious discussions of appealing against prohibition have been circulating since 2017, he said. But the impending arrival of last month’s federal election probably lent impetus to the current exemption request.

“I think … the pieces aligned in terms of the federal election happening, how that might go, and trying to get something in ahead of the election,” Boyce said. “[The worst-case scenario] didn’t happen, as we still have a liberal government in place, so there’s still a window of opportunity to consider something.”

The Liberal Party of Canada clinched victory on September 20, albeit with a minority government. Advocates’ urgency beforehand is understandable when you consider that the Liberals’ chief rivals, the Conservative Party of Canada, campaigned on an abstinence-oriented drug policy. Canadian provinces under conservative leadership have notoriously undermined harm reduction services with such policies; implemented on a federal scale, they could have spelt disaster for harm reduction nationwide.

It would have been the last thing Toronto’s beleaguered harm reduction services needed, as the city faces record-shattering overdoses.

“We had 2,500 deaths in Ontario last year, and if that’s not enough, what will be? Five thousand? Ten thousand?”

“They continue to fight but they’re so burnt out and traumatized,” said Boyce of his harm reduction colleagues. “I don’t know how much worse it can get, but every year it continues to get worse. I’m not sure what the tipping point is. We had 2,500 deaths in Ontario last year, and if that’s not enough, what will be? Five thousand? Ten thousand?”

The number of deaths occurring in Toronto is the major factor behind the request, This August, Toronto recorded a total of 30 overdose deaths—for comparison, there were 15 in August 2020 and nine in August 2019.

Those working in harm reduction hope that whatever shape decriminalization comes in, it will bolster the accessibility of anti-overdose resources by diminishing the threat of potential drug-related arrests. 

“I’m fairly skeptical of major change happening so quickly, but my hope is that we will see less arrests and people changing attitudes about other drugs, so we can finally start having conversations about other issues that [underlie] drug use,” Thomas said.

With the dust settling on the election, it would appear that the government has no intention of directly committing to decriminalization. Prime Minister Justin Trudeau’s past statement that decriminalization is “not a silver bullet” reflects that mood.

But the wheels are still turning in Toronto. The city recently concluded a public survey on behalf of the stakeholders behind the exemption initiative. It sought to engage residents to gain insight into city-wide perspectives on what ideal decriminalization would look like.

“I definitely think the community needs to be consulted if we’re talking about laws that are affecting those who use drugs—ideally, those people need to be the first people consulted on how that’s going to impact them,” Jolene Eeuwes, manager of the Safe Opiate Supply Program at South Riverdale Community Health Centre in Toronto, told Filter.

Vancouver’s decriminalization plan received criticism for falling short in just this area.

Official Silence Means a Tense Wait

Filter reached out to the office of Councillor Joe Cressy, chair of the Toronto Board of Health, for comment on the state of this survey and the exclusion request. However, a scheduled interview was abruptly cancelled, with correspondence from his operations manager stating that Cressy is engaging in emergency public health meetings and council business for the foreseeable future.

Whether the deluge of engagements is a result of the survey’s pending review or the exclusion request itself remains to be seen.

When Dr. Rita Shahin, associate medical officer with Toronto Public Health (TPH), was asked for comment, her office responded: “At this time, TPH is not giving interviews on the subject of decriminalization to respect the important work of the community consultations and the working group on the TPH submission.”

With radio silence from officials behind the request, Toronto’s harm reductionists are left reflecting on the possibilities that could stem from the survey’s review.

“It is very hard to feel optimistic given the last four years, where all levels of governments have consistently not listened to people who use drugs and those working in the front line.”

“I feel like drug use is still so very stigmatized that there is a part of the population that exists that are not for harm reduction and aren’t for the well being of those who use drugs,” Eeuwes said, “so I’m worried about those voices being part of the conversation.”

Boyce, too, is worried.

