Reducing the Harm Associated with Injection Drug Use in Canada

1. Introduction

The injection use of drugs represents a significant and increasingly important public health issue in Canada. The problems associated with the use of drugs by injection are reaching crisis proportions in many communities in Canada and account for the major share of deaths and hospitalizations attributed to drug misuse^f. This is cause for alarm when considered in light of the resurgent use of drugs by youth,^1,2,3 rising rates of injection drug use, the emergence of injection drug use as a major risk factor for infection with HIV, hepatitis viruses and other blood borne pathogens, and the overwhelming impact of addiction and injection drug use on socially and economically disadvantaged groups including Aboriginal Canadians, homeless people, prisoners and street youth.⁴

A number of reports^g have been developed, describing and analyzing injection drug use and associated harms. All of these reports have identified the need for urgent action by governments and the non-government sector to reduce the harm associated with injection drug use. This paper is the federal/provincial/territorial response to these reports and to the situation in Canada. It is intended to provide a framework for multi-level strategies and action plans to reduce the harm associated with injection drug use in Canada and to promote a new level of coordinated action and collaboration among various sectors and jurisdictions in adopting policies and practices to address injection drug use and the associated harms. The framework builds on past initiatives and consultations and is complementary to the goals, objectives, principles, and priorities of Canada's Drug Strategy, the Canadian Strategy on HIV/AIDS and the Hepatitis C Prevention, Support and Research Program.

In February 2001, the Federal/Provincial/Territorial Deputy Ministers of Health approved the release of a draft of this report, as a working paper, to allow for broad consultation within and outside of government. The intensive consultation included representatives of health, social services, addictions, HIV/AIDS, hepatitis C, police, corrections, justice, Aboriginal peoples, community agencies, and people who inject drugs. The purpose of the consultation was to gain further support and to obtain feedback in order to refine the paper. This revised document reflects the results of the consultation.

Although intervention strategies and activities should relate to local needs, populations and jurisdiction, injection drug use is a countrywide problem that requires a comprehensive, collaborative and consistent response. Federal/provincial/territorial governments should provide leadership and coordination in addressing injection drug use and its associated harms and in fostering and stimulating participation from all sectors.

This paper does not include an analysis of the regulatory framework regarding access to and use of psychotropic substances in Canada. Each of the aforementioned reports have identified some aspects of Canada's drug laws as contributing to the harms associated with injection drug use and have identified the need for changes to drug policy in Canada.

There are a number of initiatives, however, which should be undertaken immediately. Given the urgency of the situation in Canada, this paper deliberately focuses on these immediate initiatives, while recognizing the importance of undertaking action in the longer term and a close examination of Canada's drug law, regulations and policies related to injection drug use and to drug misuse in general.

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^f Drug misuse is defined as use that is associated with physical, psychological, economic or social problems or which constitutes a risk to the health, security or well-being of individuals, families and communities. Whether or not any particular use is defined as misuse depends on the user, the substance, and the context in which it is used. (Ministère de la Santé et des Services sociaux du Québec. Pour une approche pragmatique de prévention en toxicomanie. Orientations et stratégie. Document de consultation, 1998.)

^g Injection Drug Use and HIV/AIDS: Legal and Ethical Issues; HIV/AIDS in Prisons: Final Report; HIV, AIDS and Injection Drug Use - A National Action Plan; HIV, Hepatitis, and Injection Drug Use in British Columbia - Pay Now or Pay Later?; Second National Workshop on HIV, Alcohol, and Other Drug Use; The Red Road: Pathways to Wholeness - Report of the Task Force into Illicit Narcotic Overdose Deaths in British Columbia; Drug use and the HIV epidemic, a frame of reference for prevention (MSSS Québec).