Deputation to the House of Commons Special Committee on the Non-Medical Use of Drugs (February 19, 2002)

Author(s): 
Walter Cavalieri, on behalf of The Canadian Harm Reduction Network

My name is Walter Cavalieri, and I am a founder of the Canadian Harm
Reduction Network, which is a nexus for individuals and organisations
dedicated to reducing the social, health and economic harms associated with
drugs and drug policies in Canada.

I am President of The Toronto Harm Reduction Task Force, an alliance of
individuals, community organizations and neighbourhood groups working
together to reduce the harms associated with the use and distribution of
drugs in Toronto.

As well, I am a researcher with the University of Toronto Faculty of
Medicine, engaged in a qualitative study of people in Toronto who inject
drugs, and also a multi-city, ethnographic study of crack injection
practices

Also, I am a councillor at the Centre for Student Development and
Counselling at Ryerson University.

Finally, I am an honorary member of iDUUT – Illicit Drug Users’ Union of
Toronto – and of the Internet-based International Drug Users’ Union and the
North American users’ Union.

Over time, I have come to know hundreds of people who use drugs. The first
were successful working professionals. I was employed in the theatre for
many years, and the most dangerous drug there – in terms of damage to
performances – was alcohol, a legal drug that some of the people seemed
unable to control. It ruined many a career.

When I went to work on the front lines, first with youth and later with
adults living on Toronto’s streets, I found that drugs of all sorts were an
overwhelming fact of life, and drug-related death a constant companion. But
it was when I started to develop and deliver AIDS education and services
that went beyond condoms and basic syringe exchange that I became truly
aware of the complexity of drug use and how and why people lived with drugs
as they do.

A starting point in the practise of social work is that you have faith that
the persons you are working with are making the best possible choices,
according to their circumstances and knowledge. Given the circumstances of
the people I was meeting, drug use made sense to them. Ultimately it became
something to which I could say – “OK. I get that. But now what is the real
problem?” Often, you see, the drug was genuinely helpful to them in
getting by. Often, too, when life situations would rectify, the drug use
would become moderated and sometimes even disappear. Even “hard” drugs,
like heroin or cocaine . . . or alcohol.

My most current research is putting me in close contact especially with
people who are injecting crack-cocaine. I have interviewed them in detail
about this practice, and I have observed them actually prepare and inject
crack. It was a surprise to me how calming and satisfying crack was to the
people who injected it. Mild euphoria, relief from everyday pain and ills,
and serenity were the prevailing experiences.

Who – living on the street, the object of misunderstanding and scorn, of
abuse and uncertainly – wouldn’t want a few minutes of feelings like this?
Only a few, mind you, because that is about how long a hit of crack lasts –
often less than a quarter hour. Then, they must return to dire reality of
their lives, lives often threaded through with depression. Tales of
drug-crazed behaviour not withstanding, taking a walk or smoking a joint to
prolong the good feeling were the predominant activities that people I spoke
with or observed said they do after a hit. The so-called truths we hear
about the “dangerous” drugs – the illicit ones – are at best half truths or,
at worst, treacherous lies or mythologies maintained by those who would
support the status quo of prohibition – or sell their broadsheets – no
matter what the cost.

There are many reasons why people use illicit drugs. Most of the reasons
are exactly the same as those for using alcohol, but self medication is the
dominant one.

The more important question is, why do they use drugs in harmful ways? One
reason is economy. People choose to inject drugs because drugs are
expensive, and they are expensive because they are illegal and available
only through the black market. Inflated prices make people seek out more
efficient ways of getting the effect they pursue. Injecting drugs is much
more efficient than, say, smoking them. There’s more bang for the buck, to
put it in advertising vernacular. True, there are risks to injecting, but
by and large people try to mitigate them. Most of the risks could be
eliminated if injecting could be carried out in a clean, well-lighted place,
with good, new equipment. And of course using drugs of known quality and
strength. These are not available because drugs are illegal. Were they not
illegal, most drugs could be used with at least the same degree of safety as
alcohol or tobacco.

The point I wish to make here is that the major contributor to the harms
associated with drug use are the laws themselves, and, as well, the climate
of ignorance, apathy, neglect and fear which they have fostered. Our
current laws – and the attitudes they cultivate – vilify and demonise people
who use drugs. Moreover, they create a climate in which it is difficult to
discuss drugs honestly. The cumulative effect of this, over the years, has
been to give rise to many falsehoods and myths, both about drugs and the
people who use them – especially the poor people who use them – and to
reduce the person who uses drugs, in the public mind, from “a whole and
usual person to a tainted, discounted one”. (Irving Goffman) That is, it
stigmatises them. Further, the person, over time, internalises this stigma
and actually comes to believe that she or he is tainted.

This is similar to the experiences of homosexuals and people with mental
illness. However in these latter cases, laws have been developed and passed
to address this, and over time the stigma has been lifting and people are
not merely receiving better service and earning respect and understanding
but are acknowledging and proving their worth. This has yet to happen to
people who use drugs, save where drugs and social status intersect. Would
that the understanding expressed toward Noelle Bush and her family were
distributed in the same quantity to the people caught possessing or scamming
drugs, who happen to live in poverty.