“It is very hard to feel optimistic given the last four years, where all levels of governments have consistently not listened to people who use drugs and those working in the front line,” he said. “And while we’ve had little band-aids here and there, there has not been the wholesale shift and fundamental rethink that needs to happen. The deaths—despite harm reduction programs being effective—continue to go up and the frontline workers and drug users continue to get discounted.”  

Even if the request is accepted, fundamental issues will remain for Toronto and governments across Canada to address. Particularly, how to find a way to ensure that the drugs being used in a decriminalized jurisdiction are safe.

“We need to fix the illegal drug supply and have some kind of regulated quality assurance on the supply of drugs, which decriminalization is not going to do…” Boyce said. “You can have decriminalization but you’re still going to have a toxic supply of drugs, and people are going to die.”  

Data show that with closed borders as a result of the COVID-19 pandemic, drug supplies in Canada have remained heavily tainted.

A safe supply of drugs, avoiding the adulterants and uncertain dosages that contribute to so many deaths, is something that pro-harm reduction provinces like British Columbia are already administering.

“I feel like BC is always a little ahead of us, in terms of what drug formularies they have available,” Eeuwes said. “I know that they’re getting powdered cocaine and they’ve got fentanyl tablets, and they’re working on potential formularies to actually offer people and prescribe.”

But existing safe supply programs still have shortcomings, in terms of being over-medicalized and not accessible or extensive enough. The solution to the toxicity problem in the eyes of many harm reductionists is complete federal regulation of drugs. Canada has an imperfect precedent of sorts, having legalized cannabis back in 2018.

“There were exemptions, then prescriptions and then finally, there was a rollout of monetization that came on a federal level across Canada,” Eeuwes said. “Looking at the way that went, I’m only left with many questions moving ahead.”

Federal legalization would be a tall order, according to Boyce. It would require a major shift in civic attitude towards people who use or sell the substances that governments have long sought to criminalize. For now, getting decriminalization right in Toronto is a big enough challenge.

“This consistently happens across all levels of government; people who use drugs are not included in the discussion or decision-making process,” he said. “The City of Toronto has done a better job at trying to attain some of this engagement, but it has been an incredibly rushed process. It would be nice to pause a little, slow it down, but we’ll just have to keep working with what we’ve got right now.”

Photograph by Thank You via Flickr/Creative Commons 2.0

The post Toronto’s Bid to Decriminalize Drugs Hangs in the Balance appeared first on Filter.

The United Conservative Party (UCP), which forms the abstinence-focused Alberta administration, has shut down facilities, issued a much-criticized anti-SCS report, and sought to impose regulations that make sites harder to access and operate.

But two harm reduction organizations operating within the province are pushing back. In August, they filed a lawsuit against the Alberta government, seeking to overturn restrictive new provincial licensing mandates that were due to take effect on September 30.

As Filter reported when the UCP announced the policy in June, the requirements create several barriers—including that any person using an SCS hold a medical referral and provide a provincial health care number; that anyone working at an SCS undergo a background check; and that sites ask permission from surrounding businesses and neighbours to operate.

The two plaintiffs in the legal case are byproducts of the ever-expanding battle over harm reduction rights in Alberta. Moms Stop the Harm is a coalition of mothers and family members who have lost children to overdose. Lethbridge Overdose Prevention Society (LOPS) was formed out of necessity due to the UCP’s closure of ARCHES, which had been the busiest SCS in North America.

“We’ve ended up with six police officers stationed outside our tent at night, with vehicles and spotlights on the tent.”

Over the last year, LOPS has been operating as a pop-up SCS in Lethbridge, often located in the city’s downtown core. Its work has not been unimpeded.

“The provincial government openly instructed the local police force to shut us down, which is unusual because the government is not allowed to instruct police to do things like that,” Timothy Slaney, a member of the LOPS board of directors, told Filter. “What we’ve ended up with is six police officers stationed outside our tent at night, with vehicles and spotlights on the tent. They know we’re not doing anything illegal but they’re doing their best to have a chilling effect on us and our clients.”

This adversarial relationship reflects how Alberta has become a powder keg for harm reductionists—and the planned regulations addressed by the lawsuit have shortened the fuse.

