Report 1: Recommendations on alternatives to criminal penalties for simple possession of controlled substances

Table of contents

• Message from the Co-Chairs
• Executive summary
• Introduction
• Task Force members
• Task Force guiding principles
• Approach and methodology
• Core issues
• Other considerations
• Recommendations and advice
• Appendix A - Task Force member bios
• Appendix B - Glossary of terms
• Appendix C - Suggested background materials

Message from the Co-Chairs

We are pleased to submit this first report from the Health Canada Expert Task Force on Substance Use on alternatives to criminal penalties for simple possession of controlled substances.

We are honoured to have been given the task of Co-Chairing this Task Force and are conscious of the historical opportunity this represents to contribute to the discussion on how to improve the way controlled substances are managed and regulated in Canada.

It is a privilege to have the opportunity to work with the diverse group of experts who make up the Task Force. Each member has brought a unique perspective to our collective effort, and all have contributed to a rich dialogue that has resulted in the recommendations we present to you today. Though the Task Force members have diverse views, they are united in the belief that criminal penalties for simple possession and consumption of controlled substances needs to end and that there is a spectrum of viable alternatives available to government.

The Task Force received presentations and written submissions from a variety of sources. We are thankful to all those who shared their knowledge and wisdom. They have helped the Task Force to develop its thinking and build recommendations based on the best evidence. Finally, our thanks go to the Secretariat and to the report-writer who have so skillfully supported us through this work.

Sincerely,

Co-Chairs of Health Canada's Expert Task Force on Substance Use

Carol Hopkins
Dr. Kwame McKenzie
Mike Serr

Executive summary

This report presents the conclusions and recommendations from the first part of the mandate of the Health Canada Expert Task Force on Substance Use. The Task Force met, heard presentations, reviewed documents, and deliberated on the topic of alternatives to criminal penalties for simple possession of controlled substances from March 10 to May 4th, 2021.

The Task Force found that criminalization of simple possession causes harms to Canadians and needs to end. The Task Force was mindful of five core issues when making recommendations: stigma; disproportionate harms to populations experiencing structural inequity; harms from the illegal drug market; the financial burden on the health and criminal justice systems; and unaddressed underlying conditions.

The Task Force also considered Canada's obligations under international treaties, lessons learned in other jurisdictions, the important issue of safety, supports for community, recent developments under the Controlled Drugs and Substances Act, and the broader Canadian legal framework.

The Task Force makes the following recommendations related to decriminalization and regulation:

1. The Task Force unanimously recommends that Health Canada end criminal penalties related to simple possession and most also recommend that Health Canada end all coercive measures related to simple possession and consumption.
2. Most Task Force members recommend that the Government of Canada immediately begin a process of legislative change to bring the Controlled Drugs and Substances Act (CDSA), the Tobacco and Vaping Products Act (TVPA), the Cannabis Act, and any other relevant federal legislation under a single public health legal framework with regulatory structures that are specific to different types of substances.
3. The Task Force recommends that thresholds for simple possession be based on presumption of innocence, and that they be set high enough to account for the purchasing and consumption habits of all people who use drugs.
4. As part of decriminalization, the Task Force recommends that criminal records from previous offenses related to simple possession be fully expunged. This should be complete deletion, automatic, and cost-free.

In addition, the Task Force makes the following related recommendations:

5. The Task Force recommends that Canada make significant investments in providing a full spectrum of supports for people who use drugs or substances or who are in recovery.
6. The Task Force recommends the implementation of a more comprehensive and responsive system to rapidly and effectively gather, use, and disseminate evidence about substance use, its effects, and the impacts of government policies on the health and wellbeing of Canadians.
7. The Task Force strongly urges Health Canada to respect the sovereign rights of the Indigenous Peoples of Canada and support their governments in providing appropriate prevention and treatment approaches.
8. The Task Force recommends that Health Canada convene a new committee that centres people with lived and living experience of substance use to provide advice on the implementation of its recommendations.

Introduction

Canada is facing an unprecedented and tragic drug toxicity crisis. Between January 2016 and September 2020, 19,355 apparent opioid toxicity deaths were recorded. 96% of those deaths were accidental, and 60% of accidental opioid toxicity deaths in 2020 also involved a stimulant, evidence that the crisis is about more than one substance^{Footnote 1}. The crisis has escalated during the COVID-19 pandemic, and while governments have implemented some measures, supporting expanded treatment approaches, implementing pilot projects that provide pharmaceutical alternatives to people who use the illegal drug market, and expanding overdose prevention services, these measures have not been sufficient to stem the crisis. A wider health promotion approach to substance use is needed to deal with the systemic issues, stigma, and racism that are fuelling it.

