Everyone has the capacity to recover and live a dignified life. Policies which shun or ignore recovery, and enable drug use without expectations of behavioural change, devalue the lives of drug users by abandoning them to the disease of addiction. We must focus on giving people their lives back, rather than just palliating users until they die.

There is no human right to use addictive, euphoria-inducing substances to the point of physical and social disability. The reality is that the unrestricted use of addictive substances typically leads to significant social harms, and the conceptualization of drug use as a human right ignores these harms and fails to balance individual liberty against community interests. This radical strain of “drug libertarianism” is bad for everyone.

The best way to treat addiction is to stop it from developing in the first place. Educating the public about the dangers of drugs, including pharmaceutical substances, is essential to any responsible drug policy. However, it is just as important to address the underlying causes of drug use, such as poor mental health and housing instability.

While we advocate for those who struggle with addiction, we recognize that their rights and interests do not exist in a vacuum. Addiction policies must minimize harms to surrounding communities, including significant increases in crime, if they are to be ethical and politically sustainable.

Research has consistently shown that, for most types of drug addiction, treatment is more effective when patients are provided medication in addition to non-pharmacological supports. While some have opposed medication-assisted treatment, it is clinically the superior option in most cases, and should be offered to patients across the spectrum of addiction care, from supervised consumption sites to inpatient treatment centres. No one should be penalized or stigmatized for seeking it.

Supporting diverse communities requires an understanding of their distinct cultural and spiritual attitudes towards drugs, as well as community-specific historical traumas regarding drug use. Addiction policies should be culturally-sensitive where possible, and should symbiotically engage with community-specific beliefs, practices, and stakeholders. It should simultaneously be remembered that ideological and cultural diversity exists within every community.

Addiction medicine practitioners are the most credible experts on addiction issues. However, these experts have been marginalized in Canada more recently, as drug activists and experts from other fields, such as epidemiologists and public health researchers, have gained outsized influence. We challenge this trend and assert that ethical advocacy must prioritize the insights of those who have specialized in, and practice, addiction medicine. A sound grasp of the scientific research and the rational underpinnings of clinical addiction medicine is essential for drug treatment policy.

Canada’s addiction crisis is killing thousands of people every year and exacerbating related social ills, such as public disorder. No level of government has provided enough public funding to adequately address this problem. Budgets for tackling addiction must be scaled up significantly.

A significant portion of the drugs being distributed by Canada’s safer supply programs are being resold on the black market, leading to an increase in public access to these drugs, a drop in their street prices and rising addiction. Safer supply also appears to be causing infections among users. Many of these programs dissuade drug users from engaging in recovery-oriented treatment. These harms must be investigated and publicized, and the low-quality evidence base behind these programs must be scrutinized. Safer supply must be reformed so that program access is more controlled, dosing is strictly supervised, and regulated substances are provided only as a temporary measure to transition patients onto recovery-oriented treatment.

Due to significant restrictions on pain-related opioid prescribing, and insufficient funding for non-pharmacological pain treatment, chronic pain patients are often left behind and forced to access street opioids or abuse safer supply programs. Supporting chronic pain patients is essential to solving the larger addiction puzzle, especially if access to safer safer supply is restricted. Canada should provide more funding for non-opioid and non-pharmacological pain treatments, such as physiotherapy, and cautiously explore loosening pain-related opioid-prescribing in some cases.

For severely addicted individuals, whose brains are entirely hijacked by drugs and whose behaviour puts themselves and others in serious danger, involuntary rehabilitation can be a compassionate intervention. While some argue that involuntary addiction treatment may conflict with the Canadian Charter of Rights and Freedoms, it is nonetheless worth exploring – an ethical and legal framework could be modelled after involuntary treatment for those undergoing severe mental health crises.

Sublocade is a monthly injection of buprenorphine which can act as a de-facto vaccine against opioid abuse. Higher doses of Sublocade can also provide significant l protection from overdose. There needs to be more public awareness of these treatment options.

Due to historical trauma and societal exclusion, indigenous communities have been disproportionately impacted by alcohol and drug abuse. At the same time, many indigenous communities have developed their own, culturally-specific approaches to addiction which stress sobriety and community participation. Within these communities, treatment may include using cultural and spiritual practices, such as sweat lodges and mentoring with elders, for psychosocial support. Policymakers should support indigenous-informed treatment for indigenous communities, and make Indigenous-informed treatments available to non-Indigenous Canadians who may prefer these options.

Substance abuse is an underappreciated problem among LGBTQ Canadians. The popularization of “chemsex” (mixing drugs with sex) has been particularly concerning, and has fuelled a long-term, invisible methamphetamine epidemic among gay men. While LGBTQ-specific organizations are addressing these issues, some community stakeholders appear to be exacerbating the crisis by arguing that chemsex and meth should be “destigmatized” and normalized. More attention needs to be invested into exploring these issues, and leveraging community-specific networks to reduce addiction.

Addiction care should be fully funded so that services are free and available on-demand. It is morally indefensible that Canadians are currently being denied access to life-saving treatments due to excessive costs and wait times. Considering the downstream costs of addiction (i.e. hospitalization, incarceration), increasing investment into treatment is also fiscally responsible.

Recovery centres are inconsistently regulated throughout Canada, which can create confusion and gaps that undermine the quality of patient care. The government must do more to ensure that recovery providers operate in a consistent, transparent, and accountable manner, especially if increased public funding subsidizes demand for their services.