“We call these malicious regulations,” Slaney said. “They’re intended to bury SCS providers under red tape and force them to operate in a way that is really hostile to the people they serve.”

Requiring the collection of identifying information through the new health number mandate ignores how anonymity has often been vital to marginalized people utilizing SCS. Many people who use SCS are unhoused, and seldom have identifying information readily available.

“From what we’ve seen from the research, up to two-thirds of clients would abandon these services from the get-go and start using on the streets instead,” Slaney said. “The government knowing that and deciding to go ahead with it is an attempt to cut off the client load from services and shut them down in one fell swoop.”

LOPS’ struggle with the provincial government and the Lethbridge police created the foundation for a lawsuit that could impact the entire province.

“Moms Stop the Harm would come down and form a human barrier between us and the protestors and police that would appear,” Slaney recounted. “They’ve been natural allies throughout this whole thing; we talk to them every day and they’re some of the best people I know.”

“In Lethbridge right now, they have a person dying of overdose daily, and a very high percentage of the Indigenous community is impacted.”

Kym Porter, a key representative for Moms Stop the Harm in Alberta, has been an integral part of the province’s fight for regulated access to opioids since losing her son to an overdose five years ago.

“Everything we say makes sense but [the government] counters it and the public gets gaslighted,” she told Filter. “These lives to them seem to be dispensable. My son’s life wasn’t … In Lethbridge right now, they have a person dying of an overdose daily, and a very high percentage of the Indigenous community is impacted.”

“it’s beyond unjust,” she concluded. “I don’t have the word in my vocabulary to describe how wrong it is.”

Porter has been monitoring the logistics around Moms Stop the Harm’s involvement in the ongoing lawsuit, including the group’s correspondence with their legal representation and the collection of supporting evidence.

One of many challenges, she said, is allocating people who use SCS—who may be uncomfortable being known publicly, let alone in open defiance of the provincial government—to take the witness stand. Additionally, “they might not have the means and they might not necessarily have the routine where they can say, ‘yeah I’m available to show up at court on such and such a date.”

Avnish Nanda, the lawyer representing the plaintiffs, has been following the harm reduction conflict in Alberta closely—and particularly how the UCP’s policies have targeted the Indigenous community. Statistically, members of Alberta’s Indigenous community who use opioids are disproportionately likely to lose their lives to overdose.

“Since this government has taken power and implemented its approach to addressing these issues, there has been a nine-time increase to the rate of First Nation opioid overdose deaths,” Nanda told Filter. “That’s a product of poor policy, that’s a product of a government that is indifferent to the lives of its most vulnerable and marginalized substance users.”

Communications between Nanda and representatives of the Alberta government have been limited in scope. It hasn’t quite been radio silence, he said, but they’re not backing down. “They’re going to continue to stick with what they think is the most excellent approach and it’s an approach that will cause more people to die.”

Nanda’s administrative and legal actions in the ongoing lawsuit have not been in vain, as the health care number mandate put forward by the provincial government has been temporarily halted. Riding on this momentum, Nanda has also filed an injunction application for December to halt the government’s other planned regulations.

“I applaud them, I think it’s good that they’re using a tool that we have at our disposal.”

Members of the public and the harm reduction community focused on the UCP’s harmful policies are joined by some political voices.

Lori Sigurdson of the Alberta NDP (New Democratic Party), a member of the Legislative Assembly of Alberta for the Edmonton/Riverview constituency, has long been one of them. The NDP formed Alberta’s government before Jason Kenny—the current UCP premier—was voted into office in 2019. The party has a history of being pro-harm reduction.

“The sad, tragic thing is that the UCP have really come in with backwards thinking and an antiquated approach and are reducing the harm reduction model in our province and more and more Albertans are vulnerable and losing their lives,” Sigurdson told Filter.

