“THE DRUG IS NOT THE PROBLEM”: THE PERCEPTIONS OF THOSE WHO HAVE
EXPERIENCED SUBSTANCE ADDICTION ON CANADIAN DRUG POLICY

by
Meghan Jansons
Bachelor of Arts (Criminology and Criminal Justice), University of the Fraser Valley, 2018

GRADUATE THESIS SUBMITTED IN PARTIAL
FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
MASTER OF ARTS (CRIMINAL JUSTICE)
In the
School of Criminology and Criminal Justice

© Meghan Jansons 2020
UNIVERSITY OF THE FRASER VALLEY
Winter 2020
All rights reserved. This work may not be
reproduced in whole or in part, by photocopy
or other means, without permission of the author.

Approval

Name: Meghan Jansons
Degree: Master of Arts (Criminal Justice) Degree
Title: “The Drug is not the Problem”: The Perceptions of those who have Experienced Substance
Addiction on Canadian Drug Policy

Examining Committee
Amanda McCormick
GPC Chair
Director, School of Criminology and Criminal Justice

____________________________________________________________
Jon Heidt, Ph.D.
Senior Supervisor
Associate Professor, School of Criminology and Criminal Justice

____________________________________________________________
Amy Prevost, Ph.D.
Secondary Supervisor
Associate Professor, School of Criminology and Criminal Justice

____________________________________________________________
Jane Buxton, MBBS, MHSc FRCPC
External Examiner
Professor and MPH Practicum Director
School of Population and Public Heath, University of British Columbia
Physician Epidemiologist and Harm Reduction Lead,
British Columbia Centre for Disease Control

____________________________________________________________

Date Defended/Approved:

May 4, 2020

ii

Abstract
In recent years thousands of people have died due to illicit drug overdoses caused by
increasingly powerful and contaminated substances offered through the illicit drug market
(Corace et al., 2019). The current drug-related overdose crisis has presented an opportunity for
drug policy changes throughout Canada. While the current government has made progressive
changes to Canadian drug policy in recent years, further research on effective and efficient drug
policy is warranted to combat the growing concerns related to the harms associated with drug use
and substance addiction.
This study furthers the understanding of how those who have experienced substance
addiction view the current and past drug policies in Canada. This research also served to gain
this population’s insight on the effective and ineffective drug strategies within the system and
what approach would best prevent and treat substance addiction. To complete this research, 19
qualitative one-on-one interviews were conducted with individuals who have experienced or are
currently experiencing substance addiction.
Several related themes emerged from the interviews, including findings that demonstrate
the support among people who have had substance addiction for: the decriminalization of all
illicit substances in Canada; a legalized safe supply of specific illicit substances; a rehabilitated
and modern approach to treatment programs for substance addiction; and the reduction or
elimination of stigmatization towards people who use drugs. The findings of this research add to
the growing body of literature that considers the perspectives of those who are addicted to illicit
substances – a population that is arguably the most affected by drug policy.

iii

Acknowledgements

For without your support, I would not have succeeded.

The Participants
Thank you to all those who were willing to take to take part in this study. Your insights and
personal histories were incredibly moving and critical in the development of this project.
Without your contributions, this project would not have progressed past an idea. I also want to
thank you for your support and positive feedback throughout the interview process. I will forever
value your insights, lived experiences, and personal knowledge.
Dr. J. Heidt
Your support, guidance, and feedback have been invaluable over the past year. Your patience
with answering my phone calls and emails and your incredible knowledge of drug policy were a
blessing to me. Thank you for all that you did to bring my ideas to the final product that I have
here today. You truly are the “Drug Guy”.
Dr. A. Prevost
Thank you for taking part in this journey. I truly appreciate the time you have dedicated to aiding
me in finalizing this project and realizing my thesis goals. Without your final touch of support,
feedback, and directions this project would not be the same.
Dr. Jane Buxton
Thank you for being an amazing external evaluator. I truly appreciate your final
recommendations and participation in the defence process.
My Family and Friends
Thank you all for the endless love and support. Thank you to the family members who sent care
packages, including prepared meals and baking, to fuel my writing. Thank you to all my closest
friends for your encouragement and understanding, I know I disappeared for a few (or more)
months, so I am determined to make up for lost time.
My love, Matt Walz
You have been, by far, my greatest support. For every dinner you made, floor you vacuumed,
and washroom you cleaned so that I could write. For every weekend spent home so I could focus
and all that you gave up so that I could accomplish this dream – I will forever be grateful. Your
unconditional love, patience, and encouragement have been the motivation to push me through
the hardest days of this degree. Thank you, I love you.

iv

Dedication
This body of work is dedicated to all those who have been affected by substance
addiction, including the thousands of individuals who have lost their lives due to this illness.
May we all strive for a future that embraces a compassionate and understanding approach to
substance addiction.

v

Table of Contents
Abstract ......................................................................................................................................... iii
Acknowledgements ...................................................................................................................... iv
List of Tables .............................................................................................................................. viii
Chapter 1: Introduction ............................................................................................................... 1
Chapter 2: General Problem – The Stigmatization of Drug Use.............................................. 8
Stigmatization and Labelling: Reviewing Goffman, Lemert, and Braithwaite ................................ 9
The Dirty and the Dangerous: The Ugly Reality of Stigma .............................................................. 18

Chapter 3: Review of the Relevant Sources ............................................................................. 24
Literature Review ................................................................................................................................. 24
Drug Laws: A User Perspective ......................................................................................................... 24
The Good, the Bad, and the Ugly: Thoughts on Drug Strategies ....................................................... 27
It all Comes Down to This: A Summary of the Literature ................................................................. 32
Canadian Drug Policy: The Evolution................................................................................................ 32
Moral Panics and Racism: The Beginning of Drug Prohibition......................................................... 34
Changes in the 1960s and 1970s: Groovy or Far Out?....................................................................... 37
One Step Forward, Two Steps Back: Drug Policy in the 1980s and 1990s ....................................... 39
Moving into the Early 21st Century: Progressive Changes to Regressive Policy .............................. 41
Finally Advancing: Drug Policy Changes in 2015 ............................................................................. 42
To Dismantle a Century of Poor Decisions ........................................................................................ 44
So What? ............................................................................................................................................ 45

Chapter 4: Methodology............................................................................................................. 48
Research Question ................................................................................................................................ 48
The Objectives....................................................................................................................................... 48
Sample ................................................................................................................................................... 48
Research Design and Procedure .......................................................................................................... 52
Ethical Considerations ......................................................................................................................... 54

Chapter 5: Findings .................................................................................................................... 56
General Perspectives on Canadian Drug Policy: Advancing or Archaic? ...................................... 56
To Legalize, Decriminalize, or Penalize ............................................................................................ 60
Reducing Harm: It Should be a Simple Answer, Right? .................................................................... 65

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All or Nothing, the Machine called Abstinence-based Treatment ..................................................... 68
Canadian Drug Policy: Have You Felt the Changes? ....................................................................... 71
Beneficial or Harmful? Punitive vs. Rehabilitative Approaches ...................................................... 73
Is there Love for Tough Love? ........................................................................................................... 73
The Winner of the Least Effective Strategy Vote Goes to… ............................................................. 76
Strategies to Save Lives: Is it Enough? .............................................................................................. 77
Participants’ Suggestions for the Future ............................................................................................ 79
From the Streets to the Court House: Let’s Talk About It ................................................................. 79
The Elephant in the Room: Treatment Program Woes ...................................................................... 80
Education to End Stigma .................................................................................................................... 82
Keep the Resources Coming .............................................................................................................. 83

Chapter 6: Discussion and Analysis .......................................................................................... 85
Theme One: Decriminalizing Drug Use .............................................................................................. 85
Theme Two: Saving Lives by Legalizing a Safe Supply .................................................................... 89
Theme Three: Re-hashing Old Ways – Bringing Treatment into the 2020s ................................... 93
Theme Four: Stigmatization and the Need for Education ................................................................ 97

Chapter 7: Recommendations ................................................................................................. 102
Where there is a Will, there is a Way: The Push for Decriminalization ....................................... 102
Safety is First: Exploring Regulatory Options ................................................................................. 103
Modernized Substance Addiction Treatment: We Are Not all the Same ...................................... 104
Ending Stigmatization through Awareness and Knowledge .......................................................... 104

Chapter 8: Limitations ............................................................................................................. 106
Sample Size, Composition and Technique........................................................................................ 106
Limited Perspectives........................................................................................................................... 107
Inter-Rater Reliability ........................................................................................................................ 108

Chapter 9: Conclusion .............................................................................................................. 110
Appendix A – Interview Guide ................................................................................................ 114
Appendix B - Certificate of Human Research Ethics Board Approval ............................... 115
Appendix C – Informed Consent and Consent of Participation Forms .............................. 116
References .................................................................................................................................. 119

vii

List of Tables
Table 1. Sample Demographics and Substance Use Characteristics ………………………… 51

viii

Chapter 1: Introduction
For many, substance addiction is a reality. Either they have struggled with or succumbed
to an addiction, or if not themselves, they have watched their mother, father, daughter, son,
sister, brother, or friend battling in the trenches of drug use. Those who have experienced this
reality live in fear. They fear they will say good-bye for the last time, or never get to say goodbye at all. They fear their loved one will be imprisoned or will be killed. They fear for the
damage their loved one may cause to others, or the damage they may cause to themselves. They
fear that the latest hit will be the last. This fear is the reality.
Approximately one in five people in Canada will experience substance addiction at some
point in their lives (Hoskins, 2019). While substance addiction has always existed and varies in
nature, there have been an increasing number of drug-related deaths in recent years – owing to an
increase in contaminated illicit substances made available (Corace et al., 2019). Such deaths have
brought the issue of addiction to the forefront of Canadian conversation. For example, the
Canadian Government has made the opioid epidemic a leading public health and safety concern,
and drug-related legislation and strategies have been reformed and implemented. However, as
concerns related to the harms associated with drug use and substance addiction grow, the
effectiveness and efficiency of these changes need to be examined and future drug policy reform
needs to be considered.
Addiction is a complex process in which problematic patterns of substance use or
behaviours can interfere with a person’s life (Canadian Mental Health Association [CMHA],
2019b). An addiction can be broadly defined as a condition that leads to compulsive and
continuous engagement with a stimulus, regardless of negative consequences (CMHA, 2019b;
Hartney, 2018). This can result in both physical and psychological dependence on particular

1

stimuli. Addictions can be either substance-related, such as the problematic use of alcohol or
cocaine, or process-related, which includes gambling and internet additions (CMHA, 2019b).
While both substance-related and process-related addictions can disrupt an individual’s ability to
maintain a healthy lifestyle, this research specifically focuses on substance addiction.
Substance addictions under the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition (DSM-V) are referred to as substance-related disorders; however, for the purposes
of this research, the term substance addiction will be used as it a colloquial term used in Canada
(CMHA, 2019b). The DSM-V is based on decades of research and clinical knowledge that
recognizes that substance addictions can result from the use of various drugs, such as: alcohol;
cannabis; hallucinogens; inhalants; opioids; sedatives, hypnotics, or anxiolytics; stimulants;
tobacco; and other or unknown substances (Hartney, 2018).
The DSM-V also recognizes that not all individuals are equally vulnerable to developing
substance addictions, as some individuals are predisposed to a greater likelihood of developing
an addiction (Hartney, 2018). Likewise, these substances vary in their potential to be addictive,
yet this has little to do with their legal status. For example, tobacco is legal, but it is one of the
most addictive drugs on the list. Lastly, this disorder varies in nature and can range from mild to
severe depending on specific individual symptoms (CMHA, 2019b; Hartney, 2018).
In its international drug report, the United Nations Office on Drugs and Crime (UNODC;
2018) reported that approximately 275 million people worldwide, which is roughly 5.6% of the
global population aged 15 to 64, used illicit drugs at least once during 2016. Of those, 31 million
suffered from a substance addiction. Further, the report indicated that approximately 450,000
people died as a result of drug use in 2015, and of those deaths, 167,750 were directly associated

2

with substance addictions. The report also noted that opioids accounted for 76% of all substance
addiction related deaths (UNODC, 2018).
In Canada, while drug trafficking and production have increased in recent years, the
overall use of illicit drugs across all age groups has slightly declined (Canadian Centre for
Addictions, 2019). Further, from its 2012 Canadian Community Health Survey, Statistics Canada
(2015) found that lifetime rates of substance addiction accounted for 21.6% of the sample. The
abuse or dependence of alcohol (18.1%), cannabis (6.8%), and other substances (4.0%)
accounted for the total lifetime rates of substance addiction in this survey (Statistics Canada,
2015). Thus, it can be inferred that only a small proportion of the Canadian population exhibits
substance addictions to illicit drugs, as both alcohol and cannabis are legal in Canada. Despite
this, there has been a growing illicit drug overdose epidemic in Canada in recent decades.
Drug overdoses and drug overdose-related deaths have increased substantially in North
America since 2000, especially within the past several years (Fischer, Vojtila, & Rehm, 2018;
Rudd, Aleshire, Zibbell, & Gladden, 2016; Rudd, Seth, David & Scholl, 2016). In Canada,
unintentional drug overdoses have become a public health crisis (Karamouzian, Kuo, Crabtree,
& Buxton, in press). The increase in overdoses and drug-related deaths has been linked to the
rise in fentanyl and its analogues within the illicit drug market (Corace et al., 2019).1
Additionally, several other factors have been noted as contributors to the current opioid crisis,
including: opioids being prescribed for pain relief; a lack of access to non-pharmacological
treatments for pain; a lack of access to evidence-based treatment for opioid use disorder; silos
between the mental health and substance use systems; and the stigmatization of people who use
drugs (Corace et al., 2019).

1

Fentanyl is synthetic opioid that is similar to morphine but is 50 to 100 times more potent (National Institute on
Drug Abuse, 2019, para. 1).

3

In 2017, there were almost 4,000 opioid-related deaths in Canada, 1,482 which occurred
in British Columbia (BC; Government of Canada, 2018c). Another Canadian report noted that
between January 2016 and June 2019, there were more than 13,900 suspected opioid-related
deaths (Government of Canada, 2019b). Reported opioid-related hospitalizations occurred more
frequently, with 17,050 between January 2016 and March 2019 (Government of Canada, 2019b).
Further, in BC, the proportion of illicit drug overdose deaths with detected fentanyl increased
from 4% in 2012 to more than 80% in 2017 and 2018 (BC Coroners Service, 2019). Given that
BC has been the epicentre of the current drug-related overdose crisis in Canada, in April 2016,
BC’s Provincial Medical Health Officer declared a public health emergency (BC Centre for
Disease Control, 2017). This drug-related overdose crisis has presented an opportunity for drug
policy changes throughout Canada.
Historically, Canadian drug policy has been largely based on social and political factors,
rather than on scientific research and ‘evidence-based’ practices (Malleck, 2015).2 This led to
over a century of prohibitionist policy that resulted in an array of adverse outcomes, including
high drug overdose rates, high rates of infectious diseases caused by needle-sharing, high rates of
incarceration for drug offences, expensive law enforcement costs, and no significant reductions
in drug use (Hathaway & Tousaw, 2008). However, the current Canadian Prime Minister (PM)
Justin Trudeau and the Liberal Party of Canada have been taking steps since 2015 to reform
Canadian drug policy and legislation. To date, they have implemented several progressive
policies on drug possession and use, including legalizing cannabis in 2018 (Department of
Justice, 2018).

2

Evidence-based policy is based on scrutiny and assessment of existing research, and the measurement of
information about a program or treatment and its subsequent effectiveness (Valentine, 2009).

4

Moreover, this government has increased its efforts towards researching and
implementing evidence-based drug strategies. In particular, the Federal Government has
supported the implementation of several harm reduction initiatives across the country. These
harm reduction initiatives include: naloxone programs; needle-exchange programs; and
supervised injection facilities (SIFs), supervised consumption facilities (SCFs), and overdose
prevention sites (OPSs; Government of Canada, 2018b).
Irvine et al. (2019) conducted a study in BC to determine the combined effect of largescale opioid overdose preventions implemented in BC between April 2016 and December 2017
on the number of deaths averted. They considered the effects of take-home naloxone kits, SCFs,
OPSs, and opioid agonist therapy. Irvine et al. (2019) found that between 2900 and 3240 deaths
were averted in BC by all interventions combined, with approximately 1580 averted by takehome naloxone kits, 230 by OPSs, and 590 by opioid agonist therapy.
While these initiatives have been effective in reducing various drug-related harms,
including fatal overdoses, the rate of drug-related overdose deaths have continued to increase
each year (Government of Canada, 2018c; Irvine et al., 2019; Kennedy et al., 2019).
Additionally, some have argued that while drugs remain illegal, those who use drugs will
continue to be marginalized from society and further criminalized, which decreases the overall
effectiveness of the harm reduction strategies (van der Meulen, De Shalit & Ka Hon Chu, 2018;
Lavalley, Kastor, Valleriani, & McNeil, 2018). These arguments and the ongoing drug-related
deaths have fuelled support for increasingly liberal drug policy in Canada, including discussions
on decriminalizing all illicit drugs and providing safe supplies for those who use opioids (Angus
Reid Institute, 2019; Corace et al., 2019). Therefore, while the current government has made
progressive changes to Canadian drug policy in recent years, it is clear that further research on

5

effective and efficient drug policy is necessary to combat the growing concerns related to the
harms associated with drug use and substance addiction.
To aid in informing future drug policy changes in Canada, several key groups of
stakeholders should be involved. In particular, the perceptions of people who have experienced
addiction should be considered when developing and implementing drug policy. This includes
recognizing the lived experiences of those who use drugs and considering their opinions on the
current legislation and subsequent strategies employed by the government to reduce the use of
drugs, decrease the harms associated with drug use, and prevent and treat substance addiction.
This research was designed to further the understanding of how those who have
experienced substance addiction view the current and past drug policies in Canada. It explores
what this population believes are effective and ineffective drug strategies within the system and
what approach may be best in preventing and treating substance addiction. The findings of this
research add to the growing body of literature that considers the perspectives of those who are
addicted to illicit substances – a population that is arguably the most affected by drug policy.
There are several objectives of the current study. First, it examines how the current state
of Canadian drug policy affects the various perceptions of those who have experienced or are
currently experiencing substance addiction. Second, the study explores the history of Canadian
drug policy and its impact on individuals with substance addictions. Third, this research strives
to understand the consequences of government mandate changes on drug policy on those who are
struggling with substance addictions. Fourth, the project analyzes the perceived effects of
punitive versus rehabilitative approaches to preventing and treating substance addictions. Lastly,
the project investigates potential options for future drug policy changes that are supported by

6

those who have experienced or are currently experiencing substance addictions. From these
objectives, several themes emerged from the analyzed data, which will later be explored.

7

Chapter 2: General Problem – The Stigmatization of Drug Use
There is a small but growing body of literature that has examined how individuals who
use illicit drugs view current drug policy (Darke & Torok, 2013; Lancaster, Ritter, & Stafford,
2013; Lancaster, Santana, Madden, & Ritter, 2015; Lancaster, Sutherland, & Ritter, 2014). These
studies have been recognized as an important step towards considering and incorporating the
views of those who use drugs in drug policy analysis, since a majority of public opinion research
on drug policy has focused on the perceptions of the general public (Lancaster et al., 2015).
Lancaster et al. (2013) contended that policy should be informed by those who use drugs – the
individuals it most directly affects. Similarly, Montagne (2002) concluded that there is a need for
Canadian research that focuses on the perceptions and experiences of people who use drugs.
Unfortunately, the voices of those who use drugs have often been excluded from drug
policy debate – in Canada and worldwide (Lancaster et al., 2013). This has resulted in policy and
practices that have excluded the opinions and lived experiences of the specific community it
affects (Tutenges, Kolind, & Uhl, 2015). The lack of research on the perceptions of drug using
groups is reflected in the policy, prevention, and treatment interventions implemented and has
resulted in various ineffective and inefficient drug strategies.
However, critics have argued that individuals who use drugs are too delusional,
disorganized, or biased to provide useful information about their own lived experiences. As such,
they have argued that this population should be excluded from contributing to drug policy
decisions (Tutenges et al., 2015). Regardless of these critical assertions, drug policy should be
informed by those who use drugs, since giving this population a voice can better inform policy
development and decisions, build trust between this population and the government, and increase
the legitimacy of the strategies implemented (Lancaster et al., 2013). Thus, despite the belief

8

among some individuals that drug policy should not be informed by those who use drugs, there is
value in considering and incorporating this population’s knowledge and lived experiences into
future policy decisions.
Stigmatization and Labelling: Reviewing Goffman, Lemert, and Braithwaite
There are many theories that relate to crime and deviance; however, this analysis will
focus on specific theories that aid in explaining how negative societal perceptions of drug using
groups affect this population. This negative societal response ultimately lends support to
excluding their involvement in policy development. Erving Goffman’s (1963) theory of
stigmatization outlined the idea of stigma and the plight of those who are stigmatized. He argued
that stigmatized individuals are those that are not fully accepted by society and who are
constantly striving to adjust their social identities.
Goffman (1963) identified three types of stigma: physical stigma; stigma of group
identity; and stigma of character traits. Physical stigma refers to physical deformities of the body,
while stigma of group identity refers to stigma that is caused by being a part of a particular race,
nation, or religion. Goffman (1963) explained that stigma of character traits are:
…blemishes of individual character perceived as weak will, domineering or unnatural
passions, treacherous and rigid beliefs, and dishonesty, these being inferred from a
known record of, for example, mental disorder, imprisonment, addiction, alcoholism,
homosexuality, unemployment, suicidal attempts, and radical political behaviour. (p. 14)
Goffman (1963) also argued that the three types of stigma are similar in that they share the same
sociological features – an individual who may have been accepted within normal social
interactions “possesses a trait that can obtrude itself upon attention”, which results in a negative
societal reaction and subsequent labelling (p. 15). In other words, an individual who possesses
stigma has an undesired differentness from what ‘normal’ society expects – making that
individual an outcast or an ‘other’ in that particular society.

9

Goffman (1963) argued that stigma theory is constructed as a way to explain the
inferiority of the stigmatized individual, to account for their dangerousness, and to rationalize an
animosity based on other differences, such as social class. He suggested that those without
stigma, or ‘normals’, believe that an individual with a stigma is not quite human. Consequently,
he maintained that ‘normals’ exercise multiple forms of discrimination against the stigmatized
individual, which effectively reduces their quality of life.
The discrimination against stigmatized individuals leads them to question how others will
identify and receive them. He contended that the stigmatized individual’s awareness of
inferiority leads to self-consciousness, feelings of insecurity, anxiety, and sometimes jealousy
(Goffman, 1963). This is referred to as internalized stigma, which is when a stigmatized
individual cognitively or emotionally internalizes the negative messages or stereotypes that the
greater society places on him or her. Goffman (1963) also asserted that those with similar
stigmas, such as alcoholics, sex workers, or people who use drugs, will form small social groups,
in which the members of the group all derive from the specific stigmatized category. The
individuals who share a particular stigma and social group will subsequently rely on each other
for mutual aid or support (Goffman, 1963).
Goffman (1963) explained that there are many signs that can convey social information,
and the nature of this information can lead to prestige or to stigmatization. For example, the
symbols, or signs, of stigma on an individual can include the scars from an attempted suicide,
pock marks or sores from drug use, or the handcuffed wrists of an offender in transit. He argued
that due to the visibility of many stigmas, the stigmatized individual will make efforts to conceal
their stigma, or to adapt or conform their identity in an effort to be perceived as normal. This
allows for some individuals to function with a stigma, while others are outcasted. However,

10

Goffman (1963) highlighted that there are some individuals, such as sex workers, thieves, and
people who use drugs, who must conceal their stigma from one class of persons, such as the
police, while simultaneously exposing themselves to other classes of persons, such as clients,
fellow-members, and drug dealers. Ultimately, an individual’s social identity can affect how they
are perceived by others.
Goffman (1963) argued that the term ‘deviance’ represents the actions of social deviants,
a group of stigmatized individuals that consists of sex workers, people who use drugs,
delinquents, criminals, jazz musicians, carnival workers, homeless persons, gypsies, alcoholics,
show people, full-time gamblers, beach dwellers, and the urban unrepentant poor. He maintained
that these individuals are perceived as: failing to use available opportunity for advancement;
openly showing disrespect for their superiors; lacking piety; and, representing failures in the
motivational schemes of society. Consequently, he affirmed that social deviants collectively
deny the social order of normal society. Ultimately, Goffman’s (1963) theory of stigmatization
concluded that stigmatized individuals are those who are not fully accepted by society, which
leads to various forms of discrimination.
Comparatively, Edwin Lemert (1951) hypothesized the notion of primary and secondary
deviance. Lemert (1951) argued that the socially visible deviations within a group, community,
or society creates a reaction among the whole of the group, community, or society – the nature
and severity of the reaction and attitude towards this deviation would depend upon the
expectations of the conforming majority. The severity of the societal reaction will depend on the
compulsory nature of the norm being violated or deviated from. He explained that the societal
reaction will affect the intensity, degree, amount, and visibility of the deviation.

