Nick Kadysh: A plan to get Canadian drug policy back to sanity

We need to turn the page and harmonize how all drugs are treated on a science-based and common-sense basis.

By: Nick Kadysh

Canada in 2024 seems to be a very confused place when it comes to drugs. Marijuana is legal, you can smoke it anywhere. Psilocybin (magic mushrooms) is illegal, but there’s a shop selling them around the corner. Nicotine is dangerous and addictive when put into a pouch by a tobacco company, according to the Toronto Star Editorial Board and the Minister of Health, but that same nicotine is safe and effective when sold in bulk at Costco. Deadly cigarettes must be strongly regulated in corner stores, but can be safely ignored when sold in bulk on reserve. Drinking in a public park in Toronto is dangerous and mostly illegal. Injecting opioids or smoking methamphetamine is permitted instead.

Are you confused yet?

Canada’s approach to drug policy has been desperately jumbled and sclerotic for nearly a decade. While the average voter is likely tired and confused by how we got here, there is a clear pattern to the federal government’s behaviour: increasing regulation and uncertainty for legally regulated drugs, while either ignoring or easing penalties for illegal drug use and sale.

Today, Canada needs to turn the page and harmonize how all drugs are treated on a science-based and common-sense basis. Over my career I've led public policy for blue-chip companies in Food and Beverages, Medical Devices, Natural Health Products and Psychedelic Drugs; I've also sat on the CD Howe Institute Health Policy Council. I believe we can refocus our approach by adopting five simple principles:

1. All drugs have risks

Different drugs have different risks. Opioids are addictive, and potentially deadly, whether they are provided to you by a doctor, or by a street dealer. The risk of that addiction doesn’t go away if the government provides them as “safe supply.”

With the legalization of marijuana having now occurred almost six years ago, most people now accept that for certain low-risk drugs, a recreational commercial framework is a good thing. But you absolutely cannot automatically apply that lesson to other drugs, because other drugs can be more dangerous than marijuana.

All drugs, both legal and illegal, must be assessed on one continuum of risk, and regulated accordingly.

2. Enforcement is important

The reason that alcohol prohibition failed is because the drugs that replace alcohol, when prohibited, are often adulterated and more dangerous than alcohol itself. Black markets are bad for all involved, but if alcohol killed people and destroyed lives at the same rate as opioids, we would never countenance its legal sale in stores, much less defend governments profiting off of these sales. Many of the arguments for “safe supply” programs argued that they would take the place of black market dealers, but in practice, we have seen black markets spring up and grow where these programs attract both drug users and the dealers who prey on them.

The reality is that we accept black markets far too easily in Canada: illicit cigarettes are smuggled and sold on reserves; alcohol is stolen from government-run liquor stores and re-sold with alarming frequency; illicit drug shops occupy storefronts. Enforcement cannot be an afterthought, even when society decides that a drug is legal for recreational use.

3. Medical and recreational drug use must be regulated differently

There are numerous drugs which are allowed for use in our medical system but should be strictly controlled due to their abuse potential. Opioids, when used properly, can significantly reduce pain for patients during and after medical procedures; horrible abuses of these types of medications don’t reduce their medical usefulness in a controlled setting. But recently, activist groups have begun using the “medicalization” of policy and language around recreational drugs to muddy our assessment of drug policy. “Safe supply” is not “safe,” and in the context of addictions, opioids are not a medical drug to healing a disease. “Safe supply” is a program to provide addicts with drugs, and the results in the real world have been decidedly horrific both for drug users and for their communities. We do not hand out free beer to alcoholics in an effort to “help” them, although this seems to be the logical endpoint of the current policy.

The reverse is also true: there are drugs which are currently illegal, but probably have some legitimate medical uses — psilocybin and MDMA have intriguing clinical evidence behind them, and there are limited existing pathways for their use in medicine in Canada. (Full disclosure: My company produces MDMA for medical use.) Both governments and private business should invest in clinical research to establish potential benefit of their use within the strictly regulated medical system. In the U.S., the push for this type of medicalization is coming from veterans and Congressional Republicans. But Rule 2 still applies, and we should not accept the existence of illegal mushroom shops – or any other form of black market sale — for recreational use.

4. “Good Intentions” cannot be allowed to create bad outcomes

Too often in the past decade, drug policy has been assessed not based on its outcomes but based on the stated intentions of its proponents. Public-health advocates of “safe supply” drug giveaway programs want to stop overdose deaths, and so these programs are good; drug decriminalization activists, meanwhile, are assumed to have no skin in the game, just conviction.

Pharmaceutical companies are bad when they make opioids to be used in the medical system, but they’re good again when they provide those same opioids to be given away for free by public-health departments.

All of this is bunk.

Drug policy must constantly be assessed on the merits of the policy outcomes rather than policy intentions. If a tobacco company wishes to reinvent its business to focus on making COVID vaccines in the leaves of tobacco plants — as one did — they should be lauded for focusing on the production of a product that helps society rather than harms it. Instead, activists scuttled the first new vaccine developed in Canada in 20 years.

Similarly, we must acknowledge that, on its real-world merits, consumption sites and “safe supply” programs have not passed the test for improving the lives of either drug users, or for the neighbourhoods and residents which host them. It would be a heavy burden to demand that neighbours of these sites accept playgrounds full of needles and occasional street shootings if they were proven to help addicts. At this time, they don’t meet even that bar. Overdose deaths from opioids have risen alarmingly for 6 straight years.

Activist groups that demand we ignore the evidence of our eyes do a disservice not just to the public interest, but to their own cause: our job is to help people in practice, not theory.

5. Everything Has a Cost

There is a very real and quantifiable cost to managing failed harm-reduction programs. The drugs sold in “safe supply” programs don’t grow on trees; They are bought by the government and manufactured by pharmaceutical companies. The sites are staffed by paid employees. The money used to support these programs could be directed to any number of other uses that provide a better environment for drug users, especially drug rehabilitation programs and psychiatric supports.

If the primary budget request for a decade has been to open safe supply and consumption centres, do not be surprised if governments find it challenging to fund other priorities. There is literally no end to the demand for government-subsidized addictive drugs. By providing a supply of opioids to drug users, we are now in the unenviable position of competing with the cartels. The increased supply is driving down the cost of drugs for addicts, and making them easier to obtain. 

It should surprise absolutely no one that addicts will sometimes sell drugs to other addicts, or that the safe-supply programs will end up paying for drugs that end up BEING sold on the street. This was touted as a “feature” of the system rather than a “bug”: we were told that we could supplant the tainted opioids of the black market with a “safe” supply. 

It is apparent now that we cannot. There is literally no bottom to this spiral, and thus no end to the potential cost. The money spent siphons resources away from other, more effective support systems.

Canada must turn the page on a decade of failed drug policy experimentation. We must accept that while there is no silver bullet, our current policies have clearly failed. By refocusing our efforts to both regulate and control drugs using the five principles I have outlined, there is still an opportunity to help both drug users and regular Canadians. Admitting failure is difficult, but it is the first necessary step to moving forward.

Nick Kadysh is a health public policy expert, and the CEO of PharmAla Biotech.

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