As for the legal actions taken by Moms Stop the Harm and LOPS, Sigurdson said: “I applaud them, I think it’s good that they’re using a tool that we have at our disposal in our society through the legal system. To have the court look at how medical support is being denied for people who are very vulnerable.”

The impact of the current lawsuit will ripple out over the coming months, with the next step being the provincial government’s reaction to the injunctions put forward by Nanda for this December.

As for what keeps the plaintiffs and their allies stalwart in the face of overwhelming challenges, Kym Porter had this to say: “It’s an attitude of hope; we can’t just run on our anger alone.” 

Photograph of downtown Lethbridge by Kim Siever via Flickr/Public Domain

The post Alberta’s Battle Over Harm Reduction Is Heating Up appeared first on Filter.

The FDA has made no secret of its attitude to the plant, following numerous attempts to schedule it as a federally illegal substance in recent years. Dr. Scott Gottlieb, the agency’s former commissioner, even groundlessly blamed kratom for “fueling the opioid addiction crisis” this past spring. While the failures of attempts at federal scheduling have represented victories for kratom advocacy, it doesn’t mean the FDA is slowing down.

In late July, the FDA publicly announced that it will be gathering feedback from the US public as part of an effort to compile data on kratom. This has been done in preparation for a major meeting that the World Health Organization (WHO) is holding this October, where the FDA’s data will help inform the US stance on kratom.

“It came as a bit of a shock to all of us, both the FDA pressure and the fact that the peer-review appeared on the agenda.”

Delegates from the WHO’s Expert Committee on Drug Dependence (ECDD) will be convening for a peer-review session, in order to combine data and reach a conclusion on how kratom should be classified internationally. News of this was an abrupt and concerning development for kratom advocates across the globe.

“It came as a bit of a shock to all of us, both the FDA pressure and the fact that the peer-review appeared on the agenda for the October ECDD meeting,” said Martin Jelsma, director of the Drugs and Democracy program at the Transnational Institute in Amsterdam and a key figure in the International Drug Policy Consortium. “So there is now a big question mark surrounding what the procedure is. I did get confirmation from the ECDD that what triggered the peer-review has to do with the Early Warning Advisory.”

The Early Warning Advisory (EWA) is an ongoing series of reports made on behalf of the United Nations Office on Drugs and Crime (UNODC) in order to monitor New Psychoactive Substances (NPS). They document drug-related fatalities, toxicology reports and the scientific process of their findings on a regular basis.

While the reports do not target kratom directly, they’re not afraid to make grim and highly dubious implications about the plant, which has mild opioid- and stimulant-like properties and is said by many people to help with chronic pain and withdrawal from opioids.

“There is a graph in the report that shows a very irresponsible representation from the UNODC, where it says something like ‘46 percent of these [overdose] cases involve kratom,’” Jelsma told Filter. “So that gives the image that among all the new psychoactive substances it’s the most dangerous…”

“It’s absolutely inflated,” he continued. “All of these recorded cases involved other substances like oxycontin or oxycodone, so none of these cases had kratom as a direct [cause] of an overdose.”

As a result of the combined EWA reports, kratom was put under “surveillance” by the WHO—a sort of regulatory limbo where no official scheduling is reached.

However, this is only the first step in a lengthy process. The impending peer review this October will be the second step. The final step (if reached) will be a critical review.

The October meeting will be the defining factor in what happens next.

“Critical reviews can only be triggered directly; so if a member-state asks for it, let’s say the US or Malaysia, they would have made a request and it could have gone directly to that step,” Jelsma explained.

The fact that the US hasn’t yet done this, despite the FDA’s record, could be a hopeful sign. However, this does not mean the possibility of a critical review is off the table, as the October meeting will be the defining factor in what happens next.

Some kratom advocates believe the FDA’s anti-kratom fires were stoked by rising kratom acceptance in South East Asia combined with the FDA’s failed attempts at federal criminalization—and essentially amount to an attempt to circumvent domestic obstacles by pushing for an international ban. Not all international advocates subscribe to this cause-and-effect narrative, however.