Recognizing the profound changes in the Canadian landscape in recent years, and the need to reflect those changes in its policies, Health Canada established the Expert Task Force on Substance Use ("Task Force") to provide Health Canada with independent, expert advice and recommendations on:

• potential alternatives to criminal penalties for the simple possession of controlled substances, with the goals of reducing the impacts of criminal sanctions on people who use drugs, while maintaining support for community and public safety; and
• the federal government's drug policy, as articulated in a draft Canadian Drugs and Substances Strategy (CDSS), with the objectives of further strengthening the government's approach to substance use.

The Task Force convened for the first time on March 10, 2021 and was tasked with providing two reports to the Associate Assistant Deputy Minister, Controlled Substances and Cannabis Branch, Health Canada. This is the first of those two reports; it describes the work of the Task Force to date and outlines its recommendations and expert advice on alternatives to criminal penalties for simple possession of controlled substances.

The Task Force will later submit a final report with recommendations that inform the finalization of the draft CDSS.

Task Force members

Membership list and bios available in Appendix A.

Task Force guiding principles

The Co-Chairs and Task Force members have engaged in discussions on guiding principles to support their collective work. The principles are a living document and continue to evolve as the Task Force deepens its understanding of the diverse perspectives of its members and works to reconcile them. The following high-level principles have informed Task Force discussions on alternatives to criminal penalties:

• Respect the Charter and human rights of all people who use drugs.
• Centre the voices of people with lived and living experience of substance use, in partnership with multiple other stakeholders distributed across a continuum of health and social responses.
• Recognize that substance use is a complex phenomenon, that people are motivated to use substances for several reasons, and that substance use occurs in a variety of different contexts that greatly influence health and social well-being.
• Acknowledge that while substance use can lead to harms to individuals, families, and communities, many of these harms derive from problematic public policies and structural inequity, and most people who use drugs do so without significant harm to themselves or others.
• Recognize that drug criminalization has amplified structural inequities in Canada, and that these have contributed to First Nations, Inuit, Métis, and Black people being disproportionately and negatively impacted by much higher rates of criminal prosecution and incarceration.
• Consider the benefit of viewing substance use through a health promotion lens, recognizing the impact of the social determinants of health on outcomes, and the need for multiple pathways and approaches to reduce harms.
• Be mindful of the roles that various governments - federal, provincial, territorial, First Nations, Inuit, and Métis - play and should play in addressing substance use in Canada, and of Canada's obligations under international treaties.
• Be mindful of the dynamic and often violent and predatory nature of the illegal drug market, and of continuing efforts to reduce the involvement of organized crime.

Approach and methodology

Overview

The work of the Task Force on alternatives to criminal penalties took place over a series of six meetings, on March 10, March 24, April 7, April 14, April 21 and April 28, 2021. Meetings lasted between two (2) and five (5) hours and were held using an online web conferencing tool. The Task Force Secretariat prepared records of proceedings, which are available under separate cover, for each of the meetings.

Task Force members reviewed documents and briefs before meetings. They also collaborated and exchanged asynchronously between meetings using email and the Government of Canada's GCcollab platform.

Documents reviewed

Task Force members were invited to review the background documents listed in Appendix B. In addition, the Task Force received and considered the following documents to inform its work:

• Advancing Drug Policy Reform: A New Approach To Decriminalization, Global Commission on Drug Policy, 2016
• A New Approach to Managing Illegal Psychoactive Substances in Canada, Discussion Paper of the Canadian Public Health Association, 2014
• The Effectiveness of Compulsory Drug Treatment: A Systematic Review, International Journal of Drug Policy. Author manuscript, 2017
• Relapse to opioid use in opioid-dependent individuals released from compulsory drug detention centres compared with those from voluntary methadone treatment centres in Malaysia: a two-arm, prospective observational study, Lancet Global Health, 2017
• Regulation - The Responsible Control of Drugs, Global Commission on Drug Policy, 2018
• How to Regulate Stimulants - A Practical Guide, Transform Drug Policy Foundation, 2020
• Stopping the Harm: Decriminalization of People Who Use Drugs in BC, Provincial Health Officer's Special Report, BC Office of the Provincial Health Officer, 2019
• The World Drug (Perception) Problem: Countering Prejudices about People Who Use Drugs, Global Commission on Drug Policy, 2017
• Drug Decriminalisation: Progress or Political Red Herring? Assessing the Impact of Current Models of Decriminalisation on People Who Use Drugs, International Network of People who Use Drugs, 2021
• A Quiet Revolution: Drug Decriminalisation Across the Globe, Release - Drugs, The Law & Human Rights, 2016

