After decades of advocacy by civil society, the government finally approved the opening of the first drug consumption room in Slovenia. On this occasion we interviewed Katja Krajnc from the 

, a leading harm reduction organisation in the country.

Drugreporter: Can you talk a bit about your own background? How and why did you choose to work in the field of harm reduction? What work do you do for the organisation?

: I think that in choosing this field, the work, in a way, chose me. Even when I was a student and occasionally passed by the drop-in centre of the NGO Stigma, I often envisioned working for this organisation. After completing my studies, I had the opportunity to be employed by the association, and I have stayed here ever since. In my opinion, working in the field of harm reduction is not for everyone. Anyone who takes a job in harm reduction must start from the belief that drug use is a matter of personal choice and a human right to bodily integrity. It is necessary to be aware, without moral judgments and a patronising attitude, that there are people who, for various reasons, cannot or do not want to stop taking drugs.

The NGO Stigma is one of the leading harm reduction organisations in Slovenia. What is the story of Stigma? When and why was it established?

That’s right. The Harm Reduction Association Stigma is the first organisation that began operating in the field of harm reduction in Slovenia. The NGO was founded in 1990, and through its collaboration in the project ‘Preventing AIDS through the organization of aid and self-help for drug users,’ we established a framework for harm reduction in Slovenia. During this period, drug use increased, reflected in a higher number of overdose deaths and more frequent responses to drug issues in the media. Initiatives by drug users began to emerge as a reaction to repressive policies and moralistic treatment. With these initiatives, they sought to assert the right to health care, soon followed by the right to protection against infectious diseases, and, ultimately, destigmatisation of their social role. Stigma was formed as a collaboration project between drug users and professionals, with the aim of reaching out to those drug users who were labelled as “hard to reach”.

The choice of the name Stigma is aimed at drawing attention to the problems of the marginalisation and exclusion of a population, which, due to its hidden nature and life on the social fringes, is even more exposed to risks and dangers resulting from drug use.

What kind of services do you provide to people who use drugs?

Our NGO has two drop-in centres where needle exchange takes place, which is the basic measure and starting point for all other harm reduction approaches. Unhindered access to sterile equipment is a preventive measure and at the same time provides access to the largest number of intravenous drug users. The program provides free sterile equipment such as insulin syringes, various needles and syringes, cookers or spoons with filters, condoms, needle disposal containers, and informational materials.

Returning used needles is part of the needle exchange program, but returning a used needle is not a condition for issuing a sterile one. In the drop-in centre, we also provide counselling and practical assistance. Counselling is initiated by users who have contacted us personally, by phone, or online, within the framework of the drop-in centre program or mobile needle exchange through outreach. We assist people who use drugs access various services, such as opioid agonist treatment, and support them to find housing and jobs.

In addition, we have an outreach program to contact drug users in the initial phase of their drug use and try to reduce the harm that drug use could cause them. Our outreach workers step out of offices and counselling rooms to meet drug users in their environment, providing them with sterile injection equipment, necessary information, and incentives to follow safety instructions in drug use. If a need for more targeted treatment arises during a conversation, the person is invited to visit the drop-in centre, where we continue to address their situation.

Drug consumption rooms are coming to Slovenia – an interview with Katja Krajnc

Accra, Jan. 30, GNA – Ghanaian Law students have been urged to help prevent drug policies, measures and legislations that work against the rehabilitation of substance abusers. 

The students were asked to not only play roles in the prevention of the use and circulation of drugs (cocaine, marijuana, tramadol, etc.) but also be critical of incarceration of abusers and lack of rehabilitation centres. 

The call was made by drug policies and legislations advocates at a day’s hybrid workshop for tertiary students and faculty members in Ghana by POS Foundation on the theme: “Substance Use and Prevention: A Comparative Dialogue between Ghana and the USA’s Drug Policy.” 

Participating universities were GIMPA Law School, Ghana, Adler University, Chicago, Illinois and Columbia University, New York and Fordham University, New York and Students for Sensible Drug Policy (SSDP) with the students sharing their perspectives.

Madam Maria-Goretti Ane Loglo, Lawyer and IDPC Consultant for Africa, said the people languishing in jail because of drug use had been the younger population, a situation we had to avert because there had been lack of jobs to engage them.

“As a country we also need to revisit the fines given to offenders. The fines are very high and many of the people cannot afford. The State must resource the Fund to help in rehabilitation and put up rehabilitation centres that are accessible and less expensive,” she said

Ghana: Law students urged to guard against inimical drug policies

We, the undersigned organisations, are deeply concerned about the drastic intensification of anti- drug operations in Sri Lanka leading to significant human rights violations.

