Drugs: Harm and Harm Reduction

Cannabinoids (note: cannabis is not included as an illicit drug due to legalization)
- Cannabis (Marijuana)
- Hashish
Stimulants
- Cocaine
- Amphetamine (uppers)
- Methamphetamine (speed)
Dissociative Drugs
- Ketamine
- PCP
Opioids
- Heroin
- Opium
Club Drugs
- MDMA
- GHB
- Flunitrazepam
Other Hallucinogens
- LSD
- Psilocybin
- Mescaline
- Salvia divinorum
Inhalants
Alcohol
Tobacco
Note: This list is not exhaustive. New drugs are continuously being synthesized.

Overall Statistics (2017)
- 15% of Canadians reported using at least one of the following: cannabis, cocaine, methamphetamine, ecstasy, hallucinogens, or heroin.
- Increase from 13% in 2015 and 11% in 2013 due to increased cannabis and cocaine use.
- Gender differences:
- Males: 19%
- Females: 11%
- The greatest proportion of users are under age 25:
- Age 15-19: 20%
- Age 20-24: 35%
- Age 25 and older: 13%
- Source: Government of Canada; Canadian Tobacco, Alcohol and Drugs Survey (2017)

Cannabis Statistics (2017)
- 15% of Canadians reported using cannabis (pre-legalization data).
- Increase from 12% in 2015 and 11% in 2013.
- Gender differences:
- Males: 19%
- Females: 11%
- Use among males increased to 15% since 2015, no change for females.
- Use is highest in British Columbia (23%) and lowest in Quebec (11%).
- Age of initiation:
- Males: average age 18 (no change since 2015)
- Females: average age 19 (up from 18 in 2015)

Statistics (2017)
- 3% of Canadians reported using illicit drugs other than cannabis, up from 2% in 2015 due to increased cocaine use.
- Types of drugs consumed:
- 2% cocaine (from 1% in 2015)
- 1% hallucinogens
- 1% ecstasy
- Numbers for methamphetamine, heroin, and salvia too low to report.
- Demographics:
- Age 15-19: 4%
- Age 20-24: 10%
- Age 25 and older: 3%
- Males more likely to use illicit drugs than females.

Psychoactive Pharmaceuticals include opioid pain relievers, stimulants, and tranquilizers.
Statistics (2017)
- 22% prevalence of use for therapeutic purposes.
- Age-specific usage:
- 17% among those aged 15-19
- 21% among those aged 20-24
- 23% among those aged 25 and older
- Gender-specific usage:
- Females: 24%
- Males: 20%

Definition: Problematic use refers to use beyond therapeutic purposes, such as using drugs to alter mood, cope with stress, or for pleasure.
Statistics (2017)
- 1% prevalence of problematic use overall, up from 0.6% in 2015.
- Among users of psychoactive pharmaceuticals, prevalence is 5%.
- Greatest proportion of problematic use reported among ages 15-19 and 20-24.

Opioids
- Most commonly used; 12% used therapeutically (about 3.5 million Canadians).
- Problematic use stands at 3% (about 100,000 Canadians).
Stimulants (e.g., Ritalin, Adderall)
- Used for attention and concentration problems; therapeutic use at 2% (about 714,000 Canadians).
- Problematic use at 19% (about 103,000 Australians).
Sedatives
- Nearly as commonly used as opioids; therapeutic use at 12% (around 3.5 million Canadians).
- Problematic use at 1% (about 49,000 Canadians).

Blood-borne Diseases
- Injection and inhalation drugs are linked to HIV and hepatitis C.
- Statistics:
- Injection drug use accounted for:
  - 19% of new HIV infections in 2002
  - 14% in 2005
  - Over 30% of new AIDS diagnoses in 2006.
  - 63% of hepatitis C cases from 2004-2008 due to injection drug use.
Soft-tissue Infections
- Associated with injection drug use (e.g., abscesses, cellulitis).
Stigma
- Drug users face significant social stigma leading to discrimination across various sectors.
Violence
- Illicit drug use correlates with violence at multiple levels, from community to national.
Overdoses and Drug Toxicity
- 1/5 Canadians using injection drugs reported an overdose in the last six months.
- In British Columbia, illicit drugs have become the leading cause of unnatural deaths.
Statistics on Drug Toxicity Deaths:
- Fentanyl: 82.9%
- Cocaine: 49.8%
- Methamphetamine: 34.2%
- Alcohol: 27.9%
- 80% are male, 70% aged 30-59 years.

Social Determinants of Health
- Factors: age, gender, ethnicity, socio-economic status impact vulnerability.
- Higher susceptibility for women and youth towards violence and HIV.
- Many drug users have histories of trauma and abuse.
- Homelessness is often associated with drug use and mortality.
- Cultural dislocation can also increase susceptibility.

Prohibition and Law Enforcement
- Illegality of possession/selling with prosecution aimed at preventing drug use.
Harm Reduction
- Acknowledges some drug use is unavoidable; aims to reduce risks and promote health.

Pragmatism: Accept the complexities of drug use.
Human Rights: Right to self-determination and making informed decisions.
Focus on Harms: Priority on minimizing drug-related harms rather than pushing for abstinence.
Maximize Intervention Options: Multiple treatment options to cater to varying needs.
Prioritize Immediate Goals: Focus on immediate and pressing individual needs first.
User Involvement: Empower drug users to help determine effective interventions.

Needle Distribution and Recovery Programs
- Offers sterile injection tools and collects used needles.
- Goals include reducing blood-borne diseases and increasing access to healthcare.
- Shows no increase in drug use or crime rates.
Outreach Programs
- Target hidden drug user communities to provide resources and connection to services.
Overdose Prevention Programs
- Train peers to administer naloxone during overdoses.
Methadone Therapy
- Methadone helps reduce withdrawal symptoms and risk of using harder drugs.
Heroin Maintenance Programs
- Controlled doses of prescribed heroin to minimize illegal use.
Supervised Consumption Sites
- Enable safe drug use with access to health services.

Historical Commissions
- Le Dain Commission (1969-1972): Suggested removing marijuana from the Narcotic Control Act.
- Senate Special Committee (2000): Advocated for treating cannabis as a public health issue and legalizing it.
The Cannabis Act
- Legalized on October 17, 2018, with goals to:
- Keep cannabis away from youth.
- Prevent illegal profits.
- Protect public health with legal access.
- Outcomes of legalization: 18% of Canadians using cannabis in early 2019, increase notably in older demographics (45-64).