People use drugs, get over it

Attitudes about drugs and drug enforcement have changed a lot over the years. 

Many Canadians take pride in this country's shift towards an evidence-based drug policy. But in this essay for The 180, public health physician Hakique Virani says even the most forward thinking policy makers need to recognize the limits of managing drug abuse.

During Canada's tragic opioid crisis, many have written some variation of the sentence, "The war on drugs has failed."

It's true.

Decriminalizing drug use is required to solve this problem.

But accompanying a policy shift will need to be a major attitude adjustment, including among us bleeding hearts.

It's time to accept that human beings use mind-altering substances.

They always have.

Sumerians used opium in 5000 BC; Egyptians brewed alcohol in 3500 BC; the Chinese consumed caffeinated tea beginning in 3000 BC; the First People of the Americas used tobacco.

Probably more than any other species in the animal kingdom, humans adapt to environments by occasionally choosing to change perceptions of them.

For as long as people have been using mind-altering substances, others have tried to stop them.

Russian Czars in the 1600s executed or tortured anyone found with tobacco.

In the 1800s, an imperial edict in China forbade the use of opium.

The 18th Amendment to the United States Constitution in 1920 prohibited alcohol. 

But there continued to be smoking in Russia, opium in China, and drinking in the U.S.

Where drugs are criminalized, worse drugs often arrive.

In North America, highly toxic bootleg fentanyls now dominate the street opioid trade.

More toxic opioids are less prone to interdiction than heroin because they can be trafficked in small packages.

Smaller doses are required to cause euphoria or death.

As a result, far more people are dying from drug poisoning now than from any other injury including car crashes.

Reducing harms is critical, of course. The growing acceptance of supervised injection services is encouraging.

But we also must finally get beyond our fixation on the use of some substances, and our need for things to fit into simple categories.

To most, "prescribed" means helpful, "legal" means okay, and "illicit" means addictive, harmful to health, perhaps evil.

These distinctions are not based on rational thought.

They are based on what the dominant "we" happen to be comfortable with.

The truth is that some things we're comfortable with like caffeine, alcohol, and cigarettes can be harmful.

Substances that many people are uncomfortable with like cannabis and psychedelics might be helpful in some medical conditions.

And what we prescribe may not always be useful in the ways we think.

Some antidepressant therapy might increase the risk of suicide, for example.

When it comes to substance use, there are other blanket assumptions that even progressive-types don't challenge.

Most accept that social inequities, trauma, and mental health problems factor into substance use behaviours.

Sit in on a meeting or event where the opioid crisis is being discussed, and at some point, you'll hear some thoughtful person say, "We can't just focus on harm reduction and treatment. We have to move upstream and address the reasons these people use substances to start with."

Nods around the room typically follow.

This emphasis on prevention, a pillar of Canada's new drugs and substances strategy, surely comes from a good place.

But we must ensure this is not just a more subtle manifestation of the ultimately harmful drug war mentality.

We should address poverty, homelessness, social inequity, and poor mental health because it is right to do these things.

Not because it would mean that all people will magically stop using drugs.

Many will not stop.

As well-intentioned do-gooders immersed in an unjust drug war, we may have been conditioned to think that if people continue to use illicit mind-altering substances, they haven't achieved "recovery", and our work isn't done; we have to un-sick, un-poor, and un-trauma them some more.

After all, we ask, why would any well person do illicit drugs?

Well, some do. Some always will.

Expecting that they stop entirely can, in turn, alienate them, and perhaps increase the chances that their drug use then becomes problematic.

In other words, our imposition of "help" (on our terms) while failing to truly accept the humanness of the individual's behaviour might paradoxically cause the problem we thought we were fixing.

To address this overdose epidemic, what we need to fix is our perspective.

Deciding to use substances like tobacco, alcohol, marijuana or heroin does not make people less human.

It reflects the fact that they are human.

But what might make the rest of us less human is our insistence on creating environments that force people who use substances to be more dejected, debased, desperate, and in danger than anyone should be.

Dr. Hakique Virani is a public health physician specializing in addiction, and a clinical assistant professor in the Faculty of Medicine at the University of Alberta.