On January 31, 2023 BC started a three-year pilot project under which mere possession of certain drugs (opioids, methamphetamine, cocaine and MDMA) can no longer lead to prosecution or even seizure of the drug by the police. The measure applies to possession of up to 2.5 grams of the substance for personal use.
While an important step in the right direction, decriminalization does nothing to address what is fueling the drug poisoning crisis: the compounding of an unregulated and toxic drug supply.
Indeed, the imposed carry restrictions of 2.5 grams could theoretically lead to unintended consequences as drugs become more potent to fit within legal limits.
The stated goal of the decriminalization policy change is remove the stigma associated with drug use to encourage people to seek help when they need it.
While the effect decriminalization may have on the stigma of drug use remains to be seen, what it won’t affect is the toxicity of the drug supply that kills thousands of Canadians each year.
Inconsistent and unreliable drug supply
The chemical analysis of drugs (such as the drug control or police investigation) can tell us what is going on in the supply, but i toxicological results of those who have died of overdoses tell us what is actually causing the death.
These data sources describe how the increase in drug adulteration with fentanyl analogues, benzodiazepine and animal tranquilizers such as the salvation is driving the drug poisoning crisis.
Fentanyl has been the leading opioid sold on the unregulated market for several years. It is typically sold mixed with other powders such as caffeine or sugars to make a final product.
Drug supply monitoring has shown that the concentration of fentanyl in these powders sold on the street can range from zero to nearly 100%, with a standard sample in BC around 10-15 percent.
Research conducted in Vancouver described how the concentration of fentanyl in these samples was somewhat consistent between 2018 and early 2020, with between-sample variability even decreasing over that period. What may speak is that the manufacturers of fentanyl hit a kind of “sweet spot” that satisfies their customers. People selling drugs described how they listen to feedback of their regular customers and tailor the product to meet their needs.
However, after the onset of the COVID-19 pandemic, the variation in potency among fentanyl samples has increased dramatically, leading to further unpredictability. These changes to fentanyl supply around spring 2020 coincided with never-before-seen drug poisoning rates in the province.
Under BC’s decriminalization framework, possession for personal use is limited to 2.5 grams of the substance. While 2.5 grams may be more than enough for a night out, heroin may not be enough to last a single day for someone who has a high opioid tolerance. People who use drugs say they will be forced to comply with these limits make more frequent and smaller purchases. With the drug supply volatile and unpredictable as it is, every new purchase puts someone at risk.
The legal limit can affect the potency
Since we know drug supply is dynamic, it raises a question: Will the enforced legal carry limit of 2.5 grams result in an increase in the potency of fentanyl to return to the new threshold of 2.5 grams?
Increases in mean potency of fentanyl have been shown to be related to increases in drug poisonings in the same geographic area. If the unregulated fentanyl market adjusts to fit more active ingredient into a smaller package, there will be downstream effects on people’s lives.
The provincial and federal governments have committed to a data-driven approach to decriminalization. Continuous monitoring of drug supply will help public health professionals identify what changes are occurring in the unregulated supply of drugs as a result of policy change. Yet the act of decriminalizing drugs for personal use has no direct effect on the cause of the ongoing poisoning crisis.
Consent among the experts has consistently pointed to unpredictable drugs from an unregulated supply and the absence of a functioning addiction treatment system. For those who want to seek treatment, the lack of available space leaves people waiting, once again left relying on the supply of toxic drugs.
If BC is serious about addressing the leading cause of unnatural death in the province, it will take more than just decriminalizing drug possession. People who use drugs require an alternative to the unregulated toxic supply in order not to risk their lives every time they use drugs.
Increase access to a safer supply of drugs through a variety of formats and providing meaningful funding for accessible treatment options are a few examples of ways the province can take immediate steps to make an impact.
In the meantime, six more people will die today for drug poisoning in BC And six more will die tomorrow. How many more days can this go on?
(Samuel Tobias – PhD Student, School of Population and Public Health, University of British Columbia -, su The Conversation del 06/02/2023)
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