11

According to Lemert (1951), primary deviance refers to behaviour that does not abide by
a social norm yet causes no long-term consequences for the wrongdoer. He noted that the
absence of long-term consequences may be due to the fact that the initial deviance prompted no
reaction, or that the reaction to the deviance was not particularly negative or stigmatizing.
Consequently, primary deviance does not lead to a permanent label from peers, nor to a deviant
or stigmatized self-identity.
Lemert (1951) explained that recurring deviations and the formation of a deviant subgroup will work to alter the culture and social organization of the community where the
deviations occur. This leads to mythologies, stigma, stereotypes, patterns of exploitation,
accommodation, segregation, and methods of control that formalize between the deviants and the
rest of society. He suggested that the informal societal reactions are further extended by the
formal processes of penalizing and restraining or reforming those who are perceived as deviant.
This leads to the status of the individual being redefined as deviant. In this sense, secondary
deviance arises when this status is placed on an individual – the permanent status among peers as
an outcast.
In essence, Lemert (1951) argued that not all violations of social norms result in longterm negative consequences. Some acts, such as driving over the speed limit, may go undetected
by law enforcement or other persons, and result in no consequences. In some cases, the act may
be detected, and the perpetrator may be subject to a punishment that serves to deter that
individual from further violations, such as being issued a fine for speeding. However, these
violations are quickly forgotten, and the perpetrator will proceed with generally law-abiding
behaviour. While primary deviance receives no social reaction or mild, corrective action, if
deviant behaviour is repeated or persists, the societal reaction becomes stronger and increasingly

12

punitive (Lemert, 1951). As previously noted, when the continued violations of social norms
produce societal consequences strong enough to cause stigmatization, secondary deviance can
result.
Lemert (1951) explained that as the individual becomes increasingly reprimanded by
society, the individual will begin to resent both the societal norms being violated and the social
structures that are imposing the consequences. Eventually the individual will reach a level of
resentment that results in the individual creating a self-concept that mirrors the definition of
deviant as set by the group. He maintained that the most significant personality changes that
occur at this stage manifest when societal definitions become generalized. As a result, the
individual is left to define themselves by the greater society, without choice of an alternative
role. However, Lemert (1951) also explained that an individual’s internal make-up and
personality will affect their likelihood of accepting this deviant role, since not all individuals
labelled deviant or criminal adopt a criminal role. Those who do accept the deviant social status
will make efforts to adjust to their new role, leading to further deviant behaviour.
Essentially, secondary deviance is more severe than primary deviance and results from an
entrenched self- and social-identity. Those who display secondary deviance are also more likely
to align themselves with others who have been similarly labelled – becoming part of a subculture
that rejects the normative framework created by the original social group. In general, Lemert’s
(1951) theory on primary and secondary deviance sought to explain how labelling and
stigmatization affects the deviant nature of those who violate social norms.
John Braithwaite’s (1989) theory outlined in Crime, Shame, and Reintegration referred to
all societal processes of expressing disapproval and evoking remorse in the person being shamed.
This theory drew from both Goffman’s (1963) theory of stigmatization and Lemert’s (1951)

13

theory on primary and secondary deviance. Goffman’s (1963) concepts on shame and
stigmatization were used to explain reintegrative and disintegrative shaming, while Lemert’s
(1951) theory was used in defining a labelling theory. In general, Braithwaite’s (1989) theory
utilized labelling theory – a theory that posits that some individuals continue to commit crime or
engage in deviant acts due to the label that they have been given.
Braithwaite (1989) noted that life circumstances impact interdependency. The most
important of these circumstances include individuals who are between the ages of 15 and 25,
married, female, and employed, and who have high employment and educational goals. He
argued that interdependent persons are more susceptible to shaming, and societies that have
increased interdependencies among its citizens are more likely to be communitarian. Braithwaite
(1989) identified two types of shaming constructed by interdependency and communitarianism:
shaming that is followed by reintegration; and shaming that becomes stigmatization.
Reintegrative shaming is shaming that occurs as an exchange between the injured parties
and the perpetrator. This type of shaming is followed by efforts to reintegrate the perpetrator
back into the community as a law-abiding and respectable citizen. The efforts of reintegration are
often words or gestures of forgiveness or ceremonies to remove the deviant label on the
perpetrator. In essence, the act is labelled as evil, while the identity of the perpetrator is labelled
as essentially good. Moreover, societies that utilized reintegrative shaming have lower crime
rates, due to disapproval being dispensed without stigmatizing labels being instilled (Braithwaite,
1989).
In the second type of shaming, Braithwaite (1989) stated that shaming occurs as part of
an individual’s stigmatization. He argued that stigmatization is disintegrative shaming, where no
effort is made to reconcile the perpetrator with the community. Consequently, the perpetrator

14

becomes an outcast, with their deviance becoming their master status, or self-identity. In this
regard, Braithwaite (1989) drew from the concepts posed by Howard Becker (1963), a labelling
theorist who argued that deviant subculture formation partly arose from society’s negative
reactions to an individual’s actions, and the subsequent labelling of the individual. He argued
that a negative public label may encourage further deviance, which may lead to criminalization
and a ‘deviant career’. This is the stage at which the label may become a master status for the
outcasted individual, overriding all relationships outside of the deviant group (Becker, 1963).
In the same sense, Braithwaite (1989) maintained the shaming that is stigmatizing
increases the attractiveness of criminal subcultures, due to the sense that these subcultures reject
the rejecters. Stigmatizing shaming also reduces an individual’s interdependencies, such as
connections to family and pro-social peers, which increases the individual’s attraction to criminal
subcultures.3 Subsequent participation in subculture groups increases interactions with criminal
role models and enables training in techniques of crime, which makes the choice to engage in
crime more attractive.4 Thus, just as reintegrative shaming lowers crime rates, when
stigmatization is employed, crime rates increase.
It should be recognized that while Braithwaite (1989) drew heavily from labelling
theorists, such as Goffman, Lemert, and Becker, his concepts also integrated ideas from social
control and social learning theories. Thus, his theory can be categorized as an integrated theory.
Ultimately, although this description is only a short summary of Braithwaite’s (1989) theory, it
helps to explain how shaming and stigmatization can lead to further delinquency.

3

This idea draws from social control theories, which stipulate that deviance and crime occur due to inadequate
constraints; the constraints being positive connections to family, peers, or society.
4
According to social learning theories, deviance and crime is learned through interactions with close peers. Within
these relationships, individuals learn what is and what is not acceptable, based on the reactions of their peers to
delinquency.

15

These theories were reviewed in an effort to connect the stigmatization of people who use
drugs to their subsequent discrimination from informing research and policy. Goffman’s (1963)
theory on stigmatization outlined how individuals become stigmatized based on undesired
differences from what ‘normal’ society expects. Under his theory, people who use drugs are
stigmatized based on their character traits – the perception of being weak willed, dishonest,
dangerous, and having an unnatural passion. Similarly, Lemert (1951) argued that individuals are
stigmatized according to the reactions of a group, community, or society to their ‘deviant’
characteristic. Differing from Goffman (1963), Lemert (1951) explained that when an excluded
and stigmatized individual begins to identify with and display the behaviours of a similarly
excluded group, secondary deviance occurs – resulting in ongoing deviance.
However, both Goffman (1963) and Lemert (1951) acknowledged that those who share a
stigma will associate with each other. It is evident in that those who use drugs are punished by
criminal law and socially excluded from normative society; thus, it is not surprising that these
individuals seek the support and companionship from similarly excluded individuals. This can
lead to the further stigmatization of these individuals, negative self-perceptions, and continued
drug use.
Likewise, Braithwaite’s (1989) stigmatized shaming also explained how stigmatization
leads to increased or continued drug use among those with substance addiction. Braithwaite
(1989) differed from Goffman (1963) and Lemert (1951) in that he considered both positive
shaming, which is reintegrative shaming, and negative shaming, such as disintegrative, or
stigmatized, shaming. According to this theory, criminalizing and increasing punitive measures
against people who use drugs, with no options for healthy reintegration into society, will only
exacerbate their situations. That being said, laws and penalties meant to deter people who use

16

drugs from consuming illicit drugs will only be successful if there are positive supports or
reintegrative options for the them to return to society in a positive way; if these supports are
lacking, harsh laws and penalties will only further stigmatize and criminally entrench these
individuals. Thus, according to this theory, traditional ‘tough-on-crime’ approaches will not be
successful in reducing illicit drug use, due to the lack of options offered for healthy reintegration
into society.
Overall, these three theories can be combined to explain how those who use drugs are
stigmatized and why they have been rejected from the drug policy debate. First, Goffman (1963)
explained the societal reaction to those who use drugs problematically, and their subsequent
social stigmatization. Second, Lemert’s (1951) concepts supported the criminalization process of
these individuals, by illustrating how societal reactions to drug use have led to the stigmatization
and the penalization under law of these individuals – leading to further drug use by the
individual. The stigmatization of those who use drugs has subsequently resulted in this
population being excluded from the policy debate. Lastly, Braithwaite’s (1989) theory lends the
idea that positive shaming can be successfully applied to deviant actions; however, for shaming
to occur without the outcome of stigmatization, positive supports or reintegrative options need to
be offered. From this, it can be concluded that harsh laws, penalties, and stigmatization, will only
exacerbate the current drug epidemic; yet positive reintegrative action may ultimately reduce the
number of those with substance addiction.
It is clear that the stigmatization of particular individuals often leads to further deviance.
Moreover, as Goffman (1963) suggested, individuals with a stigma, including those who use
drugs, are perceived by ‘normals’ as not quite human. This perception decreases the perceived
value of this populations’ knowledge and lived experiences that could help inform drug policy.

17

Additionally, it could be argued that the continued discrimination of this population has
negatively impacted their ability to contribute to policy development. Nonetheless,
acknowledging the lived experiences and knowledge of those who have experienced drug use
and addiction is the first step to reducing the current stigma against this population.
The Dirty and the Dangerous: The Ugly Reality of Stigma
Several researchers have indicated that the stigmatization of those who use drugs and
people who inject drugs has contributed to the lack of research exploring this community’s views
on drug policy (Lancaster et al., 2014; Lloyd, 2013; Tutenges et al., 2015).5 Tutenges et al.
(2015) explained people who use drugs are often written and spoken about, yet this community is
rarely given the chance to speak for themselves. They argued that this trend has resulted in a
negative perception that vulnerable populations, such as those who use drugs, are too delusional
to provide useful information about their experiences. Furthermore, people who use drugs are
often stereotyped as homeless, unemployed, unclean, or dangerous (Australian Injecting and
Illicit Drug Users League [AIVL], 2011; Lancaster et al., 2014). Thus, it is important to
understand the current research literature on the stigmatization of people who use drugs.
AIVL (2011) reasoned that the criminalization of drugs and drug use is a direct result of
stigma. They argued that the criminalization of this population negatively affects their health and
wellbeing. This is due to the barriers to health care and other resources that arise when
stigmatization and discrimination occur. Additionally, the report maintained that very few people
who use drugs are able to overcome being labelled a ‘drug user’, as terms such as ‘rehabilitated

5

Stigmatization is described as a negative stereotype which results in the discrimination and ostracism of a
particular group or members of society (Australian Injecting and Illicit Drug Users League [AIVL], 2011).
Stigmatization has always been a part of human society and while the stigmatized group may change over time,
there is always a group or groups that are viewed negatively based their behaviour (AIVL, 2011). In recent years,
the term ‘stigma’ has been increasingly associated with the discriminatory and prejudicial treatment of minority
groups, such as individuals who are disabled or mentally ill (Lloyd, 2013).

18

drug user’, ‘treatment user’, ‘criminal user’, and ‘ex-user’ are still used to identify those who
may have recovered from their addiction. Those who are able to transcend the status of a ‘user’
are often still associated with the drug using community as guest speakers, research subjects, or
peer support (AIVL, 2001).
Likewise, Lloyd (2013) found several themes regarding the stigmatization of people who
use drugs. Lloyd (2013) concluded that the stigma associated with problematic drug use reflects
wider public fears about illicit drug use in general. He argued that the rationale behind the fear of
illicit drugs is complex but is often derived from the social history of the drugs, negative media
attention, political rhetoric, and the fact that many illicit drugs are unfamiliar and poorly
understood by the general population. Lloyd (2013) also noted specific stigmas that revolve
around public conceptions of the ‘junkie’ or ‘addict’. A key aspect of this stigma is the injection
of illicit drugs, as this was perceived by many as ‘dirty’. Additionally, Lloyd (2013) found that
those addicted to drugs are perceived as dangerous and desperate – willing to commit crimes or
odious acts to support their addiction.
Moreover, the literature revealed that blame and personal responsibility often
characterize the general population’s attitude towards this group of individuals. Lloyd (2013)
reported that individuals with substance addiction are often blamed for their condition due to the
misconception that they chose to use drugs. Thus, this group is viewed as having the personal
responsibility to quit using illicit drugs.6 Similarly, Corrigan, Kuwabara, and O’Shaughnessy
(2009) found that individuals addicted to drugs were viewed as significantly more responsible
for their disorder than people with mental illness or physical disabilities. People who use drugs

6

Research on substance addiction has indicated that addiction is linked to genetic, psychological, and social factors,
which helps to reduce the stigma of blame against people who use drugs and further challenges the idea that ceasing
to use drugs is simply a matter of self-will (Lloyd, 2013). Despite this, the stigmatization of drug use continues
within many societies.

19

were also viewed as substantially more dangerous and fear-evoking (Corrigan et al., 2009). The
findings from these studies illustrated the stigmatization of people with substance addiction and
demonstrated how discrimination results from such stereotypes and stigma.
Peretti-Watel (2003) studied the public opinions and attitudes toward drug issues in
France. They concluded that the stigmatization of those who use heroin is an obstacle to risk
reduction policies. That being said, a minority of the participants endorsed a stereotyped
perception of this population, viewing this group as ‘folk devils’ or people who are dangerous,
have no will of their own, and corrupt young individuals (Peretti-Watel, 2003). Furthermore, a
majority of the participants considered people who use heroin as dangerous towards their family
and friends. These stigmatizing views were found to affect policy decisions on substance
addiction and drug use.
To further this understanding, Lancaster et al. (2015) presented people who inject drugs
with the survey results of a previous study (see Lancaster et al., 2013) and asked them to
interpret and discuss the results (Lancaster et al., 2015). Lancaster et al. (2015) found that the
participants’ interpretations of the data were largely informed by the negative stereotypes of
people who use drugs. For example, Lancaster et al. (2015) found that the participants
unanimously agreed that needle and syringe programs were an important public health
intervention, yet the results of the previous study indicated that some of those who use drugs did
not support this intervention. The participants explained that their views could have reflected
their internalized stigma about their own drug use – a perspective of shame (Lancaster et al.,
2015).
The participants also explained why their peers were not universally supportive of drug
law reform. They suggested that certain sub-groups of people who use drugs and specific drug

20

types are often perceived as being worse or more dangerous than others, leading to within-group
stigma. The participants also explained that certain substances, like methamphetamine, are
perceived as more dangerous, while those who used heroin generally faced more discrimination
than other sub-group populations (Lancaster et al., 2015). Within-group stigma occurs when a
marginalized group, such as those who inhale drugs, stigmatize or discriminate against another
similarly marginalized group, such as those who inject drugs. This type of stigma can also be
called horizontal stigma. Overall, this study found that people who use drugs’ own internalized
stigma can negatively affect their interpretations of drug use and drug law reform, and can also
lead to within-group, or horizontal, stigma.
Similarly, Radcliffe and Stevens (2008) conducted qualitative interviews with people
who use drugs and found that they both recognized their own lived experiences of drug use and
viewed the existence of junkies as an ‘other’ or someone to be rejected. Many also indicated that
their experiences of drug treatment were stigmatizing. They reported that their own selfidentities became tainted upon contact with the drug treatment facilities due to being viewed as a
junkie or an addict. This view was particularly prominent among several groups of people who
use drugs, including females, young people, and those who misuse prescription drugs and
cannabis (Radcliffe & Stevens, 2008). In effect, several of the participants indicated that the fear
of being seen using drug treatment services was a barrier to continuing treatment.
Overall, it is evident that there are highly stigmatizing views towards people who use
drugs and between sub-groups of those who use drugs. Moreover, it is clear that the
internalization of these stigmatizing perceptions has affected this population. Nevertheless, the
stigmatization of people who use drugs has continued to silence this population. This has
resulted in limited research that addresses the perceptions of those who have experienced

21

substance addiction and has hindered the development of consumer-informed policy, prevention,
and treatment interventions (Tutenges at al., 2015). In effect, various ill-informed and illprepared drug strategies have been implemented by policy makers, who were eager to show
initiative and social responsibility yet lacked a clear understanding of the people that the policies
were meant to benefit (Tutenges et al., 2015).
The review of the literature on the stigmatization of people who use drugs was critical in
the development of the current project for several reasons. First, the findings demonstrated how
drug use is characterized as deviant, consequently leading to further discrimination and
stereotyping. This parallels the conclusions drawn from the theories presented. As a result, such
barriers exclude people who use drugs from partaking in research and informing drug policy.
Second, the connection between the theories and the research helped to explain why there
is limited research focusing on the perceptions of those who use drugs. The stigmatization of this
population has contributed to their exclusion from research. People who use drugs have been
perceived as too delusional to provide useful information about their own lives and situations.
Furthermore, they are often labelled as deviant and stigmatized as homeless, unemployed,
unclean, or dangerous. These misconceptions have resulted in an overall lack of understanding of
this population’s acute needs. Accordingly, there has been an over-reliance on biased and
misinformed research to inform drug policies. This is an important discovery that is rationalized
by both the theories and literature reviewed. Consequently, the research on the stigmatization of
people who use drugs defends the need for more inclusive and comprehensive drug policy
research.
Third, this review allowed for a better understanding of the current findings. In other
words, considering the stigmatization of this population led to a better appreciation of the

22

participant’s responses in the current project. That being said, the studies aided in the discussion
of this project’s findings, particularly regarding the issue of stigmatization in Chapter 6.
Ultimately, this review was necessary to understand the foundation of the current research.
Fortunately, in recent years, academics have increasingly acknowledged the importance of
people who use drugs’ perceptions. As a result, there has been a growing body of literature that
analyzes the perceptions of those who use drugs, which will be explored below.

23

Chapter 3: Review of the Relevant Sources
Literature Review
Drug Laws: A User Perspective
A number of studies on the perceptions of those who use drugs have focused on their
views of either drug policy or drug strategies. For example, Greer and Ritter (2019) conducted a
qualitative investigation with 37 participants on their opinions regarding drug laws and how they
think drug laws could be improved. Results from this study indicated that decriminalization,
legalization, and a medical or prescription model were all common preferences.
The most supported model for drug reform was drug regulation through the medical
system. Greer and Ritter (2019) noted that support for this model was largely based on its
perceived helpfulness. The researchers also found that while many of the participants supported
drug law reform, they shared the view that drug laws were unlikely to change. Moreover, the
participants argued that a change in public opinion is necessary for any vital drug law reform to
be successful (Greer & Ritter, 2019). Essentially, the participants supported drug law reform in
Australia, yet were sceptical of these reforms occurring.
Greer and Ritter (2020) furthered the discussion on the government’s role in regulating a
legal market and why participants were sceptical of this approach. Some of the concerns related
to the personal agency of people who use drugs under a medically regulated drug supply model.
The researchers explained that the concerns stemmed from the participants’ lack of trust in the
government, and their belief that the government is corrupt. Additionally, some of the
participants argued that the government had vested interests in maintaining prohibition, as it
creates jobs throughout the criminal justice system. Others believed that the government would

24

only support regulation of drug use to increase their own monetary profits from drug-related
revenues (Greer & Ritter, 2020).
The participants discussed both the potential harms and benefits of legalizing and
medically regulating a drug supply. Potential harms included an increase in use and
experimentation from those who otherwise would not have tried drugs. On the other hand,
perceived benefits included an increase in the quality and the safety of drug supplies (Greer &
Ritter, 2020). Ultimately, these findings suggested that while drug regulation through the
medical system was supported by the participants, there were still concerns regarding this drug
reform model.
In Australia, Darke and Torok (2013) interviewed persons who inject drugs to learn their
perspective on the legal status and perceived harms of five illicit drugs, including: heroin;
methamphetamine; cocaine; 3,4-Methylenedioxymethamphetamine (MDMA); and cannabis. The
researchers found that people who inject drugs viewed different drug types distinctively, with
perceptions being related to their own drug use history. A majority of respondents supported
legalizing cannabis, and there was modal support for the decriminalization of heroin. However,
Darke and Torok (2013) found that this population did not favour legal changes for
methamphetamine, cocaine, and MDMA. In terms of associated harm, methamphetamine was
rated by participants as the most harmful, followed by cocaine, MDMA, heroin, and cannabis
(Darke and Torok, 2013). Ultimately, lower levels of perceived harm led to increased support for
the legalization of all substances and the decriminalization of heroin.
In another Australian study, Lancaster et al. (2014) assessed the opinions people who use
drugs on Australian drug policy and its subsequent strategies. They used survey information
from the 2012 Ecstasy and Related Drugs Reporting System (EDRS) and the 2011 Illicit Drug

25

Reporting System (IDRS).7 Lancaster et al. (2014) found that support for legalizing cannabis was
expressed strongly by both the IDRS and EDRS participants. However, while 44.3% of the
EDRS participants supported the legalization of MDMA, only 24.9% of the IDRS participants
did. As well, 54.9% of the IDRS participants supported the legalization of heroin, whereas only
12.8% of the EDRS participants shared this support (Lancaster et al., 2014). Furthermore, 75.5%
of the EDRS participants opposed the legalization of heroin, yet only 33.1% of the IDRS
participants responded similarly. Ultimately, with the exception of support for the legalization of
MDMA, a greater proportion of IDRS participants supported legalization for the personal use of
each drug (Lancaster et al., 2014).
Lancaster et al. (2014) also measured and compared the support for strategies to reduce
the harms associated with heroin use. They noted significant differences in reported levels of
support for all harm reduction and treatment interventions between the IDRS and EDRS
participants. While 96.6% of IDRS and 83.6% of EDRS participants supported needle and
syringe programs, and 80.5% of IDRS and 63.3% of EDRS participants supported regulated
injecting rooms, opinions differed in regard to treatment inventions (Lancaster et al., 2014).
Moreover, Lancaster et al. (2014) reported that IDRS participants were more supportive of
methadone and buprenorphine maintenance treatment and rapid detoxification therapy than the
EDRS participants.
The most notable differences were observed in responses to the trial of prescribed heroin,
as 74.6% of IDRS participants supported the implementation of prescribed heroin, while only
30.6% of EDRS participants shared this support (Lancaster et al., 2014). Furthermore, 33.4% of

7

The EDRS is used to monitor the ever-evolving patterns of drug use among those who regularly use MDMA and
psychostimulants, such as cocaine and methamphetamine, as well as examines drug prices, purity, and perceived
availability (Lancaster et al., 2014). Comparatively, the IDRS monitors patterns of use and drug market trends
among people who inject drugs.