“I’m still not fully convinced that this is a byproduct of the FDA’s failed attempts to schedule it nationally—that’s a theory put forward by the American Kratom Association,” Jelsma said. “The only thing that is clear is that the FDA has definitely increased domestic pressure on kratom.”

US Efforts to Push Back Against the FDA

The American Kratom Association (AKA) has watched the FDA attempt every play in the book in order to criminalize kratom. Mac Haddow, the AKA’s senior fellow on public policy, has been on the frontlines of this particular regulatory skirmish for some time. Having formerly served as the chief of staff for the Department of Health and Human Services, under whose umbrella the FDA falls, he has substantial insight into how the agency operates.

“We have to take this fight on, both in the US and now that they [the FDA] have opened the international stage with their efforts,” Haddow told Filter. “It’s absurd and we all know it; this is a battle that I’ve been preparing for decades and we’re going to continue to fight and push back at the FDA with every opportunity.”

“The FDA is so wrong about the public policy they’re trying to enact, it’s not even funny.”

The AKA is as open about its conflict with the FDA as the FDA is about its desire to schedule kratom. The main page of the AKA website even displays a counter showing how long it has been since the FDA ignored the organization’s meeting request (1,113 days at publication time.)

“If you have a non-addictive substance that can be used by people who are suffering from acute chronic pain, why the hell wouldn’t we do it?” Haddow said regarding legal regulation. “The FDA is so wrong about the public policy they’re trying to enact, it’s not even funny—and that is why we’re successfully convincing members of state legislatures to pass the Consumer Protection Act.”

This legislation, according to Haddow, generates the same kind of consumer protections that would be in effect if the FDA weren’t so determined to criminalize kratom. These include manufacturing standards to ensure that products are monitored, not altered or contaminated with dangerous substances, properly labelled and marketed strictly to adults.

“Utah, Georgia, Arizona and Oklahoma have passed it in the past,” Haddow said. “It did pass in Oregon but the governor vetoed it only because she believed—due to FDA pressure—that the Department of Agriculture was the wrong regulatory body.”

Texas and Missouri are among other states that have been favourably inclined toward this legislation, only to have their attempts thwarted by red tape and obstruction, according to Haddow.

So how does the state-by-state battle between the AKA and the FDA translate to the impending international summit with the WHO?

“If they do go to critical review, then we’re going to fight tooth-and-nail to make sure that science prevails.”

Recently, the FDA’s requests for feedback, the AKA opened a channel for people with pro-kratom views to share their opinions with the FDA ahead of the summit. At publication time, almost 64,000 people had submitted comments, according to the AKA website.

Haddow is optimistic that this volume of US voices can effectively push back against the FDA’s apparent international intentions.

“If the ECDD looks at the science and applies the standards as doctors then we’re going to be able to successfully get them to put this in the right category, which is a substance that should be under surveillance but not one that should be regulated on an international level,” he said. “If they do go to critical review, then we’re going to fight tooth-and-nail to make sure that science prevails, rather than this nonsense.”

Photograph by Ahmad Fuad Morad via Flickr/Creative Commons 2.0

The post FDA’s Suspected Push for Global Kratom Ban Rattles Advocates appeared first on Filter.

In May, the Thai government voted to remove kratom from the nation’s list of “narcotics,” making an unambiguous statement after 80 years of speculation on the plant’s role.

In a recently released report published in the International Journal of Drug Policy, researchers surveyed over 1,000 Thai citizens about their views on the plant’s decriminalization. The results showed a majority in favour of the removal of kratom’s criminalized status.

This rising acceptance of kratom stems from its history of being interwoven with Thai culture; past research has shown kratom’s consistent use amongst people in rural Thailand for centuries. Praised for its properties in herbal medicine, kratom has also been used to manage or end use of potent opioids. The result has been kratom advocates fighting for the plant’s place in Thai culture and across the globe.

“It was mistaken by policymakers in the past … we should accept this was a wrong law and should be corrected.”

