Organised by the Washington Office on Latin America with the support of Canada, the Canadian Association of People who Use Drugs, the Centre on Drug Policy Evaluation and the Drug Policy Alliance

Moderator: John Walsh, Washington Office on Latin America

Jennifer Saxe, Director General, Controlled Substances Directorate Health, Canada: The government of Canada’s perspective takes a public health approach to substance use, including response to overdose crisis that we’re facing. This includes barriers to and putting into place harm reduction measures. Supervised consumption services – evidence shows they help save lives. They establish pathways to care for drug users, who may not have other social supports. In Canada we have collected data on this – seen significant increase in federally authorised sites from 1 site in 2016 to 38 today. During that time these services have received more than 4 million visits, reversed over 40,000 overdoses. Another HR measure is naloxone, we have had that available without prescription since 2016 in Canada. Most first responders are equipped to administer naloxone. But there are still gaps. Particularly in remote, rural and indigenous communities we need to do more. There are other HR measures including drug checking, guidelines etc. A key part of all our work is building evidence around new harms to drugs. We’re also looking at a robust evaluation framework about recent exemption from drug laws in one province in Canada. Adults will not be charged for a small possession of drugs. Harm reduction also helps to connect people to broader health and social services. We have to look at those connections, pathways and care. We have taken a broader look at human rights, and that includes addressing stigma, which creates barriers to accessing important services, and that reduces the quality. We seek to humanise addiction and help people overcome negative attitudes and foster understanding. We prioritise meaningful engagement with people with lived experience of using drugs. We look forward to continuing important discussions on stigma, harm reduction. Tomorrow we have a side event on stigma.

Kassandra Frederique, Executive Director, Drug Policy Alliance: The U.S. is in the middle of a really sad situation with our increasing overdose deaths. Today mostly what I want to prioritise is the kind of cautionary tale of the US. The US has played a strong role in exporting drug control strategies that relies on supply control. We have created the conditions and circumstances for our drug supply to get more and more toxic. We have created a bigger problem because as we make drugs illegal, people just found all different kinds of drugs that were not made illegal. Now we are dealing with bad precursors, people are not even using heroin anymore. People are using fentanyl. We are seeing a drive in our overdose deaths – 100,000 deaths in a year, largely driven by the presence of fentanyl in our drug supply. It is critical to make the connection between supply interventions as health. As we make investments on the supply side, we only make the health side more volatile. As civil society, we are dealing with the emergency that our government has set up. Rather than creating alternative strategies, we are trying to keep people alive so that they can benefit from the alternative strategies. We are grateful for Canada – we do invest in needle exchange strategies, in naloxone. The language is super politicised in the US. Its just a political volley these days. But the consequence of that is 100,000 people. We are recognising that human rights in and of itself completely focused on a public health infrastructure is not enough. We have to broaden the conversation around human rights and also build infrastructure. I often say you can reverse an overdose by giving someone naloxone, but they walk outside and get killed by the militarised police, you have not saved their life you have delayed their death. That is representative of the way we think about harm reduction. Its not just about giving people syringes, its looking at what are the harms in peoples lives outside of drugs? We are seeing older black men dying in the U.S., they have been using drugs for a long time. They are not dying because they don’t know how to use drugs, there dying because the supply has become toxic. People who use drugs have other chronic health conditions that we need to be addressing – not just look at people who use drugs but people who are navigating the world and having a hard time in some instances. People use different kinds of drugs. In the U.S. the model of harm reduction we focus on opioids, yet stimulants are rising among black folk and we don’t really have infrastructure for that. Look at the US as a cautionary tale. Black folks and indigenous folks are most affected by drug control. When were having conversation about harm reduction, its also to talk about humanity and dignity and rights. I would be giving people syringes even if there weren’t 30 years of research because I believe people should have dignity. The think we focus on is how do we increase the types of interventions that are actually going to reduce the harms of someone having a hard time in the states. What is their access to healthcare, food etc that are not associated with their drug use? One of the things I have heard over and over, when it comes to stigma, we don’t want to stigmatise people, we want to stigmatise the drug. That is not an effective strategy, stigma travels. Us really focusing on ending stigma for everything and not just creating an arbitrary mind as stigma moves. It really is detrimental to our ability to keep people alive.