On 17 December 2023 the Acting Inspector General of Police Deshabandu Tennekoon, with the endorsement of Minister of Public Security Tiran Alles, spearheaded an operation titled “Yukthiya”, with the stated aim of controlling “the drug menace”. The operation is ongoing as of 10 January 2024, with at least one thousand persons arrested daily.

This operation is unfolding in a context of already severe repression against persons who use or are suspected of using drugs, who suffer discrimination and stigma within the Sri Lankan criminal justice system and society.

Alongside the Sri Lankan police, members of the armed forces have been supporting this operation, during which several human rights violations have been reported. These violations include alleged arbitrary arrests, primarily against individuals from marginalised socio-economic communities; searches conducted without warrants or reasonable suspicion; and degrading treatment including strip searches in public as well as cavity searches. The searches and arrests have been televised, in violation not only of the right to privacy (and of basic human dignity) but also of a person’s right to be presumed innocent. According to lawyers, persons are being arrested even when no drugs are found in their possession, simply for having been arrested for drug offences or having been sent to compulsory rehabilitation in the past. The arrests of main livelihood earners and mothers have adversely impacted the ability of families to meet their basic needs during a time of economic crisis in Sri Lanka, and the wellbeing of children.

Persons are being arrested primarily under Section 54A of the Poisons, Opium and Dangerous Drugs Ordinance, an offence which is non-bailable. As a result, those arrested are bound to spend time (sometimes months) in pretrial detention, thereby exacerbating already poor conditions of imprisonment in an overburdened prison system. The Human Rights Commission of Sri Lanka has previously stated that the existing prison conditions and treatment of incarcerated persons are “inhumane and degrading.”At present, as per statistics issued by the Department of Prisons, the level of overcrowding of the prison system is at nearly 200% - with punitive drug policies playing a significant role: as of 2022, 63% of convicted persons were sentenced for drug-related offences.

The total reported number of arrests pursuant to operation Yukthiya has exceeded 29,000 as of 9 January 2024, while nearly 1,500 people are in administrative detention in police custody for further investigation.  At least 1,600 more persons have been sent for compulsory drug rehabilitation, in violation of several fundamental rights; including the right to the highest attainable standard of health, which includes the right to consent to and withdraw from medical treatment. “Drug treatment” in these centres is abstinence-based, essential harm reduction services are not available, and persons undergo severe withdrawal symptoms without any medical assistance while in detention. The use of violence to discipline and punish has been reported in at least two compulsory drug rehabilitation centres which are within the purview of the Bureau of the Commissioner General for Rehabilitation and are operated by the military, which is in itself a violation of international standards.

The UN Working Group on Arbitrary Detention in its statement at the conclusion of its visit to Sri Lanka in 2017 expressed concern regarding the involvement of military personnel in drug treatment and rehabilitation, the fact that strenuous physical exercise was the core component of compulsory drug treatment, and at the lack of trained professionals to monitor the health of people in detention. Furthermore, the statement highlighted the irregularities in the judicial process by which persons were sent to drug rehabilitation centres without a medical assessment.

More broadly, the UN Special Rapporteur on Torture has highlighted that by denying persons access to substitution therapies, states are subjecting “a large group of people to severe physical pain, suffering and humiliation, effectively punishing them for using drugs and trying to coerce them into abstinence.” The Special Rapporteur has further stated “forcible testing of people who use drugs without respecting their autonomy and their right to informed consent may constitute degrading treatment, especially in detention settings. States are obliged to respect the enjoyment of the right to health, including by refraining from using coercive medical treatment. The requirement of informed consent, including the right to refuse treatment, should be observed in administering any treatment for drug dependence.”

Since the 2016 UN General Assembly Special Session on drugs, there is international consensus on pursuing a holistic and health and human rights-based approach to drugs, which encompasses supply and demand reduction as well as harm reduction. The 2019 Ministerial Declaration on drugs – the current global drug policy document - as well as multiple resolutions of the UN General Assembly, the UN Commission on Narcotic Drugs, and the UN Human Rights Council reiterate and recommend a similar approach.

A punitive and militarised approach to drug control contravenes recognised international human rights standards and guidelines, is ineffective to protect individual and public health, and ultimately fails to make communities safer.

