Hamilton board of health considers decriminalizing drug possession

Hamilton's board of health has asked staff to study the idea of decriminalizing the possession of small amounts of illegal drugs, a step some advocates say is one of many required to stem the tide of the opioid crisis.

At its March 21 meeting, board members passed a motion directing staff to report back on recommendations from the Canadian Drug Policy Coalition, which include providing a legal, safe supply of drugs to substance users and increasing access to safe consumption sites.

The motion — put forward by Mayor Fred Eisenberger — specifically references the coalition's recommendation to decriminalize possession as a focus for staff's attention.

Advocates say decriminalization would help reduce the stigma that drug users face when they access treatment, medical care and other services. 

"The issue of decriminalization of simple possession... is an important step," Eisenberger told the board, noting the city has seen a spike in deaths related to opioid, specifically Fentanyl, use in recent years. "We're treading water on those issues. 

"There's got to be better, safer ways in helping people through their addictions. We're not encouraging addictions but we need to recognize the fact that addiction happens," he said. 

Hamilton is not the first Canadian jurisdiction to consider decriminalizing street drugs. The cities of Vancouver and Toronto, and the province of British Columbia, have recently applied to the federal government for exemptions from federal drugs laws governing possession. Health Canada is currently reviewing those applications.

Federal Minister of Mental Health and Addictions Carolyn Bennett told CBC Toronto in December that the government recognizes "the different approaches cities, provinces, and other organizations are taking" and it is "supportive of their work to find innovative solutions" when it comes to saving lives. 

The Canadian Association of Chiefs of Police is also in favour of decriminalizing small amounts of drugs, saying it is "an effective way to reduce the public health and public safety harms associated with substance use."

In Hamilton, at least 115 people are believed to have died from an "opioid-related" cause between January and September of last year. The city has not posted data for the last part of the year. In 2020, there were 124 opioid deaths, following 105 in 2019 and 123 in 2018 — a significant increase over 2017 figures.  

'My father's death was not an isolated issue'

The board of health discussion followed a presentation from Hamilton-raised Carleton University student Kayla Hagerty, whose father Ian Harrington died after an overdose in May 2020. Fighting through tears, Hagerty said COVID-related isolation has led to more people using drugs alone, and more overdose deaths.

"My father's death was not an isolated issue," said Hagerty, who is pursuing a master's degree in sociology. "Within the first 15 weeks of the pandemic, Ontario experienced a 38 per cent increase in opioid-related deaths.

"For three out of four overdose deaths during the pandemic, there was no one there to intervene or administer Naloxone," she said, referencing the medication that can help reverse the effects of an opioid overdose.

She said research shows that supporting drug users without stigma and helping them access safe drugs can massively reduce opioid-related deaths and overdoses. 

Hamilton 'safe use' trial sees reduction of overdoses

A recently published paper looking at a harm-reduction initiative at the Salvation Army's Booth Centre men's shelter in Hamilton appears to show something similar.

The paper was published March 21 in the peer-reviewed Harm Reduction Journal, a publication that looks at "the evolving patterns of drug use around the world." The paper, co-written by six doctors affiliated with McMaster University, looked at a temporary "safer use space" that healthcare workers and harm reduction group Keeping Six set up in the shelter during a COVID-19 outbreak there in February 2021.

Because of the outbreak, residents weren't allowed in and out of the shelter.

"We were all very concerned about any shelter undergoing full-on quarantine and lockdown for COVID-19, particularly because we know that in any given shelter population, 30 to 40 per cent use substances," said Dr. Suzanne Turner, a Hamilton family doctor with expertise in addiction medicine, and one of the paper's authors.

"Overdoses are very common in shelters. If the shelter was in lockdown and people couldn't leave, we worried that they would start using a supply of opiates they weren't familiar with."

Lack of access to drugs could also lead to reduced tolerance, which could put people more at risk of an overdose later, she added.

The group set up a space within the shelter where users would be supervised and provided with clean supplies, and also offered prescriptions for hydromorphone, Methadone, and long-acting morphine.

The project ran for 26 days, and resulted in a five-fold reduction in overdoses at the shelter, compared to the four weeks immediately preceding the pilot.

"It's a really compelling story of what can happen when multiple community agencies come together… to save lives," Turner said.

When asked about decriminalization, Turner said it could help people feel more willing to discuss their substance use, which in turn could lead to better health outcomes.

"It is one part of the overall spectrum that will lead to better outcomes for the people who are my patients," she said. "It's about giving clients the tools they need to [use drugs] in a safe way."