There is also a clash between laws and the ability to provide service.
Though the harassment which service providers and service users experienced
in the early days of needle exchange has diminished some, it is not gone.
Needle exchange programs have survived and proven themselves – but they are
still not universal. However, fundamental and essential services with
proven effectiveness – services such as heroin prescription and safe
injecting facilities – are still held in abeyance while some people dither
and some people die.

This is not an abstract debate for me. I see the direct and indirect harms
at ground level, the day to day consequences of bad laws. I witness the
suffering and the deaths. And that has changed me.

Though we claim that our drug policy is guided by a harm reduction approach,
it remains totally committed to prohibition. As a result, Canadian citizens
who use illicit drugs are still becoming infected with HIV and hepatitis C
at rates far higher than are members of the general population, because of
bad laws . . . they are still forced by circumstance into crime and
incarceration, because of bad laws. They still die prematurely, because of
bad laws. These were never their dreams . . . their vision or hope for the
future.

The evidence is overwhelming that the “war on drugs” – one of the longest
and costliest social experiments in the history of civilisation – has not
worked, is not working and will probably never work, and yet it thrives and
flourishes. Since the war’s inception, drug use has increased. The variety
of drugs available has increased. Drug-related crime has increased.
Incarceration of people who use drugs has increased. How, in all good
conscience, can one pretend that it constitutes most prudent and responsible
approach? What are the bases of this belief? What is there to recommend
it – that it supports organised crime? That it supports a bloated and
costly correctional system? That it supports the spread of disease? That
it supports terrorism? Maintaining the status quo in our drug laws is a
disservice to our country and its citizens, and to all humanity. It merely
makes some people feel morally superior.

There IS a shift in public opinion. Canada’s stand on medical marijuana has
received very good press in the United States. The Cato Institute, The
Fraser Institute, The Economist Magazine all support ending drug prohibition
in favour of legalisation, with a degree of social control similar to that
imposed on tobacco and alcohol, a sensible solution which can be attained
over time. And, according once again to The Economist, zero tolerance laws
are falling out of favour, even in their cradle, the United States.

I implore you to not merely be spectators at this transformation. Even if
you do not happen to like drug users, think of the impact on your families,
think of the health issues that prohibitionist laws are fostering – the
spread of hepatitis C, AIDS – the huge burden on your purses and wallets
created by the law enforcement and criminal justice systems alone. Recognise
your own selfish interests – they are not unworthy – and show leadership.

In the meantime . . . to begin with . . . we must stop cowering before the
so-called moral agency of the United States. Their drug laws are a paragon
of disaster. Surely the experience of the Netherlands must be seen as a
guide. When they liberalised their treatment of people who use drugs,
Europe was aghast. Yet no one invaded the Netherlands and forced them to
alter their practices. What has happened, in fact, is that other
jurisdictions have not merely caught up with . . . but have actually
surpassed the Netherlands.

We must, instead, look abroad, to Europe and Australia, for successful
efforts at humane, efficacious, cost-effective and comprehensive harm
reduction programming and adapt their ideas and philosophies to our
situation. We must immediately enable the legal framework which will
permit the initiation of innovative harm reduction measures such as heroin
prescription and safe injecting rooms. They are absolutely necessary, and
they must become as ubiquitous as is the use of drugs. It is insufficient
to establish these programs only in the isolation of a few key cities.

Drug
use is not merely an urban phenomenon. We must involve people who use drugs
and drug user networks in reducing harm associated with drug use. And we
must ensure the expansion of effective harm reduction and addiction
treatment services across Canada.

I’ll close with some words from Jan Skirrow, former Deputy Minister of
Community & Occupational Health of Alberta:

“A marginalized community (in this case injection drug users) is
experiencing an epidemic of death and disease resulting not from anything
inherent in the drugs that they use, but more from the ineffective and
dysfunctional methods that characterize our attempts to control illicit
drugs and drug users. There is the same unwillingness to carefully analyze
the problem or to depart from traditional methods and conventional thought
that was integral to the blood tragedy. There is a struggle for power and
control over the issue between law enforcement and public health. There is a
profound lack of understanding among decision-makers and many health
professionals regarding the nature of the community and individuals at risk.

“Our committees meet, the media reports the political rhetoric and the
disagreements of experts, and effective program responses remain in limbo as
we try to sort out what are in essence power and control issues. Yet people
continue to die in alarming numbers, and no one seems to notice or care very
much.”

Let me invite you to come back, and to go with me to meet some of the people
who have been so harmed both directly and indirectly by our laws, and hear
first hand what they have to say. Not as prurient observers but as
interested fellow citizens of Canada open to learning. Merely doing this
was an experience that changed and focussed my life. I thoroughly believe
that the humanity of the people I have been working with – and whom I have
come to know well – will have a profound impact on you and your
deliberations.

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