Africa Network of People Who Use Drugs (AfricaNPUD) (Africa)

Anti-Death Penalty Asia Network (ADPAN) (Asia)

Association for Humane Drug Policy (Norway)

Centre on Drug Policy Evaluation (CDPE) (Canada)

Centro de Estudios Legales y Sociales (CELS) (Argentina)

Corporación Acción Técnica Social (Colombia)

Correlation - European Harm Reduction Network (Europe)

Drug Harm Reduction Advocacy Network Nigeria (Nigeria)

Foreningen Tryggere Ruspolitikk /Safer Drug Policies (Norway)

GREA - Groupement Romand d'Etudes des Addictions (Switzerland)

Helsinki Foundation for Human Rights (Poland)

International Commission of Jurists (ICJ)

International Drug Policy Consortium (IDPC) (Global)

International Network of People who Use Drugs (INPUD) (Global)

Skoun, Lebanese Addictions Centre (Lebanon)

Zimbabwe Civil Liberties and Drug Network (Zimbabwe)

Sri Lanka: Stop abusive anti-drug operation and release those arbitrarily detained

Gloria Lai, regional director of the International Drug Policy Consortium, also raised concerns over the government's decision to open drug rehab in the country's military camps. Ms Lai said Thailand has a history of violence and abuse related to drugs, and it still continues. Much violence and abuse, perpetrated by both military and law enforcement, took place during the Thaksin Shinawatra administration after he announced a zero-tolerance policy on drugs. The military are not health experts and should not be involved in the delivery of health services to the public, she said. "In addition, you have seen concerns of violence, including extrajudicial killings," she said.


"So, I think it is inappropriate for the military to take a bigger role, particularly in the provision of drug treatment services. "If the proposal is for the military to take over more work, strong justification as to why that is necessary will be needed," she added.


Ms Lai praised Thailand's efforts to reduce harm under its new Narcotic Codes. However, she said she is concerned compulsory treatment is still in place for people who use drugs.


"I think harm reduction, if you are going to make it voluntary, means you have to allow people a degree of freedom and liberty to choose what they like," she said.

Thailand: Army drug rehab plan sparks rights concerns

Speaking at a January 16 rally to support DULF outside a Vancouver court, Vince Tao, an organizer with Vancouver Area Network of Drug Users (VANDU), noted that there are two questions prosecutors need to answer in weighing whether or not to charge: whether there is a “substantial likelihood of conviction,” and if so, whether it is in the public interest to prosecute.

“They would probably be convicted on [the first question]. Because it’s a technical charge: did they possess drugs? Yes. So, unfortunately, that’s the letter of the law,” Tao told 

. But he believes that the second criterion is the more important of the two in this case.

“I think that’s exactly why they are slowing down on their prosecution, because they can see what’s going on,” he said.

Tao cited how 600 people attended a Vancouver rally in solidarity with DULF in November, shutting down Hastings Street as they marched to Victory Square. Another 400 people attended the January 16 rally, despite its being held in the middle of a Tuesday.

“Since November, we’ve had plenty of editorials [and] letters,” Tao said, adding that there was international support for DULF.

Some in attendance at the rally were people from Paris who happened to be in Canada. A solidarity rally was also held outside the Canadian embassy in London. In Mexico, a Mexicali supervised consumption site expressed support for DULF. And Irish allies in Belfast and Dublin submitted letters of support to Canadian ambassadors. Solidarity rallies were also held in Calgary, Alberta, and Nelson, a small city in southeastern BC.

Canada: Outpouring of solidarity as BC prosecutors push back DULF case

I hope this letter finds you in good health and high spirits. I am writing to you with great concern regarding the proposed Narcotic and Psychotropic Substances Bill that is currently under your consideration.

As a concerned citizen deeply invested in the well-being and progress of our beloved Uganda through the Uganda Harm Reduction Network (UHRN), I am compelled to express my apprehensions and urge you to desist from signing this bill into law.

While I understand the importance of addressing the challenges posed by drug abuse and trafficking, I am concerned that certain provisions in the proposed bill may have unintended consequences for individual freedoms, public health, and the overall development of our society.

The global community has increasingly recognized the need for balanced and evidence-based drug policies that prioritize harm reduction, rehabilitation, and human rights. According to the Uganda police annual report of 2022, 2,797 cases of narcotics/ drugs were reported countrywide, yet of that figure, 1,816 cases were taken to court and only 367 cases secured convictions, most of which were minor offences.

By measure of the Penal Code Act, an offence that attracts such paltry convictions needs deeper scrutiny to find ways of reducing them rather than rolling out tough laws that may be detrimental.

So, the concept of decreasing harm should be important to public policy, yet expressly trying to remove drug-related harms through legislation has never worked in drug control anywhere in the world. In passing the bill, parliament has an assumption that all drug use is ‘abuse’ and that only immediate abstinence is acceptable.

