In North America, the War on Drugs takes aim at illegal drugs, but in fact prescription drugs are responsible for more harm than those prohibited by law.
The War on Drugs and the media frenzy surrounding it has been successful in sidetracking Americans and Canadians from focusing on the most pervasive drug problem of all: prescription drug misuse.
Escalating Use of Prescription Drugs
Dr. Jurgen Rehm, senior scientist at the Centre for Addiction and Mental Health calls Canada a “pill-popping country”, with doctors prescribing opioids at a rate five times that of the United Kingdom.
Canadians spent approximately $20 billion on pharmaceuticals prescribed by physicians in 2015; more than the total amount spent on physician services that year. In 2015 the University of British Columbia produced the Canadian Rx Atlas, which analyzed both public and private spending on prescription drugs, with some startling results:
With $578 per capita being spent on these drugs, Canadians are well medicated. Middle-aged people, from 45 to 64 years of age, spend over twice as much on drugs as those 20 to 44. Between 2000 and 2015 prescribing of antipsychotic medication to children under the age of 14 increased ten-fold in British Columbia, although currently these drugs are only licensed for prescribing to adults over the age of 18, UBC reports.
Concerns have been raised regarding long term use of the newer, relatively untested antipsychotic drugs on children. Metabolic changes during sensitive growth periods and dangerous side effects are some of the risks that experts say need more research.
Antipsychotic use has also increased among seniors in Canada, with the highest rate among those residing in nursing homes, female, and over 85 years in age.
Harm From Licit Drugs
In the United States, results of the misuse of prescription drugs costs about $289 billion annually, and nonmedical use of legal drugs comprises 23% of admissions for drug-related emergencies. Over 60% of drug-related deaths are caused by licit drugs every year, compared to 40% by illicit drugs (regional variations).
32,000 people die annually in the U.S. from adverse events related to prescription drugs, compared to 17,000 deaths annually from illicit drugs, including direct and indirect causes. Another deadly legal drug is tobacco, accounting for 435,000 deaths, and its partner, alcohol, killing 85,000 Americans per year.
In Canada there are significant regional variations, but in British Columbia alone, 210,000 patients each year are treated in emergency rooms due to adverse drug events, with 70% of these considered preventable. Adverse drug events result from nonadherence to prescribed use and non-medical use.
Of particular concern is the increasing abuse of legal opioids such as OxyContin (oxycodone). With the introduction of extended release forms these prescription drugs are used as a heroin substitute and have become popular street drugs.
Harm from Illicit Drugs
The Centre for Addictions Research for B.C. at the University of Victoria reports that the number of deaths related to alcohol consumption remains steady while deaths related to tobacco and illicit drug use have been declining in recent years. In 2015 in B.C., hospitalizations for overdose/injury from alcohol was 201 per 100,000 residents, and for overdose/injury from illicit drugs was 39 per 100,000.
Experts in North America have been recommending a change in drug policy since the 1970s. Most recently, an experimental safe injection site, Insite, was opened in Vancouvers notorious downtown eastside, where the greatest concentration of addicts reside. The purpose of this experiment was to determine if providing a safe site and clean needles for addicts to safely use illicit drugs would reduce deaths from overdose. This harm-reduction approach has been a success; overdose deaths in the immediate area went down by 35%.
Harm-reduction concentrates on education and health care rather than the courts to minimize harm to society and individuals from misuse/abuse of drugs. Canadas federal government has repeatedly attempted to close down Insite in contradiction of recommended health practices for addictions.
Harm from the lucrative illicit drug industry includes bystander injury and death from territorial wars among organized crime figures.
Long History of Failed Drug Prohibition
Prohibition of the use of various stimulants and sedatives has been attempted by government and military leaders for centuries. Motivation behind these attempts has varied, with the inherent reasoning behind them often being based on inadequate information.
In 1800 Napoleon forbade his troops from inhaling smoke from Cannabis, or drinking Moslem beverages made from this plant. Despite this prohibition, his troops reportedly brought the weed back to France after occupying Egypt.
North Americas flirtation with alcohol prohibition in the 1920s was a resounding failure in terms of law enforcement, with speakeasies, distilleries and rum-running proliferating, making resourceful individuals rich and allowing organized crime to get a firm foothold on the continent.
Since the 1980s the War on Drugs has consumed billions of dollars annually without making a significant impact on illegal importing and distribution in the United States and Canada.
The European Union acknowledged that prohibitionist policies were failing to protect individuals or society from the harm inherent in addictive drugs and that the illegal status of drugs provided opportunities for organized crime to flourish.
Portugals Success With Decriminalization
In 2001 drugs were decriminalized (not legalized) in Portugal in recognition of the failure of existing restrictive laws in protecting citizens. During the years following this policy change drug use stabilized or went down in some categories, but the most positive result was the significant reduction in associated harm such as overdose deaths and sexually transmitted diseases.
Portugals decision to embark on decriminalization rather than legalization was affected by international agreements that restrict the freedom of individual countries to change the legal status of some drugs. Thus their decision was to decriminalize and to respond to illicit drug use through policies that focus on prevention, education, and harm reduction. Their success sets a precedent for other countries, as fears of an upsurge in drug tourism have proven unfounded.