Decriminalize possession of small amounts of illegal drugs, Toronto's top doctor recommends

Toronto should decriminalize the possession of small amounts of drugs as a response to the worsening opioid overdose crisis, recommends a new report from the city's medical officer of health.

The report, signed by Dr. Eileen de Villa, was released publicly Monday and will go before the Toronto Board of Health at its next meeting on Dec. 6.

If approved by the board, it would direct de Villa to officially ask the federal government to exempt people within Toronto's geographical boundaries from criminal charges for possessing small amounts of drugs for personal use. Drug trafficking, including production and sale, would remain illegal.

Toronto would become the second major Canadian city, after Vancouver, to ask Health Canada for such an exemption from the Controlled Drugs and Substances Act, which regulates the possession, distribution and sale of unregulated drugs in Canada.

"The status quo approach to the drug poisoning crisis is not working," the report reads. 

"There is an urgent need for a comprehensive public health approach to drug policy that removes structural barriers to healthcare and social services, provides alternatives to the toxic drug supply, and enhances and expands services to improve the health and well-being of Toronto's communities."

A 'comprehensive approach'

De Villa's recommendation is one of many that seek to expand the city's approach to the toxic drug crisis and would continue a trend toward treating drug use as a public health issue, rather than a criminal justice one. 

Her report also recommends the city push higher levels of government for additional funding so that it can expand safe supply programs, harm reduction services and treatment initiatives. And it calls for more resources for overdose outreach beyond homeless shelters to parks and drop-ins, and mobile drug consumption services outside of downtown.

"It is important to note that decriminalization alone will not solve the drug poisoning crisis," the report reads. "Seeking an exemption from criminal penalties for personal possession is only one part of a comprehensive approach."

The report says decriminalization can help people who use drugs connect to harm reduction and treatment services, along with other social services such as housing, without fearing criminal charges or discrimination. 

It also cites evidence showing that criminalization of drug possession disproportionately impacts Black and Indigenous people, those suffering from mental health issues and the recently-incarcerated.

Jason Stateman, a drug user for the past 25 years, told CBC News it's about time that drug use is treated as a medical issue, instead of a criminal act.

"The people that are doing it aren't doing it because they like to. In fact, they're doing it because they have to and they're sick," he said.

Under the Controlled Drugs and Substances Act, the federal Minister of Health can provide municipalities and provinces with an exemption from the provisions that criminalize drugs if there is a medical purpose or if it is deemed to be in the public interest.

Supervised consumption sites, where drug users consume drugs under the supervision of trained health workers, operate legally under similar exemptions.

Jeanette Bowles, a postdoctoral fellow at St. Michael's Hospital with the Centre on Drug Policy Evaluation, said decriminalization will help reduce the stigma associated with drug use.

"Stigma can lead to shame. Shame can lead to folks using drugs alone. Using drugs alone is a very high risk factor for overdose death, as there's no one around to intervene," said Bowles.

Police, mayor supportive

Chief James Ramer of the Toronto Police Service expressed his support for the recommendation in a letter released alongside the report.

"We agree that the current approach to managing drug use does not support safe communities or advance the health of people who use drugs," Ramer's letter reads.

"Decriminalization of the simple possession of all drugs — combined with the scale-up of prevention, harm reduction, and treatment services — is a more effective way to address the public health and public safety harms associated with substance use."

In a statement, Mayor John Tory said he is open to considering the alternative approach being put forward by de Villa, "but only if it is preceded by a robust system of addiction healthcare supports and referral pathways to effectively address the problem as a whole, which are not currently in place or have too many barriers to access them." 

The national association representing police chiefs and Ontario's big city mayors are among those who have pushed for decriminalization in recent years. 

Drug crisis worsens during pandemic

The opioid overdose crisis in Toronto has dramatically worsened during COVID-19 pandemic.

According to data from Toronto Public Health, 531 people died of opioid-related causes in 2020, an 81 per cent increase compared to 2019.

Meanwhile, in the twelve months from Nov. 1, 2020 to Oct. 31, 2021, paramedics responded to 5,776 suspected overdoses, including 351 calls involving death. That's a 61 per cent increase in overdose calls and a 53 per cent increase in calls involving death compared to the previous 12 months. 

Medical experts say the recent spike in overdoses has largely been caused by a range of toxic substances found within the street drug supply. The city's drug checking service has reported finding unexpected, highly potent drugs in samples.

Those include opioids like carfentanil, etonitazene, isotonitazene, and etizolam. These substances, which are mixed with more common opioids like fentanyl, can contribute to higher incidents of overdoses.