This is counterproductive and prevents harm reduction from being a drug policy priority. So, I respectfully request you, Mr President, consider the following points before making any decisions on the Narcotic and Psychotropic Substances Bill:

Some provisions in the bill may pose a threat to individual privacy and freedom. It is crucial to ensure that any legislation preserves and protects the fundamental rights of Ugandan citizens.

As a result, criminalizing drug use may dissuade people from seeking medical care for drug-related health problems, infringing on their right to health. Punitive measures can stymie harm reduction attempts by making it harder for people to get clean needles, overdose prevention measures, and other health services.

Emphasizing rehabilitation and treatment over punitive measures has proven to be more effective in addressing drug-related issues. Investing in healthcare, education and support services can contribute significantly to reducing the demand for illicit substances.

What we need are diversion programs that redirect people who use drugs away from the criminal justice system into community-based rehabilitation programs. In fact, from my experience at UHRN, such centres further need to be allocated resources and protection to provide accessible and evidence-based treatment for individuals with substance use disorders.

It would be beneficial to align the proposed legislation with international best practices in drug policy. Learning from the experiences of other nations can help in crafting effective and humane policies.

So, since harm reduction approaches aim to minimize the negative consequences associated with drug use, engaging in open and inclusive consultations with various stakeholders, including health professionals, legal experts, civil society organizations and affected communities, is crucial to ensuring a comprehensive and well-informed approach to drug policy.

Mr President, you may not be aware but people who inject drugs need access to clean needles and syringes to reduce the transmission of blood-borne infections, such as HIV/Aids and hepatitis.

I also wish to inform you that organizations such as UHRN regularly conduct public awareness campaigns and educational programs to disseminate information about the risks associated with drug use, safer consumption practices, and harm reduction strategies. These outreach programs have saved hundreds of thousands of people who inject drugs.

Therefore, it is on this background that I advocate for a law that prioritizes public health over punitive measures, decriminalizing personal drug use and possession while focusing on diversion and treatment options.

Mr President, I understand the challenges you face in addressing complex issues such as drug abuse and trafficking. However, I believe that a balanced and evidence-based approach will be more successful in achieving the desired outcomes without compromising the rights and well-being of our citizens.

I appreciate your attention to this matter and trust that you will give due consideration to the concerns I have raised. Your leadership in promoting policies that prioritize the health, welfare, and human rights of our people will undoubtedly contribute to the continued prosperity of our great nation.

Thank you for your time and consideration.

Uganda: Dear Mr President, here’s my appeal to resist signing the Narcotic bill

Last year, the UN Committee on Economic, Social and Cultural Rights (CESCR – the UN Committee of independent experts in charge of overseeing the implementation of the International Covenant on Economic, Social and Cultural Rights) 

 to describe how drug laws and practices affect the enjoyment of the right to an adequate standard of living, the right to work, the right to housing, the right to health, the right to an adequate standard of living, or the right to education, to name a few, and what States’ obligations are in this regard.

Civil society now has the opportunity to contribute to an important initiative.

The repressive approach to drugs, together with the stigmatisation and discrimination against people who use them, has numerous negative consequences on the daily lives of our clients and peers. Drug dependence and criminal records related to drug offences are often an obstacle to finding or continuing employment. In most countries of the region, women who use drugs are denied entry to shelters or crisis centers, even in cases of domestic violence. Children, particularly those with parents who use drugs, are being separated from their families. People who are imprisoned and have drug use disorders may be denied access to treatment. The list goes on.

In order to ensure that the process is as inclusive as possible – and importantly reflects the views and concerns of civil society and affected communities – 

 has been set up for us all to share information and provide comments on the preliminary draft outline of the General Comment. 

For more information about the General Comment, and to submit a contribution, please visit 

Call for civil society comments on the preliminary draft outline of the UN CESCR General Comment on drug policy

CEBU, Philippines – The words "shoot to kill" never leaves Johann “Panki” Nadela’s mind as he works day and night to provide health services to young people with substance abuse disorders (SUD) and those that use drugs to cope with life. Nadela made it his life’s mission to fight for a “better answer” to the war on drugs. That better alternative is harm reduction—a concept that consists of providing healthcare services, social reintegration, legal assistance, and psychosocial support for all persons who use drugs (PWUDs).

Before Duterte, Nadela worked for several outreach programs focused on case-finding and service-delivery for people who inject drugs (PWID) and persons at risk of the human immunodeficiency virus (HIV).

In 2015, the outreach worker became a community organizer and co-founded IDU Care—a community-led organization of PWUDs that actively advocates compassionate and realistic methods in solving the country’s drug problem.

