Toronto is the latest Canadian municipality seeking to end the criminalization of drug use. The city’s board of health voted in June to support an exclusion order to decriminalize controlled substances.
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
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