Presentations and submissions

The following organizations presented to the Task Force on alternatives to criminal penalties for simple possession of controlled substances:

March 10, 2021

• Health Canada

March 24, 2021

• Moms Stop the Harm
• HIV Legal Network - Presentation and written brief
• Aboriginal Legal Services - Presentation and written submission

April 7, 2021

• Transform Drug Policy Foundation (UK)
• Pivot Legal Society
• Canadian Association of People Who Use Drugs

April 21, 2021

• Canadian Students for Sensible Drug Policy
• Canadian Association of Chiefs of Police

Core issues

The presentations and documentation underlined that criminalization of simple possession causes harms to Canadians; simply put:

"My son Danny died from Fentanyl poisoning - a victim of bad drug policy."^{Footnote 2}

"Although punitive policies claim to protect young people, ultimately they create more harm than good, both for young people and their broader communities."^{Footnote 3}

This section of the Task Force report highlights specific core issues that our recommendations seek to address regarding the negative impacts of criminalization. These core issues are stigma, disproportionate harms to populations experiencing structural inequity, harms from the illegal drug market, the financial burden on the health and criminal justice systems, and unaddressed underlying conditions.

Stigma

Current public policies on substance use, and criminalization chief among them, are part of a vicious cycle that is fed by and continues to feed inaccurate, stigmatizing perceptions of people who use drugs. Canada's current policies are based on an outdated and deeply problematic position, which the Task Force members reject, that devalues and dehumanizes people who use drugs by labelling them as immoral, "addicts", or weak.

Furthermore, by criminalizing simple possession, Canada's Controlled Drugs and Substances Act (CDSA) increases the stigma by labelling people who use drugs as criminals, which multiplies the harms they experience and increases the risk of negative outcomes, even for people who use substances occasionally or for the first time^{Footnote 4}.

Yet evidence suggests that most people who use drugs do so for an actual or perceived benefit and may not develop a substance use disorder or experience other drug-related harms:

"Drug use is relatively common and, in 2016, an estimated quarter of a billion people used currently illegal drugs, while about 11.6% of these are considered to suffer problematic drug use or addiction. The most common pattern of use of psychoactive substances is episodic and non-problematic."^{Footnote 5}

In Canada, in 2017, 47.9% of Canadians had used illegal drugs in their lifetime^{Footnote 6}. 15% of Canadians aged 15 or older reported using an illicit drug (cannabis, cocaine or crack, ecstasy, speed or methamphetamines, hallucinogens, or heroin) in the previous year, but only 4% reported experiencing at least one harm from their illicit drug use in the same period^{Footnote 7}.

Disproportionate harms to populations experiencing structural inequity

The legislation criminalizing drug possession is part of historical and ongoing structural racism and continues to have disproportionate effects on Indigenous and Black populations, which are more often targeted for prosecution for simple drug offenses.

"It must always be kept in mind that substance use in the Indigenous community arises as a consequence of colonial action and harm."^{Footnote 8}

"The never-ending drug war is a war on us that has caused massive and irreparable harm to Black communities, who are over-criminalized, disproportionally impacted, and over-surveilled."^{Footnote 9}

Incarceration has greater negative impacts on women and their families than on men.

"Federally-sentenced women are 2x more likely to serve a sentence for drug-related offences than male counterparts. Indigenous and Black women are more likely than white women to be in prison for that reason."^{Footnote 10}

Youth who are caught up in the criminal justice system because of simple possession or substance use have inadequate pathways to access support and face major struggles to overcome the negative economic, social, and health impacts of criminal records^{Footnote 11Footnote 12}.

And people without status - international students, refugee claimants, temporary foreign workers - are unable to seek help or supports because they fear being reported and removed.

Harms from the illegal drug market

Drug criminalization leads to drug toxicity deaths in Canada. Specifically, drug criminalization has resulted in an unregulated market that is rife with contaminants and toxic, high-potency opioids and other substances, which has led to tens of thousands of deaths since 2016 alone, as noted in the introduction to this report. The link has been clearly established, for example by the Office of the Provincial Health Officer of BC:

"Due to the toxicity of BC's illegal drug supply, there is considerable risk of overdose and overdose death related to illegal drug use in any capacity, including use that is otherwise beneficial or non-problematic."^{Footnote 13}

The physical and psychological violence inherent to the illegal drug trade also directly and indirectly harms people who use drugs. And not only are specific communities disproportionately affected by criminalization, they are also disproportionately affected by the violence associated with the illegal drug market.