IDU Care currently manages a community drop-in center in Cebu City that provides paralegal assistance, counseling, medical treatments and therapy, and resources for peer education programs on safe practices for persons living with drugs.

According to Nadela, the drug war heavily impacted operations at IDU Care’s community drop-in center, forcing them to integrate precautionary measures in their outreach activities and services. Nadela shared that at least two members of the organization were victims of extrajudicial killings during Duterte’s drug war.

One of them, the community organizer said, was 

 who was an active member of IDU Care and an activist who advocated for workers’ rights in Cebu. Kaloy was shot dead as he stepped down from a tricycle on his way home in Consolacion town in 2017. 

Nadela told Rappler that he dreams of seeing a comprehensive harm reduction policy being used by the national government to address the needs of PWUDs in the country. In recent years, IDU Care has collaborated with civil service organizations, local government units, and international organizations like the International Drug Policy Consortium (IDPC) for programs aimed at harm reduction.

For Gloria Lai, IDPC Asia Regional Director, harm reduction involves health-based approaches that put value on treatment rather than actions that reinforce the stigma associated with drug use.

“When we talk about harm reduction, the focus is usually on HIV and treatment but a lot of that is impacted by the surrounding environment and that comes down to drug laws and policies,” Lai said in a phone call interview with Rappler.

The harm reduction advocate explained that changing drug policies from a punitive framework to a health-based framework can provide an enabling and rehabilitative environment for PWUDs.

Philippines: Before and after Duterte, Cebu group banners ‘better answer’ to drug war

Japan has passed a bill to legalize cannabis-based medicines in a landmark revision of its stringent drug laws, while toughening its ban on recreational use of marijuana. This is a win for patient groups that have campaigned for access to these medicines.

However the changes amount to a tightening of Japan's already tough cannabis policy. Marijuana consumption was criminalized, closing a loophole that officials partly blame for a recent rise in cannabis-related arrests. Prior to the revisions, inhaling marijuana had been technically legal, as opposed to a jail term of up to five years for possession. Under the revised laws, those caught using or possessing marijuana can face a prison sentence of up to seven years.

Still, decades of a strident government crusade against illegal drugs, synonymous with the mantra of "dame zettai" (absolutely not), have led to marijuana being heavily stigmatized in Japan. Just 1.4 percent of people in Japan say they have tried marijuana, compared to more than 40 percent in France and around half in the United States, data compiled by the health ministry show.

Japan's tough anti-cannabis laws have ensnared international stars including Beatle Paul McCartney, who spent nine days in detention in 1980 after the drug was found in his baggage.

Japan to legalize cannabis-based medicines

 proposing to amend the federal Controlled Drugs and Substances Act (CDSA) by expanding the existing listings of the fentanyl precursor 4-piperidone and its salts to include its derivatives and analogues under the CDSA.

This boils down to criminalizing the possession and distribution of such compounds—in effect, an expansion of police and border control powers to search and seize shipments. Health Canada’s apparent intent is clear: to reduce the access of illegal fentanyl producers to the ingredients they need to make fentanyl and its analogues.

Health Canada consulted law enforcement and pharmaceutical researchers and companies, along with “interested members of the public.” As far as we know, they did not invite people who use drugs, people who produce or distribute drugs, or anyone at the frontline of the drug toxicity crisis (aside from police) to determine what impacts the scheduling of additional fentanyl precursors might have.

 of the Canadian Drug Policy Coalition was paying attention and prepared a statement for submission to Health Canada. In it, Boyce outlines the harms that could arise from this perpetuation of drug war mindset through increased fentanyl criminalization. This article adapts Nick’s submission—an important read for understanding the life support system of the drug war in Canada: the Controlled Drugs and Substances Act (CDSA).

Under Health Canada’s proposal, the existing listing for 4-piperidone and its salts would be expanded to include its derivatives and analogues, including 1-boc-4-piperidone, 3-methyl-4-piperidone, and 1-benzyl-4-piperidone. Health Canada claims that these substances are being imported into Canada and/or detected in clandestine laboratories and being used to synthesize fentanyl and fentanyl analogues. (Drug Data Decoded has 

 the size and frequency of major drug busts at production labs in Canada, including a sizeable shipment from Vancouver that arrived on Australian shores.)

The current regulatory environment and persistent and growing scheduling of substances and precursors does not achieve the intended outcome of reducing the use of substances and has unintended health and societal risks, especially for people who use drugs. In Canada, in the last decade, we have seen an exponential rise in drug deaths and hospitalizations, primarily as a result of heroin being almost entirely replaced by numerous fentanyl analogues. But fentanyl may not have proliferated had we sensibly regulated, instead of prohibited, heroin.