“This [positive] perception has been passed down from generation to generation. In fact, the persons who changed the paradigm include policymakers, government officers and politicians,” Dr. Darika Saingam, a researcher at Prince of Songkla University in Thailand, told Filter. “For nearly 80 years, kratom was classified as an illegal substance. It was mistaken by policymakers in the past, and we should look back to the original point and accept this was a wrong law and should be corrected.”

Saingam is a renowned investigator of kratom’s effects. Her insight stems from years researching various kinds of kratom use among the majority-Muslim, mostly rural population of southern Thailand—including as a recreational drug, as a medicinal remedy and as a substitute for more potent intoxicants. Her findings have been reported in the International Journal of Drug Policy.

“I studied kratom use as a substitute among heroin users and the result was that the user was still healthy and had no serious health problems despite prolonged use,” she said. “Kratom is a psychoactive drug but we haven’t found its traditional use to have any adverse impact on mental health or to cause social problems.”

“Kratom has been used as a ‘traditional medicine’ for centuries by local people,” she continued. “The qualification of the traditional healers and knowledge of the regimens and methods was passed from ancestors to their descendants.”

According to Saingam’s research, cough symptoms, diarrhea, stomach ache, the common cold and even greater ailments such as diabetes and hypertension can be mitigated by kratom.

A holistic attitude to kratom is not limited to rural Thailand; researchers and other Thai citizens have shared it for decades. This has all resulted in positive public views around its legal regulation—beyond the decriminalization adopted by the government this year.

Potential Legalization and “4×100”

“In terms of legalization and in terms of people’s attitude, deep down people understand and believe in its beneficial effects because they have used it for such a long time,” Ekkasit Kumarnsit, associate professor with the faculty of science at Prince of Songkla University in Thailand,” told Filter. However, “even though something can be useful, there’s always a hidden agenda or more complex reason and that’s why it takes time.”

The discussion of Kratom’s legalization in Thailand is sometimes viewed as a double-edged sword, as Kumarnsit hinted. Even as its cultural significance as a remedy has ushered in an era of medicinal research, it has also gained prominence in the form of an altered recreational cocktail, known to the local population as “4×100.”

“It has had a very negative influence in terms of how the debate has been framed.“

“It is more harmful to its users than traditional kratom,” Saingam said, referencing the combination of other ingredients. “The kratom 4×100 cocktail is a mixture of boiled kratom leaves with other addictive substances such as codeine cough suppressant syrup, and illegal substances, with cola soft drinks. The users of this new kratom are predominantly teenagers or young adults who use it socially for fun or relaxation after work.”

Increasing use of 4×100 may be linked to sensationalized media coverage in Thailand, which has spread awareness of the formula and how to make it, resulting in a major uptick of 4×100 consumers, according to Saingam—and in turn inspiring more coverage.

The rising prominence of this cocktail has not halted the discussion of kratom’s legalization, experts say—but the speed of the debate did suffer as a result.

“It has had a very negative influence in terms of how the debate has been framed,“ Martin Jelsma, director of the Drugs and Democracy program at the Transnational Institute in Amsterdam, who is currently operating out of Thailand, told Filter. “I think that the distinction between recreational, medical, cultural and traditional has been very blurred.”

The complex debate has still made its way to the forefront of regulatory discussion amongst Thai officials.

This paradigm shift has also furthered a new branch of discourse: export.

“The House of Representatives here in Thailand voted in favour of taking kratom out of the narcotics act and to reschedule it [in May],” Jelsma said. “The Senate also adopted a change in the Narcotics Act, so it is not yet in force but it is fully adopted, so by August kratom will no longer be listed under the Narcotics Act.”

This paradigm shift has opened up conversations surrounding medicinal and non-medicinal regulation and has also furthered a new branch of discourse: export.

“This is a move to fully regulate kratom markets, which includes the possibility of the ONCB [Office of the Narcotics Control Board], the drug control agency here in Thailand, to give licenses for kratom plantations, which include crops for non-traditional, non-medical and export use,” Jelsma said.