Financial burden on the health and criminal justice systems

Criminalization leads to higher drug-related health costs because it keeps people who use drugs away from prevention and early treatment health services due to fear of being arrested, labelled, or outed.

"Criminalization drives people underground and means that people are less likely to seek assistance, or have difficulties if they try to obtain assistance."^{Footnote 14}

Because criminalization pushes people who use drugs to rely on an illegal, often contaminated drug supply, it is also responsible for high hospitalization costs.

"23,240 opioid-related and 10,518 stimulant-related poisoning hospitalizations occurred from January 2016 to September 2020 in Canada (excluding Quebec)"^{Footnote 15}

In 2017, the estimate of healthcare costs in Canada related to the use of opioids and other depressants and cocaine and other stimulants was one billion dollars^{Footnote 16}.

The cost to our country of policing and of legal proceedings related to drug possession is also high:

"More than $6.4 billion of policing, courts and correctional costs in 2017 could be attributed to the use of criminalized substances"^{Footnote 17}

Unaddressed underlying conditions

Social determinants of health, trauma, and other underlying factors often contribute to substance use disorders. Criminalization means that these underlying conditions often go unaddressed, both because people who use drugs are fearful of seeking treatment and being reported by healthcare and other service professionals who may not be appropriately prepared to meet their needs, and because the billions spent on policing and legal proceedings are not available to address the social determinants of health.

"Canada has made (dis)investment decisions that further marginalize PWUD: Funding cuts to housing (decreased cost-based/non-profit through CMHC); Underinvestment in pensions, EI; Underinvestment in transfer payments for provincial programming (housing, healthcare); Continued failure to create universal pharmacare program"^{Footnote 18}

Other considerations

International treaties

The Task Force received and considered information about Canada's obligations under UN drug control conventions, including the Single Convention on Narcotic Drugs, the Convention on Psychotropic Substances, and the UN Convention Against Illicit Traffic in Narcotic Drugs and Psychotropic Substances.

The Task Force accepts the argument, presented by the HIV Legal Network, that these conventions are not an impediment to decriminalization or legalization of simple possession:

"Under international law, Canada has both important latitude under the drug control conventions, and important obligations under human rights treaties it has ratified. It can and should use that latitude in the realm of drug control to better respect, protect and fulfil the human rights it has pledged to uphold, and which are also embodied to various degrees in its own constitution."^{Footnote 19}

Members of the Task Force believe that our recommendations on this aspect are protected under the articles that make any penalties subject to countries' constitutional principles and limitations. It is clear to us that our recommendations are essential to respect Canadian constitutional principles set out in the Canadian Charter of Rights and Freedoms, more specifically Section 7 on Life, liberty and security of the person.

Lessons learned in other jurisdictions

Over 30 countries have either never criminalized possession of substances or have implemented formal decriminalization policies^{Footnote 20}. The Task Force is aware of various international models like those in Uruguay and Spain, where drug possession has never been a formal criminal offence, and Portugal, where penalties are administrative rather than criminal^{Footnote 21}. We are also aware of the potential for unintended outcomes such as those experienced in the Czech Republic in 2010 (confusion leading to increased arrests) and South Australia in 2020 (administrative fines leading to 'de facto' criminalization, with more people receiving civil sanctions and being incarcerated due to non-payment of fines)^{Footnote 22}.

The Task Force has considered the lessons learned in these other jurisdictions in developing its recommendations, but was also committed to making recommendations specifically for Canada and its unique context, notably the drug toxicity epidemic compounded by longstanding structural racism.

Safety

Although the focus of this report is on alternatives to criminal penalties, the Task Force recognizes that increased supports for people who use drugs are urgently needed and will continue to be required. While most people who use drugs do so for their perceived benefits and without developing a substance use disorder or experiencing other drug-related harms, for a small minority of people drug use becomes problematic and may jeopardize their safety.

The risks are different for different substances. A comprehensive system of health and social supports for different substances and social contexts is needed to minimize the harms, including death, caused by drug toxicity.