26

EDRS participants opposed this trial in Australia, compared to 13.1% of IDRS participants
(Lancaster et al., 2014). Ultimately, the findings of this study show that the views on drug policy
interventions in Australia vary significantly between people who inject drugs and those who
regularly use MDMA.
To further their understanding, Lancaster et al. (2015) conducted three qualitative focus
groups in Australia with participants who had a history of injection drug use. The participants
were presented with the survey results from the 2011 IDRS (see Lancaster et al., 2013) and were
asked to discuss whether they supported or opposed each policy item. The discussions served to
elicit participants’ interpretations of the survey findings. The researchers found that the
participants’ opinions and interpretations of the quantitative data was largely based on an
amalgamation of the participants’ opinions, knowledge, and lived experiences. They noted that
their peers might not have been universally supportive of drug law reform due to differences in
their preferred drug type, and their perception of the harms caused by each drug. Moreover, the
participants wished for more non-punitive and non-discriminatory treatment opportunities.
Evidently, there are differences in opinions on drug policy within different populations of people
who use drugs (Lancaster et al., 2015). Therefore, these findings speak to the diversity of
attitudes and experiences within the drug using population.
The Good, the Bad, and the Ugly: Thoughts on Drug Strategies
Many research studies have also explored the perceptions those who use drugs on general
and specific drug strategies, which include methadone maintenance programs and harm
reduction initiatives. Lancaster et al. (2013) found that respondents who used drugs strongly
supported needle and syringe programs (96.8%), methadone and buprenorphine maintenance
programs (86.3%), drug treatment either than methadone (82.7%), regulated injecting rooms

27

(80.5%), and a trial of prescribed heroin (74.6%). Additionally, in their comparison of drug using
groups, Lancaster et al. (2014) found that both the IDRS and EDRS groups supported harm
reduction measures, such as needle and syringe programs and regulated injection rooms.
Evidently, harm reduction strategies are supported among many of those who use substances.
Several studies examined the general perceptions of those who use illicit drugs on various
service providers. For example, Neale (1998) conducted interviews with people who use drugs in
England to understand views on drug service providers, such as: specialist drug agencies;
counsellors; general practitioners; pharmacists and pharmacy staff; needle exchanges;
detoxification and rehabilitation units; self-help groups; and criminal justice agencies.
Participants commented positively on the specialist knowledge of staff, the availability of advice
and help, the provision of a wide range of facilities, and staff being accessible, willing to listen
and having a good attitude (Neale, 1998). The participants noted that negative attributes of
service providers included: frequent staff changes; lack of knowledge; workers trying to take
control, or being dishonest, about the range of treatment options; inconsistent prescribing
policies; strict appointment times; stereotyping; and not trusting the clients.
Additionally, Neale (1998) found gender differences in drug service utilization. Men
were more likely than women to use specialist services, such as needle exchanges, detoxification
units, and self-help groups. Comparatively, women were more likely than men to use generic
services, such as those provided by doctors and pharmacists, drug counsellors, and written
material. Lastly, Neale (1998) found that women were more likely than men to report
dissatisfaction with the services provided for those who use drugs.
Over a decade later, Neale et al. (2015) conducted five focus group interviews in
England. A majority of the participants felt that many of the service providers expected too much

28

from the service users. Furthermore, in all the focus groups, participants reported frustration with
service providers who failed to consider the complex needs and vulnerable circumstances of each
individual. For example, Neale et al. (2015) noted that many argued that the seemingly positive
goals for their recovery could have negative consequences on their lives, such as overconfidence, stress from the pressure to gain employment, constant self-reflection that prevents
closure, and avoiding people to prevent relapse. These consequences serve to show the complex
needs and vulnerable circumstances of each individual struggling with addiction. Overall, Neale
et al. (2015) concluded that given the participants’ experience with such programs, they could
provide valuable insight into the perceptions of service providers.
In a similar study, Kolind (2007) used semi-structured interviews with the consumers of
the Danish Methadone Project, in order to gain their perspective on the advantages and
limitations of this program. The Methadone Project varied from the standard methadone
treatment program in several ways. The program featured a reduced client-counsellor ratio, and
frequent and accessible individual counselling. Moreover, the program’s drop-in centers were
open more than three hours a day and included health-related services. Lastly, the program
experimented with methadone dispensing, such as intravenous methadone and individual face-toface flexible dispensing. Those who utilized this program found that the attitudes of their
counsellors were positive and attentive, and they commented positively on the accessibility of
spontaneous counselling and the spaces that facilitated non-stigmatizing social encounters
(Kolind, 2007).
While the Danish Methadone Project received positive feedback, Fischer, Chin, Kuo,
Kirst, and Vlahov (2002) found less supportive views in their Canadian-based study. Fischer et
al. (2002) conducted focus groups with individuals who use opioids in Canada’s three largest

29

cities – Toronto, Montreal, and Vancouver. This study examined participant views on methadone
and other opiate prescription treatment. The study found that many perceived it to be punitive
and controlling, pervasively regimented, and disempowering. Moreover, the majority of
participants felt that methadone was harmful to the body, citing negative side effects, such as
back-aches, constipation, sweating, body aches, weight gain, headaches, nausea, sleepiness, loss
of sex drive, numbness, and seizures (Fischer et al., 2002).
Furthermore, many of the participants who had been on a methadone treatment program
believed that methadone was more addictive than heroin. The participants noted that the structure
of the methadone program limited their ability to work, travel, and socialize. Moreover, many
perceived the treatment providers and staff to be ‘out of touch’ with the clients’ experiences,
disinterested, and profit driven. Comparatively, those who positively viewed the methadone
treatment programs noted its benefits in helping them reach sobriety, reducing their need to
commit crimes to support their addiction, providing structure and stability in their lives, and
being cheaper, more accessible, and more reliable than heroin (Fischer et al., 2002).
Fischer et al. (2002) also noted that the participants had divergent beliefs of what
constituted an ideal treatment program. While some believed that the ideal treatment would be a
program that prioritizes detox and abstinence-based treatment programs, others believed that an
ideal program would focus more on harm reduction. Regardless, all participants strongly
expressed the need for choice and freedom in both the design and course of their treatment
(Fischer et al., 2002).
Interestingly, Fischer et al. (2002) found that although participants supported the idea of
having a prescription heroin program available, opinions regarding the eligibility criteria,
structure, and objectives varied (Fischer et al., 2002). Many of the participants agreed that heroin

30

prescription programs should be highly regulated and supervised. Some positive benefits of
implementing a heroin prescription program included: a reduction in drug-related crime; a
reduction in the use of other substances; and increased stabilization (Fischer et al., 2002).
Similarly, in Montagne’s (2002) study on the perceptions of Canadians who use opioids
on methadone maintenance programs, a majority of the respondents indicated that they would
prefer heroin maintenance, while 18.0% preferred buprenorphine, and the other treatments were
chosen by 5.0% or less of the respondents. These studies demonstrated the difference in
perceptions and experiences between those who participate in methadone treatment and those
who offer this treatment, develop policy, or research addiction and pharmacotherapies (Fischer et
al., 2002; Montagne, 2002).
Lutnick, Case, and Kral (2012) presented another study that considered the views of the
consumer group on a specific drug strategy. Lutnick et al. (2012) completed semi-structured
interviews on people who inject drugs in San Francisco, California, to assess their perceptions on
increasing services for them within pharmacies. While many of the participants welcomed more
services for people who inject drugs, they voiced concerns with the implementation of such
services in pharmacies. Many reported negative experiences resulting in the perception of
pharmacists and pharmacy staff as judgemental and unhelpful. Additionally, none of the 11
participants had been offered information by pharmacy staff about testing services, HIV risk
reduction, or drug treatment services (Lutnick et al., 2012). Further, in discussing syringe
exchange programs in pharmacies, many voiced concerns with privacy and accessibility and
noted that they feel more comfortable receiving services from community clinics. Overall, while
the participants noted some benefits to expanding services in pharmacies, issues of privacy and
negative experiences with pharmacists and pharmacy staff were most concerning.

31

The previous studies have helped shed light on the various views on effective and
efficient addiction related services and service providers. All participants strongly expressed the
need for choice and freedom in the design and the course of their treatment (Fischer et al., 2002).
Moreover, many of the participants expressed frustration with service providers (Neale et al.,
2015). These findings demonstrate the importance of incorporating the views of people who use
drugs when creating and implementing drug strategies.
It all Comes Down to This: A Summary of the Literature
Many studies on the perceptions of those who use drugs have focused on their views of
either drug policy and legislation or drug strategies, such as methadone programs or harm
reduction initiatives. The findings highlight the diversity of attitudes and experiences among
people who use drugs. For example, it was reported that those who use drugs have different
opinions on what constitutes an effective and efficient addiction related service and service
provider. Despite the differences, many participants strongly expressed the desire for choice and
freedom in the design and course of their treatment.
After reviewing the literature in this area, it is clear that there is tension between the
opinions and lived experiences of this population and the reality of the policies and practices
implemented. Although it is clear that those who use drugs have varying views, their opinions
are critical in contributing to the implementation of effective and efficient drug policies and
strategies. These opinions should be considered an important step in creating an ethically sound
approach to drug treatment (Kolind, 2007).
Canadian Drug Policy: The Evolution
The criminalization of certain drugs under Canadian law is fairly recent. Laws
prohibiting the use of cannabis, heroin, cocaine, and other substances were first passed in the

32

early 1900s and were criticized for relying heavily on the social, cultural, and moral contexts of
the time (Malleck, 2015; Toronto Public Health [TPH], 2018). As such, academics have argued
that certain substances were first prohibited due to their status as a public health risk (MacKay,
2018). In other words, they have maintained that the government prohibited these substances
based on their potential harms to society, while only marginally considering their potential health
risks. Thus, the motivation to implement these early laws were largely motivated by social ideals
and control (MacKay, 2018). This ideology led to over a century of prohibitionist drug policies
in Canada that have relied on criminal law to control drug supplies and to punish those in
possession of illicit substances (Erickson, 1992).
Since 2015, Canadian Prime Minister (PM) Justin Trudeau and the Liberal Party have
worked to reform Canadian drug policy and legislation. They implemented several policies on
drug possession and use, including the legalization of cannabis in 2018 (Department of Justice,
2018). Moreover, this government increased its efforts towards researching and implementing
‘evidence-based’ drug strategies. The implementation of these strategies, such as take-home
naloxone kits, OPSs, and opioid agonist therapy, has been successful in preventing many drugrelated deaths in Canada in recent years (Irvine et al., 2019).
While these initiatives are effective in reducing various drug-related harms, including
fatal overdoses, the rates of drug-related overdose deaths have continued to increase each year.
This increase is related to the rise in fentanyl and other high powered opioid contaminated drugs
(Government of Canada, 2018c; Fischer, Vojtila, & Rehm, 2018; Irvine et al., 2019; Kennedy et
al., 2019). In an effort to better understand the implications of these recent changes, and to
appreciate the results and recommendations of this research, it is necessary to analyze the history
of Canadian drug policy.

33

Moral Panics and Racism: The Beginning of Drug Prohibition
The first legal framework of drug control in Canada was introduced in 1908, with the
implementation of the Opium Act (MacKay, 2018; Riley, 1998). While regulations on all
medicines, tobacco, and alcohol were introduced at this time, the Opium Act was the first
Canadian document that prohibited a drug (Riley, 1998). The Opium Act specifically prohibited
the importation, manufacture, and sale of Opium for non-medical purposes, as well as imposed
criminal penalties for using and trafficking this substance (MacKay, 2018; Malleck, 2015).
Scholars have argued that the Opium Act emerged directly from racial violence (Malleck,
1997). In 1907, there were rumours that Japanese labourers were set to arrive in Vancouver,
causing white residents to riot through Vancouver’s Chinatown. Deputy Minister of Labour
William Lyon Mackenzie King was dispatched by the Federal Government to Vancouver. King
considered the damages to Japanese and Chinese businesses, and recommended reparation
payments (Malleck, 1997). King received applications for damages to two opium manufacturers.
These applications led a review of opium smoking in the city, which resulted in the
recommendation to prohibit the substance (Malleck, 1997).8 The Opium Act was subsequently
passed through the House of Commons with little discussion.
In 1911, the Opium Act was replaced by the Opium and Narcotic Drug Act (ONDA),
which prohibited the use of other opioids, such as morphine, and cocaine (Riley, 1998). The
ONDA also added harsher penalties, such as imprisonment, for individuals caught using the
prohibited substances (TPH, 2018). In 1922, the ONDA was amended to include the penalty of
deportation for immigrant offenders. Amendments also stipulated that those charged under this
act were considered guilty until proven innocent (Hewitt, 2004). Further, in 1923 cannabis was

Scholars have argued that King’s motives were based on regulating the behaviour of the Chinese labourers, a group
that was gaining upward mobility in BC through the sale opium (Malleck, 1997).
8

34

added to the list of prohibited substances (Riley, 1998). The ONDA remained in effect until 1961
(TPH, 2018).
Early Canadian drug policy was most notably influenced by the strong moralistic values
and the Eurocentric and racist attitudes of society (Gordon, 2006; MacKay, 2018). Before 1908,
many Canadians opposed the consumption of drugs and alcohol, as they believed these would
negatively affect the morality of the consumer (MacKay, 2018). Organizations, such as the
Women’s Christian Temperance Union, ardently encouraged abstaining from drugs and alcohol
as a means to improve personal health and religious morality. These moralistic values permeated
Euro-Canadian society in the early twentieth century, which largely influenced the creation of
law and policy (MacKay, 2018).
Moreover, in the late 1800s and early 1900s, Canadian society was openly hostile
towards immigrants who were deemed inassimilable, in particular those of Chinese heritage
(Hewitt, 2001; Malleck, 1997). These racist ideologies were prominent in popular literature,
which affected policy development. Emily Murphy’s The Black Candle outlined the evils of the
drug trade. 9 The sentiments shared by Murphy (1922) were focused on the dangers of opium,
cocaine, and cannabis. Murphy (1922) blamed the Canadian immigrant population for the supply
and sale of these substances – specifically focusing on the Chinese immigrant population when
discussing opium. Murphy’s (1922) work is argued to have contributed to the amendments made
to the ONDA in 1922 and 1923 (Jackel, Cavanaugh, & Marshall, 2019).
The popular rhetoric on opium and its criminalization was underpinned by anti-Chinese
sentiments, and Chinese-Canadians were heavily affected by the imposed legislation (Gordon,
2006; Hewitt, 2004). For example, between 1923 and 1932, nearly two percent of the Chinese

9

Murphy was a Canadian author, women’s right activist, and judge.

35

population in Canada were deported under the ONDA, and in 1922 alone, nearly three percent of
this population were convicted (Hewitt, 2004). Similar to the criminalization of opium, the use of
both cannabis and cocaine were widely viewed as drugs used by the non-Euro-Canadian ‘other’
and were prohibited. This ideology mirrored the United States (US), who strictly prohibited the
use of cannabis and crack-cocaine since those of Hispanic and African descent were viewed as
using these substances. Overall, early Canadian drug policy was largely affected by the views
and attitudes of society, which resulted in the prohibition and criminalization of various
substances (Gordon, 2006).
While the ONDA prohibited and criminalized several substances, there were no
provisions in the act for the treatment of addictions (Hewitt, 2004). Specifically, in 1923, the
Federal Minister of Health acknowledged that the government had failed to support addiction
treatment, as it was considered a provincial responsibility (Hewitt, 2004). Further, in 1933, a
Member of Parliament questioned the availability of funding for the treatment of substance
addictions. It was reported that there was no funding available and that addiction treatment was a
Provincial responsibility (Hewitt, 2004). As such, the Federal Government’s first response to
substance use was to treat it as a criminal problem; thus, federal money was distributed among
law enforcement agencies and correctional facilities, rather than for treatment (Hewitt, 2004).
It is important to understand the history of Canadian drug policy, as these laws and
strategies deeply affect current Canadian policy on illicit substances. The earliest of drug policies
in Canada were based on moralistic attitudes and racist ideals, with little regard for empirical
research or scientific thought – let alone the opinions and insights of the people that they sought
to criminalize. Subsequently, the prohibitionist foundation of these policies has been the basis of
the laws and strategies on drugs developed in Canada. Thus, it is not surprising that these

36

policies have continued to be ineffective and inefficient in addressing substance use and
addiction. Unfortunately, a reliance on this prohibitionist foundation has continued throughout
the past century.
Changes in the 1960s and 1970s: Groovy or Far Out?
While Canadian drug policy and legislation changed in 1961, these modifications
reinforced the division between licit and illicit drugs. The United Nations (UN) codified
international drug prohibition and regulation through the Single Convention on Narcotic Drugs
and the Convention on Psychotropic Substances, both of which Canada is a signatory (UN, 1961
& 1971). The Canadian Government passed the Narcotic Control Act (NCA) in 1961 to
implement the provisions that were outlined in the Single Convention on Narcotic Drugs. The
substances referred to as ‘narcotics’ under the NCA included heroin, cocaine, and cannabis
(Canadian Foundation for Drug Policy [CFDP], 2001). Under the NCA, the possession of a
narcotic substance was prohibited, with a penalty of up to seven years imprisonment. Moreover,
possession for the purpose of trafficking, and trafficking, cultivating, importing, and exporting
were all heavily penalized (CFDP, 2001).
Despite the provisions against illicit drug use under the NCA, the use of substances, such
as cannabis, lysergic acid diethylamide (LSD), and cocaine, were popular among youth in the
1960s and 1970s (Marquis, 2005). This led to a moral panic among older generations (Marquis,
2005). Further, the increased use of substances among youth pressured the Federal Government
to consider liberalizing its drug laws, as the court system was becoming inundated with a rising
number of youth sentenced with drug offences (Riley, 1998). Canadian drug policy followed the
pattern in the US – as the impetus to change drug laws occurred suddenly when middle- and
upper-class Caucasian youth became heavily involved in the system.

37

In 1969, in response to growing social and political concerns, the Federal Government,
under PM Pierre Trudeau, formed the Commission of Inquiry into the Non-Medical Use of
Drugs, which is popularly referred to as the Le Dain Commission (Marquis, 2005). This
commission concluded that drug prohibition resulted in high social, political, and economical
costs (Le Dain, 1973). As such, a less punitive approach was recommended to discourage the use
of illicit substances and reduce harm. This included a gradual withdrawal from criminal
sanctions against drug use, particularly for the use of cannabis (Le Dain, 1973).
The conclusions of this Commission were ignored by the Federal Government; however,
an amendment was made to the NCA in 1969 allowing prosecutors to proceed summarily in
possession cases, resulting in fewer penalties for drug use. Further, the Canadian Criminal Code
was amended in the early 1970s to allow for absolute and conditional discharge options in drug
possession cases (Riley, 1998). While small changes were made to the existing legislation,
Canadian drug policy was still very much centred around the idea that drugs should be
prohibited, and those use who drugs should be criminalized.
The developments to Canadian drug policy in the 1960s and 1970s did not incorporate
empirical evidence or scientific thought. Rather, these policies were largely influenced by the
reactions of middle- and upper-class Euro-Canadian adults – as mirrored in the US. This
population opposed the rampant use of illicit substances among younger generations and feared
their subsequent involvement with the criminal justice system. As a result, the Le Dain
Commission was formed, and amendments were made to the NCA. Despite these actions,
Canadian drug policy remained soundly prohibitionist in nature, and the recommendations made
by the Le Dain Commission were ignored. Essentially, the Federal Government disregarded the

38

research conducted by the commission to appeal to the masses of those who moralistically
opposed drug use.
One Step Forward, Two Steps Back: Drug Policy in the 1980s and 1990s
By the mid 1980s, it was clear that there were serious limitations regarding the role of
law enforcement and education. However, in 1986, PM Brian Mulroney announced that Canada
was in the midst of a drug epidemic, despite reports indicating that drug use was declining
(Erickson, 1992; Jensen & Gerber, 1993). This announcement came just two days after US
President Ronald Reagan declared a national ‘War on Drugs’. In response, the Canadian
Government created a federal secretariat whose task was to consult with community groups and
agencies to create a new national focus on a drug strategy (Erickson, 1992).
In May 1987, the Federal Government released the Canada Drug Strategy, which
included a ‘four-pillar’ approach to combating illicit drug use. The four pillars included
prevention, harm reduction, treatment, and enforcement, although the majority of federal funding
was enforcement driven (TPH, 2018). Despite this shortcoming, the inclusion of the four-pillar
approach marked a significant step towards a national strategy that incorporated treatment and
harm reduction. This strategy was funded for an initial five-year term ending in April 1992 and
was subsequently renewed for another five years (Riley, 1998). Following this term, heavy
financial cuts were made to Canada’s drug-related initiatives and the Policy and Research Unit of
the Canadian Centre on Substance Abuse, which had been researching and documenting
alternatives to drug prohibition, was closed (Riley, 1998).
Further, Canada introduced the Controlled Drugs and Substances Act in 1996, which
replaced the NCA. This act did not consider the expert opinion from the Le Dain Commission
(TPH, 2018). Rather, the new legislation remained soundly prohibitionist in nature, and further

39

powers were given to police and prosecutors to increase efficiency in processing those who use
drugs and sellers (Riley, 1998; Hathaway & Tousaw, 2008). Despite the attempt to provide a
balanced approach to combating illicit drug use during the implementation of the Canada Drug
Strategy, the dominant policy regarding illicit drugs remained one of criminal prohibition.
The politics surrounding PM Mulroney’s term in Federal Office were associated with the
Canadian drug ‘epidemic’ in 1986. In previous decades, the factors that affected drug policy
were largely based on societal attitudes and moral panics, yet the initiation of the Canada Drug
Strategy and the renewed War on Drugs also appear to have been influenced by politics (Jensen
& Gerber, 1993). Mulroney and the Progressive Conservative Party obtained a majority vote in
1984, however, within a year, his approval ratings dropped. By 1986, PM Mulroney’s approval
ratings stood at 37 percent (Jensen & Gerber, 1993). In order to bolster support for his Party, PM
Mulroney announced the Canadian drug epidemic, which would ultimately create an opportunity
for drug policy change; however, little change was made and progression under the Canada
Drug Strategy was short lived.
Similar to previous decades, the Federal Government continued to respond slowly to the
treatment of drug addiction. In 1987, amidst growing concerns over the spread of human
immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), the Canadian
government funded needle syringe programming (NSP). The Federal Health Minister allocated
$100,000 to each province that agreed to match equal funding for the NSP. However, after only
two years, Federal funding for the NSPs ceased, and provinces and municipalities were left to
fund this harm reduction strategy on their own (Hayle, 2018). The Canadian Government’s
unwillingness to provide further funding was associated with the distribution of power over

40

healthcare (Hayle, 2018). While the Federal Government controlled drug policy, little support
was given to treatment and harm reduction.
Moving into the Early 21st Century: Progressive Changes to Regressive Policy
The Canadian Federal Government was led by the Liberal Party at the turn of the 21st
century. This Party emphasized the need for harm reduction initiatives and was actively seeking
change to drug policy. In 2003, North America’s first sanctioned SIF, Insite, opened in the
Downtown Eastside (DTES) of Vancouver, BC (Dooling & Rachlis, 2010). This SIF allowed
individuals who use drugs to safely inject in a clean environment, with nurses and other medical
personnel available on site to provide sterile injection equipment, to aid in cases of overdose, and
to provide educational material and treatment referrals (Dooling & Rachlis, 2010). The overall
goals of SIFs were to increase access to health care and addiction services, reduce the spread of
infectious diseases, reduce overdose related deaths, and reduce public injection use (Hathaway &
Tousaw, 2008).
To operate legally, the Canadian Liberal Government exempted Insite from certain
provisions of the Controlled Drugs and Substances Act relating to trafficking (Dooling &
Rachlis, 2010). Insite was rigorously evaluated in the years following its implementation and
multiple studies found positive results, which included the prevention of overdose deaths, a
decrease in needle-sharing, a reduction in public injecting and injection-related litter, a reduction
in vehicle break-ins and theft, and an increase in referrals to methadone treatment (Dooling &
Rachlis, 2010, 1441). Despite these results, the future of Insite, and further harm reduction
measures, became uncertain when the Conservative Party, led by Stephen Harper, was elected
into office in 2006.

