Substance use: time for drug law reform.

I n the article " Substance abuse and developments in harm reduction " (page 1697 of this issue 1) Dr. Yuet Cheung concludes that in the 21st century harm reduction should be welcomed as an important player in addressing the use of currently illicit drugs, alongside prohibition and legalization. Other strategies that have become part of the discourse on how to resolve the drug problem include medicalization, which recognizes addiction as an illness to be treated rather than as a crime to be punished, and decriminalization, which even a recent editorial in the Economist argued should be considered as an alternative policy. 2 In Canada decriminalization is advocated in many quarters for cannabis, a drug for which it is estimated 1 in 50 adult Canadians has a criminal record for possession. 3 Although much of the harm reduction literature to date has focused on the harms associated with drug use, increasingly attention is being focused on the harms attributed to drug legislation itself and its enforcement in the war on drugs led by the United States. Prohibition has fostered violent crime both in consuming and producing countries, corruption at many levels, sex work to finance drug consumption, overdose-related deaths from drugs of unknown purity, reluctance to educate drug users about safe injection practices and to provide needle exchange services, a culture of mar-ginalization that drives drug users away from their traditional social support networks of nonusing family, friends and coworkers, 4 high levels of incarceration with resultant weakening of the social fabric of communities, and high direct and indirect costs for the public purse. Following a dramatic increase in the number of deaths due to drug overdose, the chief coroner in British Colum-bia recommended in 1996 that the government examine the feasibility of decriminalizing possession of certain drugs and diverting funds destined for drug law enforcement to prevention and treatment. 5 Whereas more than $400 million was spent in Canada in 1992 for drug law enforcement , only $42 million was spent on prevention and research and $88 million on direct health costs. 6 To address this imbalance the National Task Force on HIV and Injection Drug Use recommended that a portion of the considerable proceeds obtained through drug-related fines and confiscation of assets be directed to prevention and treatment rather than remaining in law-enforcement coffers. 7 Drug laws and their enforcement affect drug choice, cost and method of consumption, …