Illicit IV Drugs: A Public Health Approach

Article excerpt

ABSTRACT

This article explores, from a public health perspective, the harm done by Canadian drug laws, to both individuals and society. It challenges the perceived dichotomy of legalization and criminalization of intravenous drugs. The article then expands the discussion by exploring eight legal options for illicit drugs and examines how these options interact with the marginalization of users, the illicit drug black market, and levels of drug consumption. While the main focus of this article is intravenous drugs, it draws some lessons from cannabis research.

Historically, substance abuse services have had "abstinence" as the dominant goal and as a result of this focus, programs for individuals who currently use drugs have not been well represented in the service spectrum. The HIV/AIDS and Hepatitis C epidemics among intravenous drug users have led to the discussion of new public health "harm reduction" service principles which begin to address the specific needs of this drugusing population.

From this debate, there is mounting evidence that Canadian drug laws are actually contributing to the harm done to society and to individuals who use/abuse currently illegal drugs. Many reports1-8 have identified some aspects of our drug laws that are problematic from a public health perspective.

These reports, which focus on injection drug use, document how our drug laws produce many harms to both users and communities, including increased HIV, crime, overdoses, unsanitary injection techniques, and the marginalization of drug users.

Now that the public debate on Canada's drug laws is expanding, it is timely to broaden the discussion of the public policy options beyond the usual criminalization or legalization dichotomy. It is commonly assumed in many media reports that these are the only two policy options available, and these terms are rarely defined. Often those who question the validity of criminalization of drug users are assumed to be pro-legalization (and those who do discuss legalization issues rarely define what legalization means). This legalization / criminalization dichotomy is both false and a needless limitation of the available alternatives. Balanced articles which explore the middle ground are rare. 10, 11

The goal of this article is to clarify the available options in terms of legal controls over drugs and to discuss how these different options impact levels of consumption, and the marginalization of drug users. The aspect of black market or criminal activity is also discussed, as this issue is strongly impacted by drug policy and is often not included in drug policy discussions.

There are eight options available to Canadians in terms of legal controls over drugs:

"Free market" legalization

An open "free market" system could be used to sell drugs. This would include promoting, advertising and finding creative ways to maximize sales and use of these substances.

Legalization with "product"

Under this model, product restrictions can be aimed at manufacturers, packagers, distributors, wholesalers and retailers. Drug packaging, marketing and method of sale would be specified. Advertising and promotion would be prohibited. Drugs would be sold in plain packaging with standardized weights. Retail outlet location, days and hours of operation would be controlled. The strength, formulation, method of use, and retail price of the drug would be regulated. The goal of these restrictions is to make the merchandise as neutral (or unattractive) as possible. Our society uses many "product" restrictions currently.

Prescription drugs and tobacco have restrictions aimed at packaging and labelling, and when alcohol is sold, packaging and retail outlets are controlled.

Market Regulation

This model would include all of the "product" restrictions as outlined above, and would also restrict purchasers. Restrictions on purchasers could include:

age of purchaser,

degree of intoxication of purchaser,

volume rationing,

proof of "need" in order to purchase,

registrations of purchasers,

proof of residency with purchase,

limitations in allowed locations for use. …