41

Despite the benefits of Insite, PM Harper did not support the harm reduction initiatives,
and pulled the federal funding (Dooling & Rachlis, 2010). In 2007, the Federal Government
released the National Anti-Drug Strategy, which removed harm reduction from Canada’s fourpillar drug strategy while shifting the focus to the role of law enforcement (TPH, 2018). In 2008,
the leadership for the new anti-drug mandate was removed from Health Canada and relocated
within the Department of Justice, which demonstrated a clear shift in ideology within the
government (van der Meulen, De Shalit, & Ka Hon Chu, 2018). This government also pushed to
intensify the War on Drugs by proposing a ‘tough-on-crime’ approach (Hyshka, Butter-McPhee,
Elliot, Wood, & Kerr, 2012; van der Meulen et al., 2018).
Canadian drug policy under PM Harper was not supported by evidence-based research or
public demand (Hyshka et al., 2012). Further, the retraction of the harm reduction pillar in the
National Anti-Drug Strategy and the tough-on-crime legislation contradicted the
recommendations of the Global Commission on Drug Policy, the Supreme Court of Canada, and
international trends (Hyshka et al., 2012). Thus, drug policy during this time was motivated by
ideological principles of punishment and retribution, rather than by evidence-based research. It is
not surprising that international observers viewed Canadian drug policies as anachronistic and
ill-advised (Hyshka et al., 2012).
Finally Advancing: Drug Policy Changes in 2015
In 2015, the Liberal Party, with leader Justin Trudeau, won the election and initiated
changes to Canadian drug policy. During its campaign, the Liberal Party was intentional in its
agenda to legalize cannabis and increase harm reduction initiatives (Liberal Party of Canada,
2013). In 2016, Canada’s current drug strategy, the Canadian Drugs and Substances Strategy,
was released. This strategy is a comprehensive, collaborative, compassionate, and evidence-

42

based approach to drug policy that includes the four-pillar approach (Government of Canada,
2019a). Further, PM Trudeau outlined his intentions to legalize and regulate cannabis possession
and use and to obtain bilateral agreements with each province and territory to improve access to
mental health and addiction services (Trudeau, 2015 & 2017).
The Federal Government authorized legislative changes to fulfill their promises. On
October 17th, 2018, the Cannabis Act was enacted in Canada, making cannabis possession and
use legal for the first time since 1923. This act implemented a strict legal framework for
controlling the production, distribution, sale, and possession of cannabis across Canada
(Department of Justice, 2018). The goals of the act were designed to keep cannabis away from
youth; to ensure that profits from cannabis sales would not support organized crime; and to
protect public health and safety by making it legal for anyone over the age of 18 to access legal
cannabis (Department of Justice, 2018).
In 2017, the Good Samaritan Drug Overdose Act was enacted (Government of Canada,
2018a). This act provides some legal protection for individuals who seek emergency help during
an overdose, including protection from being charged with possession of a controlled substance
or with a breach of conditions regarding drug possession (Government of Canada, 2018a). This
act applies to anyone who seeks emergency support during an overdose, including the person
experiencing the overdose and anyone else who may have been at the scene (Government of
Canada, 2018a).
Trudeau’s Government also supported the implementation of several harm reduction
initiatives across the country. This government recognized that while treatment for addictions
should be available, not everyone is an ideal candidate. In the meantime, the Trudeau

43

government supported several harm reduction initiatives, including: naloxone programs10;
needle-exchange programs; and SIFs, SCFs11, and OPSs12 (Government of Canada, 2018b).
Naloxone has been widely dispensed in many provinces and has been successful in reducing
opioid-related deaths (Karamouzian, Kuo, Crabtree, & Buxton, in press). Moreover, a large body
of evidence has demonstrated the effects of SIFs, SCFs, and OPSs on reducing various drugrelated risks and harms, including fatal overdoses (Kennedy et al., 2019). Evidently, the current
Federal Government has taken steps to support harm reduction measures and to reduce the
effects of substance addiction on vulnerable populations.
To Dismantle a Century of Poor Decisions
Following the analysis of Canada’s drug policy history, it is evident that this policy was
largely based on social and political factors, rather than on scientific research and evidence-based
practices. This led to prohibitionist policy that had an array of adverse outcomes, including high
drug overdose rates, high rates of infectious diseases, high rates of incarceration for drug
offences, high law enforcement costs, and no significant reductions in drug use (Hathaway &
Tousaw, 2008). Evidently, prohibiting the use of certain drugs will not end drug use and
addiction, nor decrease the associated harms.
It is encouraging that the recent changes to drug policy under the Liberal Government
have focused on reducing the harms associated with illicit drug use, rather than strictly
prohibiting substances and criminalizing those that use drugs. The current harm reduction-based
drug strategies attempt to aid the most vulnerable and drug-entrenched populations in Canada,

10 Naloxone reverses the effects of opioid-related overdoses.
11

SCFs are similar in nature to SIFs, except the customer may only inject their drugs in SIFs, whereas SCFs allow
all forms of consumption (Ponciano, 2018).
12
OPSs are similar to SCFs, but are temporary facilities meant to address an immediate need in the community and
can be in operation within weeks (Ponciano, 2018).

44

which is a historically overlooked population. Ultimately, these strategies are encouraging in that
they are a significant step towards using empirical evidence and scientific thought in Canadian
drug policy development.
Nonetheless, some still contend that the current harm reduction strategies are inadequate
to address drug use and its associated harms. Van der Meulen et al. (2018) called for a rightsbased, participant-driven, and gendered focus on drug policy development that recognizes
substance use as a health issue, eliminates the use of incarceration and punishment for minor
drug offences, and ensures that all drug treatment services are evidence-informed. Lavalley,
Kastor, Valleriani, and McNeil (2018) argued that while drugs remain criminalized, advances
toward addressing the overdose epidemic among vulnerable populations will remain futile. They
also maintained that despite the recent increase in harm reduction practices, drug criminalization
and policing practices limit the effectiveness of these measures (Lavalley et al., 2018).
Both van der Meulen et al. (2018) and Lavalley et al. (2018) contended that further
improvements to Canadian drug policy should include drug decriminalization and evidenceinformed services for addiction. Ultimately, these academics argued that while drugs remain
illegal, those who use drugs will continue to be marginalized from society and further
criminalized, decreasing the overall effectiveness of these specific strategies. Therefore, although
the Federal Government has made progressive changes to Canadian drug policy, it is clear that
further research on evidence-based policies and practices are warranted.
So What?
In reviewing the literature and considering the changes to Canadian drug policy in recent
years, it is clear that a present-day study exploring the perceptions of those who have
experienced substance addiction is needed. Accordingly, Canadian drug policy was reviewed

45

extensively for several reasons. First, to understand why the prohibition of drugs has been
unsuccessful in addressing drug use and substance addiction, one needs to understand the
establishment of this policy. As outlined, the foundation of Canadian drug policy is based on
social and political factors, rather than on scientific research and evidence-based practices. This
has resulted in prohibitionist policies that do not adequately address drug use and addiction.
Moreover, while harm reduction strategies are a positive step towards using evidence-based
practices and ensuring public safety, social and political factors remain an obstacle for serious
drug law reform. Essentially, the social and political foundation of Canadian drug policy hinders
major drug law reform, resulting in the continued implementation of ineffective policies.
Second, to recommend appropriate and effective action, one needs to understand the
evolution of Canadian drug policy. Currently, Canada is in the midst of a drug-related overdose
epidemic and has hastily pushed forward new drug policy, legislation, and strategies. While the
harm reduction strategies have been successful in reducing the harms associated with substance
use, there is clearly a need for changes to drug policy. As such, future recommendations must
consider the history of Canadian drug policy, alongside the growing body of evidence-based
literature. Acknowledging this history can prevent further repetitive action – such as the
continued implementation of prohibitionist policies – that have been essentially ineffective in
Canada.
Lastly, a thorough understanding of Canadian drug policy is needed to appreciate the
findings of the current project. Due to the specific factors that have historically influenced
Canadian drug policy, policy makers have ignored the opinions and experiences of people who
use drugs. However, this population’s perceptions are important in this policy discussion, as an
understanding of their views on Canada’s current and past drug policies will better inform the

46

decisions of policy makers. Nonetheless, the historical review highlighted the current
shortcomings of Canadian drug policies and emphasized the need for consumer-informed
research.

47

Chapter 4: Methodology
Research Question
There are few Canadian studies that examine how people who use drugs view drug
policy. Given this finding, this research will explore how people who use drugs perceive
Canadian drug policy. Specifically, this research will explore how this population feels about
drug strategies and what they believe would be the best approach to prevent and treat substance
addiction. The findings from this research will add to the growing body of research that
considers the perspectives of those who are addicted to illicit substances – a population that is
arguably the most affected by drug policy.
The Objectives
This research has several objectives. First, the study examines the perspectives of people
with substance addiction and their views on drug policy. Second, this research reviews the
history of Canadian drug policy in an effort to contextualize the current state of drug policy.
Third, the study examines the consequences of government mandate changes on drug policy.
Fourth, this project will analyze the perceived effects of punitive versus rehabilitative approaches
to preventing and treating substance addictions. Lastly, the project investigates options for future
drug policy changes that are supported by those who have experienced substance addictions.
Sample
The data for this research was obtained through qualitative interviews with 19
participants. To be eligible, participants must have experienced one or more substance addictions
and must have been 19 years of age or older at the time of the interview. 13 For the purpose of

13

Participants must have experienced a substance addiction, not including alcohol. While alcohol can be highly
addictive and is viewed as a drug, it is not an illicit substance in Canada. Furthermore, while alcohol was made
illegal for a brief period in the early 1900s, none of the participants interviewed would have experienced their
addiction during the prohibition. Therefore, they would not have been affected by this drug policy. However,

48

recruitment, substance addiction was defined as the problematic, compulsive, and continuous use
of a substance, such as opioids, stimulants, cannabinoids, hallucinogens, and sedatives, despite
the negative consequences of its use.14 Participants must have been addicted to any illicit
substance for at least six months.
To recruit participants, a snowball sampling technique was used. Snowball sampling is a
non-probability sampling technique where research participants recruit other participants for a
study. Snowball sampling is used when participants are difficult to find. This particular method
consists of two main steps: (1) identifying one or two potential participants in the population
being studied; and, (2) asking those participants to encourage other individuals to participate in
the study. In other words, a known potential participant was contacted by telephone and asked to
participate in the study – this participant recruited other participants, which led to a sample size
of 19 participants from the coastal, interior, and northern regions of BC. While the initial goal of
the research was to interview 20 participants, saturation was reached after 19 interviews.
Moreover, there was a natural conclusion after the 19th interview in that there were no new
willing participants.
The age of participants ranged from 19 to 68 years. The mean age of the sample was 46
years, with a median age of 47 years. The sample consisted of 15 (79.0%) males and four
(21.0%) females. Participants’ level of education varied, as five (26.3%) reported not having a

alcohol is illegal to those who are under the age of 19. Hence, to avoid confusion and conflict of sampling,
participants must have been 19 years or older to participate.
14
An addiction to any illicit drug served as a qualifier to participate in this study. An addiction to cannabis, despite
the drug being made legal in 2018, was also included as a qualifier for this study. This is due to the fact that
cannabis was illegal for many decades before 2018; therefore, its previously illegal nature may have negatively
affected the participants in the sample. Additionally, it is recognized that the addictive nature of both cannabis and
hallucinogens have been widely contended. However, despite the lower probability of becoming addicted to these
substances, these substances can be used problematically, and were therefore included in the sample. Regardless of
these sampling conditions, none of the participants in the sample indicated they were only addicted to cannabis or
hallucinogens. Rather, these substances were used alongside other drugs, such as opioids and stimulants.

49

high school diploma, eight (42.1%) reported completing high school, five (26.3%) reported
having completed college level credentials, such as a diploma or post-secondary certificate, and
one (5.3%) reported having a university degree. A majority (78.9%) of the participants were
employed – two were retired, one was self-employed, and one was on work disability. The
number of years of dependence on a particular substance varied, with a range of two to 33 years.
The mean number of years of dependence was 17.6 years, with a median of 21 years dependent.
The first documented substance addiction was reported in 1971. At the time of the
interviews, two participants disclosed that they were currently using illicit substances. Moreover,
five (26.3%) reported that their addiction began before the age of 12, while nine (47.4%)
reported that their addiction began during their teenage years (age 13 to 19), and five (26.3%)
reported that their addiction started in adulthood.
Almost half (47.4%) of the participants reported using all types of illicit substances, two
(10.5%) reported using all substances but heroin, and two (10.5%) reported using only heroin
and methamphetamines. Six (31.6%) of the participants reported using different combinations of
substances, which included combinations of cannabis, cocaine, crack-cocaine, lysergic acid
diethylamide (LSD), gamma-hydroxybutyrate (GHB), MDMA, and methamphetamines. Ten of
the participants (52.6%) experienced intravenous drug use.
All participants reported that, even after years of sobriety, they were still attending some
type of treatment or counselling program. For example, 16 (84.2%) reported that they currently
attend narcotics anonymous (NA) or alcoholics anonymous (AA) meetings, while three (15.8%)
reported that they were currently attending counselling. Of these participants, two (10.5%) were
currently on prescribed methadone and one (5.3%) accessed safe injection supplies through their
city’s harm reduction initiatives. A majority (57.9%) reported that they had attended a residential

50

treatment centre in an effort to overcome their addiction, while four (21.1%) relied on the 12step program offered by NA and AA, and two (10.5%) attended counselling. Of these
participants, four (21.1%) also used opioid agonist therapy, such as prescribed methadone or
Suboxone.
Table 1. Sample Demographics and Substance Use Characteristics.
N = 19
Gender
Female
Male

4
15

Age
19-29
30-39
40-49
50-59
60-68

4
1
6
3
5

Level of Education
Less than High School
High School
College / Vocational
University

5
8
5
1

Employment
Employed Full/Part Time
Self-Employed
Retired
Unable to Work due to Health

15
1
2
1

Years Dependent on a Substance
2-9
10-19
20-29
30-33

5
4
9
1
(continued)

51

Table 1. (Continued)
N = 19
Age Drug Use Began
12 Years or Younger
Between 13 and 20 Years Old
Between 21 and 23 Years Old

5
11
3

Substances Used
All
9
All Except Heroin
2
Heroin and Methamphetamines Only
2
Combinations (cannabis, cocaine, crack-cocaine, LSD, GHB, MDMA, and methamphetamines)
6
Intravenous Drug Use
Yes
10
No
9
Current Drug Use
Yes
No

2
17

Current Rehabilitation Effort
12-Step Programs
One-on-One Counselling

16
3

Method Used to Overcome Addiction
Residential Treatment
12-Step Programs
One-on-One Counselling

11
4
2

Research Design and Procedure
The research design was qualitative in nature and employed the use of semi-structured
interviews with 19 participants. The interviews took place between 30 June 2019 and 1 October
2019. The interviews were semi-structured, meaning a formalized list of questions was not
followed; rather, a series of open-ended questions were asked that allowed for a discussion with
the interviewee. In particular, an interview guide was formalized that included: several

52

demographic questions; approximately eight general open-ended questions; and several word
association prompts to organize and stimulate further discussion (see Appendix A: Interview
Guide).
The interviews were conducted in English, as it is the only fluent language of the
researcher. Additionally, all interviews were conducted one-on-one. All interviews were audio
recorded and later transcribed verbatim for data analysis. Digital audio files were transcribed by
listening to each recording and typing into a Microsoft Word document what had been said
during the interview. This was completed after the interview.
Each participant was reimbursed with a $10 CAD Tim Hortons gift card for their time
and possible travel expenses. On average, the interviews were a half hour in length, although
they ranged from 15 minutes to one hour. Each participant was met in a location that was
suitable and convenient for the participant, as well as safe and secure for the researcher. To
complete the interviews, several trips were made from the coast to the interior of BC. Several
interviews were conducted using a telephone, due to the remote location of the participant or by
the choice of the participant (one participant felt more comfortable being interviewed by
telephone). All participants signed and sent a copy of the consent form prior to the interview
being conducted.
The data collected in the in-depth, semi-structured interviews was analyzed using an
inductive approach. An inductive approach allows for research findings to emerge from the
frequent, dominant, or significant themes within the data, without the restraints enforced by
structured methodologies. This approach is different from deductive methods commonly used in
experimental and hypothesis testing in which key themes are often obscured, reframed, or left
invisible due to the preconceptions in data collection and analysis (Thomas, 2006).

53

Applying an inductive approach to evaluate the interviews was useful for several reasons.
First, it condensed broad and varied text into a summary format. Second, it established clear
links between the research objectives and the research findings. Third, it helped to understand the
main themes that emerged from the data. The analysis of the findings was an iterative process
that was completed by the researcher alone. Microsoft Word and Microsoft Excel were used to
organize and draw themes from the data.
Ethical Considerations
Ethical approval for this study was obtained from the University of the Fraser Valley’s
(UFV) Human Ethics Research Board (see Appendix B: Certificate of Human Research Ethics
Board Approval). The approval term was from 5 June 2019 to 4 June 2020. Participation in this
study was completely voluntary, and participants were asked to provide informed consent prior
to their participation (see Appendix C: Informed Consent and Consent of Participation Forms). If
a participant withdrew from the study, they were aware that their data would not be used, and the
interview recording would be destroyed immediately. Due to the nature of snowball sampling,
complete anonymity was not possible; however, confidentiality was guaranteed. All possible
measures were taken to ensure that written information could not be directly connected to any
one participant, including the use of pseudonyms in the report.15
To ensure that the participants’ information and identity were protected, the data was
stored on a password-protected folder on a personal computer and only the researcher directly
involved in this study had access to it. All identifying documents pertaining to the interviews
were destroyed after the research was completed. Lastly, while the study did not use deceptive
tactics, or intend to cause any physical harm to participants, some discussion topics had the

15

The pseudonyms used within this report were chosen by the participants of the study.

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potential to trigger difficult or sensitive memories, which could be mentally and emotionally
strenuous. Therefore, participants were provided with information on how to access a counsellor
should they require additional support or debriefing.
It should be noted that special considerations were taken for conducting research with
individuals who have experienced substance addiction. First, steps were made to ensure the
research relationships and interview environment were equitable as possible. Second, the right of
the participants to make their own decisions about their lives and the degree of participation in
the research process were respected and supported. In particular, the rights and well-being of the
participants were privileged over the objectives of this project and the dignity of the participants
was upheld during their portrayal.

55

Chapter 5: Findings
General Perspectives on Canadian Drug Policy: Advancing or Archaic?
To assess the research objectives, participants were asked about their perspectives on
current Canadian drug laws and on current strategies being implemented in Canada. These
strategies included harm reduction measures and abstinence-based treatment. When asked
specifically for their perspective on Canadian drug policy in general, 13 participants shared their
views without further prompting. Several similarities emerged from these answers, with only a
few participant outliers.
Only one participant response supported the current Canadian drug policy. The
participant stated:
I think they’re doing an ok job. I think there’s going to be some things happening in the
future, potentially legalizing certain drugs. I’ve heard they’re trying to legalize
pharmaceutical grade heroin for people who are addicted to that. I think they’re heading
in the right direction, I guess. (SMc)
While this viewpoint is optimistic, it reveals the support and desire for change in the Canadian
context.
Some of the participants had mixed feelings on the current state of Canadian drug policy.
One participant held the view that while Canadian drug policy has positively advanced in recent
years, the legalization of cannabis was not a positive improvement. He stated:
I think it’s a lot better these days. My thoughts on the legalized marijuana, I have two
thoughts. On one end it’s kind of good, but on the other end, does it really change
anything? It’s almost giving people more opportunity to become addicts and they’re just
like any other person, they don’t understand what they’re consuming. They have a
thought pattern on it, like it’s not that bad, it’s an herb, it’s grown naturally, but it’s like,
sorry it is bad, and it will mess you up and it will just lead to other things… It comes
down to education, you have to start when people are young, you have to change the
culture, you have you change the idea that you’re cool because you smoke marijuana.
You’re not cool because you smoke marijuana, you’re stupid. You’re robbing your brain,
especially for young people. These young people that start when they’re 12, I didn’t start
with weed until I was 19, I’m not saying I’m a superhero but it’s better than when you’re

56

12 and your brain is still forming. You’re disrupting all those neuropaths and what
chance have you got at becoming the best you can be. (Howler)
Evidently, there is fear of the long-term consequences of legalizing specific substances, such as
cannabis, especially given the associated consequences for young people. Similarly, a second
participant voiced his concern of the legalization of cannabis, by stating, “The legalization of pot
to me was not a good thing, I don’t like that” (Turtle). These respondents both felt that the
legalization of cannabis in Canada in 2018 would be detrimental for those struggling with
substance addiction.
Two of the participants voiced concern over the implementation of harm reduction
strategies when speaking about Canadian drug policy. Referencing opioid agonist therapy, such
as methadone and Suboxone maintenance programs, Joe Blow stated:
My overall view on them [Canadian drug policies] is that they are not working, and I
think they need to change them. So, I don’t really know what their strategy is, but I know
that their strategy isn’t working, and I believe that a lot of their strategies are about harm
reduction, and personally I believe that harm reduction does not work and is not working.
And most of the addicts that I’ve tried to help and have worked with over the past 28
years, that have been on harm reduction [methadone and Suboxone] are using other drugs
while they are on harm reduction, and harm reduction just enables them to use other
drugs and to continue in their cycle of addiction.
The other participant, Princess, voiced concerns about the implementation of SIFs and OPSs in
her hometown, reporting:
What I get in my own hometown is that they have using stations and using places, which
I get, people are going to use, and they might as well have a safe place. But honestly, I
think when they’re handing out free fucking needles, they’re enabling it all. And making
this whole problem. I’m not trying to sound like a bitch against addicts, but you’re
choosing to use. Those people that don’t want to quit are just getting free needles. So
honestly, I think the governments just enable it and keeping this vicious cycle going
instead of deleting it. The only thing I do agree with around this city is we’ve built
homeless shelters.
These concerns were shared by other participants when they were asked specifically about their
views on harm reduction measures.