Health Canada’s Drug Analysis Service data

 (DAS) and Cannabis Laboratory (CL) operates laboratories across Canada that analyze suspected illicit substances seized by Canadian law enforcement agencies. DAS data demonstrates the unintended consequences of scheduling substances: new and different substances continually emerge such as novel synthetic opioids (different fentanyl analogues and nitazene compounds) and other depressant type drugs such as a range of illicit benzodiazepines.

From July to September 2023, a total of 28,666 samples (including Cannabis) were submitted for 

There was a total of 6,819 identifications of opioids where 75% were fentanyl or fentanyl analogues (Fentanyl; Para-fluorofentanyl; Bromofentanyl; 4-anilino-n-phenethylpiperidine; Acetyl Fentanyl; Methoxyacetyl Fentanyl; Para-chlorofentanyl). From all samples containing heroin, 20% also contained fentanyl.

There was a total of 2,798 identifications of benzodiazepines during that period, which represents a 36% increase over the same period last year.

There was a total of 242 identifications of nitazenes during that period, which represents a 44% increase over the same period last year.

Newly identified depressant class substances included: Ethyleneoxynitazene; N-boc fluroro Norfentanyl.

That fentanyl first appeared in the illegal drug market at least as early as 1989 is well documented by people who use drugs, who referred to fentanyl-containing opioid supply as China White. Academic studies even referred to it in the 

Previous efforts to schedule and prohibit fentanyl and fentanyl precursors have not stopped people using substances. Instead, they have expanded the number of fentanyl analogues and other novel opioid or depressant-type contaminants in the drug supply. This has increased the volatility, danger, and toxicity of the unregulated drug supply. Over the last several years there has been an exponential increase in fatal and non-fatal overdoses, hospitalizations, and the attendant need for emergency health responses such as naloxone distribution, supervised consumption spaces, safe supply initiatives. In addition, scheduling substances further complicates law enforcement efforts.

Toxic drug deaths are primarily from the unregulated supply

Health Canada’s Notice of Intent to control the derivatives and analogues of the fentanyl precursor 4-piperidone and its salts under the CDSA notes:

“Between January 2016 and March 2023, there were a total of 38,514 apparent opioid toxicity deaths in Canada. Fentanyl and fentanyl analogues continue to be major drivers of the opioid overdose crisis, with 81% of all accidental apparent opioid toxicity deaths from January to March 2023 involving fentanyl.”

Of all accidental apparent opioid toxicity deaths so far in 2023 (January-March), 81% involved fentanyl. This percentage has increased by 42% since 2016 when national surveillance began but appears to have stabilized in recent years.

Of all accidental apparent opioid toxicity deaths so far in 2023 (January-March), 77% involved opioids that were only non-pharmaceutical. This percentage has increased by 17% since 2018 when national surveillance began but appears to have stabilized in recent years.

There was a total of 37,697 opioid-related and 16,231 stimulant-related poisoning hospitalizations from January 2016 to March 2023 in Canada (excluding Quebec)

A total of 1,309 opioid-related poisoning hospitalizations occurred so far in 2023 (January-March). This is an average of 15 hospitalizations per day.

Governments at all levels and their institutional representatives continue to hint at their discomfort with the status quo—moving beyond talking points will require focused and persistent public pressure.

The harms of drugs versus the harms of prohibition

It is important to note that fentanyl is not inherently dangerous – it is used widely in human medicine (Trade names Abstral®, Duragesic®, Onsolis®). However, in the unregulated market, dosage and purity are never assured - prohibition and unregulated drugs are killing people.

People are now unknowingly consuming drugs that contain multiple substances. Fentanyl analogues, novel opioids, and nitazine and benzodiazepine-type compounds widely contaminate the supply, increasing toxicity. Beyond the deaths, there are thousands of hospitalizations, a growing cohort of people surviving with brain damage after non-fatal overdoses, and traditional opioid therapies, such as methadone, are less effective due to increased drug tolerance.

unprecedented mortality, negative health outcomes and social impacts

, creating an untenable situation. Solutions to Canada’s toxic drug crisis require a shift away from these harms of prohibition.

Making certain drugs illegal does not stop people from using substances. Criminalization of substance use further 

 people who use drugs, making it more difficult to engage them in health care, 

 many of the factors that negatively impact health and wellbeing, and negatively impacts educational, employment, travel and other prospects of individuals convicted for drug charges. Criminalization also fosters social marginalization and encourages high-risk behaviours, such as injecting in unhygienic, unsupervised environments, poly-drug use, and binge use.

 for underground chemists to create new substances that may be even more dangerous. Scheduling each new substance, precursor, or class of substances increases costs related to enforcement strategies and social costs to people who use these drugs. Resources spent on enforcement mean less resources for the provision of health and social supports that would be more effective in reducing drug use.