Members of the Task Force are aware of concerns by some Canadians that removing criminal penalties may be perceived as condoning drug use, or that this may increase access to dangerous drugs or increase substance use disorders and drug toxicity deaths.

"It's a very polarised discussion. We need a reasonable way that our communities would also embrace."^{Footnote 23}

Task Force members believe that alternatives to criminalization offer the benefit of countering, in part, the inherent violence and toxicity issues of the illegal drug market, along with other harms of criminalization. Evidence from the Canadian experience with cannabis suggests that alternatives to criminal penalties can reduce people's use of illegally sourced substances^{Footnote 24}. As part of a comprehensive health and social care approach, alternatives to criminal sanctions for substance use could decrease the overall negative impacts of substance use, although this would have to be closely monitored.

Supports for community

Substance use does not occur in a vacuum. People who use drugs live and work in families and communities. When substance use becomes problematic, the effects are felt beyond a single individual. The Task Force considered this complex dynamic, and the importance of taking into account the role of families and communities and how they impact, and are impacted by, substance use disorders.

The Task Force concluded that a model that provides health and social supports and minimizes the engagement by police for people who use drugs will provide better outcomes. The negative impacts of drug policies on communities are highest when drugs are criminalized and when treatment services and other supports are not available and accessible.

Recent developments under the Controlled Drugs and Substances Act (CDSA)

The Task Force considered recent developments related to the CDSA in developing its recommendations. It noted that the Cannabis Act repealed certain provisions of the CDSA related to cannabis possession and use. The City of Vancouver has recently requested an exemption from the CDSA pursuant to section 56(1) that would decriminalize personal possession of controlled substances within the city. And the province of British Columbia has recently announced that it will be officially requesting an exemption under the CDSA.

These developments illustrate a range of options available to provide alternatives to criminal penalties for simple drug possession. They also signal an increasing readiness among Canadians to change the way we regulate the possession and use of substances.

The broader Canadian legal framework

This report has been prepared for Health Canada and focuses on those laws that are within its purview. Laws such as the CDSA, however, are not the only laws in the Canadian justice system that include criminal or other penalties related to substances.

People who are involved with the criminal justice system through parole and probation often have conditions of abstinence with no supports. Likewise, people who are incarcerated do not always have access to opioid agonist treatment, safe supply, or naloxone.

Many Provincial and Territorial child welfare laws include subjective statements such as neglect or risk of harm in their grounds for intervention, and Newfoundland and Labrador explicitly includes "Living in a situation where a parent is an abuser of alcohol or drugs" as grounds for intervention^{Footnote 25}. Because of the stigma related to substance use, these clauses can be - and have been - invoked as a reason for child apprehension.

Recommendations and advice

The Task Force makes the following recommendations on alternatives to criminal penalties for simple possession of controlled substances and related issues.

Decriminalization and regulation

1. Elimination of all penalties and coercive measures

It is our expert opinion that penalties of any kind for the simple possession and use of substances are harmful to Canadians. Substance use should be managed as a health and social priority, with a focus on the social determinants of health, and not through criminal or civil sanctions.

As to coercive measures, the evidence on mandatory, coerced or forced treatment, including drug treatment courts, is mixed, and success rates are typically low^{Footnote 26Footnote 27}. Furthermore, decriminalization or regulation may be less effective and may amplify structural inequities if conditions and penalties are such that people who use drugs are at risk of being criminalized for non-compliance with civil penalties.

This does not preclude offering support or voluntary treatment as options in addition to or instead of penalties under other Acts.

Implementation and pathways for youth and school-age children and their families need to be further explored and developed to ensure the necessary supports are in place for this population.

2. Legislative change

Regulation of drugs will have the greatest impact on ending the drug toxicity death crisis and minimizing the scale of the unregulated drug market. It will address key drivers of substance toxicity injury and death and facilitate a health promotion approach to substance use. Regulatory structures that are specific to different types of substances will be important to address varying levels of substance toxicity, as well as the unique health and social outcomes of each type of substance.

Bringing all substances together under a single Act will also provide an opportunity to harmonize the regulation of all substances with potential for harm, including alcohol, tobacco, and cannabis, and potentially mitigate harm more effectively through a more consistent and coherent approach.

3. Thresholds

People who use drugs have different consumption needs and patterns. Some people with substance use disorders need to use more than others because of high tolerance. Some people on low, fixed incomes tend to purchase monthly or biweekly supply when they are paid, which also leaves them in possession of larger than "average" amounts. And individuals relying on the illegal drug market may also purchase larger amounts to minimize their exposure to potential violence. Threshold determinations are of critical importance and processes to consider threshold amounts should be co-led with people with lived and living experience of using drugs.

