November 13th to the 19th is National Addiction Awareness Week, an occasion that highlights issues and solutions to help address alcohol and other drug-related harm. It also provides an opportunity for Canadians to learn more about substance use prevention, strategies for treatment and recovery and to bring about solutions for change. Indeed, it is a critical point in time to discuss drug policy and its implications on Canadians as the federal government is moving towards reforming our nation’s outdated drug policy through the legalization and regulation of cannabis in the spring of 2017.
The move to legalize cannabis is a necessary reform, yet much more needs to be done in order to address problematic substance use and and addiction. Issues with substance use and addiction are widely prevalent in Canada. According to CAMH:
- In any given year, 1 in 5 Canadians experiences a mental health or addiction problem
- Young people aged 15 to 24 are more likely to experience mental illness and/or substance use disorders than any other group
- People with a mental illness are twice as likely to have a substance use problem compared to the general population
- At least 20% of people with a mental illness have a co-occurring substance use problem
Homelessness & substance use
The relationship between homelessness and substance use is complex. Many research studies indicate that substance use and addiction are widely prevalent among the homeless population. A Toronto study found drug use to be very high among homeless individuals in comparison to the general population. As well, injection drug overdoses from substances such as morphine, heroin, cocaine, amphetamine, and methamphetamine were found to disproportionately affect marginalized populations, including people experiencing homelessness. Veterans experiencing homelessness in Canada also frequently cite addiction to alcohol or illicit substances as key factors leading to homelessness, with some citing use of alcohol and drugs as a way to cope with unaddressed mental health problems. However, homelessness cannot be explained by substance use alone and many other factors can contribute to a person becoming homeless.
Criminalization of substance use & addiction
Across the globe, a consistent trend in responding to issues of substance use and addiction has been policies that produce punitive measures and treat addiction and substance use problems as a criminal offence, rather than as a public health issue. After decades of the ‘War on Drugs’ approach that sought to eliminate illicit drug use and distribution entirely, experts have widely discredited such policies as inhumane, devoid of evidence, costly, inefficient and an infringement of human rights.
The implications of punitive responses to issues of problematic substance use and addiction continue to be experienced. For instance, Canada’s National Anti-Drug Strategy, enacted in 2007, imposed funding cuts to harm reduction programs, which are widely regarded as a best practice in successfully addressing substance use problems and addiction. Furthermore, the Safe Streets and Community Act, enacted in 2012, intensified policing and conviction of minor drug offences acting to criminalize recreational drug users and low-level street-based suppliers rather than higher level suppliers. This policy has been shown to have no implications on reducing or alleviating drug use and distribution, instead it effectively targets, criminalizes and penalizes the poorest and most vulnerable populations in Canadian society, including the homeless.
Much remains to be addressed in improving drug policy in Canada. Despite recent shifts in policy that recognize the counterproductive effects of criminalization, the illicit status of most substances continues to reflect punitive, ‘War on Drug’ like models that further disportionately impact marginalized populations.
Adverse effects of criminalization
Those experiencing homelessness are particularly vulnerable to interactions with police, given the visibility of homelessness, and are more likely to be arrested due to several factors. The activities of homeless people are considered criminal, as is their very presence in public and semi-public spaces. Individuals experiencing homelessness are can often be charged for acts in the pursuit of trying to survive homelessness, in the name of public safety. Those who are using substances are also more likely to get caught with drugs at a greater frequency than housed individuals who are able to engage in substance use in the privacy of their homes.
The illicit status of substances also intersects with the criminalization of homelessness through the policing of those experiencing homelessness who engage in the distribution and sale of illicit substances. As other means of unemployment are increasingly inaccessible to those experiencing homelessness, selling drugs allows an individual to earn an income as well as support any substance use habits they may have. However, due to the illicit status of most substances, selling drugs often acts as the largest contributor to offense rates, as seen in the homeless youth population. By this, not only are youth excluded from conventional employment, of which they would take heed of if provided, they are inundated with the stigma of a criminal record, and would be better suited if met with an alternative intervention rather than a law enforcement approach.
The current illicit status of substances also imposes significant health implications on those experiencing both homelessness as well as addiction. For instance, research demonstrates that incarceration as a response to drug use or possession is correlated with exacerbating addiction as well as other health implications, such as inmates becoming infected with HIV or Hepatitis C, relapse or persistent drug use. The study also finds that despite the well established fact that incarceration does not reduce drug use, those who use drugs are still incarcerated at alarming rates. Additionally, homelessness can also follow incarceration, due to stigma and barriers to housing or employment a criminal record imposes. Criminalization of homelessness, as well as poverty, thus serve only to exacerbate and solidify inequality creating a cycle of economic exclusion that is hard to escape.
Street policing of individuals experiencing homelessness, in addition to incarceration, has also been found to exacerbate health risks associated with the criminalization of drug use and addiction. For instance, research finds that a proliferation of police crackdowns within drug markets often results in a reluctance for users to carry sterile syringes out of fear of police intervention, promoting syringe sharing and thereby increased risk of transmitting diseases. Furthermore, homeless youth populations express a reluctance to seek out harm reduction or treatment services due to fear of victimization by the police such as harassment, increasing the likelihood of high risk behaviour associated with substance use.
As mentioned, responses to substance use and addiction have largely taken a punitive stance for the last few decades, where marginalized populations have often bared the brunt of this burden. If we are to truly address and prevent the issues that lead to substance use problems and/or homelessness in the first place, policies need to be based on good evidence.
Drug policy reform in the U.S. as well as Canada in some respects have recently started the transition from the tough on crime approaches to substance use and addiction towards evidence-based models of treatment, decriminalization and legalization. Although these measures are a critical step in addressing substance use and addiction, it is but one part of a multifaceted approach that must encompass a strategy to address the root causes of addiction.
Identifying that abstinence-based approaches to substance use and addiction are inefficient models allow for the implementation of harm reduction strategies instead. By this, efforts that seek to address substance use and addiction acknowledge that substance use may fulfil many roles in a user’s life as well as acts to tailor a harm reduction model to each individuals needs. The literature confirms that those experiencing addiction and homelessness desire services that are stigma and judgment free as well as empowering.
Housing First incorporates harm reduction as a key tenet of its framework, where supports to housing are not contingent upon sobriety. Indeed, the evidence shows that responding to individuals experiencing homelessness as well as addiction with housing and harm reduction services, rather than a prison sentence promotes encouraging results. Furthermore, studies show that a Housing First model also works to increase housing stability, improve health and well-being, decrease hospitalization and in one study, reduce alcohol consumption and policing costs for those with severe alcohol dependency.
Portugal decriminalized all illicit substances in 2001 and is a prime example of how decriminalization combined with an increase in substance use treatment and addiction services produces promising results. One study in Portugal found that overall, decriminalization, contrary to popular belief by critics, did not lead to an increase in drug use. In fact, the benefits of decriminalization, joint with an increase in harm reduction treatment services, included reductions in problematic use, drug-related harms, criminal justice overcrowding, and further social and health benefits. Furthermore, the study significantly found that such positive developments were applicable when all illicit substances were decriminalized, as opposed to just cannabis alone.
As the federal government moves to legalize the status of cannabis, such reforms although necessary should not be viewed as a panacea to substance use and addiction in Canada. Much more remains to ensure that individuals impacted by addiction are treated with dignity and evidence based approaches in order to address the factors that lead to homelessness and/or addiction in the first place.
Visit National Addictions Awareness Week to learn more.