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Seven of the participants in the sample reported similar views on Canadian drug policy –
that Canadian drug policy is both outdated and overtly harsh on those struggling with substance
addiction. One participant, Trojan Horse, stated that “They [Canadian drug policies] need
change, a lot of its archaic.” The theme of describing Canadian drug policy as archaic continued
throughout multiple interviews. One participant described Canadian drug policy as “archaic” and
then continued:
We are trying to use jail and policing to deal with a mental, social, and economic problem
more than anything else. It will never work. It hasn’t worked. Prohibition of alcohol
didn’t work and our substance abuse problem in North America is getting worse and
worse all the time. There are laws, where right now we are currently giving away needles
for people to do illegal stuff. So, when a law says it’s illegal, if we are given a clean
injection site, we are actually as a society saying it is legal. And our laws need to catch up
with that. That’s what I fully believe. We will never beat this with laws. (Tank)
Similarly, while not specifically using the term archaic, another participant reported:
They’re not helpful, they’re based on the Draconian US drug war. I think we’ve had it
wrong for a long time and even though its proven wrong we just keep it and expect
different results. And what we’re seeing, all this rampant addiction, has been there for
fifty years or more, there’s deadlier substances now, there’s generational addiction, and
people think that this is the addict’s fault, some people think this, and that influences
government policy. But if the policy changed, you’d see such a benefit in health, not only
to the individual people but society as a whole… It’s going to take like 10 years like it
did in Portugal of policy change and implementation of a totally different system of
compassionate care that hasn’t been here. So, you’re not going to change 50 years of
neglect with 1000 naloxone kits and getting everybody on methadone and then expecting
it to be different but you’re still coming at it from a punishment model and not a
compassionate model. Until we as a whole get our heads wrapped around that and some
politicians dying on the sword for that, if they have to, I don’t see the policy changing.
(Magtek158)
Essentially, these participants felt that Canadian drug policy is out-dated and has relied too
heavily on past decisions relating to Canadian drug laws and drug policy in the US.
Several participants echoed these sentiments while also suggesting alternative solutions.
One respondent stated:

58

I think we’re probably following the War on Drugs model too much, and in my opinion
that’s not very effective. Downward pressure from south of the border. So, a lot of time
legislators’ hands are tied. I think decriminalizing is a good start, so for me the cannabis
legalization is a good start, at least to get the conversation going because I think filling
our prison systems with addicts and people who need help, criminalizing them and giving
them a record, I know too many people who did something as a young person and it
follows them forever and have struggled. So, I think it needs to shift. (Ogre)
Similarly, Snowman noted:
Honestly, I don’t think when people are doing stuff to support their addiction they
deserve to get the maximum sentences, like I don’t think that they should get away with
it, but it should be like, I was saying, I think it’s Sweden but I could be wrong, where if
you get arrested and you are an addict, they give you jail, treatment, school, job, and a
place… I can’t remember the exact numbers or anything. But going back to drugs and
doing the same thing is lowered, because they give you the tools you need and here they
don’t.
Some participants also explored the link between punishment, crime, and shame, without
prompting. One such participant reported:
I think that it’s a lot of punishment in it, and I don’t think that is exactly like, I don’t
know, I don’t think that it really fixes things, you know, and I really think that a lot of it
is dehumanizing. Just the opinions on it and you know how it’s all like, let’s put them in
jail, let’s punish them like they are worthless. You know? So, I don’t particularly like it.
I’m not saying that I think it should be promoted but, it shouldn’t be so like, no no no no,
and shameful. You know? (Karma)
This participant brought the dangers of criminalizing and punishing individuals experiencing
substance addiction to the forefront, by speaking of its dehumanizing process and the outcome of
shame.
In general, and consistent with previous research in this area, these findings illustrate the
differing views between the participants, despite their shared experiences (Darke & Torok, 2013;
Lancaster et al., 2014; Lancaster et al., 2015). Notwithstanding the differences, it is clear that
many respondents view current Canadian drug policy negatively and in need of change. Due to
the generalized nature of the first question, participants were asked about their perspectives on
Canadian drug laws, harm reduction strategies, and abstinence-based treatment programs.

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To Legalize, Decriminalize, or Penalize
Participants were asked about their views on the recent legalization of cannabis in
Canada and whether they believed other illicit substances should be legalized or decriminalized.
Five of the participants objected to the legalization of cannabis in Canada. Some of these
participants noted concerns about the difficulties of enforcing laws, such as preventing
intoxicated driving. Another participant, Con, opposed the legalization of cannabis based on his
own experiences with the substance, stating:
I used to smoke a lot of weed, so, I feel that I can say that when I did smoke weed, I
wanted it to be legal, and I was like, oh it’s not that bad, but when I quit, I realized how
much it was affecting me. So, I just think that those people are caught up in their own shit
and they don’t really realize how much it’s actually affecting them.
Comparatively, 11 of the participants supported the legalization of cannabis in Canada.
These participants noted the benefits of using the drug. Some participants noted that cannabis use
was less harmful than drinking alcohol. Other participants supported the legalization because of
its health benefits to those struggling with chronic pain or certain diseases and disorders. A
participant, who had admitted to using cannabis for health reasons, stated:
My methadone has come down, I am off my anti-depressants, I am off my antipsychotics, like it [cannabis] has replaced a lot of stuff in a good way. And I don’t smoke
all day every day. It’s not like I wake up and I’m like fuck I need one now, usually I get
what I have to get done in the day, and then at night, I have a puff. (Snowman)
This participant noted that like anything, cannabis, if used, should be used in moderation.
Moreover, one participant reported little change since the legalization of cannabis, either
than seeing the drug around more than before. Rusty stated: “With it being legal, I’m not sure if
it has changed much. I haven’t noticed anything else other than you see it a lot more than you
normally would. Other than that, I don’t think it’s hurting anything.” This supports the
perspective that the legalization of cannabis has not resulted in increased harm to members of

60

Canadian society. These perspectives were consistent with the findings of Osborne and Fogel
(2017), who also found that a majority of Canadian participants favoured the legalization of
cannabis. Lastly, several others noted that the legalization of cannabis was “… a big first step”
for Canadian drug policy. These participants reported being hopeful that the legalization of
cannabis will lead to the legalization or decriminalization of other illicit substances in Canada.
Five participants opposed the legalization of cannabis, which is the same number as those
who opposed the legalization or decriminalization of other illicit substances; however, the five
participants in each group were different. This is because two of the participants opposed the
legalization of cannabis yet supported the decriminalization of other illicit substances.
Comparatively, two were against the legalization or decriminalization of other substances yet
supported the legalization of cannabis in Canada. Only three opposed all forms of legalization
and decriminalization for all substances, including illicit substances and cannabis. Hence, five of
the participants reported being opposed to the legalization or decriminalization of illicit
substances. Howler voiced concern about the effects of legalizing certain drugs, by stating:
Just think of the mayhem that would start if you decriminalized heroin. You’d have
people lining up for miles at wherever they dispense it. It’s bad enough the way it is now,
they make it too easy for people now.
Comparatively, many voiced their support for the government to legalize or decriminalize other
illicit substances.
Those who spoke of legalizing other illicit substances indicated the need for a legal and
safe supply of heroin offered in Canada. One participant reported:
When I went to university I looked into studies and some of the things they did, pilot
project in England, and you know, I mean they ended up having people who are heroin
addicts pick up their heroin every day, and go to work, and they were committed people
of society again and contributing. And they are not kicking in your back door, or
businesses back door to steal money, because they are getting their heroin every day and
they just go to work like everybody else. And so, what I would like to see is the

61

government really do an in-depth study or study it more, to come up with what that is
going to look like. You know it’s fine for the question of thinking legalization is a good
thing, but I think we need to have more information to really go, yea that’s a good idea!
Or I am not so sure. So, yea, a lot more information would really be needed, I mean there
are studies, like look at Portugal, and what they’ve done. There are a lot of countries,
Switzerland, there are a lot of countries that have done this. Will it work in Canada? I
don’t know. Being next to a country that has Neanderthal ideas about drug addiction,
amongst other things? But so yea, will it work in Canada? I don’t know… I think we
need to look at it more, we need to put more money towards it and move in that direction
of change. I just don’t know what that looks like to have it. It’s going to be regulated, but
how is the question. So, I am for it. I mean, people are dying. (Lovern)
Another participant, Centaur, added:
If you are going to legalize one, you may as well do them all. Do the ones that are
causing all the damage, major damage, and that’s the heroin and the crack that is being
made and the people that are having. How stupid are they? I mean, get the drugs legalized
and under control so that our friends, and our families, and our loved ones who are
smoking that shit aren’t going to die from it, because it’s actually got some substantial
drugs involved in it.
The need for more research on the effects of legalizing certain illicit substances resonated with
many of the participants.
Another participant, Tank, anticipated how others might react to the idea of legalizing
heroin and other illicit substances and countered it by asserting:
I know there is a lot of worry and I hear a lot of people talk, well if we legalize, we can’t
legalize heroin, and I’m like “why? Would you suddenly do heroin tomorrow if it was
legal?” and besides, if we licensed it and monitored it and somebody is overdoing it, we
could then intercede on their behalf. Right?
This participant argued that legalizing heroin and other ‘hard’ drugs would not necessarily
increase their use among the general Canadian population; instead, the legalization of these
substances would increase the ability to monitor and help those who are using.
Legalizing or decriminalizing illicit substances has been an increasingly common
approach in many countries to help reduce the harms associated with substance use. For
example, Switzerland, the United Kingdom (UK), Germany, and the Netherlands have offered

62

prescribed heroin under medical supervision (Transform Drug Policy Foundation, 2020). Heroinassisted treatment (HAT) is used to treat long-term addiction to illicit opioids, with the addiction
being unresponsive to other forms of treatment. The use of HAT has supported arguments for the
legalization of a safe drug supply in these countries (Transform Drug Policy Foundation, 2020).
In countries, such as Portugal, Costa Rica, the Czech Republic, the use of illicit
substances is not punished criminally, and the possession of small amounts of the substances are
allowed (European Monitoring Centre for Drugs and Drug Addiction [EMCDDA], 2017;
EMCDDA, 2019). These countries have formed their own drug policies, in which illicit
substances are decriminalized. These countries have succeeded in decreasing the spread of HIV
and AIDS, and decreasing drug-related overdose deaths (EMCDDA, 2017; EMCDDA, 2019).
Many of the participants agreed with decriminalizing all illicit substances in Canada and
implementing a medical model approach, as seen in countries such as Portugal. Although these
arguments varied, several participants noted how decriminalizing drug use and possession would
reduce the criminalization and the subsequent stigmatization of people who use drugs. Jesus
argued to “… decriminalize the petty addict, the 16-year-old kid homeless on the street corner
peddling a dime bag of blow because somebody gave it to him but penalize the guy that brought
in the kilo.” Echoing these sentiments, another participant, Joe Blow, maintained: “I think they
[illicit substances] should all be decriminalized. And then we should go towards a treatment
model in society, where we are encouraging people to seek help for their problem.” While the
participants did not necessarily support illicit drug use, they supported the idea that
decriminalization of illicit substances could help people recover from addiction.
A participant who eloquently explained this idea stated:
I don’t think all drugs should be legalized, they should be decriminalized. They do a
really go job in other parts of the world, Portugal is one example, in New York they have

63

drug courts that have taken a lot of the pressure off the courts. The majority of people
doing drugs are not doing criminal behaviour, there’s a faction that are, and I think some
of that driven by the policies because they’re demonized and criminalized and not
engaged in society. That’s not going to totally go away because you decriminalize drugs
but a large majority of it would and for the stuff that’s not, there should be consequences
for criminal actions but separating those two things in people’s minds, criminal action
from people who use drugs, because the use of drugs has been criminalized for so long in
North America that people associate the two as one thing. A lot of people on the whole
assume every homeless person must be an addict and using, or every person with mental
health challenges must be an addict. These are some of the attitudes that have prevailed
and helped policy lagged behind, and it doesn’t really matter which came first, the
chicken or the egg, the criminalization and demonization of drug addicts has helped
sustain those attitudes in society, or those attitudes have help sustain the policy, but they
feed each other. (Magtek158)
Given the negative implications and stigmatization that result from the implementation of these
laws, the continued criminalization of drug use is viewed as harmful.
Another participant agreed that illicit substances in Canada should be decriminalized but
was sceptical of this becoming a reality. In summary, the participant maintained that models of
decriminalization have been successful in other jurisdictions, such as Portugal; however, due to
the prohibitionist nature of Canadian drug policy, he was uncertain of this model being
successfully implemented in Canada. Despite this uncertainty, the participant was in support of
researching and testing the idea.
A majority (57.9%) of the participants supported the legalization of cannabis in Canada.
Moreover, a majority (63.3%) also supported either legalizing or decriminalizing other illicit
substances in Canada. These findings are important to note, since decriminalizing illicit
substances and legalizing a safe supply of heroin are both policy options being discussed in
Canada (Angus Reid Institute, 2019; Corace et al., 2019). Moreover, due to the overall support
for these law reform strategies, these options will be further considered and analyzed in the next
chapter.

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Reducing Harm: It Should be a Simple Answer, Right?
Participants were asked to describe their views on harm reduction measures. These
included SIFs, SCFs, OPSs, opioid agonist therapy, and naloxone kits. Perspectives among the
participants varied, with some supporting all harm reduction measures, some supporting certain
methods, and others not supporting harm reduction measures at all. The opposition or support for
these strategies seemed to be largely based on the strategy’s perceived effectiveness. Moreover,
many participants voiced uncertainty on this topic.
Those who opposed the use of harm reduction measures in Canada referenced their own
experiences with substance use. Sassy stated, “From my personal experience, the injection sites,
if there were those sites I probably would’ve used more because it was hard for me to get
paraphernalia.” Another participant, Joe Blow, who used the term harm reduction to mean opioid
agonist therapy, reported:
Harm reduction measures aren’t working… most addicts that go on harm reduction are
only using it to enable them to use other drugs, and not be dope sick, and they are using.
If harm reduction was monitored way more closely, and if you had people who tested
positive for any other drug while they are on harm reduction, and they were removed
from harm reduction immediately, the abuse of that system would go away, but there’s a
lot of financial gain and kickbacks to doctors and methadone recovery houses, and it’s all
about money, right? Those people need to be in it more for the actual help and helping
the addicts than the money that is involved.
In this instance, the participant did not agree with the implementation of methadone and
Suboxone maintenance programs, due to availability of other substances. Comparatively, Rusty
commented positively on the methadone maintenance program, maintaining, “I think the harm
reduction can be trouble at times, but I’ve also seen guys I work with come in on methadone and
within six months can slowly ween off that and actually have long term recovery.” Evidently,
participants have divided views on the benefits of this harm reduction measure.

65

There was also concern about the distribution of drug paraphernalia to people who use
drugs. These participants argued that while this practice was a positive advancement in drug
policy, there needs to be more addictions resources offered. One participant expressed:
Just getting them off the streets so we can’t see them doesn’t solve the problem, not even
slightly. So, I am glad we are moving towards that, but we need to move farther so that
we invest more in actual treatment so that when somebody says that they need help, our
response as a society should be, “Where are you? Somebody’s coming.” Not, “We are
putting you on a waiting list and in a month or two you’ll make it in”. That’s my belief to
really start solving the problem, in the meantime I think that it’s good the we’re giving
some clean needles, I just wish they had a plan to pick them up. And just handing them
out, us junkies aren’t really known for our cleanliness. It’s not on the top of the list, right
after you bank back a few points of heroin. (Tank)
These comments reflect how the perspectives among the participants vary. Many of the
participants formed opinions on harm reduction strategies based on their own lived experiences
with substance addiction. Some had negative experiences with certain harm reduction strategies,
which resulted in negative perspectives. Others understood the benefits of the strategy yet
highlighted the strategy’s weaknesses. Regardless of these variations, the benefits of harm
reduction strategies were contended.
Despite these concerns, there were several participants who indicated their support for
harm reduction measures. Many noted the benefits of harm reduction measures, maintaining that
they work to keep people who use drugs alive and well during a time that they may not
necessarily be capable of quitting. AJ explained:
I believe in every strategy to help and to minimize the effects of drugs is a good strategy.
Harm reduction helps people sometimes to be less scared of and less imprisoned, you
know what I mean, so in the long run it works both ways, to the government too, like less
spending money on drugs, that they want or not, they criminalize, you know, people for
the drugs, they spend more money on keeping them in prison, which is useless, right?
And then when they do this harm reduction, they can have more chance to educate people
about drugs and the rehabilitation, so it’s kind of like, in the long run, I think they can
save more people or change a lot of lives that way, than imprisonment.

66

Another maintained that harm reduction measures are “… a step in the right direction…” and
“… anything, be it safe injection sites and mobile clinics passing out needles, stuff like that is
positive” (Ogre). These participants recognized the need for increased safety measures for people
who use drugs, to avoid the spread of diseases, and to prevent overdoses and drug-related deaths.
One participant, Karma, who has utilized harm reduction strategies in her community, stated:
I think that it is really good that they have harm reduction, because I know that there
would be a lot of people with HIV and stuff like that if there wasn’t harm reduction. And
I might even have HIV if there was not harm reduction. You know? And I think that even
the people that you know, even if there was no harm reduction, there would be people
that get diseases, and if they become clean, they still have a disease for life. So that is
bad, and that could spread to more people that even never were drug users. So, I think it
helps the population, our community.
This participant argued that harm reduction measures help to decrease the health risks associated
with drug use.
Lastly, several participants indicated their support of the take-home naloxone kit program
in Canada. They explained that, due to the increase in opioid-related overdoses, the need for
naloxone has increased in recent years. Centaur explained: “The last three years I have attended a
total of 14 different people who have overdosed, to which I have had to either pump their chest,
or I had to inject them with Narcan.” Another participant, Rusty, similarly spoke about using a
naloxone kit on an overdosing stranger, stating:
Last week I actually had to bring somebody back in a Subway and it just happens that
they had a naloxone kit on them. It’s great, there’s just not enough people that are
educated on it, for example the workers at Subway had no idea what to do if someone
overdosed in their store and luckily, I just happen to walk in and hit them with the
naloxone. So, a little more education for the community would be great but I think that’s
starting to come together too because they are doing a lot more awareness with the
fentanyl crisis and the overdose crisis.

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These examples illustrate how important the distribution of naloxone kits is, as they are routinely
used to save lives. In general, the participants of this sample were conflicted in their views on
harm reduction measures.
All or Nothing, the Machine called Abstinence-based Treatment
A majority of the participants viewed abstinence-based treatment positively. This is not
surprising, given that a majority (57.9%) had attended a residential treatment centre to overcome
their addiction, while four (21.1%) relied on the 12-step abstinence-based program offered by
NA and AA. Additionally, 16 (84.2%) reported that they currently attend NA or AA meetings
regularly. Consequently, 14 (73.7%) of the participants perceived a combination of a treatment
program, counselling, and partaking in NA and AA meetings as the most effective approach.
One participant reported:
I think it works. I’m in an abstinence-based program and I think that works really good. I
don’t like the other wet facility very much because they’re not helping the problem in any
way. I think there are more recovery houses where people having a better shot at getting
the problem fixed. The recovery house where I’m at does a great job. (SMc)
The successful completion of an abstinence-based treatment program may have affected
the policy views of the participants in this sample. Critics may argue that this diminishes the
value of these findings; however, the study aimed to gain the insights of the participants – these
insights being made based on the learned knowledge and lived experiences of the participants.
While it is recognized that there may be a higher rate of support for abstinence-based treatment
in this sample, the responses are inherently valuable. Moreover, there were several themes drawn
from the participants’ responses.
Though a majority of the participants supported abstinence-based treatment avenues,
many reported the need for more available and affordable treatment options. One participant,
Karma, who supported abstinence-based treatment, stated:

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I think it’s unfair that they have treatment centers that you have to pay a lot of money for
though, because, you know, not everyone can do that. Like, why do they even have
those? But there’s a lack of treatment too. Like I know there’s not enough for everyone.
So, you have to get on a long waitlist and that’s not always good because you might be in
a different place in a year.
Similarly, Sassy recognized the difficulties of getting admitted into affordable treatment,
explaining, “… if you don’t have money, I don’t know how you’d get treatment, like I wouldn’t
have ever. And there are ones where you don’t pay but there’s such waiting lists.” Moreover,
Princess maintained that “We need cheaper rehab facilities, so people can afford to get that kind
of help.”
Participants also expressed the need for more treatment beds. One participant stated:
Abstinence based treatment programs? They’re wonderful, we need more. And we need
more free ones, not everyone can afford $13,000 a month for treatment programs. The
government needs to look at getting people to abstain somehow to get them back
integrated into society and feeling good about themselves. When you’ve got homeless
people that hate life and aren’t happy it’s just a downward spiral. And then the crime that
spews out of the addiction like the B&E’s, drug dealing, prostitution and on and on, it’s a
plague. We need more treatment centres. (Turtle)
These findings are important, as many of the participants indicated that those who are deeply
entrenched in drug use often lack family and positive peer support or the money to afford
immediate treatment. Subsequently, this deters those in active addiction from seeking and
successfully completing abstinence-based treatment programs.
Some of the participants also indicated that while treatment programs are beneficial, they
need to incorporate holistic healing methods. AJ explained:
The treatment programs, in my view and in my studies, I feel like you can’t treat one
thing without the other. Like it’s going to have to be dual treatment, like you can’t treat
addiction without treating other parts of like, the environment, you know what I mean,
the background, the disorders, along with the addiction. So, I think you have to be treated
all at once in order to really beat addiction. Cause if someone, they do drugs because of
depression, then if you don’t treat the cause of the depression, why they are depressed,
then they will keep doing it. Like kids that grow up that are homeless, and they are
dysfunctional, they have to steal and when they do all those things, they become

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depressed and anxious, and live in fear, and drugs become almost like a medicine to
function or feel comfortable, like less care. So, if you want to treat that addiction, you got
to make sure that these people have a life worth living. Like, you know, they have access
to education, access to a home, stuff like that, so I mean, the whole community and the
government have to be a part of treatment, in a sense.
This participant emphasized the need for treatment programs to consider and respond to the
unique needs of every individual. This includes considering the lived experiences and past
traumas of each patient, before creating a treatment plan for that individual.
Several participants noted that abstinence-based treatment programs are largely
unsuccessful when the individual is forced to participate. Joe Blow explained, “Well treatment
programs are wonderful, if you get the addict when they are willing to get clean…”, while
Princess added, “Unfortunately, I think many people go to treatment that are forced to and they
don’t really want to get treatment and they relapse right away.” Another participant, Con, who
was not entirely in support of abstinence-based treatment programs, stated:
I guess they kind of work, they work for people who want to do them. If you want to quit,
then you’ll quit, but if you don’t then no one can force you to. So, they are effective for
people who want to, or maybe if they’ve gone rock bottom or something like that, but
otherwise, I don’t really know. They don’t seem that effective. And people don’t seem to
really like it, the whole stigma around it where people don’t really like that sort of thing.
Participants agreed that abstinence-based treatment programs are beneficial for those interested
in overcoming their addiction; however, these programs are usually not beneficial to those
mandated to participate.
Only two of the participants opposed against abstinence-based treatment programs. Both
had experienced abstinence-based treatment in some capacity yet were sceptical of their benefits.
Moreover, one participant, Lovern, explained the danger of a uniform approach to substance
addiction, stating:
I think there was this philosophy of one size fits all and there is still that mentality among
many of the old timers in alcoholics anonymous and narcotics anonymous, that one size

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fits all, that we are the answer. The book that I read in alcoholics anonymous says that on
the very last page, says that we know only a little, you know? We know only a little. And
so, I think that abstinence-based programs had their day, and it will be a good day when
they are gone for good in that regard where we forced people to do this, abstinencebased, no. People need choice. People need freedom to be able to decide what’s best for
themselves. You know, there’s this idea that on one hand, that addicts can’t decide for
themselves, and don’t, you know, all people, you, me, we know the sum total of all our
days and I do, and you do, and we know what has worked for us in our lives and what
hasn’t. No one else knows, but we do. And with that information we really need to
choose, well I tried that, and it really didn’t work for me and I didn’t feel comfortable,
well then, it’s time to look at something else. So, yea, I think these other options need to
be even more available to people and yea, abstinence-based, I don’t know.
While many of the participants had experienced abstinence-based treatment programs during
their recovery, there were two suggestions made to improve these programs. The first suggestion
was to increase treatment availability and affordability. The second recommendation was to
increase treatment options that focus on each individual’s specific needs. Apart from these
suggestions, it is evident that abstinence-based treatment programs should be entered willingly,
as the effectiveness of the programs can be hindered by an individual’s reluctance to become and
remain sober.
Canadian Drug Policy: Have You Felt the Changes?
All of the participants indicated that they felt the approaches taken by the government
towards substance addiction have changed in Canada. Moreover, a majority (63.2%) agreed with
the perceived changes. Many indicated that they agreed with the increase in harm reduction
measures and low-income housing developments that have been implemented by the government
in recent years. One participant explained:
I haven’t been around that long, so I don’t know, but it seems like they are more like, I
can go to interior health and get supplies, I can go to a pathways and get counselling or
drugs that help, and there are some places that are accepting about it, whereas back in the
day, I think it wasn’t allowed at all. I think it was so shameful and a secret. You know?
So, I think we are coming around to accepting, not accepting it, but it being like, okay
let’s help you not just like, you’re bad. Yea, I am glad. It’s better. (Karma)

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While many identified and supported the changes to Canadian drug policy, many argued
that more change was needed to address the current epidemic. Becky maintained “I think that
they should be doing more, like, I do agree [with the changes], I just think they could be doing
more.” Mirroring these sentiments, another participant stated:
It’s progressed, has it progressed fast enough? You know, I guess if you talk to a mother
or father who has just lost their son or their daughter, not quick enough. So, do I think
that it’s a good idea? The faster that we can progress with studies and ideas and move in a
direction towards more harm reduction and legalization, and the regulation of that, the
better off moms and dads and their children, whoever else’s families are going to be.
(Lovern)
Additionally, a third explained:
Yeah, it’s changing, I agree with them, there’s more talk than there is change, like there’s
a lot of discussion. I do feel the swing starting, I think it started about 5 years ago and
we’re about a quarter of the way into the pendulum where it needs to swing to where
we’re really doing well, having all these resources available and treating people.
(Magtek158)
It is clear from these statements that while the recent changes in legislation and strategies are
generally supported, there is still a need for further innovation.
A minority (31.6%) indicated that they did not support the changes the government has
made in recent years. This is due to the perception that these changes had not fixed or improved
the underlying causes of the overdose epidemic, rather these changes were viewed as addressing
merely the symptoms of a greater problem. Moreover, those who opposed the implementation of
harm reduction measures were also opposed to the government’s mandate in recent years. One
such participant, Tank, asserted:
I am seeing quite a change, I am seeing a lot more investment and a lot more political
will to help, but I am afraid that I am seeing the approach stay much the same that is has
been for a long time. As I say, just giving somebody a place to live so we can’t see them
in the park and then clean needles has not worked, they are still out doing the same crime
that they were… Drugs are not the problem, they are a symptom of an underlying
problem and if we never deal with the actual problem, we will never get rid of the
symptom.

