We are told from the time we are children that drugs are bad. This message is not just something we encounter passively, but rather it is actively marketed to us. In the early 1990s there was a public service announcement, in which children danced around in a circle to a catchy little tune (that even 30 years later still gets stuck in one’s head) that goes, “Drugs, drugs, drugs. Which are good? Which are bad? Drugs, drugs, drugs. Ask your mom or ask your dad.” If you have heard this song, it is no doubt stuck in your head now. Sorry about that. If you have not heard it, consider yourself among the lucky ones. Of course, now you are going to go Google it, aren’t you? Well, don’t say we didn’t warn you.

Marketing drug awareness to children is not a bad thing, but the campaigns tend to be so over-simplified or one-sided that the message that comes across is that drugs are bad and should not be used. Period. Yet, we as a society use drugs and mind-altering substances all the time. Raise your hand if you poured yourself a coffee or tea before sitting down to read this, if you plan to take a cigarette break at the end of the section, or you had a beer or glass of wine yesterday evening as a way to unwind. Substance use, whether drugs or alcohol, is commonplace in Canada, as in many other countries. Rather than saying drugs are bad, we need to take a more balanced approach. This way we can better understand when substance use becomes problematic such as through addiction, what impacts problematic use has on people within society, and how our government’s approach impacts the programmatic responses we are able to provide.

Before moving into our discussion of drug use as a public health issue, it is beneficial to start here with some information on addiction. The Centre for Addiction and Mental Health (CAMH, 2021) defines addiction as, “the problematic use of a substance” with harms ranging from mild (e.g., feeling hungover, being late for work) to severe (e.g., homelessness, disease). They note that people become addicted due to a combination of factors that include genetic predisposition, brain chemistry, socialization and influences within the home and community, mental health issues, and coping with trauma or difficult life circumstances (CAMH, 2021). We can see from this, that addiction is not a matter of personal choice but rather the result of many complex and intersecting factors. We have to look beyond the personal trouble to see the public issue. We do this in Canada through policy and legislation.

As a country, Canada has wavered in its approach to managing drugs. In 2003 reducing alcohol and drug-related harms was a national priority under Canada’s Drug Strategy, and a range of harm reduction approaches and therapeutic interventions were identified. In 2007 new Federal policy was released to replace Canada’s Drug Strategy. The new one was called the National Anti-Drug Strategy, and it consisted of a three-part action plan focused on prevention, treatment, and enforcement. Noticeably absent from this lineup was the “fourth pillar” of harm reduction (Buccieri, 2013). Fast forward to December 2016 when the Minister of Health announced the Canadian Drugs and Substances Strategy, which brought harm reduction back into the 4-pillars of prevention, treatment, harm reduction, and enforcement (Government of Canada, 2016).

The importance of harm reduction as a priority approach is discussed further in the section that follows. It is exactly as the name suggests – taking measures to reduce the harm associated with substance use. We introduce it briefly here to demonstrate that the landscape of drug policy, that is how we have responded to drug use as a country, has shifted back and forth over the years hinging on the issue of harm reduction in contrast to more punitive measures. In the video that follows Dr. Bernie Pauly, a leading harm reduction researcher in Victoria, discusses Canadian drug policy.

What do you think?

Decriminalization means that people would not face criminal charges associated with drug use. This is sometimes confused with legalization, which involves governmental regulation of production and access. After watching the video segment and hearing from Dr. Pauly, how do you think Canada should approach drug policy and law? Should we decriminalize and/or legalize other drugs, following the Cannabis Act?

Research from Vancouver’s Downtown Eastside, a low-income inner-city neighbourhood, demonstrates the housing precarity of people who use drugs. Using qualitative baseline and follow-up interviews with people who use drugs and were recently evicted, Fleming et al., (2019) found that most participants had been evicted unlawfully into homelessness. This study shows that existing housing policies and tenancy supports are generally not designed to support people who use drugs, who face related social and economic challenges, and who may not be able to advocate for their rights.

The overdose crisis requires novel and targeted public health interventions (Bardwell, Boyd, Kerr, & McNeil, 2018). A qualitative study of the overlapping housing and overdose crises in Vancouver shows that being evicted has serious implications for people who use drugs, including challenges navigating drug supply changes, decreased access to trusted dealers, an increase in public drug use, and a change in drug use patterns (McNeil et al., 2021). The risks of losing one’s housing, and experiencing homelessness, as a result of drug use are real and growing concerns, as housing prices rise and the market becomes more competitive in cities across the country.

The connection between addiction and housing precarity is the topic of Episode 6 in the podcast “Crackdown,” which looks at the war on drugs from the inside perspective of drug users as war correspondents. We encourage you here to sit back and listen to “Room 821” about tenants of the rundown Balmoral Hotel standing up for their rights amidst a growing overdose crisis. You will also find many more episodes to explore on a range of public health and substance use topics. Have a listen below and remember to consider how these personal troubles are actually larger public issues that impact society as a whole.

While this podcast and much of the research comes out of Vancouver, the opioid crisis is occurring all across the country. People are dying from unregulated drug supplies, often alone or in the presence of others who are unable to help them. Dr. Naomi Nichols discusses this in the next video as it relates to young people and their families.

In this section, we asked you to adopt a wide lens and think about how drug use is not only a personal trouble that impacts individuals, but also a public issue that requires thoughtful policies and legislation. We began by discussing the limitations of many public awareness campaigns aimed at children and arguing that we need a more balanced message about drug use in our society. By reviewing the national policies and legislation, we saw how Canada has gone back and forth on harm reduction as one of its key pillars over the past few decades. At the time of writing, in late 2021, harm reduction is currently part of our nation’s strategic approach.

At the same time, our review of the current research showed that people who use drugs in our society are highly marginalized, particularly in relation to housing. We asked you to listen to an episode of the podcast “Crackdown” that explored this issue, and to consider calls from leading researchers and advocates to decriminalize drugs. Individuals who use drugs and experience homelessness are often isolated and risk overdosing alone or with others who are also using drugs at the time. National legislation has been passed in Canada to allow people to call for emergency medical or police help without fear of arrest, but many are still rightfully worried about calling for help in a society that discriminates against people who use drugs. In the next section, we take a closer look at harm reduction, as a strategy that uses a rights-based approach to offer non-discriminatory person-centered care to people who use drugs.