While this may spell economic potential for Thailand, the plant’s global status is still in limbo. It is only legal in certain states in the US, where authorities have attacked its use and marketing. It has a  “grey market” classification in Canada and is fully illegal in Australia.

As for the impending possibility for export from Thailand, Saingam calls for vigilance. Even though her research has shown that kratom has minimal harmful impact in its multiple applications, she still stresses that its regulation would not indicate that it is a cure-all.

“A clear warning message should be given to the public that, despite some benefits … its use has disadvantages and side effects, especially when co-used with other substances,” she said.

According to Jelsma, Thailand’s decriminalization could not have been achieved without researchers like Saingam and Kumarnsit.

“It was good for the whole debate in Thailand for it to go through this stage, researchers have done a really amazing job,” he said. “There’s now a wealth of knowledge surrounding the multiple uses of kratom, whether it is its medical applications or its history—it’s an unprecedented achievement anywhere.”  

Photograph of Phuket City by Myinternationalwikipedia via Wikimedia Commons/Public Domain

The post “An Unprecedented Achievement Anywhere”—Thailand’s Decriminalization of Kratom appeared first on Filter.

The government of Alberta, Canada, currently formed by the province’s United Conservative Party (UCP), provides one example of this. In March 2020, it released a report that cast Alberta’s safe consumption sites (SCS) in an entirely negative light.

UCP opposes harm reduction in favor of abstinence-based approaches, as its 2019 election campaign made clear. After winning power, it went on to pull funding from North America’s busiest SCS in Lethridge later in 2020, forcing its closure.

Its report on SCS—“Supervised consumption services review,” produced by a specially convened panel—drew scrutiny from Albertan harm reductionists and academics, who criticized it as baseless, unscientific and harmful.

Elaine Hyshka, an assistant professor at the University of Alberta’s School of Public Health, was one of them. She found the report to be full of bias and divisive rhetoric, broadly as she had expected.

“It was a deliberate political choice to make supervised consumption a component of their campaign,” Hyshka told Filter. “It wasn’t much of a surprise to see that in August of 2019 they announced that there would be a panel that would examine the sites that have been implemented in Alberta.”

The report’s key findings were increases in crime, needle debris and opioid-related 911 calls in the areas surrounding SCS, plus inconsistencies in facilities’ record-keeping. (This last point was also one of the reasons Lethbridge’s SCS was shuttered last year.)

“There’s no systematic analysis of any of the information they claim to have collected.”

While such findings would be matters of public concern, they would also be far from the whole picture when the evidence of many years indicates that SCS save lives and reduce the spread of blood-borne diseases.

“It’s important to note that the scope of the review was very limited,” said Hyshka. “The assumption was that the panel was looking at the pros and cons of these services, whether there were things that needed to change or stay the same. They weren’t allowed to take into account or examine the health benefits of supervised consumption services, they were only allowed to focus on socio-economic impacts in the surrounding community.”

And as for the negative findings the authors claimed, “they didn’t report the methods that were used to gather the survey data they presented,” said Hyshka. “We don’t know what controls were in place for people doing the survey twice and we don’t know if the participants were residing in the community … There’s no systematic analysis of any of the information they claim to have collected.”

The report has since been used in UCP’s efforts to reduce and threaten safe consumption services in Alberta. But it has also been raised elsewhere in North America.

“I’ve seen [the report] in media coverage across other jurisdictions. Safehouse in Philadelphia is an example of that,” Hyshka said. “I’ve also heard from some colleagues that work in the field across the country,” she added, mentioning Manitoba and Saskatchewan, “and the United States that it’s being raised by opponents of proposals of SCS as reasons to not move forward.”

The Safehouse Case

Safehouse, the Philadelphia-based overdose prevention nonprofit that Hyshka mentioned, has been involved in a long-running battle in federal courts over its efforts to open the first sanctioned SCS in the United States.

