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A drug policy expert who's spent years on the front lines says the war on drugs has failed and it's time to legalize illicit drugs.

"Drugs that are currently illegal, we should make them legal," Donald MacPherson says. "Then we can focus on problematic substance use and issues like dependency and addiction."

MacPherson, now executive director of the Canadian Drug Policy Coalition, spent years working around Vancouver's infamous downtown eastside.
READ MORE: Opioid-related deaths continue to soar in Alberta, up 40% over last year
"The so-called war on drugs is this sort of masterful distraction that we will get it right someday in the future if we just try a little harder," he says.

"That's not going to happen."

MacPherson's been at this fight for decades. As North America's first drug policy coordinator for a municipality, he authored the City of Vancouver's Four Pillars drug strategy. Approved in 2001, it was considered radical and controversial for calling on governments to reduce the harm of illegal drug use.
READ MORE: Mayors across the country call for feds to lead on opioid 'national emergency'
His argument is one based on public health, but also economics.

"If we were to just legalize these substances and put our resources to helping people who develop problems with them, we'd waste less money and have much better outcomes."

To opponents who say governments or agencies shouldn't be providing illegal substances, MacPherson turns the argument inside out. His solution? Rewrite the laws.

"Laws change, he says. "Bad laws get changed. We do that all the time. Those drugs are illegal but we made them illegal. We can change it up."

Worse than the AIDS crisis
Opioids are killing us at a faster rate than ever. In fact, right now, more Canadians are dying than at the height of the AIDS crisis.

MacPherson says the current opioid crisis is different because of the extremely toxic drug supply, and that enforcement efforts are to blame.

"Our drug policy has created this phenomenon called fentanyl. Fentanyl is a very powerful opioid. It's in the drug supply because it's highly concentrated and easy to get across borders and extremely lucrative to sell.

"It's really unstoppable in terms of our traditional enforcement strategy."

Speaking to Global News from the Alberta Community Crime Prevention Association Conference, the co-chair of Alberta's Minister's Opioid Emergency Response Commission says easier access to treatment should be the priority. Elaine Hyshka says scientific research shows drug substitution, like methadone or suboxone, is the most effective treatment for opioid use.
READ MORE: More than one person dies every day from drug overdose: Vancouver Police
"Those medications reduce your risk of death and are the best bet for long-term abstinence," she says.

MacPherson says it should happen as quickly as possible.

"Nowhere in Canada is there a good treatment system, so you have the opportunity to build one in the face of this catastrophe," he says.
The failure of prohibition
"But we also need to come to grips with the fact that drug prohibition itself is at the end of its road," MacPherson says. "It's failed. So we have to start looking at allowing people to have access to a safer drug supply.

"We'd do it with food if the food was toxic, we'd do it with water if the water was toxic. The drug supply is toxic and it's killing people," he adds.

"People who are addicted, and we know tonight will be accessing the illegal market, have a great chance of dying."

There were 74 fentanyl-related deaths in Alberta during the first three months of 2018. That's about a 25 per cent increase compared to the same period last year.

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Canadian drug policy expert says it's time to legalize all drugs

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A drug policy expert who's spent years on the front lines says the war on drugs has failed and it's time to legalize illicit drugs. "Drugs that are currently illegal, we should make them legal," Donald MacPherson says. "Then we can focus on problematic substance use and issues like dependency and addiction."

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Medical marijuana appears to have put a dent in the opioid abuse epidemic, according to two studies published Monday.

The research suggests that some people turn to marijuana as a way to treat their pain, and by so doing, avoid more dangerous addictive drugs. The findings are the latest to lend support to the idea that some people are willing to substitute marijuana for opioids and other prescription drugs.

Many people end up abusing opioid drugs such as oxycodone and heroin after starting off with a legitimate prescription for pain. The authors argue that people who avoid that first prescription are less likely to end up as part of the opioid epidemic.

"We do know that cannabis is much less risky than opiates, as far as likelihood of dependency," says W. David Bradford, a professor of public policy at the University of Georgia. "And certainly there's no mortality risk" from the drug itself.

The National Academy of Sciences, Engineering and Medicine says there's good evidence that cannabis is effective at treating pain for some conditions. So Bradford and three colleagues - including his scientist daughter - decided to see whether people who can get easy access to medical marijuana are less likely to get prescription opioids. The answer, they report in JAMA Internal Medicine, is yes.

"There are substantial reductions in opiate use" in states that have initiated dispensaries for medical marijuana, he says.

The researchers studied data from Medicare, which mostly covers people over the age of 65. (It was a convenient set of data and available to them at no cost.) They found a 14 percent reduction in opioid prescriptions in states that allow easy access to medical marijuana.

They estimate that these dispensary programs reduced the number of opioid prescriptions by 3.7 million daily doses. States that allowed homegrown marijuana for medical use saw an estimated 1.8 million fewer pills dispensed per day. To put that in perspective, from 2010 to 2015 Medicare recipients received an average of 23 million daily doses of opioids, the researchers say.

Because opioid use nationwide was rising during the study period, their estimate of reduced uses reflects a slowing of the increase, rather than an actual decline in opioid use in these states, Bradford says.

The analysis found a correlation and can't prove that marijuana use led to a reduction in the growth of opioid use. There might be other factors at work.