4. Expungement

Criminal records expose people who use drugs to discrimination and makes it hard for them to be gainfully employed, which leads to further stigma and marginalization.

Related recommendations

The measures recommended above, while important, will not be sufficient. Further measures are needed to mitigate the harms experienced by people who use substances, and to avoid unintended consequences as policy changes are implemented.

5. Supports for people who use drugs or substances or who are in recovery

Supports could include supervised consumption sites, an array of treatment options, pharmaceutical grade alternatives to illegal street drugs, housing, drug checking services, and other social supports. Access to these supports should be equitable and universal.

There is an urgent need for a safe supply of pharmaceutical grade alternatives to reduce people's exposure to the toxicity of illegal street drugs.

The need for more supervised consumption services, including supervised injection, snorting, smoking, and accommodating assisted injection for those who are unable to inject themselves, is also urgent.

6. Evidence and monitoring

Systems must be in place to monitor the impacts of policies and enable rapid responses to changing circumstances. This is critical to ensure that Canadian substance-related policies are grounded in the best available evidence while also being responsive, adaptive, and effective. The focus of evidence-gathering to date appears to be mostly on substance use harms rather than a health promotion approach to substance use. Correcting this bias is important to ensure that policies are as effective as possible in meeting the needs of Canadians.

More targeted research is needed with marginalized populations, including Indigenous people, Black people, racialized people, and newcomer communities. This will require capacity building in these populations for this work. More also needs to be done to disaggregate existing data on these populations and to publish disaggregated data consistently at the national level and across all provinces and territories.

The evidence collected should be used to strengthen public education, health promotion, prevention, treatment, and protection from contaminated substances.

7. Rights of Indigenous Peoples of Canada, First Nations, Métis, and Inuit

Whatever changes are implemented must not encroach on Indigenous rights, and First Nations, Métis, and Inuit should be able to self govern and apply their knowledge, culture, and traditional responses to substance use.

Furthermore, legislation and regulation must recognize the authority and sovereignty of First Nations, Métis and Inuit and support them in righting the disproportionate harms that have been inflicted on their people from current policies.

8. Further consultation

People with lived or living experience of substance use have unique expertise on substance use and they will be directly impacted by any policy decisions about substance possession and use. Future consultations should ensure that their diverse voices are strongly and equitably represented, including those of specific groups such as Indigenous women, Black people, racialized people, those who are incarcerated, migrants and people without status.

Consultation should also be broadened to include a wider range of voices and perspectives generally, to maximize the potential for successful implementation of eventual decisions.

Appendix A: Task Force member bios

Carol Hopkins (Co-Chair), CEO, Thunderbird Partnership Foundation (a division of the National Native Addictions Partnership Foundation)

Dr. Kwame McKenzie (Co-Chair), CEO of Wellesley Institute, Director of Health Equity at the Centre for Addiction and Mental Health, Full Professor in Psychiatry at the University of Toronto and consultant with the World Health Organization

Mike Serr (Co-Chair), Chief Constable, Abbotsford Police Department; Chairperson of the Drug Advisory Committee, Canadian Association of Chiefs of Police (CACP), and Chair of the CACP's Special Purposes Committee on the Decriminalization of Illicit Drugs

Natasha Touesnard (Co-Chair), Executive Director, Canadian Association of People who Use Drugs (withdrew on April 21, 2021)

Serge Brochu, PhD, Professor, École de criminologie at the Université de Montréal

Deirdre Freiheit, President and CEO, Shepherds of Good Hope (SGH) and Shepherds of Good Hope Foundation

Gord Garner, Executive Director, Community Addictions Peer Support Association

Charles Gauthier, President and CEO, Downtown Vancouver Business Improvement Association

Cheyenne Johnson, Co-Interim Executive Director, British Columbia Centre on Substance Use (BCCSU) and founding Director of BCCSU's Addiction Nursing Fellowship Program

Harold R. Johnson, Elder, Advisor and Ambassador, Northern Alcohol Strategy Saskatchewan, Former Crown Prosecutor

Damon Johnston, Chair, Addictions Foundation of Manitoba, and President, Aboriginal Council of Winnipeg

El Jones, Spoken Word Poet, Educator, Journalist, and a Community activist living in African Nova Scotia

Robert Kucheran, Chairman of the Executive Board, Canada's Building Trades Unions

