Bernie Pauly is a professor of nursing at the University of Victoria; Meaghan Thumath is the Trudeau Scholar at the department of social policy and intervention at the University of Oxford; and Marilou Gagnon is the founder of the Coalition of Nurses and Nursing Students for Supervised Injection Services.
The federal changes to withdraw the National Anti-Drug Strategy are significant for Canada's nurses and their ability to deliver ethical and evidence-based care. Harm reduction will again be a pillar of Canadian drug strategy. Evidence, not ideology, will be privileged. And the Minister of Health, not the Minister of Justice, will be in charge.
However, proposed changes will take time to translate into action. Nowhere is this more evident than in British Columbia, where on one December night 13 people died of overdoses. Our hearts are with everyone who is experiencing these losses and with those who are working hard to save lives daily.
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The recent policy changes undo regressive drug policies, for which we are thankful, but they do not go far enough to address the root causes of this epidemic. Canada's current approach to the control of drugs is killing people. Life-saving interventions such as supervised consumption and heroin prescription require federal exemptions to operate. In line with the United Nations, we are calling for the decriminalization of drug use and for a public-health approach that moves people toward services rather than the criminal-justice system.
As nurses, we routinely witness the effects of Canada's failed drug policy. People in desperate need of care do not access health services for fear of judgment. Time and again, researchers have demonstrated that social stigma acts as a barrier to health care. This is causing harm. It is costing lives.
As a result of criminalization, people often use drugs alone – contrary to good public-health overdose measures, which advise people to use with others. We see housing policies that prohibit guests or restrict people in resident rooms. Even when shelters and housing programs distribute harm-reduction supplies, many have policies that prohibit and sanction use on site, pushing people into bathrooms, alleys and alcoves.
These policies must be rescinded immediately. In British Columbia, overdose-prevention sites are critical emergency interventions to ensure people are not alone and have access to lifesaving harm-reduction measures. We still need to expand supervised-consumption services, which provide the full scope of primary nursing care, peer education and support, counselling, treatment referrals and housing. Nursing research has consistently demonstrated that trust and culturally safe care are central to the delivery and effectiveness of such services to counter criminalization.
As nurses, we have an ethical obligation to implement the best evidence available, treat people with respect and promote fairness and justice. While some nurses are being stretched beyond capacity, others have found their ability to respond quickly restricted by drug policies and organizational barriers that limit the provision of the anti-overdose drug naloxone and supervised injection – despite the evidence and the fact that harm reduction is B.C. provincial policy, national nursing policy and now federal policy. We have witnessed the decimation of street nurse programs that would have been able to respond quickly in crisis situations.
So, as we approach 2017, we need to dramatically scale up comprehensive harm-reduction services as part of the treatment continuum. We need to work with people who use drugs and ensure that interventions are culturally appropriate and coupled with strong links to housing, income and other supports. Registered nurses need to be used to their full scope to provide these services. We need to get to the real work of changing the Controlled Drugs and Substances Act and stop criminalizing drug use. Decriminalization, along with increased harm reduction and treatment, has been successful in countries such as Portugal in reducing drug-related deaths, drug use, crime and societal costs. If we want to get fully upstream, we need to move from criminalization to regulation. We need a radical shift in thinking to challenge long-held ideas about abstinence as the only path to recovery. Harm reduction saves lives and is a path to recovery.