To Incarcerate or Not to Incarcerate: Is That the Right Question for Drug Addiction?

Dear Editor,

Fischer and colleagues ¹ discuss the limits of Bill C-22, which proposes to remove mandatory minimum penalties for drug possession with discretionary referral to treatment. While their criticisms of the Bill are justified, the extrapolation of these criticisms to all decriminalization polices is unfounded. Moreover, they imply that drug use should remain illegal, and that individuals should continue to be arrested for possession, while providers grapple with the best way to enact a public health policy. This is unacceptable.

It is imperative we stop arresting individuals for drug possession. Current approaches within the criminal justice system, including prison-based treatment programs, remain largely ineffective at reducing drug use. ² Even if reductions in use occur while institutionalized, the likelihood of maintaining abstinence upon release is low, due to limited access to social supports or aftercare programs. Individuals often return to using their pre-incarceration amount, increasing their risk of overdose, particularly on opioids. ² Additionally, the yearly cost of prison in Canada is over $100,000 for male and $200,000 for female inmates. ³ Reducing institutionalization expenditures, and redirecting such resources to healthcare, is imperative.

Furthermore, prison is traumatizing and reduces meaningful engagement with society due to subsequent restrictions in vocational/educational opportunities and stigma. Imprisoning people who use drugs increases risk of relapse and reduces opportunity for functional recovery.^2,4 Moreover, systemic disparities in incarceration rates for Black and Indigenous people ² results in these harms disproportionately impacting the BIPOC community.

Fischer et al. discuss Portugal's decision to decriminalize drugs in 2000, claiming it resulted in a “limited reduction in drug use and criminal justice burden” and dismiss this model in Canada, claiming it's “dependent on social-cultural and structural contexts”. However, they do not elaborate on what contexts would prevent this model from working in Canada. Portugal's implementation of a nationwide harm reduction framework, including decriminalization, propelled it from being the “heroin capital of Europe” to having among the lowest rates of drug-related overdoses in the European Union in addition to considerably lower rates of drug use, some crimes, Hepatitis B and C, and HIV transmission. ⁵ Dismissing the opportunity for such progress in Canada, especially amidst the current opioid crisis, is irresponsible. This is not to say that Portugal's approach was perfect, but with 20 years of advancements in addiction science, Canada has a model that can be improved upon if implemented thoughtfully.

While decriminalization may not be sufficient to address the harms of drug use, it is necessary for moving towards a public policy of harm reduction. Canada's current patchwork approach to harm reduction has resulted in disparities in local resources; Toronto shelters offer needle exchange programs, but evict individuals who make use of it, likely out of fear of legal repercussions for “allowing” drug use. Decriminalizing drug possession, coupled with broader implementation of harm reduction initiatives, may result in large-scale adoption of evidence-based practices, such that organizations cannot terminate essential services like shelter or food based on drug use status.