Banning drugs and relying on enforcement based supply-side approaches to discourage their use has not stemmed drug use or stopped the drug supply. Despite Canada’s significant investment in drug control efforts, drugs or more dangerous substitutes are just as available as ever. There is 

 among international experts that drug prohibition has failed to deliver its intended outcomes and has been counterproductive.

Rather than reducing the supply of drugs, prohibition abdicates the regulation of drugs to criminal markets. This approach has several negative effects.

Drug policies that prohibit substances eliminate age restrictions on them by abandoning controls to an unregulated market. In addition, when we prohibit rather than regulate substances, it becomes impossible to control the purity and strength of drugs. Illegally produced and supplied drugs are of unknown strength and purity, increasing the risk of overdose, poisoning, and infections.

If the use of one drug is controlled by reducing supply, suppliers and users may move on to another drug with similar psychoactive effects, but less stringent controls. An example of this was emergence and subsequent banning of a novel synthetic cathinone (mephedrone) in the United Kingdom in 2010. People started using (unscheduled) mephedrone because drug enforcement efforts had negatively impacted the availability and quality of other stimulants such as cocaine and MDMA. However, people who used mephedrone before the ban either continued their use or switched back to previously prohibited and unregulated substances after the ban. Research showed that prohibiting mephedrone did not have the intended effect of reducing substance use; rather it 

 drug use to either new substances or older illegal substances of unknown purity or dose.

 also suggests that the ban on mephedrone displaced provision of this substance from internet and “head shop” suppliers to street-level sellers, thus involving more people in illegal activity, and the price increased.

 also demonstrated that law enforcement efforts to disrupt local drug markets by seizing opioids or stimulants are associated with increased spatiotemporal clustering of overdose events in the surrounding geographic area.

Increasing challenges and costs for law enforcement

Consumers face growing challenges from synthetic drugs owing to the unknown pharmacology and harms of the drugs, lack of pharmacological retail markets, as shown by the growing numbers of tranquilizers, including novel benzodiazepines, found in the drug supply.

The toxic drug crisis in North America has not been associated with a sizeable increase in the number of opioid users but driven by overdose deaths, mainly attributed to the use of fentanyls.

On November 18, 2023, the head of the RCMP unit responsible for fighting organized crime was 

 as saying: “Sadly, Canada is a producing country of fentanyl and synthetic opioids. Not only are we a producing country, we're an exporting country. One of the challenges is that a lot of these precursors are not illegal.”

While this may appear to be a challenge from a law enforcement perspective, the unintended consequences of never-ending scheduling and prohibition are a far greater challenge.

On November 26, 2023 the vice-president of intelligence and enforcement at Canadian Border Services Agency was 

 as saying: “CBSA is in a constant game of cat-and-mouse with criminal organizations that are trying to import dangerous narcotics as well as the ingredients for fentanyl—sometimes through ‘creative’ means…It's an ever-evolving game where we're constantly looking at new and different tactics to smuggle drugs into the country or out of the country."

A drug-free world is an unattainable and, for many, undesirable world. It is time to consider a new approach that eliminates the negative effects of drug prohibition, provides a variety of health and social supports and harm reduction services, and avoids criminalizing those who choose to use drugs.

Clearly all drugs, whether legal or illegal, can pose risks. The 

2019 Canadian Alcohol and Drugs Survey (CADS)

 asked about five harms people may have experienced in the past 12 months due to alcohol consumption. Types of harm include being unable to stop drinking once started, failing to do what was normally expected from you because of drinking, needing a first drink in the morning to get yourself going after a heavy drinking session, being unable to remember what happened the night before because of your drinking, or having a feeling of guilt or remorse after drinking.

Of those who reported past-year alcohol use, 21% (4.8 million) experienced at least one alcohol-related harm in the past year due to alcohol use. These data demonstrate that alcohol, a regulated substance, can still be harmful. However, alcohol is subject to regulatory controls, including pricing, age restrictions and dose that help to contain the negative public health and public safety effects while avoiding the negative effects of complete prohibition. As a result, people do not die from a toxic alcohol supply.