Ronda Goldfein, who serves as vice president on Safehouse’s board (she is also executive director of the AIDS Law Project of Pennsylvania), confirmed that the Alberta report cropped up in United States v. Safehouse, the high-profile case in which the federal government fought to block her organization’s plans.

“The US Attorney for the Eastern District raised it in their motion for a stay regarding Safehouse,” Goldfein told Filter. “After ruling in their favor, the judge gave it the negligible weight it merited in his opinion granting the stay. It’s important to note that in granting the stay, the judge stood behind his analysis that Safehouse’s proposed activities were lawful. He even entered into the record the public health research supporting efficacy of SCS. During the hearing on Safehouse, the judge didn’t allow the introduction of public health research, but in responding to the stay request, he cited it.”

The “negligible weight” that he attached to the Alberta report can likely be pinned to the fact that it did not adhere to standard practices of peer-review and research methodology and relied on a loose community survey, as Hyshka noted.

“Philadelphia is still interested in exploring [SCS] … and no, nothing in Alberta has changed our minds.”

Haphazard methodology, she emphasized, was worsened by bias. “It was clearly designed to support a foregone conclusion [about] these services.”

James Garrow, communications director with Philadelpia’s Department of Public Health, indicated that the report wouldn’t carry much weight with the city, either.

“Philadelphia is still interested in exploring OPS [Overdose Prevention Sites, another term for SCS] and working with partners, and no, nothing in Alberta has changed our minds,” he wrote in an email.

Government sources in Manitoba and Saskatchewan—Canadian jurisdictions where Hyshka heard the report has been raised—did not respond to Filter’s requests for comment by publication time.

California Law Enforcement Lobbying

The real-world impact of the Alberta report beyond Alberta has been, as far as we know, very limited. But it has figured in numerous debates, and harm reduction organizations have been keeping a close eye on it.

“It has been showing up in the discourse, but luckily, it hasn’t had much influence. Due to the fact that it is not evidence-based, it’s a political document,” Laura Thomas, director of harm reduction policy at the San Francisco Aids Foundation, told Filter.

“We have a state bill here in California, Senate Bill 57, that would allow San Francisco, Oakland and the county of Los Angeles the ability to open overdose prevention services, and so it has come up in the context of that legislation specifically,” she explained.

An email from a Californian government spokesperson in response to a question about the Alberta report’s potential influence stated that “The Department of Health is unable to comment on pending legislation.”

So who is using the Alberta report to oppose SCS?

“The law enforcement opposition to that bill has attempted to use the Alberta report to sow confusion about the evidence base,” Thomas said. “They have not been very successful because the advocates pushing for this bill have been able to show ways in which the report is a thoroughly political and intentionally misleading document.”

“We have to explain to legislators what it is and why it exists. So it’s taking time away from [talking] about the benefits of supervised consumption services.”

“In the US, when it comes to pushing for harm reduction … generally the discourse is full of fear, stigma and stereotypes,” she continued. “So it’s certainly not the first time that opponents have tried to misuse information or have just manufactured information.”

One key player in this battle is the California Narcotics Officers Association, which according to Thomas routinely shows up to bat for the opposition when any harm reduction legislation is on the table. “This is the fourth year we’ve done a bill on this and they opposed it,” said Thomas.

Although Californian harm reduction advocates have worked to slow the drip-feed of disinformation, the Alberta report’s influence is not making things any easier.

“It’s frustrating to me that it exists because it is a political document,” said Thomas. “We have to explain to legislators and their staffers what it is and why it exists. So it’s taking time away from being able to talk about the very clear and concrete benefits of supervised consumption services.”

The Alberta report’s clear flaws limit the damage it can cause. Yet the way it has crossed borders into other provinces and into US cities, despite this lack of credibility, is nonetheless striking. Those who are using it as ammunition against harm reduction may just be firing blanks, but even blanks can make a lot of noise.

Photograph of SCS in Alberta in 2018 by Government of Alberta via Flickr/Creative Commons 2.0

The post Alberta’s Discredited Anti-SCS Report Still Raised Across North America appeared first on Filter.