Anne Elizabeth Lapointe, Executive Director, Maison Jean Lapointe and Addiction Prevention centre

Dr. Shaohua Lu, Addiction Forensic Psychiatrist, Member of the College of Surgeons and Physicians of BC Prescription Review Panel

Donald MacPherson, Director, Canadian Drug Policy Coalition

Akwasi Owusu-Bempah, PhD, Assistant professor, Department of Sociology, University of Toronto

Dan Werb, PhD, Executive Director, Centre on Drug Policy Evaluation, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Assistant Professor, University of Toronto Institute of Health Policy, Management and Evaluation, and Assistant Professor, University of California San Diego Division of Infectious Diseases and Global Public Health

Appendix B: Glossary of terms

Addiction
A severe form of substance use disorder, addiction is a treatable chronic illness involving complex interactions among brain circuits, genetics, the environment, and an individual's life experiences.

Decriminalization
Removal of criminal penalties for an activity. De facto approaches are ones that do not require any changes to the laws or regulations. De jure approaches involve changing the laws or regulations.

Drug
For the purposes of this report, "drug" means an illegal or unauthorized psychoactive substance.

Drug toxicity
A poisonous quality of a drug that can cause functional, biochemical, or structural damage to the human body. Toxicity can be acute or chronic; toxicity can cause temporary or permanent physical, cognitive, or psychological injuries, up to and including death.

Equity
The absence of avoidable or remediable differences among groups of people, whether those groups are defined socially, economically, demographically, or geographically. (WHO)

Harm
A negative consequence to an individual, family, community, or society at large, including direct and indirect physical and mental health, social, and economic and financial impacts. These harms are specifically highlighted as part of the negative consequences of criminalization.

People with lived and/or living experience of substance use
People who currently consume or have in the past consumed substances, or their family or community members collectively and directly impacted by the consumption of substances.

People who use drugs
People who consume illegal or unauthorized psychoactive substances.

Recovery
Can be defined differently by each individual, but generally includes changes to lifestyle and behaviours by accessing formal (e.g., treatment programs) and/or informal (e.g., meditation) supports to manage or eliminate substance use and improve multiple aspects of quality of life. (Canadian Centre on Substance Use and Addiction)

Regulation
Government oversight of production, manufacture, importation, distribution, product promotion, and sale.

Safe supply
A legal and regulated supply of drugs that are traditionally only accessible by medical prescription or through the illegal drug market.

Simple possession
This refers to possession as defined in section 4(3) of the Criminal Code of Canada and referenced by the CDSA:

1. a person has anything in possession when he has it in his personal possession or knowingly
   1. has it in the actual possession or custody of another person, or
   2. has it in any place, whether or not that place belongs to or is occupied by him, for the use or benefit of himself or of another person; and
2. where one of two or more persons, with the knowledge and consent of the rest, has anything in his custody or possession, it shall be deemed to be in the custody and possession of each and all of them.

Social determinants of health
Social and economic factors that influence people's health, such as social status, income, education, employment and working conditions, equitable and timely access to health services and care, the experience of discrimination or racism, etc. These factors are largely outside of an individual's control. For Indigenous populations, determinants of health also include processes of colonization, culture, language, and land.

Stigma
A negative social, political, and cultural attitude toward a group or individual with a distinguishing attribute or behaviour, founded on a deeply held set of false beliefs, and involving overt and covert judgement, oppression, and discrimination. Common causes of stigma are stereotypes, fear, colonizing norms, unequal power dynamics, lack of awareness, and misinformation. Policies and laws often entrench and exacerbate stigma (see structural racism).

Structural racism
A system of public policies, institutional practices, cultural representations, and other norms that work in various, often reinforcing ways to advantage white people and perpetuate inequity toward people of colour.

Substance
Except when referring to the Controlled Drugs and Substances Act and its provisions, substance in this report is defined more broadly as a psychoactive substance, i.e., "chemicals that cross the blood-brain barrier and affect mental functions such as sensations of pain and pleasure, perception, mood, motivation, cognition, and other psychological and behavioral functions" (CPHA), and includes controlled substances under the Act as well as other unauthorized substances, alcohol, tobacco, and cannabis.

Substance use disorder
A complex pattern of symptoms resulting from the use of a substance that a person continues to take despite harmful consequences and a negative impact on their ability to function in day-to-day life.

Treatment
Services to identify and address substance use disorders through withdrawal management, pharmacological interventions, and/or psychosocial interventions.