Ryan Hampton (virtual), Author, Recovery Advocate: I am the founder of mobilised recovery. We have over 20,000 members across the country. Author, advocate and person in long term recovery. For over 10 years I was an IV drug user and formerly unhoused person. Grateful to join and help put a rest to the vast misconception community and harm reduction community. Our coalition are strongly in support of harm reduction principles that we all know will save lives. As a former iv drug user myself, I know the value of compassionate harm reduction without shame, without judgement and without prejudice. I like to share a story: Early 2000s at the height of heroin use, harm reduction was not available. Clean syringes were only available with a prescription. I walked into a pharmacy in 2003 and asked for a bag of clean needles. The pharmacist almost called the cops. I contracted hepatitis C. when I entered my own personal recovery journey my liver was in really bad shape. Thanks to Medicaid, I could start treatment in 2018. The cost to medicate for this hep c treatment was nearly 80,000 dollars. Had I had access to clean syringes during my use, not only would I have provided a costs savings to the government and Medicaid of $80,000, I would have had access to qualified and trusted resources such as treatment even earlier. There were no harm reduction peers available to me during my active use. There were no resources available to me when I needed them the most. And as a result I almost lost my life because of it. I recall countless overdoes during those days and there was never a person available to save me when I needed it, to create a bond of trust when I needed it the most. I am one of the lucky ones , I was able to survive. Many of my friends did not. Access to harm reduction and to the tools we know will help keep people safe should never be a matter of luck. That’s why the recovery community and advocates across the us applaud the Biden administration for their forward thinking approach, including harm reduction as a critical and essential tool in the overdose crisis. The ground beneath us is literally shifting, it shifts every day in how we must address this complex and catastrophic crisis that has come because of failed policies from the past. Right now there are pieces of legislation being proposed federally and being passed across state capitals that will double down on failed criminalisation tactics. Legislation that makes the war on drugs from nearly 50 years ago look like a walk in the park. Laws are re-felonizing people that use drugs. US still spends 5 times as much money locking up people who use drugs than it does on actually treating addiction. This must change and it must change quickly. While the Biden administration has taken noble steps, increasing harm reduction services etc., it certainly must do more and quickly. We should be looking at policies that decriminalize drugs use. With the legislation that takes us to the dark ages of the WOD, we need to be pushing for evidence based studies and assessing the devastating impact of criminal penalties. We need to decriminalise drug checking supplies and protecting people who use drugs, their dignity and constitutional rights. We have come so far but we have so much further to go. I can say with certainty that despite the negative efforts of some in media and ill informed policy  makers, the harm reduction community stands strong and we will do everything we possibly can to work together towards a more sensible and humane approach to drugs and protecting those that we love.

Zayed Mahmood, Human Rights and Drug Policy Advisor, Office of the UN High Commissioner for Human Rights: What is the UN position on harm reduction? Start with different point of view to look at this crisis from the right to life. The right to life is the core human rights in HR declaration and all HR treaties and regional treaties. Let me read out one specific comment: in this document, the mention duty to protect life – this implies the state parties should take appropriate measures to address the general condition in society that may give rise to the direct threat to life. This general condition may include the prevalence of life threatening diseases such as AIDS, tuberculosis and malaria and substance abuse. The HR committee are saying exclusive substance use or drug overdose crisis it is the state parties duty to put it right. ‘Appropriate measures’- what are they? This includes measures designed to allow access to treatment without delay. I would like to look at one specific document. International guidelines on human rights and drug policy which were launched in 2019. In these guidelines it mentions harm reduction. Moving from the right to life to right to health, as applied to drug policy it calls for right to access to services. When we are formulating from public health perspective we must bring human rights into the discussion. In these guidelines, what states should do to ensuring this right has been protected with regard to harm reduction services, are ability and accessibility. It is important for governments to ensure that. When talking about funding, appropriate attention needs to be given to the particular vulnerable groups. People of African descent – we know how they are being targeted which also links to poverty, racism. 2 years back our previous high commissioner submitted a report on transformative justice on racism and law enforcement. The killing of George Floyd – how drug law enforcement is becoming a tool for racism. Marginalised groups need to be looked at. Within that group, I would like to highlight the LGBTQI+ population. With regard to that, would like to refer to 2018 report on HR and drug policy. Ireland government submitted a document to us regarding how they are addressing problem of LGBTQI+ in drug. Third point – remove age restriction on HR services. Exclude from list of criminal offences. All of these issues go back to decriminalization. Harm reduction is not enough. It is important to ensure that decriminalisation comes into the discussion of harm reduction services.