Even so, the findings suggest that expanding access to medical marijuana could help ease the opioid epidemic.

Hefei Wen at the University of Kentucky College of Public Health was lead author on another study in the same journal that reached similar conclusions. Wen, with Jason Hockenberry at Emory University, used Medicaid data. Medicaid is primarily a health insurance program for low-income people.

The authors write that laws that permit both medical marijuana and recreational marijuana for adults "have the potential to reduce opioid prescribing for Medicaid enrollees, a segment of population with disproportionately high risk for chronic pain, opioid use disorder and opioid overdose. Nevertheless, marijuana liberalization alone cannot solve the opioid epidemic."

Bradford agrees that medical marijuana laws could have a role to play. "But it is not without risks," he says. "Like any drug in our FDA-approved pharmacopeia, it can be misused. There's no question about it. So I hope nobody reading our study will say 'Oh, great, the answer to the opiate problem is just put cannabis in everybody's medicine chest and we are good to go.' We are certainly not saying that."

One concern is marijuana use might encourage people to experiment with more dangerous drugs. Dr. Mark Olfson, a professor of psychiatry and epidemiology at Columbia University, authored a study that found marijuana users were six times more likely than nonusers to abuse opioids.

"A young person starting marijuana is maybe putting him - or herself at increased risk," Olfson says. "On the other hand there may be a role - and there likely is a role - for medical marijuana in reducing the use of prescribed opioids for the management of pain."

This is a question of balancing risks and benefits. And that's difficult to do with the current studies based on broad populations - and in this case, populations that are not representative of the at-risk population as a whole.

Olfson says what they really need is studies that follow individuals, to see whether marijuana use really does supplant opioids. It's hard to do a study in this area because the federal government regards marijuana as a very dangerous drug and puts tight controls on research.

"That does make this a difficult area to study, and that's unfortunate because we have a large problem with the opioid epidemic," Olfson says. "And at the same time, with an aging population, we have lots of people who have pain conditions and who will benefit from appropriate management."
You can contact Richard Harris at rharris@npr.org.

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Opioid Use Lower In States That Eased Marijuana Laws

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Medical marijuana appears to have put a dent in the opioid abuse epidemic, according to two studies published Monday. The research suggests that some people turn to marijuana as a way to treat their pain, and by so doing, avoid more dangerous addictive drugs.

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For as long as I can remember, I've thought all drugs should be legal. In a nutshell, I believe that people should be allowed to put themselves at risk if they want to.

There are limits. Like everyone, I'm glad when a police officer tackles someone before they can jump off a bridge. But absent a good reason to think that a specific individual will greatly harm himself if allowed his freedom, the government should butt out. And no, wanting to try a drug, even a hard drug, is not such a reason.

This opinion doesn't depend on any particular set of facts. Comfortingly, though, I also thought the negative consequences of legalization would be mild. I'm feeling less comfortable these days.

I was never so naive as to think there would be no increase in drug use or abuse if drugs were legal. But I did think legalization would easily pass a practical cost-benefit test: reduce incarceration, if perhaps not as much as some might think; end an illegal market whose violence spills far beyond our borders; and expand personal freedom, all for the acceptable price of an extra overdose or other health problem here and there, plus maybe some extra property crimes by addicts stealing to feed their habit.

Drug addiction couldn't go up that much. The War on Drugs is an utter failure and drugs are widely and cheaply available anyway. Everyone knows that.

Well, reality is not lining up with this view of the world. In 1999, Americans had fatal drug overdoses at a rate of 6 per 100,000. In 2014, that number stood at 14.8 per 100,000 - a rise of 8.8 per 100,000. To put this in perspective, America's famously high homicide rate is about 5 per 100,000. And the overdose spike is apparently driven by a policy change much gentler than full legalization.

The general consensus seems to be that in recent decades, doctors started taking patients' pain more seriously, and thus began prescribing opioid painkillers more generously. Some patients became addicted; others got medications they didn't need and sold them. (It appears that most addicts are not getting their drugs directly from a doctor.) Efforts to clamp down on this problem may have had an effect on painkiller overdose deaths - there was a dip in 2012 and 2013 - but 2014 saw another record high. Many addicts are switching to heroin, another opioid with a staggering and growing death toll.

Now, extrapolating from this narrative, imagine if we completely legalized all drugs, not only removing the threat of incarceration but also dramatically driving down prices.

Perhaps this isn't as bad as it looks; after all, 14.8 per 100,000 can also be expressed as 0.0148 percent. Perhaps it's not fair to extrapolate; it's possible people would react differently to drugs that aren't prescribed, but instead are discouraged, by doctors. Perhaps legalization could be paired with better education. Perhaps drugs could be taxed and the proceeds used to fund treatment. Perhaps legalization would still be a net benefit, thanks to reduced incarceration and drug-gang violence, but by a slimmer margin than I'd originally thought and hoped.

Or perhaps there's a good reason these numbers made me so uncomfortable when I saw them.

I don't know; this is not an issue I write about frequently or have studied in much depth. But it sure looks like loosening control of a drug made all hell break loose, and that's not what I would have predicted, say, ten years ago.
Robert VerBruggen is editor of RealClearPolicy. Twitter: @RAVerBruggen
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