Unregulated drug market
The sale and purchase of substances that escapes oversight by the Canadian legal and regulatory system.

Appendix C: Suggested background materials

Title	Author/Date	Brief description
Government of Canada background documents
Canadian Drugs and Substances Strategy	Health Canada 2016	Main webpage for information on the Canadian Drugs and Substances Strategy (CDSS).
CDSS News Release	Health Canada December 2016	The news release announcing the creation of the CDSS and the federal government's public health approach to substance use, replacing the National Anti-Drug Strategy.
Supplementary Information Tables 2020-21 Departmental Plan: Health Canada	Health Canada & Government of Canada September 2020	The federal government's primary annual report on the CDSS, including: all federal departments involved, governance, expenditure breakdown, planning highlights, activity themes and performance indicators.
Consultation on strengthening Canada's approach to substance use issues	Health Canada September 2018	Announcement and information on the 2018 public consultation undertaken by Health Canada on potential next steps in federal drug policy/CDSS.
What we heard: Strengthening Canada's approach to substance use issues	Health Canada July 2019	Health Canada's report on the feedback received from the 2018 public consultation.
Canadian Tobacco, Alcohol and Drugs Survey (CTADS): Summary of Results for 2017	Health Canada & Statistics Canada December 2017	Summary of findings from the latest available biannual Canadian Tobacco, Alcohol and Drugs Survey, showing drug use trends for Canada.
Canadian Student Tobacco, Alcohol and Drugs Survey (CSTADS): Summary of Results for 2018-2019	Health Canada & Statistics Canada 2019	Summary of findings from the latest available biannual collection on student (grades 7-12) tobacco, alcohol, and drug use.
Alternatives to criminal possession/decriminalization
Findings and recommendations report: Decriminalization for Simple Possession of Illicit Drugs: Exploring Impacts on Public Safety & Policing	Canadian Association of Chiefs of Police (CACP) July 2020	Report highlights the research by the Canadian Association of Chiefs of Police's Special Purpose Committee on the Decriminalization of Illicit Drugs.
Stopping the Harm: Decriminalization of people who use drugs in BC	Office of the Provincial Health Officer (British Colombia) April 2019	Special report that recommends reducing the harms associated with the toxic street drug supply and the criminalization of people who use drugs in BC.
Drug use, arrests, policing, and imprisonment in Canada and BC, 2015-2016	Susan Boyd, PhD March 2018	A report prepared for the Vancouver Area Network of Drug Users (VANDU) that provides an in-depth look at official policing and corrections statistics related to drug possession charges.
Advancing Drug Policy Reform: A New Approach to Decriminalization	Global Commission on Drug Policy 2016	Report on the negative outcomes caused by the criminalization of people who use drugs. It explores alternatives to this approach and calls on governments and the public to change their perception of people who use drugs.
Decriminalization: Options and Evidence	Canadian Centre on Substance Use and Addiction (CCSA) June 2018	Policy brief on the various ways in which decriminalization of controlled substances is interpreted and implemented.
Drug policy
Canadian Substance Use Costs and Harms (2015-2017)	Canadian Institute for Substance Use Research & the Canadian Centre on Substance Use and Addictions 2020	Report on the estimated costs and harms associated with substance use in Canada from 2015-2017, including enforcement related costs.
Canada's Drug Futures Forum: Summary of Proceedings and Final Recommendations	Canada's Drug Futures Forum July 2017	Summarizes the dialogue and recommendations generated by the Forum's participants in April 2017 on forward-looking ideas for drug policy in Canada.
Open Letter: A Call for Reprioritization of Metrics to Evaluate Illicit Drug Policy	International Centre for Science in Drug Policy (ICSDP) January 2016	A call to stakeholders at the 2016 United Nations General Assembly Special Session on Drugs (UNGASS) to prioritize indicators that provide specific evidence on the impact of drugs and drug policies on communities.
First Nations Mental Wellness Continuum Framework Full Version Summary Report	Indigenous Services Canada, Assembly of First Nations, and various First Nations NGOs January 2015	Joint report on a coordinated and comprehensive approach to mental health and addictions programming that considers the cultural values and practices of First Nations.
Honouring Our Strengths: A Renewed Framework to Address Substance Use Issues Among First Nations People in Canada - Full Version	Indigenous Services Canada, Assembly of First Nations, and the National Native Addictions Partnership Foundation Inc. November 2011	Outlines a vision for a comprehensive continuum of services and supports to guide community, regional, and national responses to substance use issues among First Nations people in Canada.