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In a sense, the participant is speaking to the inability of harm reduction strategies to address the
root causes of substance addiction.
Beneficial or Harmful? Punitive vs. Rehabilitative Approaches
One objective of this study was to analyze the perceived effects of punitive versus
rehabilitative approaches to preventing or treating substance addiction. To do this, participants
were asked about their views on tough-on-crime and harm reduction approaches – specifically
whether these strategies were beneficial or harmful to someone experiencing a substance
addiction.16
Is there Love for Tough Love?
The participants were asked if, in their own experience, they felt tough-on-crime
approaches were beneficial or harmful to someone experiencing a substance addiction. A
majority (78.9%) of the participants stated that tough-on-crime approaches were harmful.
Notably, only one supported this approach, stating “Who cares? If they are breaking the law, let
the time suit the crime” (Centaur). Those who opposed the use of tough-on-crime approaches
explained that punitive measures, such as harsh penalties for drug possession and use, were
harmful to those in active addiction. These participants agreed that the criminalization of people
who use drugs contributes to an increase in shame and stigmatization. Moreover, the participants
seemed to agree that punitive approaches do not address the root causes of addiction and

16

The participants were asked their views on harm reduction approaches, since rehabilitative-based drug policy
generally involves an emphasis on strategies aimed at reducing drug use and its harms. Treatment, programming,
and counselling are all associated with a rehabilitative approach. Nonetheless, harm reduction strategies, such as
SIFs, SCFs, OPSs, opioid agonist therapy, and naloxone kit programs are arguably rehabilitative in nature, as they
serve as a stepping stone before an individual is accepting of treatment, programming, and counselling. Moreover,
harm reduction strategies are also often used alongside treatment, programming, and counselling, as a means to
reduce harms before an individual has fully recovered from their addiction. Essentially, harm reduction approaches
were used to guide this interview question, since these approaches are currently being emphasized by the Canadian
Government’s drug policy mandate, which is a mandate focused on the rehabilitation of those with substance
addiction.

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subsequently lead to institutionalization and further criminal behaviour. Lastly, many explained
that while people who use drugs should not be penalized for drug possession or use, there should
be harsh penalties for the non-addicted drug supplier.
When describing the negative effects of punitive measures, the participants spoke of their
own increased shame as they became criminally entrenched. Jesus explained:
Well when I first started using, well I started using for all sorts of stupid reasons, but
what I found was that I was ashamed that I used, so I used to feel not ashamed, and the
more I kept using, the more ashamed I got which meant the more I had to use. And it led
to petty crime and theft and then the more I got punished for it, the more ashamed I
became, so the more I kept using because I felt ashamed. So, it just compounds it, I mean,
it makes it worse, it’s stupid. Like what, you did a bad thing, we are going to make you
feel like shit and we’re going to alienate you from friends, family, and loved ones, we’re
going to exile you in a corner somewhere, because the rest of the world hates you. But go
fix yourself. So, no, it’s the worst thing you can do.
This sentiment was shared with other participants in the study. For example, Becky maintained:
At the end of the day, they are just people, they are just people like you and I, and I don’t
think that ostracizing them because they have an addiction makes them different in any
way, and I think that there could be different measures, so instead of criminalizing them
and putting them in prison, they should be provided with treatment, or a recovery
program, or something like that. As opposed to like, “You are going to jail, because you
are addicted to heroin!”
These examples indicated a negative effect associated with the criminalization of people who use
drugs. Unfortunately, this is not the only negative outcome of utilizing punitive measures against
this population.
A second theme that emerged was the fact that these measures simply do not address the
root causes of substance addiction. One participant explained:
I don’t think sending someone to jail because they’re a heroin addict helps the situation.
They need treatment, they need to get to the source of their addiction. All that
incarceration does, in my opinion, and I’ve been there, it gets you institutionalized in
these places, you get hardened in these places. (Turtle)

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Another participant, Magtek158, echoed these sentiments by stating that tough-on-crime
approaches are “…harmful, completely… Obviously that hasn’t been working but people are
wanting to punish them harder. But we should be dealing with their substance abuse, and then
dealing with that emotional, childhood trauma, whatever is causing this and see what happens.”
Ultimately many of the participants shared the opinion that tough-on-crime approaches neglect
the causes of substance addiction and only address the symptoms. This results in criminalization
and institutionalization – an outcome that is not necessarily conducive to rehabilitation.
A third theme that emerged was the view that tough-on-crime approaches increase
criminal entrenchment. When responding to the benefits or harms of tough-on-crime approaches,
Snowman asserted:
Oh, it is definitely harmful. Like I know for sure that if I didn’t end up spending so much
time in jail over fucking drugs, not drug charges, but stuff to do with drug related
charges, I wouldn’t have gotten into everything else that I did, because, like, you learn so
much. It’s pretty much university for criminals. Right? And somebody, like I agree that
drug addiction is an illness, right? Like it’s not a choice, it’s an illness, so like, would you
lock somebody up because they are diabetic? Or they are down-syndrome? Or like, you
know. You don’t put them in jail. It’s not the way to deal with it.
This participant was not alone in suggesting that incarceration increased their propensity to
commit more crimes and to continue using drugs. Another participant, AJ, explained:
I’ve been arrested for possession and for something like a very small amount, and I was
just imprisoned for like a possession, and like, when I go to jail, like, I remember I did, in
jail I met more criminal people and so I had more connections of criminal mentality, and
I would sell drugs too and so I would get hooked up in that business and that lifestyle,
and I know more connections with criminals, so it didn’t help me and I don’t think it
helped the government either because when I go it costs a lot of money for the
government to keep me in prison, and at the same time, it doesn’t benefit me or the
government.
These examples illustrated how incarceration can lead to increased negative peer connections
and solidified criminal lifestyles. Ultimately, tough-on-crime approaches were not perceived as

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beneficial to those struggling with addiction, as they were perceived to increase shame and
stigmatization, decrease the chances of rehabilitation, and increase criminal learning.
The last theme to emerge from this question was the agreement among participants that
tough-on-crime approaches should be used against those who are supplying the drugs. Princess
mentioned, “If you’re a drug dealer, you need to fucking go away and stay away. You’re
choosing to sell hard drugs to addicts and you’re destroying lives. Those people need to be put
away and stopped.” Another participant, Joe Blow, who agreed with this idea, stated:
I think they [tough-on-crime approaches] are actually harmful, now, harsher penalties on
trafficking, especially on traffickers that aren’t actually addicted to drugs, right? The
people that are actually making money off of the misery that’s going on. See, there are
two types of traffickers, there’s the traffickers that are making profit off of it, that don’t
use drugs, and then there are the ones that are trafficking merely to support their
addiction. The ones that are trafficking merely to support their addiction, giving them
harsher penalties really isn’t helping them, it’s just allowing them to be in a different
environment and building a network of people that are involved in the same stuff, so it
doesn’t help the solution at all. Harsher penalties for people who are trafficking narcotics
who are not addicted, I’d be all for that. Because in my opinion, those people are really
scummy. Now, when you are addicted to drugs and you are selling drugs because you are
addicted, well sometimes you are doing it because that’s what you go to do, you know?
These sentiments support the view that the personal possession and use of illicit drugs
should be decriminalized in Canada. The participants argued that if a medical model approach
was imposed, more individuals could seek help for their substance addiction. Furthermore, they
maintained that this option would still allow for drug traffickers to be charged and convicted of
crimes, which they strongly supported. In general, the negative views on tough-on-crime
approaches among the participants supported arguments for decriminalization.
The Winner of the Least Effective Strategy Vote Goes to…
When participants were asked about the least effective approach in Canada, 52.6% (10)
indicated criminalization and incarceration. Many explained that treating those with substance
addiction would be more effective than charging, convicting, and imprisoning them. Joe Blow

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asserted that the least effective method for handling people with substance addiction was “…
treating them like criminals instead of treating them like people, right? Addicts are somebody’s
son, daughter, mother, father, somebody’s child, right? We need to start treating them more like
people.” These participants recognized that there were harms associated with the incarceration
and criminalization of people who use drugs, which led to the belief that this option was the least
effective for those struggling with substance addiction.17
Strategies to Save Lives: Is it Enough?
A majority of the participants reported that harm reduction approaches were beneficial
for reducing drug associated harms and drug-related deaths. However, many voiced concerns
that these strategies were merely short-term bandage solutions, failing to address the more
important issues in Canada. Moreover, many reported that improvements are needed to the
implementation of harm reduction strategies to ensure that a connection between harm reduction
and treatment is made.
There were two participants who believed the use of harm reduction strategies were
harmful. They both maintained that harm reduction strategies enable those who use drugs to
continue using. One explained that harm reduction measures are “definitely harmful. I think it
helps them out, it keeps them going like, ‘It’s not a big deal if I overdose now’” (SMc).
Comparatively, another participant, Magtek158, stated:
They’re obviously beneficial. We’ve seen huge cuts in overdose deaths, the last I heard
there hasn’t been an overdose death in the Vancouver safe injection site. Even the
handing out of clean paraphernalia, you even have some questions, like my sponsor, if
17

These perceptions are consistent with previous research that has illustrated the serious health and social harms of
criminalizing individuals for using and possessing illicit substances (de Villa, 2018). Some of these recognized
harms included: increasing negative stereotypes and stigma of those who use drugs from service providers, family
members, and the general public; creating criminal records that hinder employment and ability to find housing;
enhancing difficulties accessing harm reduction services; forcing individuals into unsafe spaces and high-risk
behaviours; increasing overdose and blood-borne infections, such as HIV, hepatitis, and tuberculosis; creating an
illegal drug market; and costing Canadian police, courts, and prisons an extra two billion dollars a year to enforce
drug laws (de Villa, 2018).

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you’re enabling. But when we were using people just overdosed and died because they
didn’t get help and then you just went through their pockets for what they didn’t need
anymore. And I asked him if he ever smoked out of a light bulb or out a tin can, did you
ever shoot up with puddle water? Of course, he did. It didn’t change the fact if you had a
good needle to use, nobody enabled him, and he used for 30 years. And he said, “Oh yeah
that’s a good point”. It’s very beneficial, they’re great engagement tools, especially the
safe use sites. Another mistake that people make is thinking people want to be using, I
would be very shocked if 10% of the people we housed said this is the life they wanted,
and they wanted to keep using.
Those who supported harm reduction approaches argued that harm reduction saves lives.
Karma explained:
I think it’s good, because some of those people, like it could be your daughter, and you
know, if there wasn’t Narcan then your daughter could be dead. And since there is
Narcan and she can get saved, maybe in a couple years from now, she might recover and
become really successful and have a good life. But if there was not Narcan, she would be
dead and not have that ability. So, I think it’s good that people can have second, third,
fourth chances and stuff. And I think that it’s also like, some people think it’s bad
because you know people keep getting Narcaned and they don’t change, but I think that
it’s like, you know those people, at least they have a chance to live and change one day or
at least they are alive.
Some participants believed that these measures simply hid the problem. For example,
some argued that the underlying issues relating to the opioid epidemic in Canada were not being
addressed. However, they maintained that these measures were needed to reduce the associated
harms of substance use. Therefore, harm reduction measures were viewed as a necessity, but not
as a solution to the larger problem.
Some of the participants supported harm reduction measures but explained that there was
a need to connect the harm reduction strategies to further rehabilitation efforts. One participant
recalled the time he saved an individual using naloxone. He stated:
For me it’s just about building that relationship “Hey man, you okay from last time?”
“Oh, that was you?” “Yeah it was, hey have something to eat.”, and then we’ll have that
relationship. So that, as a harm reduction approach, opens up that conversation providing
that person with follow through, if you don’t have any follow through your just turning
into a number, yourself as a person that’s applying it, and the person you’re just
reminding them they’re just a number or a statistic. (Trojan Horse, age 46)

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The participants also spoke about the link between offering harm reduction programs and
successfully admitting people into treatment programs. They argued that relationships need to be
built between those accessing the programs and those running the programs. Ultimately, many of
the participants believed that treatment programs should be the end goal of harm reduction
strategies.
Participants’ Suggestions for the Future
Another objective of this study was to investigate options for future policy changes. The
participants were asked to share their suggestions regarding drug laws and treatment. The options
for legislation and strategy changes included: (1) to decriminalize all illicit substances and
implement a medical model approach or to legalize specific substances for prescribed use; (2) to
increase treatment program availability and affordability, along with holistic and individualized
care practices; (3) to increase Canadian society’s awareness and knowledge of substance
addiction to aid in reducing the stigmatization; and, (4) to increase community resources. The
findings will be reviewed below.
From the Streets to the Court House: Let’s Talk About It
The most common suggestion was to decriminalize or legalize all illicit substances in the
country. Nine participants suggested that all illicit substances in Canada be decriminalized, while
two suggested that Canada legalize a safe supply of drugs. The two who suggested the
legalization of illicit substances were also in favour of decriminalization but viewed legalization
more strongly. In addition to supporting the decriminalization of illicit substances, many
supported heavy penalties for drug traffickers. They clarified that decriminalization or
legalization should not be a ‘free for all’ but rather a way to regulate drug use and treat substance
addiction.

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Ogre, who was in support of decriminalizing illicit substances in Canada stated:
I think they’re moving towards an enlightened approach with decriminalization and I
think that conversation needs to start with other drugs. The more they’re able to keep in
that vein of conversation, even with harder drugs, and also stop the absolute underground,
like grow ops were the big thing when I was young, well now government does it and
that’s going to put a lot of that out and I think that’s a positive. I don’t see how people
can say that’s going to cause a whole new generation of addicts because we have that
with alcohol, we have that with cigarettes, nobody had to sit there and say I’m going to
do it now that its legal. People are going to do what they’re going to do and they’re going
to find an avenue for it, but I think now our path is a little more enlightened and I hope
that we don’t regress… I think we’re moving in the right direction with
decriminalization.
Those who supported decriminalizing all illicit substances emphasized implementing a medical
model approach. Joe Blow explained, “Medicalize it and make it readily available, right?
Treatment needs to be readily available when an addict says I want to stop, right?”
Similarly, those who supported legalizing all illicit substances explained the importance
of legalizing a safe supply of drugs to reduce the harms associated with drug use, overdoses, and
drug-related deaths. One participant maintained:
For me, I think you’d alleviate a lot of the problems in society if you legalized these
drugs. I mean, it’s a choice for people, if they want to choose, they can do it safely. I
don’t think you can influence choice, people have their own mind and choices and if they
choose to go down a road then at least give them the proper chance. (SMc)
Many of the participants also felt that these approaches would aid in the rehabilitation of those
suffering from substance addiction. Both the decriminalization and legalization of illicit
substances in Canada will be further explored in the discussion.
The Elephant in the Room: Treatment Program Woes
The second most common suggestion was to increase the availability and affordability of
treatment programs, while also increasing the availability of treatment programs with holistic
and individualized care practices. The participants called for more treatment programs, as they
argued that there are usually long waitlists to be admitted. They argued that waiting for a bed

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was not conducive to rehabilitation, as an individual with substance addiction will typically only
abstain from intoxicants for a short period of time. Joe Blow explained:
So, a little bit more about my story, I was overdosing on crack cocaine pretty regularly,
and I had epileptic seizures, so I would end up in the hospital quite regularly, and my
doctor would say you should quit using dope, and then I would say, yea yea yea, okay, I
will quit using, and then he would sign me up for a treatment facility, and he would say
you have to stay clean for two weeks, and I would say yea okay, no problem, and by that
point I just wanted out of the hospital and 20 minutes later I’d be getting high. If
treatment had been readily available while I was at the hospital, like maybe if they had a
treatment facility in the hospital, they could have said, hey you have a serious problem,
we are putting you in this treatment facility.
The participants understood that those who qualified for welfare in BC, also qualified for
a subsidy from the BC Government to attend a treatment program without fees. However, they
stated that those who were able to pay the $10,000 or more to attend a treatment program were
more likely to be admitted sooner than those who were subsidized. In response, Rusty stated,
“…it doesn’t matter if you’re loaded or poor as can be, addictions going to get you and the
biggest problem is accessing treatment for those that don’t have the funds to put themselves
through long term recovery.” Similarly, another Turtle argued for:
More treatment facilities that are free. Not everybody can afford these private treatment
centres, they’re all over BC but not everybody has $13,000 to stay in one tomorrow, and
some of these people stay in there for three months and there forty some thousand dollars.
The government needs to get more of that kind of thing going and make it more available
for everybody.
Lastly, two of the participants called for a change to the design and delivery of treatment
programs. They explained that not all people with substance addiction are the same; therefore,
their treatment needs will be different. Lovern explained:
I just think that there are many approaches and that is what we have to entertain, and
what we have to look at for people, because not everybody is a cookie cutter cut type of
deal. And that’s what we’ve been working from in the past, cookie cutter. We are all the
same right? No, we are not. You know? My life is not the same as the guy who sat beside
me in a meeting. My life is not like his today.

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With a similar perspective, the second participant, Ogre, stated, “I know to do that
[individualized treatment] it takes funding and changing a whole system and attitude, but ideally,
I think that, multi-pronged with nutrition, with environment, with people’s education, poverty
level, I know those all factor in.” In general, these participants acknowledged the need for
treatment programs that account for the unique experiences of each patient. Additionally, they
recognized potential difficulties with implementing these ideas, due to limited funding and
effecting system-wide change. Regardless of these concerns, these suggestions are worth more
analysis.
Education to End Stigma
The third most suggested recommendation was to decrease stigma by increasing the
public’s education. Six participants stated the need to reduce stigmatization. One suggestion was
to educate Canadians about substance addiction. For example, when speaking of the need for
more knowledge on substance use and addiction, Centaur, explained, “I would start talking to
kids at the earliest age that you could, and I would make that a part of their curriculum in
school”. This participant explained that education would inform children of the reality of
substance addiction. Snowman also stated that people should be “… getting out there with
knowledge.” In other words, he suggested that information on addiction be more readily
available and distributed to members of the public. These suggestions have the potential to
reduce the stigmatization of those who use drugs.
Throughout the interviews, many participants spoke about their own experiences with
stigmatization. This was an interesting theme, since the participants were not asked about this.
One participant commented on the stigmatization and the need for more education by stating:
It’s like, that’s why people end up hiding it, or being dishonest, they can’t tell even their
own family members because of fear of being judged or discriminated, you know,

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rejected. So, they don’t say anything and that’s our view. Our perception of addiction, the
more we change it, I think it will make a huge difference, because then people will be
open about it, and when they are open about it they have a chance to make a right
decision. But out of fear, your paranoia, like you lose… you are not calm enough to make
the recognition, you are kind of confused. And you have no one to talk to. The people
you care about and love, you can’t tell them. (AJ)
Another participant, Con, argued that an ideal approach to substance use and addiction
would be to reduce stigmatization so that “… maybe you will feel yourself as an equal rather
than as a less. So, that’s probably like a lot of it, so many of these people feel as if, and they are
also treated like they are less than a person, so they almost feel like they are not people, which is
unfortunate.” This participant’s comment emphasized the desire to live in a society that does not
stigmatize and discriminate against those who use drugs. To address stigmatization, the
participants repeatedly emphasized the need for more knowledge and education on this disease.
Keep the Resources Coming
The final suggestion was to continue increasing resources for those struggling with
substance addiction. For instance, four participants suggested the ongoing availability of
resources in Canada for people who use drugs, such as SIFs, SCFs, OPSs, take-home naloxone
kit programs, and opioid agonist therapies. Additionally, it was suggested that more funding be
made available for housing placements, including the housing first initiatives – also known as
wet houses. Karma explained that her ideal approach to substance use and addiction would be:
Giving them a chance and getting to know them and giving them some things in life so at
least they have a bed to sleep on, you know, so they can feel a bit more like a normal
person in society. And then at least they can get a job, they have a place to shower and
sleep at night, you know? So, I think they should just like, humanize them a bit more.
Moreover, many of these participants also felt that resources are helpful in treating
substance addiction. One participant, Tank, stated:
Yea, throwing more into really helping the people, some of what we do is just sort of,
“well if they are not in the park and we can’t see them, well I don’t have a problem in

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town”. And I know that is not everybody, like many people are really trying to help these
people and I am not trying to belittle that or downplay it, I appreciate what they are
doing, but we really need to help them get to the core [of their addiction].
The participants emphasized the need for resources to support people who use drugs, to reduce
the harms associated with substance use, and to limit drug-related overdoses. These suggestions
are not to say that the current resources implemented have not been beneficial. Rather, this
finding is shared as a way to emphasize the need and want for these resources – with a hope that
these supports will continue to increase in availability and accessibility over time.

