Abhishek Gupta is a research and medical sub-intern at CAMH who graduated from the Windsor University School of Medicine
The controversial debate over cannabis legalization has concluded on an official level, legally placing the drug in the hands of the Canadian public. Very soon, anyone over the age of 19 will be able to walk into a store and obtain it for personal consumption.
For mental health professionals, some aspects of this decriminalization effort are appealing. Conventional marijuana is often laced with far more dangerous substances leading to highly dangerous health outcomes. Furthermore, individuals with substance abuse issues are more likely to seek professional help when the consequences of drug possession are milder. Much like needle exchange sites, this move towards legalization provides consumers with a safer alternative for addressing their cravings for cannabis.
Proponents of legalization have often touted the Portugal’s massive decriminalization model as one that Canada should emulate. Initiated in 2000, this involved Portugal legalizing all illicit drugs in response to massive spikes in heroin use and HIV infection rates amid its population. The results spoke for the policy; with a massive reduction in HIV incidence (from 1016 new cases to 56) within a span of only one year. While many have claimed that decriminalization would have a similar effect in Canada, there is a significant issue that has yet to be raised. Portugal’s model not only addressed the result of drug use, but also its root cause and society’s collective response.
Portugal provided a holistic model that responded to substance use, not with severe criminal charges, but instead with mental health services and rehabilitative efforts. It not only lessened the legal consequences of personal possession and consumption; it also substantially redirected the revenues gained from the sale of these substances towards mental health services for its consumers. First time users are given guidance, warnings, or small fines. Repeat offenders are referred to dissuasion panels that require periodic drug testing by family physicians or an institutional drug rehabilitation program. Even law enforcement is used strictly to ensure compliance with health services. This program took advantage of a socialized free healthcare system in which citizens already had pre-existing relationships with family physicians. Essentially, Portugal’s drug policy reform ensured continual access to mental health services for those with substance use disorders, coupled with decriminalization of use.
However, the conversation in Canada around decriminalization has largely focused on undercutting the black market for cannabis rather than rehabilitating its victims (i.e., the substance users). Although Canadian society and government identify cannabis legalization as a potential new revenue stream to fund social healthcare programs, given the choice of funding for mainstream non-psychiatric healthcare or drug rehabilitation, the priority seems to be the former. Furthermore, Ontario’s new policy has opened recreational cannabis sales privileges to the private sector (in order to increase supply and revenue) while simultaneously halting mental health funding, especially for overdose prevention sites. As such, it is missing key elements that Portugal instituted in its drug policy reform.
The current public healthcare system in Canada is well-poised to adapt Portugal’s approach given pre-existing relationships between citizens and their family physicians. Furthermore, specific and easily understandable guidelines have been created for consumers and law enforcement to provide a strong framework for effective legalization.
However, in the current system, it is still ultimately the consumer’s responsibility to seek assistance when necessary and many users may not be connected with family physicians. Perhaps the most similar example is alcohol use; despite an extensive support system and massive public education campaign, alcohol use disorder remains a highly significant issue within the community. Irrespective of resources devoted to assisting them, it is still up to the consumers of recreational cannabis to seek assistance and use it responsibly (unlike in Portugal, where the burden of responsibility has been placed on the societal, legal and health support framework to ensure that the resources provided are used in an appropriate and timely manner to minimize adverse health outcomes).
Therefore, while legalization is a positive step in addressing rampant cannabis misuse in Canadian society, the full measures required for an effective decriminalization policy have yet to be adopted. Recreational cannabis sales cannot simply be a revenue stream for general healthcare; rather, they should fund mental health services specifically designed to assist its consumers and, ultimately, discourage its own use.