Regulation, not prohibition, of all substances would ensure they are manufactured under safe and sanitary conditions and can be subject to penalties for sale in adulterated and/or unlabeled forms. A key benefit of regulation is that it allows appropriate controls to be put in place over price and availability (location, times of opening and age restrictions) as well as controls over advertising and promotion. It is precisely because unregulated drugs pose risks that they need to be appropriately regulated to ensure that dosing and conditions of manufacture protect the safety and health of Canadians. Allowing people reasonable access to substances of known quality and purity would:

Significantly reduce unintentional fatal and non-fatal overdose or poisoning.

Remove the control of drugs from the criminal market and its associated corruption and violence.

Reduce criminal market incentives to produce new or novel substances to skirt scheduling and enforcement.

Free-up resources wasted on ineffective and harmful prohibition and law enforcement that could be directed to myriad health and social programs.

Stopping the endless and harmful cycle of scheduling and prohibition and to follow recommendations and calls found in:

The August 2023 Report of the Office of the United Nations High Commissioner for Human Rights, 

Human rights challenges in addressing and countering all aspects of the world drug problem

, specifically recommendations: (a) Adopt alternatives to criminalization, “zero tolerance” and elimination of drugs, by considering decriminalization of usage; and take control of illegal drug markets through responsible regulation, to eliminate profits from illegal trafficking, criminality and violence; (c) Consider developing a regulatory system for legal access to all controlled substances;

The Global Commission on Drug Policy 2021 report, 

The Global Commission argues that options for legal regulation should be explored for all psychoactive substances. Regulation means not only protecting the health and safety of the end-consumer, but also creating a supply chain with strict controls for potency, quality and access. Regulation ultimately requires the boldness to build a world that does not yet exist.

Consider different models of legal regulation such as those outlined by the UK’s 

Canada: Net-widening the 'war on drugs'

Experts – and editorials – have recently claimed that no one has been imprisoned for drug use for years, long before Measure 110 was approved in 2020. But that is not accurate.

You don’t have to be sent to prison to be incarcerated for drug use. I know. Between 2013 to 2014, I was jailed for 65 days for drug possession.

From 2018 to 2019, more than 3,100 Multnomah County residents were charged with drug possession, according to the Oregon Criminal Justice Commission. Many of those people ended up in jail. Traditionally, the graduation rates for drug courts are low. So, while billed as an “alternative to incarceration,” many of those who opt for them end up being jailed and given a criminal record anyway.

Diversion will inevitably result in incarceration for those who do not stop using drugs, even absent any other crime and alongside earnest treatment attempts. Once someone is terminated from diversion, they’re placed on probation where they often end up back in jail.

Addiction is defined as the continued use of a substance despite repeated negative consequences. The consequences I faced – such as the destruction of my interpersonal relationships, financial ruin and write-ups for being late to work as I waited for a drug dealer that never came – were not enough to force me to quit, and imposing more consequences such as jail was not enough to silence the siren song of opioids that had gripped me for so long. 

US: Recriminalizing drugs would be a bad choice for Oregon

 has proven to be a complete failure in achieving a drug-free world and reducing the size and power of illegal drug markets. Instead, punitive policies have led to human rights violations, harmed the health of millions, and undermined global security, economy, and social fabric. This punitive approach restricts access to essential pain relief medications and prevents drug users from accessing basic healthcare services. Here we are in the 21st century, and an alarming 80% of the world’s population does not have access to essential pain medications.

In 2019, the U.N. Commission on Narcotic Drugs convened in Vienna and issued a 

 for the next 10 years to strengthen actions at all levels and accelerate the implementation of joint commitments to address the world drug problem. A “midterm” review of the declaration is set for 2024 to evaluate the progress made and ensure ongoing alignment with the objectives.

Nearly five years later, the results are brutally discouraging, which is why this review is so important. To move forward, we need a transparent and evidence-based analysis of reality. We should also assess the recent progress made by U.N. organisms like the General Assembly, the Commission on Narcotic Drugs and the Human Rights Council. The midterm review in 2024 is an opportunity to define a drug policy aligned with the 2030 sustainable development goals and consistent with human rights, the right to health, and the right to economic, social, cultural and political development.

Throughout my career as a lawyer, judge of the Inter-American Court of Human Rights, Peruvian government minister, and human rights expert, I have personally witnessed how 

 in Latin America and around the world have driven violence and mass incarceration. This impact is especially harsh on women, racial and ethnic minorities, and people living in poverty. Moreover, drug prohibition has eroded the traditional, cultural, and ancestral rights of Indigenous peoples, especially in 

 on December 5 with an evaluation of the outcomes of the 2019 ministerial declaration. The forceful report presents solid evidence that drug policies have failed to effectively prohibit and eradicate illegal drug markets, and their connection to citizen 

, I am proud to contribute to the IDPC’s work on drug policy.

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