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Chapter 6: Discussion and Analysis
Theme One: Decriminalizing Drug Use
A theme that emerged from the findings was the support for decriminalizing all illicit
substances in Canada. The decriminalization of illicit substances is the implementation of noncriminal responses, such as fines and warnings, for designated activities, including possession of
small quantities of a controlled substance (Jesseman & Payer, 2018). Decriminalization does not
mean that the substance is legal and regulated, as cannabis is in Canada.
When the participants were asked about their thoughts on legalizing or decriminalizing
illicit substances in Canada, a majority (63.3%) supported such drug law reforms. Of these
participants, 10 supported the decriminalization of all illicit substances. Additionally, when
asked about their preferences regarding drug laws and treatment approaches, nine participants
suggested that all illicit substances in Canada be decriminalized. Essentially, the findings showed
that a majority of participants not only supported decriminalizing illicit substances in Canada,
but also believed that this should be a priority for Canadian drug law reform.
Those who supported decriminalizing all illicit substances commented on the perceived
benefits and concerns about this legislative change. Participants argued that a medical model
approach would be most effective in assisting and rehabilitating those with substance addiction.
Moreover, several participants noted how decriminalizing drug use and possession could help
reduce the criminalization and stigmatization of people who use drugs. While participants agreed
that illicit substances should be decriminalized in Canada, they questioned the likelihood of this
change.
These findings were consistent with previous research. Greer and Ritter (2019) found that
decriminalization was supported by a majority of the participants. Similar to the current study,

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Greer and Ritter (2019) also found that many of the participants believed that drug laws were
unlikely to change, due to negative public opinion. Evidently, the support for decriminalization
among those with substance addiction is not unique to the current study, nor are the concerns
regarding the fulfilment of this law reform.
Due to the growing opioid epidemic, support for the decriminalization of illicit
substances in Canada has grown among health officials and advocates in recent years (Corace et
al., 2019; de Villa, 2018; Lavalley et al., 2018; van der Meulen et al., 2018; Vashishtha, Mittal,
& Werb, 2017; Virani & Haines-Saah, 2020). A report by the Medical Officer of Health at
Toronto Public Health (TPH) identified several themes that support drug decriminalization (de
Villa, 2018). TPH conducted interviews and surveys with the general public and with those who
had experienced substance addiction. They found that those who supported legal reform
emphasized the need for a public heath approach to illicit substances, rather than a criminal
approach (de Villa, 2018). Two recommendations were made, including the decriminalization of
illicit substances for personal use and the creation of a task force that includes people who use
drugs and policy makers to explore future options (de Villa, 2018). Overall, this report illustrated
the support for decriminalization among those who use drugs, the general public, and the TPH.
Several other organizations and researchers in Canada have called for the
decriminalization of illicit substances. Henry (2019), the Provincial Health Officer of BC,
recommended that the Province of BC “… urgently move to decriminalize people who possess
controlled substances for personal use” (p. 5). Jesseman and Payer (2018) argued for
decriminalization on behalf of the Canadian Centre on Substance Use and Addiction, while
Corace et al. (2019) recommended the same legal reform model in their position paper for the
Canadian Psychological Association. Virani and Haines-Saah (2020) recognized the need for

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drug law reform in Canada due to increasing harms associated with drug use, and also suggested
decriminalization as a viable option. Similarly, Vashishtha et al. (2017) argued that policies of
drug decriminalization should be considered in North America in efforts to manage the current
opioid epidemic. Despite the increasing support in Canada, this model is not on the agenda of the
present Federal Government (Strike & Watson, 2019).18
While the current Federal Government has not made it a priority to decriminalize all
illicit substances in Canada, it is imperative to understand and assess the policies of
decriminalization in other jurisdictions. One model of decriminalization that was repeatedly
referenced by the participants in this study was that implemented by Portugal in 2001 (Hughes &
Stevens, 2010).19 Under this model, drug use and possession of substances under a specific limit
are not criminal offences, rather these acts are administrative.20 As such, new offences under
these laws are sanctioned through specially devised Commissions for the Dissuasion of Drug
Addiction (CDTs; Hughes & Stevens, 2010).21
Hughes and Stevens (2010) conducted a study a decade later and found several key
themes. While some critics have argued that decriminalization would increase drug use, Hughes

18

The list presented is not an exhaustive list of those who support decriminalization in Canada. Other organizations
that support drug decriminalization include: the Canadian Association of People
Who Use Drugs; the Canadian HIV/AIDS Legal Network; the Canadian Public Health Association; the Canadian
Drug Policy Coalition; the Canadian Mental Health Association, among others (Henry, 2019).
19
In the late 1980s and 1990s, rates of infectious diseases, such as HIV, AIDS, tuberculosis, hepatitis B and
hepatitis C, increased exponentially among Portugal’s intravenous drug using population. Drug-related deaths also
increased in Portugal during this period, with 369 deaths in 1999, which was an increase of 57% since 1997.
Additionally, similar to current Canadian concerns, there was a growing perception in Portugal that the
criminalization of drug use and possession contributed to drug-associated harms and the social exclusion and
marginalization of people who use drugs. It was in this context that a government-appointed expert commission
proposed to decriminalize illicit substances for personal use (Hughes & Stevens, 2010).
20
Use and possession of all illicit substances of up to ten days’ worth of a drug. The amount in practice is 0.1 grams
(g) heroin, 0.1g MDMA, 0.1g amphetamines, 0.2g cocaine or 2.5g cannabis (Hughes & Stevens, 2010).
21
CDTs are comprised of lawyers, social workers, and medical professionals. The CDTs work with the alleged
offender to address their drug use. The goal of these teams is to promote rehabilitation and treatment for those who
they determine to be dependent on drugs. CDTs can impose various penalties to those that are caught using or
possessing substances, including community work service, fines, suspensions on professional licences, and bans on
attending designated places. For those who they determined are dependent on a substance, CDTs can recommend a
person enters treatment or education program (Hughes & Stevens, 2010).

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and Stevens (2010) found only small increases in reported illicit drug use amongst adults.22 More
importantly, they found that since 2003, there was a reduction in illicit drug use among people
who have substance addiction and adolescents. Additionally, they found a reduced number of
drug offenders within the criminal justice system, an increased uptake of drug treatment, a
reduction in opioid-related death and infectious diseases, and an increase in the amount of illicit
substances seized by authorities (Hughes & Stevens, 2010). While it is difficult to assess whether
these trends are the result of the decriminalization of illicit substances, the Portuguese approach
is considered a model of best practices (Henry, 2019).
Other models of decriminalization include those imposed by Costa Rica, the Czech
Republic, and Mexico. The General Health Law of Costa Rica prohibits the personal use of
narcotics and other drugs but does not penalize those who violate the prohibition; instead, fines
may be imposed for the consumption of unauthorized substances in public places (Torres, 2016).
In the Czech Republic, one can be criminally charged for producing and distributing illicit
substances and for possessing an amount “larger than small” (Torres, 2016, p. 13).23 The
possession of illicit substances for personal use in small amounts is not a criminal offence, but
rather a misdemeanor subject to a monetary fine (Torres, 2016).
In Mexico, possession of specific narcotics under a certain quantity are not criminally
punishable, provided that such possession takes place outside of certain places, such as
educational institutions and prisons.24 Those who are found in possession of the specific

This is a trend that was also observed in both Spain and Italy – two regions that did not decriminalize illicit
substances.
23
The Supreme Court of the Czech Republic decriminalized the possession of 1.5g of methamphetamine, 1.5g of
heroin, 1g of cocaine, 10g of cannabis dry matter, 5 units of MDMA, and 5g of hashish (Torres, 2016).
24
The following narcotics are those listed as not criminally punishable if possessed under a certain quantity: Opium,
2g; heroin or diacetylmorphine, 50 mg; cannabis, 5g; cocaine, 500mg; LSD, 0.015 mg;
methylenedioxyamphetamine, 40mg; MDMA, 40 mg; and methamphetamines, 40mg (Torres, 2016).
22

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narcotics in quantities at or below the designated amounts must be referred to addiction treatment
programs (Torres, 2016). The policy underlying the change in drug legislation was that people
who use drugs should not be treated as criminals, but rather as individuals suffering from
addiction – making problematic drug use a public health problem rather than a criminal issue
(Torres, 2016). While this is not an exhaustive list of countries that have decriminalized illicit
substances, it illustrates the differing policy and laws in each jurisdiction.
The findings of the current study align with the findings of several organizations and
researchers in Canada, who have recommended the decriminalization and implementation of a
medical model approach. It is important to note that the participants in the current study did not
support drug use by advocating for decriminalization, rather they wished to reduce the associated
harms. Ultimately, decriminalization is viewed as a method of harm reduction, and a way to
promote rehabilitation for those suffering from substance addiction.
Theme Two: Saving Lives by Legalizing a Safe Supply
The second theme identified was the support for a legalized and regulated supply of illicit
substances. The legalization of illicit substances occurs when the criminal sanctions are removed.
Often regulatory controls are implemented, as in the case of alcohol, tobacco, and cannabis in
Canada (Jesseman & Payer, 2018). As noted earlier, a majority (63.3%) of the respondents
supported the legalization or decriminalization of illicit substances in Canada. While only two of
the participants explicitly voiced their support for a legalized drug supply, many of those who
supported decriminalization were also supportive of legalization.
Those who supported the legalization of illicit substances emphasized the need for
stringent regulation. They argued that government regulation could provide a source of revenue
for the country, decrease the power of the current illicit international drug market, and allow

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those who use drugs to access a safe supply of these substances. Participants also voiced the need
for a drug policy that would reduce drug-related harms. Ultimately, the participants felt that
legalizing and regulating illicit substances could help reduce the effects of the opioid crisis and
aid those struggling with substance addiction.
Several other studies found support for the legalization of illicit substances. Similar to the
current study, Greer and Ritter (2019) found strong support for cannabis legalization.
Additionally, they found that the participants’ support for legalization was contingent on the
regulation of the substances, which was similar to the views of the participants in the current
study. Greer and Ritter (2019) also found that participants believed the legalization of illicit
substances would hinder the illicit drug market. Participants in both the current study and in the
study by Greer and Ritter (2019) supported the legalization of prescription heroin.
Comparatively, Lancaster et al. (2013) found that, among those who use and inject drugs, the
highest level of support for legalization was for cannabis and heroin, while over half of this
population opposed the legalization of methamphetamine, MDMA, and cocaine. These studies
show the divergent views regarding the legalization of illicit drugs, which supports the need for
further analysis of this policy option in Canada.
The legalization of illicit substances, and their subsequent regulation, has been a
contended topic in Canada recently. The term ‘safe supply’ has been used to describe the model
being promoted by several stakeholders in this jurisdiction. Safe supply refers to a legal and
medically regulated supply of specific illicit substances (Canadian Association of People who
Use Drugs [CAPUD], 2019).25 Those who support the legalization of a safe supply contend that
this model is an element of harm reduction (CAPUD, 2019). While cannabis was legalized and

25

The illicit substances included in this definition are: heroin, stimulants such as cocaine and crystal
methamphetamine, hallucinogens such as MDMA and LSD, and cannabis.

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regulated by the Federal Government in 2018, the push for a legalized safe supply of heroin and
other more serious illicit substances stems from the current opioid epidemic and the need to save
lives (CAPUD, 2019).
CAPUD is not the only organization that has promoted this legislative change in recent
years. The BC Centre on Substance Use (BCCSU; 2019) has also reported that this option should
be considered to address the ongoing opioid crisis. The BCCSU (2019) argued that, from an
evidence-based public policy perspective, the contamination of fentanyl in illicit substances is a
predictable consequence of drug prohibition. Moreover, they argued that the prohibition of drugs
continues to contribute to a range of health and social consequences (BCCSU, 2019). Hence,
they argued that a legalized and regulated safe supply of heroin and other illicit drugs would
reduce the harms associated with people using contaminated substances. They maintained that
while illicit substances are prohibited, the illicit drug market will thrive, and organized crime
groups will profit (BCCSU, 2019).
In July 2019, Vancouver City Council approved the Safe Supply Statement – a document
made in collaboration with the Vancouver Community Action Team (VCAT). The Safe Supply
Statement acknowledged the need for further collaboration with other government partners, such
as the Government of Canada, to advocate for access to a regulated drug supply (City of
Vancouver, 2019). This document further argued that a legalized and regulated drug supply was
needed to reduce the harms associated with the current opioid epidemic. Those who have
supported the legalization and regulation of illicit substances have maintained that these drugs
could be supplied through various avenues, including: SCFs; doctor’s offices; pharmacies; and
vending machines (Proctor, 2019).

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In December 2019, the City of Vancouver unveiled an innovative experiment to fight the
current overdose epidemic. The initiative – based in Vancouver’s DTES – is a pilot of the
MySafe Project and is the world’s first biometric opioid vending machine (Little, 2020). This
project allows those who are registered as opioid dependent to access a controlled and prescribed
quantity of a heroin-alternative called hydromorphone on a pre-determined schedule (Little,
2020). The goal of this project is to reduce the harms associated with contaminated drug use, and
to allow those dependent on heroin a chance to stabilize their lives (Little, 2020). While this
project does not dispense heroin or other illicit substances, it can be seen as support for the
legalization and regulation of illicit substances.
Although the success of an intervention will depend on the individual and their specific
characteristics, evidence has shown that those with substance addiction are likely to benefit from
safe supply treatment options (CAPUD, 2019). Perneger, Giner, del Rio, and Mino (1998)
conducted a study in Switzerland on the effects of prescribed heroin for individuals addicted to
intravenous heroin. The experimental group in their study received a median of 480mg of heroin
daily, while the control group received none. Perneger et al. (1998) found significant
improvements in the health scores of the experimental group, including better mental health and
social functioning, and significant reductions in criminality, such as fewer drug and property
related offences. These authors concluded that a heroin maintenance programme is a feasible and
clinically effective treatment for people who use heroin (Perneger, 1998).
Similar research on heroin maintenance has been conducted in the Netherlands,
Germany, Spain, Canada, and in England (Uchtenhagen, 2011). Based on the unanimously
positive outcomes of these trials, heroin maintenance has become a routine treatment option in
Switzerland, the Netherlands, Germany, England, and Denmark (Uchtenhagen, 2011). These

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studies noted the positive outcomes of heroin maintenance programs, and they contribute to the
support for a legalized and medically regulated supply of illicit substances.
Theme Three: Re-hashing Old Ways – Bringing Treatment into the 2020s
The third theme that emerged from the findings related to treatment programming for
addictions. While a majority of the participants in the sample viewed abstinence-based treatment
positively, many reported the need for more available and affordable treatment. Additionally,
several participants indicated the need for a modernization of traditional addiction treatment
practices. The support for abstinence-based treatment was not surprising, since a majority
(57.9%) had attended a residential treatment centre in order to overcome their addiction, while
four (21.1%) relied on the 12-step abstinence-based program offered by NA and AA.
Additionally, 16 (84.2%) of the participants reported that they currently attend NA or AA
meetings regularly. Consequently, 14 (73.7%) perceived the most effective approach for those
struggling with substance addiction is a combination of a treatment program, counselling, and
partaking in NA or AA meetings.
Despite this support, many participants indicated a need for change in regard to
addictions treatment options, particularly treatment availability. They argued that when an
individual is ready and willing to enter treatment, there should be a bed space available. The
participants argued that, in general, there are long waits for treatment centres, which is
detrimental to those who have recently detoxed and are ready to begin treatment. They argued
that those who are forced to wait unfortunately return to using illicit substances. Moreover, the
participants argued that many people who use drugs cannot afford immediate treatment, and
often rely on assistance from the Provincial Government. They argued that those who can afford
to pay for treatment often enter treatment sooner, while those who are subsidized by the

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government are made to wait. This supports the need for more affordable residential treatment
options.
Some of the participants also indicated that while treatment programs are beneficial, they
need to incorporate modern and holistic healing methods. These participants emphasized that
treatment programs should consider and respond to the unique needs of every individual seeking
treatment. This includes considering the lived experiences and past traumas of each patient.
Moreover, several participants argued that abstinence-based treatment programs would be
unsuccessful if an individual is forced into them. In other words, those who enter willingly will
have better chances of success. Essentially, these participants understood that traditional
treatment programs are beneficial for some individuals; however, they argued that treatment
programs should take a modernized, individualized, and compassionate approach to substance
addiction recovery.
Similar to these findings, Fischer et al. (2002) found that all the participants in their study
strongly expressed the necessity for choice and freedom in the design and course of their
treatment. Moreover, Neale et al. (2015) found that many of those interviewed in their study
displayed frustration with service providers, due to their failure to consider the unique and
complex needs of people who use drugs and their status as part of a vulnerable population. The
findings of the current study are consistent with previous research, in that many who have
experienced drug use and substance addiction support an individualized treatment approach.
Additionally, they recognized that while traditional treatment options are valuable and effective
for some, there is a growing need for alternative treatment options.
Although there are various reasons why certain individuals suffer from substance
addiction, predominant addiction and treatment models have, until recently, remained entrenched

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in approaches from the 1930s (Major, 2019). Historically, western culture and drug laws focused
on the notion that drugs are intrinsically bad and should be prohibited. This has led to the
continued prohibition of illicit substances in Canada and the support for abstinence-based
treatment programming.
The work of 12-step based recovery organizations are well known throughout North
America, yet these programs, such as AA and NA, were first developed in the 1930s (Major,
2019).26 AA, NA, and other fellowships have their advantages: membership is free; relationships
and support can be easily formed; and role-modelling can be very supportive. Many treatment
and recovery centres focus on abstinence and use variations of the 12-step program. While this
approach has been successful for many struggling with substance addiction, particularly those in
the current study, the appeals for more holistic and individualized treatment alternatives need to
be recognized.
Several medical professionals, organizations, and substance addiction specialists have
argued for an individualized and compassionate approach to addiction treatment. Volkow (2018)
argued that designing an effective treatment program is challenging. She maintained that
effective treatment programs should target the individual aspects of the illness and its
consequences. Additionally, she argued that substance addiction treatment must aid the
individual in quitting their substance use, maintaining sobriety, and achieving a positive family,
work, and social life (Volkow, 2018). She explained that individuals with substance addiction
require long-term or repeated episodes of individualized care to achieve the ultimate goal of
sustained abstinence and recovery.

The goal of these programs is total abstinence – and members are taught that recovery can begin once the
substance use has ended.
26

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Maté (2009) argued that the addiction process is characterized by neurological and
psychological malfunctions in the human brain, in which the ‘damage’ varies in severity. He
asserted that these malfunctions are caused by the complex interactions between human beings
and their environment. For example, an early childhood traumatic event may affect an
individual’s predisposition to developing an addiction. Essentially, Maté (2009) argued that an
individual’s susceptibility to addiction is created by negative in-utero and childhood experiences
and by experiences of social dislocation.27
As a result, Maté (2009) maintained that individualized, compassionate, and holistic
approaches need to be considered when treating addiction. Moreover, apart from promoting
decriminalization and the implementation of a safe drug supply, he supported methods of
treatment that are not solely abstinence-based. For example, while abstinence may work for
some, others may need to access opioid agonist therapy or a safe supply to work towards a full
recovery. Essentially, Maté (2009) argued that understanding the circumstances that lead to
addiction are essential for implementing change.
Similarly, BCCSU (2018) recognized the need for a tailored treatment approach. BCCSU
(2018) argued that those with substance addiction should be aware of the variety of recoveryoriented services, addiction treatments, and harm reductions options that are available in their
jurisdiction. They argued that those with addiction should have access to an appropriate type and
stage of service and care, based on their illness status and personal strengths, choices, and goals
(BCCSU, 2018).

27

Social dislocation, as described by Maté (2009), is when a group of human beings are torn from their cultures and
individual identities. Social dislocation can affect those who are physically displaced, such as Native Africans
during the Trans-Atlantic slave trade, or those who have their cultures dissolved around them, such as the North
American Indigenous Peoples or Australian Aborigines.

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Likewise, the National Center on Addiction and Substance Abuse at Columbia University
(CASA Columbia; 2012) recognized the importance of tailored interventions and treatment for
those with substance addiction. They argued that addictions treatment needs to suit the particular
stage and severity of the addiction, the individual’s overall health status, past treatments, and any
other personal characteristics and life circumstances that might affect their outcomes in treatment
(CASA Columbia, 2012). Overall, there are changing perceptions of what constitutes effective
addictions treatment. As such, there is support for programs that promotes individualized
treatment alternatives and the use of medications, such as methadone and Suboxone, to support
recovery (McCarty, 2019).
Theme Four: Stigmatization and the Need for Education
The final theme that emerged from the data was the concerns regarding the stigmatization
of people who use drugs. When asked about their ideal approach to substance use and addiction,
six participants stated that the stigmatization of those who use drugs needed to be reduced or
eliminated. More generally, 15 (78.9%) of the participants voiced concerns about the
stigmatization of this population during their interviews. This theme was a significant discovery,
as the research questions did not ask about nor mention stigmatization. Thus, this theme emerged
entirely on its own, without prompting.
The participants explained their experiences of being stigmatized and noted the barriers
created by stigma. They argued that the stigmatization of those who use drugs by medical
professionals, criminal justice personnel, and the general public serve as an obstacle to recovery.
They stated that the judgements and discrimination by others increased their own shame of their
addiction, and subsequently decreased their ability and willingness to access the necessary
resources.

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The participants further explained that a change in society’s beliefs was needed to reduce
the stigmatization of this population. They argued that more education on substance addiction
should be disseminated among the general public and medical professionals. They maintained
that people should understand addiction as an illness, rather than as a criminal trait. The
participants argued that a greater understanding of substance addiction would decrease the
stigmatization and discrimination of those who use drugs, as a better understanding of their
condition would be known. Moreover, they maintained that further education for medical
practitioners was needed, as they continue to be stigmatized in the medical system. Overall, a
majority voiced their concerns regarding the stigmatization of this population and suggested
more education on substance addiction be distributed among all Canadians.
There is a growing body of literature that acknowledges the stigmatization of people who
use drugs. A review of this literature found highly stigmatizing views of this population among
the general public, health professionals, pharmacy staff, police officers, and those who use drugs
themselves (Lloyd, 2013). Lloyd (2013) concluded that the stigma associated with problematic
drug use reflects wider public fears about illicit drug use in general. He argued that the rationale
behind the fear of illicit drugs is complex but is often derived from the social history of the
drugs, negative media attention, political rhetoric, and the fact that many illicit drugs are
unfamiliar and poorly understood by the general population. These perceptions have led to
people who use drugs being stereotyped as dangerous, dirty, and blameworthy for their illness
(Corrigan et al., 2009; Lloyd, 2013). Moreover, AIVL (2011) argued that this stigmatization
creates barriers to health care and other resources for individuals who use drugs, which
ultimately affects their overall health outcomes. Overall, the current study’s findings are

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consistent with other literature that has focused on the stigmatization and discrimination of
people who use drugs.
These findings are also consistent with the theories of Goffman (1963), Lemert (1951),
and Braithwaite (1989). These theories were reviewed in an effort to connect the stigmatization
of those who use drugs to their subsequent discrimination from informing research and policy.
Goffman (1963) explained the societal reaction to people who use drugs, and their subsequent
social stigmatization. Lemert’s (1951) concepts supported the criminalization process of these
individuals, by illustrating how societal reactions to drug use have led to the stigmatization and
criminalization.
Likewise, Braithwaite’s (1989) stigmatized shaming also helped to explain how
stigmatization leads to increased or continued drug use among people with substance addiction.
Braithwaite (1989) differs from Goffman (1963) and Lemert (1951) in that he considered both
reintegrative and disintegrative, or stigmatized, shaming. Essentially, according to this theory,
criminalizing and increasing punitive measures against those who use drugs, with no options for
healthy reintegration, will only exacerbate their situations.
Based on the review of the literature, it is evident that those who use drugs experience
stigmatization and discrimination from being labelled deviant and criminal by Canadian society.
It is also clear that the stigmatization of particular groups will lead to further deviance and
criminality. This has created an environment that negatively effects the ability and willingness of
those who use drugs to access treatment programs or other addictions resources. Moreover, the
stigmatized perception of this population decreases the perceived value of their knowledge and
lived experiences. Additionally, it could be argued that the continued discrimination of this
population has negatively impacted their influence on policy development. Nonetheless,

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acknowledging the lived experiences and knowledge of those who have experienced drug use
and addiction is the first step to reducing this stigma.
Amidst the current opioid overdose epidemic, the Canadian Government has
acknowledged the existing stigmatization surrounding substance use. The Government has
recognized that stigma can have an immense effect on the quality of life of those who use drugs
(Government of Canada, 2020). The Government further acknowledged that the stigmatization
of those who use drugs creates barriers to accessing resources and reduces the quality of care
they receive from the health system. The Government created a public service announcement
(PSA) that outlines the steps to reduce the stigmatization of those who use substances
(Government of Canada, 2020). This PSA emphasized the need for education on substance
addiction and the need to treat those who use substances with respect, compassion, and care.
Essentially, the Government believes that the stigmatization of those who use drugs can be
reduced by increasing awareness and knowledge and encouraging people to model nonstigmatizing behaviour.
Throughout other jurisdictions, educational programs have been implemented to reduce
the public stigmatization of people who use drugs (Witte, Schroeder, & Hackman, 2018). The
programs have included education factsheets, handouts with positive stories of individuals in
recovery, and other types of programs. Some comprehensive programs have been offered to preprofessionals, such as nursing students or medical students, to reduce the stigmatization of
people who use drugs among these populations (Witte et al., 2018). The goal of these programs
is to increase the awareness of and knowledge on substance addiction and to humanize this
disease.

