“I don’t know of any other health condition that we put people in jail for,” says Guy Felicella, an advocate with 30 years of experience dealing with gangs, addiction, treatment and incarceration in British Columbia who was celebrating coming changes to the criminalization of People Who Use Drugs (PWUD) in B.C.
Exceptions exist but from Jan. 31, 2023, to Jan. 31, 2026, most adults in B.C. who hold up to 2.5 grams of certain illicit substances for personal use will no longer be the object of criminal charges. Instead, they will receive information and guidance on available social and health programs and be re-directed from the criminal system to harm reduction sites and the social and health-care system.
Drug use is common worldwide. The United Nations Office on Drugs and Crime (UNODC) estimates that per year one out of every 18 people between 15 and 64 years old uses an illicit drug, and approximately one in eight who use drugs have a drug use disorder. In Canada, it is estimated that about 6 million people will meet the criteria for addiction in their lifetime.
While “a drug-free world” was once part of the United Nations program goals and mindset, a more contemporary position defends a shift to alternative measures, including decriminalization of drug possession for personal use, as it “reduces the stigma and discrimination that hampers access to health care, harm reduction and legal services.” And, although very different, there are currently 22 jurisdictions around the globe that have decriminalized possession of most drugs. Of those, Portugal and the Czech Republic are among the most successful. The former currently has one of the lowest drug-induced mortality rates among adults in Europe while the latter has seen heroin-related intoxications fall by 80 per cent in 12 years.
“Decriminalization is not a controversial idea in the current era,” says Paxton Bach, a general internist and addiction medicine physician, co-medical director for the British Columbia Centre on Substance Use (BCCSU) and Assistant Professor in the Department of Medicine at the University of British Columbia. “The members of the public might be surprised by that, but there is remarkable agreement among stakeholders that this is a necessary step forward.”
A roadblock in B.C.’s decriminalization approach was overcome with an agreement on the 2.5-gram limit for “personal use.” In 2021, when B.C.’s Ministry of Mental Health and Addiction first requested the federal government’s exemption for personal possession, it suggested a 4.5-gram cut-off point, while the British Columbia Association of Chiefs of Police (BCACP) recommended suggested a one-gram threshold as it would be consistent with other countries such as the Netherlands and Colombia. At the same time, several associations of people with lived experience and coalitions of advocates and experts supported a higher amount. They contended that a higher threshold is necessary for PWUD in rural and remote areas, polysubstance users, those dependent on others to acquire drugs (e.g., people with disabilities) and unhoused people who need to hold their entire possessions at all times. Felicella says that even though the selected 2.5-gram threshold is different from what the community wants, it is nevertheless an improvement.
Even though the selected 2.5-gram threshold is different from what the community wants, it is nevertheless an improvement.
A goal of the change in law is to reduce economic costs associated with the criminalization of substance use and the social disadvantage of entering the criminal system. Although drug possession charges have slowly declined in Canada over the past decade, it still represents the second most frequent type of drug charge; it is estimated that illicit substance law enforcement costs the country’s criminal justice system around $4.8 billion per year.
“You can get a criminal record, which then presents challenges for you to access housing, employment … access (to) getting out of the country,” says Felicella. “It becomes a revolving door of parole violation, probation and imprisonment … and it takes a long time to break free from the criminal justice system.”
Adds Bach: “Having a criminal record for possession is an enormous barrier for people who want … all the things we are trying to facilitate. It touches every aspect of (their) lives.”
Another hopeful intent is to reduce the reliance on toxic illicit supply and the poisoning events and deaths it causes. Illicit drug toxicity is currently the leading cause of unnatural death in the province and, countrywide, has caused 32,632 apparent opioid toxicity deaths in the past six years. During the first six months of 2022 in Canada, an average of 20 people per day lost their lives.
However, Bach warns that “this is not the change we should expect, as it is not a fair metric to evaluate whether this change is effective or not.”
“When it comes to the overdose crisis, this is only a small part of a much bigger puzzle, and we need to have a comprehensive approach to solve this issue,” Bach says. “Decriminalization is a key component, is necessary, but it is an insufficient component of an overall plan.”
B.C. has 1,300 locations participating in the take-home naloxone program and about 35 Opioid Prevention Sites (OPS). The province also counts multiple substance use treatment options, including 10 First Nations residential treatment centres. Unfortunately, access is a problem.
“Current addiction treatment here in the province is very challenging to access and navigate,” says Bach. “The quality of care you receive throughout the system is highly variable, not necessarily evidence-based and not that patient-centred.”
Felicella adds that community members “are having troubles and challenges. Instead of just accessing detox and treatments right away, there is a backlog and wait list.” His plea to the government that “when someone is ready [for treatment], they need to be there to help people right away” was recently answered when the provincial legislative assembly recommended that the government “urgently fund a substantial increase in publicly funded, evidence-based and accredited treatment.”
While B.C. is Canada’s first jurisdiction to be granted a federal exemption for personal drug possession, others are following suit. In January 2022, Toronto Public Health submitted its request to Health Canada; the verdict is still on hold.
What we may be witnessing is the beginning of a countrywide shift, and governments, stakeholders and members of the public should be attentive to what unrolls in B.C. over the next three years.