Drug policy and the public good – oxymoron or inseparable concepts?

Drug policy – or really, our society’s relationship with illegal drugs – was the focus of a forum of leading researchers and policy makers in the substance use and public health arenas at CAMH in February.

The event also served as a launch for Drug Policy and the Public Good, a new book by 12 scientists published by Oxford University Press which calls for a renewed approach to drug policy that’s evidence-based, realistic and coordinated.

One conclusion they underlined is that there’s no single drug problem within or across societies; nor is there a ‘magic bullet’ to solve ‘the drug problem.’ In fact, oversimplified approaches --and the “perverse” impact of drug policies that arise from them-- are prevalent, according to Dr. Jürgen Rehm, CAMH senior scientist and one of the book’s authors.

(L-R) CAMH senior scientist Dr. Jürgen Rehm with Dr. Thomas Babor, University of Connecticut, Liz Jansen, Toronto Public Health, Dr. Benedikt Fischer, Simon Fraser University/CAMH; Dr. Maristela Monteiro, PAHO and Dr. Perry Kendall, BC Public Health Officer.

He pointed to Canada, with the world’s third-largest rate of prescription opioid use (more than five times that of the United Kingdom), as a prime example.

“Canada is a pill-popping country,” Dr Rehm said. “The [current federal] Anti-Drug Strategy has largely ignored the problem of prescription drug misuse or key evidence on effective interventions for illicit drug harms.”

Prohibition alone, or excessive emphasis on “repression” without also emphasizing the other ‘pillars’ of drug policy – namely prevention, treatment and harm reduction measures – becomes counter-productive, according to another of the book’s authors.

Dr. Benedikt Fischer, professor at Simon Fraser University, who holds a cross-appointment at CAMH, pointed out that most eradication programs have shifted drug use problems to other markets or even worsened them.

“We’ve tried [prohibition] for about 100 years now and it hasn’t proven particularly effective,” he said.

Dr. Thomas Babor of the University of Connecticut and the book’s principal author kicked off the forum by highlighting the ‘synergistic’ relationship between supply control of drugs and demand reduction measures, underlying a need for a broader public health approach to drug policy.

He also characterized as “mind-boggling” the global dimension and prevalence of drug use which drove the development of the book.

“Drug use ranks as 8^th as a major risk factor for disease burden in established market economies,” he said, pointing to United Nations statistics indicating that some 208 million people, or 5 per cent of the world’s population, had used an illicit drug at least once in the past year.