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Witte et al. (2018) investigated the potential effects of a semester-long undergraduate
addiction studies course on college students’ stigmatizing attitudes toward those with substance
addiction. While their findings did not draw statistically significant results, those who were
enrolled in the course reported more familiarity with individuals in recovery and were more
willing to interact with these individuals than the control groups tested. These findings, however,
were not seen as a direct effect of the course.
Crapanzano, Vath, and Fisher (2014) aimed to reduce stigmatizing attitudes of graduate
health care professional students by implementing an innovative curriculum combining multiple
teaching methods. While post-intervention scores for views regarding heroin significantly
improved compared to pre-test scores, the effect was small and the mean post-test scores still
reflected negative attitudes towards people with substance addiction. The written reflections of
the students following the intervention further demonstrated that this sample continued to
harbour stigmatizing views towards the drug using population. Crapanzano et al. (2014)
concluded that the persistence of negative attitudes towards people who use drugs following this
and other educational interventions indicates the need for a new approach to changing stigma
towards this population. Overall, while there have been steps taken towards reducing the
stigmatization of those with substance addiction in Canada and elsewhere, there has been
minimal research that suggests these strategies were successful.

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Chapter 7: Recommendations
Four recommendations were devised from the themes that emerged from the current
research. The themes discussed and analyzed were the support from participants to: (1)
decriminalize all illicit substances and implement a medical model approach; (2) legalize specific
substances through a prescribed safe supply; (3) increase treatment program availability and
affordability, along with holistic and individualized care practices; and (4) increase Canadian
society’s awareness and knowledge of substance addiction to aid in reducing stigmatization.
From these four themes, recommendations were made.
Where there is a Will, there is a Way: The Push for Decriminalization
In response to the support for decriminalization among the participants, this option was
further explored. After reviewing the relevant literature on this practice, it is evident that
decriminalization may be a viable option to reduce the harms associated with substance use and
addiction. Due to Canadian drug policy following social and political trends rather than
evidence-based practices, this option may be avoided by the Federal Government. Therefore,
action is needed to assess the effectiveness and efficiency of this model in Canada – to provide a
comprehensive argument for the implementation of this approach.
Given that there are several models of decriminalization worldwide, further research on
the effectiveness and efficiency of these models is needed. As Portugal’s policy on drug
decriminalization may be viewed by many as a best-practice model, it is recommended that
future research explore the feasibility of implementing this model in Canada. To accomplish this,
a transferability assessment is needed to determine if this model could be successfully
implemented in Canada. This assessment will need to consider the specific cultural and
governmental differences between Portugal and Canada, as these differences may affect the

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transferability of this model. Additionally, a cost-benefit analysis will need to be conducted. The
findings from this research will aid in distinguishing the possible effectiveness and efficiency of
this model in Canada.
Safety is First: Exploring Regulatory Options
As with all major drug law reforms, there will need to be evidence that the model will be
both effective and efficient in achieving its intended goals for the approach to be endorsed by the
government. Moreover, there needs to be both political and social support. Clearly, there is a
need for a safe supply of substances in Canada, as people continue to die from drug-related overdoses. Substances obtained through the illicit drug market are clearly not safe for consumption,
and the refusal to provide safe alternatives is contributing to the current opioid overdose
epidemic. Hence, the following recommendations were made to address this growing issue.
The Federal and Provincial Governments should continue to explore the possibility of
legalizing and regulating a safe supply of drugs to those who are suffering from substance
addiction. Further Canadian-based research is needed to explore the effectiveness and efficiency
of this drug policy reform. Both the benefits and weaknesses will need to be considered, along
with the feasibility of this reform. Moreover, research on the recent legalization of cannabis may
serve to enlighten the future of this option – since these studies will have assessed the short-term
outcomes of cannabis legalization in this jurisdiction.
Possible regulatory options will need to be assessed and collaboration with provincial
medical and mental health systems will be critical. Moreover, research on the effects of this
policy change on the criminal justice system will be essential. Overall, it is recommended that
research be implemented in the Canadian context to explore the possibility of a safe supply of
drugs.

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Modernized Substance Addiction Treatment: We Are Not all the Same
Federal and Provincial Governments must recognize the need for more available and
affordable treatment options that encompass an individualized and modern approach to substance
addictions. In other words, alternatives to traditional treatment options need to be developed and
implemented to allow more individuals success in recovering from this illness. To realize this
goal, the Federal and Provincial Governments must increase their support for and funding of
both traditional and non-traditional treatment alternatives – with the aim of increasing program
capacity and reducing costs to patients. These governments must recognize that traditional
addictions treatment does not work for all individuals experiencing substance addiction;
therefore, research and comprehensive program evaluations need to be conducted on both
existing treatment programs and innovative and modern programs to evaluate their effectiveness
and efficiency in treating substance addiction.
Moving forward, all treatment programs need to recognize the lived experiences and
differences between each individual seeking recovery and allow for non-traditional methods of
recovery, such as partnering opioid agonist therapy and other harm reduction strategies with
treatment. Essentially, traditional abstinence-based treatment programs are not beneficial to all
individuals; hence, an innovative and individualized program model that is based on science and
evidence-based practices needs to be developed and implemented. This would result in an
increase of successful recoveries from substance addiction.
Ending Stigmatization through Awareness and Knowledge
The stigmatization of people who use drugs is inherently linked to entrenched social
values and public morality; therefore, a multiple faceted strategy is needed to reduce the
stigmatization and discrimination of this population. PSAs and educational training alone will

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not end the stigmatization of this population, yet these strategies may increase knowledge on
substance addiction and normalize this disease. The Federal and Provincial Governments should
continue to promote positive messages about those with substance addiction. In addition,
education on substance addiction needs to be offered to individuals at all academic levels – and
included in school curriculums.
Apart from education, acknowledging the lived experiences and knowledge of those who
have experienced drug use and addiction is a positive step to reducing the stigma against this
population. Essentially, allowing the voices of this population to be heard may reduce the
entrenched stigmatization of those with substance addiction. Lastly, further analysis of this issue
needs to be conducted in Canada to understand its extent in the Canadian context. Findings from
this research will aid in developing and implementing a new approach to changing the current
stigma towards people who use drugs.

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Chapter 8: Limitations
Sample Size, Composition and Technique
While this study has yielded several important findings regarding the perceptions of those
who have experienced substance addiction on Canadian drug policy, there are some limitations.
The first limitation concerns the small sample size from which this research was generated.
While the researcher exhausted their options for recruiting, there were a total of 19 participants.
Due to the qualitative and exploratory nature of this study, this sample size is considered
adequate; however, statistical analysis was limited and generalizations about this populations’
perceptions on Canadian drug policy cannot be inferred. This limits the ability to generalize the
findings to a Canadian wide context. Future research in this area would benefit from recruiting
larger numbers of participants or conducting both focus groups and one-on-one interviews.
A second limitation is that a majority of the participants in the sample resided in the
interior and coastal regions of BC, while only one participant lived in the northern region.28
Thus, the study covered a large geographical region; however, it was limited to the province of
BC. Additionally, many of the participants resided in urban areas during their addiction, lending
a limited perspective of those who live in rural Canada. Given that Canada is a large country and
perceptions on drug policy may vary across provinces and between rural and urban areas, this
may have impacted the results of the study. Moreover, there are unique differences between the
west coast, central prairies, east coast, and maritime regions, which further decreases the
generalizability of the findings.

28

Some of the participants disclosed that they had resided in the Downtown Eastside of Vancouver during their
substance addiction, while others reported to have lived in cities such as Kelowna, Penticton, and Prince George.
Other participants lived throughout the Lower Mainland, and one reported he had spent some time in Alberta.
Nonetheless, all of the participants of the study resided in BC during the interviews.

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Future research would benefit from recruiting participants from across Canada. Another
option would be to conduct similar studies in specific locations across Canada to compare and
contrast the findings to the current study in BC. These studies would elicit the perceptions of
those who have experienced substance addiction across the entire country.
A third limitation concerns the sampling technique. Due to the potential difficulties in
recruiting persons who had experienced or were currently experiencing substance addiction, the
snowball sampling technique was used. This is a non-probability sampling technique, which is
based on the subjective judgement of the researcher, rather than random selection. This sampling
technique does not allow for generalizations to be made, due to its non-probability nature.
Moreover, a snowball sample allows for sampling bias, as the initial subjects tend to nominate
people they know well. Thus, the participants in the sample may have been from similar peer
groups and have similar ideologies. This may be why a majority of the sample had attended
abstinence-based treatment, counselling, or NA and AA programs. Similar participant biases and
ideologies could have skewed the findings of the research. Therefore, future research in this area
should consider other sampling techniques.
Overall, limitations within this research were found within the sample size, geographical
composition, and recruitment technique. As a result of these limitations, caution should be used
in making generalizations on the findings of the current study. Nonetheless, despite these
sampling shortcomings, the findings from the current exploratory research are valuable insights
into the perceptions of those who have experienced addiction.
Limited Perspectives
Two other limitations in this study are worth noting in more detail. The first concerns the
gender composition of the sample. Due to the snowball sampling technique, there was not an

107

equal or representative number of male and female participants. Thus, 15 of the participants were
male while only four participants were female. Given that men and women have different
experiences with their substance addictions and personal histories, the distribution of gender in
this sample may have affected the findings (Neale, 1998). Future research in this area would
benefit from utilizing a probability sampling technique or a non-probability sampling technique
that allows for representative gender groups.
The second limitation relates to the proportion of the sample that had been sober from
illicit substances for longer than 90 days compared to those who were still actively using. Of the
19 participants, only three had used illicit substances within 90 days of the interviews. The
perceptions of those who had successfully recovered from their addiction could have been
significantly different from the perceptions of those who were still active. Thus, the findings may
have been affected by the limited number of perspectives.
In that regard, future research in this area would benefit from studying the effects of
successful recovery from an addiction on the perceptions of Canadian drug policy. It would be
interesting to note if there were differences between those who had recovered from their
addiction and those who were still actively using. Essentially, while these limitations exist, the
findings still provide valuable insight into how people who have experienced addiction perceive
Canadian drug policy.
Inter-Rater Reliability
The analysis of the findings was an iterative process that was completed by the researcher
alone. This is a limitation to the data analysis process, due to the lack of inter-rater reliability. As
such, the biases and personal assumptions of the researcher, as someone who has never
experienced addiction and who is employed by the criminal justice system, could have affected

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the understanding of the content. Thus, future research should incorporate multiple reviewers of
the data to ensure inter-rater reliability.

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Chapter 9: Conclusion
In Canada in recent years, thousands of people have died due to illicit drug overdoses
caused by increasingly powerful and contaminated substances offered through the illicit drug
market (Corace et al., 2019). The current drug-related overdose crisis has presented an
opportunity for drug policy changes throughout Canada. Canadian drug policy has been largely
based on social and political factors, rather than on scientific research and ‘evidence-based’
practices (Malleck, 2015). This led to over a century of prohibitionist policy that had an array of
adverse outcomes, including high drug overdose rates, high rates of infectious diseases caused by
needle-sharing, high rates of incarceration for drug offences, expensive law enforcement costs,
and no significant reductions in drug use (Hathaway & Tousaw, 2008). However, the current
Canadian Government has taken steps to reform Canadian drug policy and legislation. To date,
they have implemented several progressive policies on drug possession and use and have funded
and supported multiple harm reduction initiatives.
While these initiatives have been effective in reducing various drug-related harms,
including fatal overdoses, the rates of drug-related overdose deaths have continued to increase
each year (Government of Canada, 2018c; Irvine et al., 2019; Kennedy et al., 2019).
Additionally, some have argued that while drugs remain illegal, people who use drugs will
continue to be marginalized from society and further criminalized, which decreases the overall
effectiveness of the harm reduction strategies implemented (van der Meulen, De Shalit & Ka
Hon Chu, 2018; Lavalley, Kastor, Valleriani, & McNeil, 2018). These arguments and the
continuance of drug-related deaths have fuelled support for increasingly liberal drug policy in
Canada, including discussions on decriminalizing all illicit drugs and providing safe supplies for
people who use opioids (Angus Reid Institute, 2019; Corace et al., 2019). Therefore, it was clear

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that further research on effective and efficient drug policy was warranted to combat the growing
concerns related to the harms associated with drug use and substance addiction.
To inform future drug policy changes in Canada, several key groups of stakeholders
should be involved. In particular, the perceptions of people who have experienced addiction
should be considered. This includes recognizing the lived experiences of individuals who use
drugs and considering their opinions of the current legislation and subsequent strategies
employed by the government to reduce the use of drugs, decrease the harms associated with drug
use, and prevent and treat substance addiction.
The research was designed to further the understanding of how those who have
experienced substance addiction view the current and past drug policies in Canada and what they
believe are effective and ineffective drug strategies within the system. The findings of this
research add to the growing body of literature that considers the perspectives of those who are
addicted to illicit substances – a population that is arguably the most affected by drug policy.
In addition to gaining the insight of those who have experienced substance addiction on
Canadian drug policy, the current study explored the history of Canadian drug policy to better
understand the effects on individuals with substance addictions. Moreover, the current study was
successful in investigating how changes in government mandate on drug policy affects those
who are struggling with substance addictions. In doing so, the research found and analyzed the
perceived effects of punitive versus rehabilitative approaches to preventing and treating
substance addictions. Lastly, the research was successful in investigating potential options for
future drug policy changes that are supported by those who have experienced or are currently
experiencing substance addictions. These options were further analyzed and discussed in Chapter
6.

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Four key themes emerged from this data. The first theme was the support among
participants for illicit substances to be decriminalized in Canada, while the second theme was the
support for a legalized safe supply of these substances. Both of these legal reforms were largely
supported by the participants, whose goals were not to allow free reign on drug use, but to
implement a system that could regulate or better monitor and address problematic drug use. The
participants recognized the current harms of drug prohibition on people who use drugs and
offered plausible solutions to the current overdose epidemic.
The following two themes considered strategies and programs, rather than laws. The third
theme was the desire for more affordable and available treatment programs, and the need for
these programs to be more holistic in nature. Essentially, the participants argued that a one-sizefits-all approach to recovery was not an ideal strategy. The final theme emerged reflected the
need to reduce the stigmatization of those who use drugs. This was viewed as an important and
critical finding, since the research questions did not ask about nor mention stigmatization. Thus,
this theme emerged entirely on its own, without prompting.
The participants explained their experiences of being stigmatized and noted the barriers
that this stigma creates. It was concluded that the stigmatized perception of those who use drugs
in Canadian society has decreased the perceived value of their knowledge and lived experiences
that could help to inform drug policy. Additionally, it was argued that the continued
discrimination of this population has exiled them from serious consideration of having a stake in
policy development. Nonetheless, it is maintained that acknowledging the lived experiences and
knowledge of those who have experienced drug use and addiction is the first step to reducing the
stigma against this population.

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Overall, the research findings are an important addition to the growing body of literature
that considers the knowledge and lived experiences of those who have experienced drug use and
substance addiction. The current research was exploratory in nature and was successful in
achieving its goals and objectives. While the findings cannot be generalized to all people who
have experienced addiction or have used drugs, they should be considered in future studies and
policy development. Research in this area must include this population in discussions on drug
policy, as they are one of the central stakeholder groups and arguably the most affected by drug
policy reform. Essentially, progressive and inclusive research and policy development should
continue to emerge with the start of the new decade, because, as one participant stated, “The
drug is not the problem, the problem is that we have stigmatization along with using drugs” – a
fact to which Canadian policies, laws, and strategies need to recognize (AJ).

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Appendix A – Interview Guide

Demographic questions:
What is your age?
What gender do you identify as?
What level of education have you achieved?
Are you employed? If so, in what occupation?
Approximately how many years were you/have you been dependent on a substance, and what
were the years?
What was/is the substance you used/use, and what method of consumption?
Approximately, when was the last time you used?
Are you currently seeking treatment for a substance addiction or using any harm reduction
measures?
General open-ended questions:
1. What are your overall views on Canadian drug policy?
a. What are your views on the recent legalization of cannabis? Do you feel that other
drugs should be legalized or decriminalized?
b. What are your views on harm reduction measures? Treatment programs?
2. Have you felt that the approaches taken towards substance addictions has changed in
Canada over time? If so, do you agree with these changes?
3. In your experience, are tough-on-crime approaches beneficial or harmful to someone
experiencing a substance addiction?
4. In your experience, are harm reduction approaches beneficial or harmful to someone
experiencing a substance addiction?
5. What would you like to see be done in Canada in regard to drug legislation?
6. What would an ideal approach to drug use and addiction be?
7. In your opinion, what current approach to substance addiction is the least effective for
those struggling with addictions?
8. In your opinion, what current approach to substance addiction is the most effective for
those struggling with addictions?
Word Prompts:
- Legalization
- Decriminalization
- Prohibition
- Tough-on-crime
- Harm reduction
- ‘soft’ drugs versus ‘hard’ drugs
- Insite/Supervised Injection Sites
- Naloxone Programs
- Treatment Programs
- Mandatory Minimum Sentencing

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Appendix B - Certificate of Human Research Ethics Board Approval

115

Appendix C – Informed Consent and Consent of Participation Forms

School of Criminology and Criminal Justice
University of the Fraser Valley
33844 King Road
Abbotsford, BC V2S 7M8
604-504-7441
The Perceptions of those who have Experienced Substance Addiction on Canadian Drug
Policy
Letter of Informed Consent
Purpose of the Study: I, Meghan Jansons, am a graduate student, in the School of Criminology
and Criminal Justice at the University of the Fraser Valley, conducting research for my final
thesis project. During this interview, I am hoping to learn the opinions and views of those who
have experienced substance addiction on Canadian drug legislation and strategies.
Procedures involved in the Research: This research project will involve a one-on-one
interview that will take approximately 30 minutes to complete. The interviewer will be taking
notes during the interview, and with your permission, the interview will be audio recorded and
later transcribed verbatim for accurate data collection. If you would like to review the transcript
from your interview, a copy can be sent to you upon its completion via email. In this interview,
you will be asked questions about your views on and experiences with Canadian drug policy
specifically regarding drug laws and various treatment and harm reduction programs.
Potential Benefits: The time that you have devoted to participating in this research will be
compensated with a $10 CAD Tim Horton’s gift card. While the research will not benefit you
directly, the results will add to the academic literature on this topic and may help to inform the
creation and/or implementation of consumer-informed drug policy and strategies in Canada.
Potential Harms, Risks or Discomforts to Participants: This study will not use deceptive
tactics, or intend to cause any physical, psychological, or social harm. However, some discussion
topics may require you to recall difficult or sensitive memories, which may be mentally and
emotionally strenuous. You may refuse to answer any questions that make you feel
uncomfortable, or that you wish not to answer. Additionally, the information to access a
counsellor is provided below for participants who require additional support or debriefing.
Fraser Valley Regional Crisis Line (24hrs): 604-820-1166 or 1-877-820-7444
Interior Crisis Line Network (24hrs): 1-888-353-2273
Confidentiality: Any information that is obtained during this study will remain confidential.
Only the primary investigator, Meghan Jansons, will have access to your interview responses,

116

which will be stored on a password protected computer. The data will be included in my thesis
paper and presented during my thesis presentation; however, pseudonyms will be used to protect
the participants’ identities and no identifying characteristics will be displayed in the paper or
presentation. All identifying documents pertaining to the interviews will be destroyed after the
research is completed, on June 1, 2020 (i.e., interview transcripts will be shredded, and all audio
and text files will be deleted).
Participation: Your participation in this study is voluntary. You may withdraw your consent and
discontinue participation at any time during the study. You may also decline to answer specific
questions during the interview yet remain in the study, if you so choose. There are no penalties
for declining to participate or withdrawing your participation. If you withdraw from the study,
your data will not be used, and your interview record will be destroyed immediately. If you
choose to withdraw from the study during the interview, please inform the interviewer. If you
decide to withdraw from the study after the interview, please contact me at
meghan.jansons@student.ufv.ca.
Study Results: The results of this study will be disseminated by myself through my thesis paper.
The research may also be made public in future conference presentations or a research paper. If
you would like to know the research findings, a copy of my final written work can be sent via
email upon request once it is completed. Please email me at meghan.jansons@student.ufv.ca if
you are interested.
Questions:
Contact for Information About the Study
For any questions relating to the study, please contact me, Meghan Jansons, at
meghan.jansons@student.ufv.ca.
Contact for Concerns

If you have any questions or concerns regarding your rights or welfare as a participant in this
research study, please contact the Ethics Officer at 604-557-4011 or Research.Ethics@ufv.ca.
The ethics of this research project have been reviewed and approved by the UFV Human
Research Ethics Board (Protocol #1163C-19, approved June 5, 2019). Please feel to ask any
questions you may have about these procedures or the research study. You may also keep a copy
of this form for your records. Thank you for your time and interest.
I have read the above and understand the procedures, risks, and benefits of this study. By
participating in this interview, I am consenting to participate in this study.

117

The Perceptions of those who have Experienced Substance Addiction on Canadian Drug
Policy
Consent of Participation Form
By signing below, I agree to participate in this study, titled the Perceptions of those who have
Experienced Substance Addiction on Canadian Drug Policy.
I have read the information presented in the letter of informed consent being conducted by
Meghan Jansons at the University of the Fraser Valley. I have had the opportunity to ask
questions about my involvement in this study and to receive any additional details.
I understand that I have the right to withdraw from the study at any time and that confidentiality
of all results will be preserved. If I have any questions about the study, I should contact Meghan
Jansons at meghan.jansons@student.ufv.ca.
If I have any concerns regarding my rights or welfare as a participant in this research study, I can
contact the UFV Ethics Officer at 604-557-4011 or Research.Ethics@ufv.ca.
By checking the box below, I consent to being audio recorded during the interview.
Note: You may still participate in the study if you do not consent to being audio recorded.

Name (please print) ____________________________________________________________
Signature ____________________________________________________________________
Date ________________________________________________________________________
Name of Witness (please print) ____________________________________________________
Witness Signature ______________________________________________________________
Once signed, a copy of this consent form will be provided to you.

118

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