Nazlee Maghsoudi, Centre on Drug Policy Evaluation Canada: There has been an evolution of language in Canada. We have moved away from speaking of an opioid crisis which has become outdated, then to an overdose crisis and now to a drug poisoning crisis. This is referring to overdose but the change of language has become very important. I’m from Toronto and that’s the situation there. To be super clear drug poisoning puts the emphasis on the unregulated drug supply beyond just the unregulated opioid supply. It’s the notion that the drug supply whether its opioid or others have become contaminated with substances. We were once concerned with fentanyl, we have seen synthetic drugs from opioids to benzodiazepines. Overdose implies that too much was consumed, drug poisoning refers to the contamination in the drug supply system.

Natasha Touesnard, Executive Director, Canadian Association of People who Use Drugs: Our whole board is people who use or have formerly used drugs. Beyond that harm reduction especially in the context of Nezlee is so important right now. I use drugs. I still use drugs and I use them occasionally. My drug use has changed over time. I was on opioid treatment for many years. My use transitioned. When we talk about harm reduction, we accept you as a person the way you are today. In my use I ended up going to prison and I found out that I was HIV and Hep c positive at the same time. I had to go to the med – health segment is what they called it and meet with a doctor. I was sent back to my cell and I was supposed to carry on my life without any tools to deal with that. I was in prison for a few years at that time. I just have to suppress this and something will be there for me when I get out. But there never was – because I’m a woman and there are no services aimed at women. I just bottled everything up and my use got worse. That is how I ended up on opioid treatment. If you cant be yourself in this world, then who can you be? Are there really people in harm reduction who fundamentally believe you don’t need to change? Now I watch all the people that I care about and love die. Over 30,000 people in Canada have died in 2016 from this poisoning crisis. People do not know what they are ingesting. I am on a Canadian delegation but I speak here as an individual. My organisation watched the people we love and care about be decimated. One of our other colleagues told us yesterday that he lost someone yesterday as we are walking to come to the UN. Where are we in this? Its just a lot of talk. We go back to our communities and have no tools to help our people and watch them die around us. Why is harm reduction important? People deserve to have a life. That is a fundamental right. If we don’t understand even somebody’s use, we don’t have to. We just have to accept them for who they are. Canada has made great stride sin safe consumption and overdose prevention sites. 39 right now, but there also OPS overdose prevention site which is the same but not as medicalised. Those sites protect people. But Kassandra brought up there are racialised issues as well. A lot of people use stimulants and we don’t have smoking sites, where does that leave people who are racialised and using stimulants? Again they are already disproportionately targeted. We notice already what is the problem and why cant we just understand the human rights of people who use drugs? We also have safe supply programs across the country which is great for opioids but we don’t have any stimulants. ADHD drugs do not cut through if someone is using methamphetamine or cocaine. They will start a safe supply of stimulant but then leave because it doesn’t adequately give what they need. British Colombia have decriminalized –  I think that the whole country should decriminalize. Is it going to fix the drug poisoning crisis? No but it’s a tool. I fundamentally believe in regulation and legalisation and decriminalisation – they all go hand in hand. People don’t know what they’re ingesting. No one is overdosing on purpose – they don’t know what they’re ingesting. Let me give you a lettuce analogy – when there is something dodgy there is a public announcement – it is recalled from the supermarket shelves. When it happens in the illicit markets, nothing happens. If you think about it, we are allowing criminal entities to prescribe drugs to people with whatever contaminants and additives that they want to put in them. On the other side of that, people just want to use drugs for the same reason that people drink alcohol. There is this fundamental shift in thinking that when we talk about opioids and meth etc. why can we not understand that alcohol is the same thing? Alcohol was prohibited for a long time and it became overturned because it was a disaster. People were dying, losing their eyesight. Why cannot people think the same way about drugs? We have to start thinking about where we are at in society and why we have these visceral responses to people who use drugs. Good people use drugs, I am a good person who use drugs. Me and my staff are working diligently to try and change that narrative and we are fortunate to have a voice within public policy. All of my staff are drug users, not every day but when we want to. The choices people have right now are essentially going to jail or dying. That has to change. We envisage a society where we can say, “I’m going to have a glass of wine, you go and have your line.”