Getting Ahead of the Opioid Overdose Crisis: Nursing Advocacy for Drug Law Reform is Critically Needed

Canadian nurses are keenly aware of the negative impacts of punitive drug laws that are implicated in the overdose epidemic.  As nurses, we provide care within a system that often directs people who use substances (both problematic and non-problematic) towards policing and prisons instead of essential health care services. The result is stigmatization and criminal charges for drug use and possession, resulting in mandatory minimum sentences and other harms such as overdose. Criminal charges for substance use are unfairly distributed based on differences in social position, often unfairly impacting Indigenous people [1] and youth [2]. Criminalization systematically creates barriers to stability, safety, and recovery for people who use drugs.

Nurses bear witness to a failed system in which public health efforts are undermined and thwarted. Criminalization of substance use has clear negative impacts on the wellbeing of people who use drugs. Police surveillance in public spaces creates environments where people who use drugs may use in isolation, decreasing the likelihood that overdose response and reversal will occur with little access to health services [3]. In public settings, individuals rush to use covertly increasing risks and harms such as injecting with non-sterile supplies. Criminalization also implies that substance use is morally wrong and deserving of punishment. Indeed, people who use drugs are often hesitant to seek health services due to fear of stigmatization from health care providers [4].

We need shift our drug laws so that substance use is treated as a health issue. Discussions on decriminalization in Canada began as early as 1994, during an earlier overdose epidemic, when BC Coroner Vincent Cain strongly argued that a criminal model to address substance use was not improving population health or overdose rates [5]. Decriminalization differs from the complete legalization and sale of substances, but instead refers to the removal or reduction of drug charges for small and personal amounts of illicit drug use, purchase, or possession. Arguments for decriminalization should go hand in hand with calls for increasing treatment and harm reduction systems that can respond to substance use and harms across the spectrum of need. Alongside decriminalizing illegal drugs for personal possession in Portugal in 2001, treatment and harm reduction services were expanded. Today, drug use in Portugal has not increased, drug related deaths have decreased, less people are incarcerated, and more people are receiving services [6].

The current reality is that illicit fentanyl in the unregulated drug market is a key driver of overdose deaths in Canada. It is not enough to simply focus on regulating the medical opioid supply through monitoring of prescribing practices. People who use drugs [7] and their allies [8] are increasingly calling upon governments to move towards decriminalization and regulation of an unpredictable drug market by expanding options related to oral and injectable opioids. As a public health measure, regulation ensures the standardized quality of substances in order to reduce harm of substance by providing safer alternatives to consumption. However, some groups such as the Canadian Association of People Who Use Drugs (CAPUD) and Canadian Drug Policy Coalition have pointed to the potential limitations of a regulation model that would only provide a safer supply as for a portion of the population with opioid dependency [7,8].   Regulation of opioids only as a treatment option will not realistically curb illicit drug deaths across the population for all of those who access an unregulated and illegal drug market. This would require legalization of currently illegal substances is aligned with the same rationale given by Justin Trudeau in support of legalization of cannabis. However, as it readily apparent in the case of cannabis, legalization would take many years to achieve.

As outlined in the Code of Ethics, nurses have a responsibility to uphold ethical endeavours including advocacy for evidence-informed policies that promote health equity. The Canadian Nurses Association (CNA) has long supported and advocated for supervised consumption sites. Harm reduction is aligned with professional and ethical nursing practice standards. Recently at the June 2017 annual members’ meeting, the CNA resolved to endorse decriminalization and the widespread availability of injectable opioid agonist therapies [9].  We argue that advancing this resolution cannot wait and a step forward must be taken: nurses must make a public call on the federal government to act immediately on drug law reform, including decriminalization alongside scale up of harm reduction and provision of safe and regulated substances. Further, we contend that the legalization and regulation of the sale and distribution of currently illegal substances should not be ruled out as a long-term solution.

Groups such as CAPUD and Canadian Drug Policy Coalition have publicly called for immediate decriminalization and an increase of safe and regulated opioids. As opioid overdose deaths continue to mount with little end in sight, we call on every nurse to prioritize a call to action on drug law reform.

Meaghan Brown, RN, BScN, Doctoral Student in Nursing, University of Victoria, Canadian Institute for Substance Use Research (CISUR)

Bernie Pauly, RN, PhD, Associate Professor, University of Victoria, Scientist, Canadian Institute for Substance Use Research

  1. Office of the Provincial Health Officer. (2013). Health, Crime, and Doing time. Retrieved online: https://www2.gov.bc.ca/assets/gov/government/ministries-organizations/ministries/health/office-of-indigenous-health/health-crime-2013.pdf
  2. Cotter, A. , Greenland, J., & Karam, M. (2015). Drug-related offences in Canada, 2013. Retrieved online: http://www.statcan.gc.ca/pub/85-002-x/2015001/article/14201-eng.htm#a17
  3. Ahern, J., Stuber, J., & Galea, S. (2007). Stigma, discrimination and the health of illicit drug users. Drug and Alcohol Dependence, 88(2), 188-196. 10.1016/j.drugalcdep.2006.10.014
  4. Kerr, T., Small, W., & Wood, E. (2005). The public health and social impacts of drug market enforcement: A review of the evidence.International Journal of Drug Policy, 16(4), 210-220. 10.1016/j.drugpo.2005.04.005
  5. Office of the Chief Coroner, Province of British Columbia. (1994). Report of the task force into illicit narcotic overdose deaths in British Columbia. Retrieved online: http://drugpolicy.ca/wp-content/uploads/2016/11/Cain-Report.pdf
  6. Drug Policy Alliance. (2016). Approaches to Decriminalizing Drug Use & Possession. Retrieved online: https://www.drugpolicy.org/sites/default/files/DPA%20Fact%20Sheet_Approaches%20to%20Decriminalization_%28Feb.%202016%29_0.pdf
  7. Canadian Association of People Who Use Drugs (CAPUD). (2017, Feb). Statement on Health Canada Occupation. Retrieved online: http://capud.ca/?page_id=269
  8. Lupick, T. (2017, December 15). Decriminalization Doesn’t Go Far Enough. Retrieved from: https://www.theglobeandmail.com/opinion/decriminalization-doesnt-go-far-enough/article37345776/
  9. Canadian Nurses Association. (2017, June 21). Annual Meeting of Members June 21, 2017: Resolutions. Retrieved online: https://www.cna-aiic.ca/~/media/cna/page-content/pdf-en/2017-meeting-of-members/cna-annual-meeting-of-members-2017_resolutions.pdf?la=en

 

 

 

 

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