Scott Bernstein has a lofty goal to realize before he hits retirement: he wants to see Canada legalize and regulate all drugs.

“We’re maybe 10 years away from legal regulation,” Bernstein, 53, director of policy for the Canadian Drug Policy Coalition, told VICE.

As Canada continues to work out the kinks of legalizing cannabis—and jurisdictions around the world follow suit—harm reduction advocates and drug policy researchers have their sights set on the regulation of all drugs, a reform they say is necessary to save lives and look at the issue from a public health perspective. Legalizing drugs would be different from decriminalizing drugs—the latter would make it legal to possess and use small amounts of banned substances but not to produce or sell them. Legalization would mean securing a safe supply of drugs and, with varying degrees of strictness, making those drugs accessible to the public.

“I think we’re coming to a point where there’s broader consensus that the prohibition, law enforcement responses to drugs don't work,” Bernstein said. “In a logical environment, we’d say, OK instead of letting the black market decide things like who gets access to it and how do they get access to it, we’d put this in the hands of the government informed by science and human rights.”

“The idea is to sort of move the conversation away from ‘should we regulate’ to ‘if we did regulate, what would it look like?’”

But what does that really look like in practical terms? The Canadian Drug Policy Coalition, a group that consists of 70 organizations across Canada, is trying to answer that question. It is in the midst of developing potential regulatory models, ranging from liberal to restrictive, for four classes of drugs: opioids, stimulants, sedatives, and psychedelics.

Bernstein said the coalition plans to present the various models to 10-20 focus groups across Canada, and to ask for feedback from thousands of Canadians before eventually presenting a case for legalization to the government. He recently presented part of the coalition’s research at the Harm Reduction International conference in Porto, Portugal a few weeks ago.

“The idea is to sort of move the conversation away from ‘should we regulate’ to ‘if we did regulate, what would it look like?’”

Opioids

Current legal status and challenges Prescription opioids including codeine, morphine, oxycodone, and fentanyl are used to treat pain in Canada. A smattering of grassroots addictions programs also offer prescription heroin and hydromorphone to people who struggle with substance issues. Prescription heroin distributed in Canada needs to be purchased from Europe and requires approval through the federal government’s Special Access Program; last year the government loosened up regulations allowing for provinces to bulk import heroin, and allowing for it to be prescribed in locations outside of hospitals and by nurse practitioners instead of just doctors, Bernstein explained. However, more than 10,300 Canadians have died due to opioid-related overdoses since 2016, according to the Public Health Agency of Canada. And many of those deaths are linked to fentanyl and “fentanyl-related substances,” which accounted for 73 percent of accidental opioid-related overdose deaths from January to September 2018. As such, regulating opioids is a top priority for researchers like Bernstein.

How opioids could be regulated

Bernstein told VICE opioids like heroin could be regulated in a medical framework, where a person would need a prescription or a referral to get into a program. The BC Centre on Substance Use wants the province to adopt a heroin buyers club model, where users who’ve undergone a medical assessment could access a safe supply of legal heroin. Less risky preparations of the drug, such as a poppy tea or smokable opium, could be available outside of a medical framework.

“We have mostly a supply problem of a poisoned drug supply and what regulation would do is not only would there be a legal access to possess and consume the drugs, there would be a legal access to the supply of them,” Bernstein said.

Bernstein said some opioids may lend themselves to being produced by pharmaceutical companies, or the government can potentially license certain producers to grow opium or continue to import it. “We’d want to not only ensure that the supply was safe, tested and unadulterated, but also that it was produced and distributed in an environmentally-friendly, cost-effective and fair way,” he said. “Considering opium, for example, we may want to balance the advantages of having a domestic supply with the fact that farmers in Mexico are already producing opium, can do it more cheaply than we can, and we would be helping to provide a legitimate income stream.”

Either way, he said “it’s probably not going to be something that lends itself to a commercial market” comparable to what we see with cannabis and alcohol.

Stimulants

Current legal status and challenges

Simulants run the gamut from coffee on the more innocuous end, to prescription medications like Adderall and Ritalin to controlled substances like MDMA, powder cocaine, crack cocaine, and methamphetamine. Results from the 2019 Global Drug Survey found that Canadians are second in the world for cocaine use, tied with Brazil, Italy, Portugal, Denmark, and England, while a recent VICE News analysis found that meth-related deaths are on the rise across the country, with 1,000 fatal meth overdoses in 2017.

Steve Rolles, senior policy analyst for the UK-based Transform Drug Policy Foundation, told VICE the prohibition of cocaine is the “worst of all worlds”—it doesn’t get rid of the black market, it creates a supply with unknown strength and purity, and it perpetuates cartel-fuelled violence in Mexico and Latin America. However Rolles said drugs like cocaine, that fall into the intermediate-risk recreational space, can be the most difficult to regulate. There’s more motivation and political will to legalize less-threatening drugs like weed and mushrooms, and high-risk drugs like opioids, where there’s a call for immediate action, he explained.

“Cocaine is really tricky. It’s quite short acting it lends itself to compulsive use,” Rolles said, and is frequently combined with alcohol, which is bad from a public-health perspective.

How stimulants could be regulated

Rolles sees a licensed user pharmacy model as a starting point for stimulants like cocaine, MDMA, and powder amphetamines, where there would be a health professional or trained vendor acting as a gatekeeper. That means users would have to pass an assessment of some sort to buy a rationed amount of a particular drug—say a gram of cocaine a week, for example.

The vendor would be trained to give harm reduction advice, including telling consumers to avoid combining cocaine with booze, to try not to use it daily, and to use a nasal douche to curb irritation and damage to the nasal passages after snorting.

“You wouldn’t want cocaine companies sponsoring sporting events.”

Another possibility would be to regulate milder cocaine products—a consumer friendly version of chewing a coca leaf or a coca leaf tea bag “that would give a longer lasting but milder cocaine buzz.” The black market favours the most powerful iterations of the drug, like powder cocaine and crack, but not everyone requires something that strong, Rolles said, noting coca energy drinks or tea could be sold in a similar fashion as coffee.

“You wouldn’t take all of the market for cocaine powder but you might be able to capture some of it,” he said.

The price (street cocaine is around $80 a gram in Canada) would have to be have to be high enough to avoid encouraging use, and it should be sold as a non-branded pharmaceutical product, Rolles said.

“You wouldn’t want cocaine companies sponsoring sporting events.”

Rolles said privacy concerns associated with having a registry of drug consumers would have to be addressed.

Rolles said coca leaves typically grow in the Andes, it is possible for other countries to produce cocaine—or there could be a model of buying fair trade cocaine from local growers.

Psychedelics

Current legal status and challenges

Psychedelic drugs include psilocybin mushrooms, peyote, ayahuasca, and LSD. (MDMA, a synthetic drug, is considered both a psychedelic and a stimulant.) In Canada, LSD and MDMA are both banned substances. With mushrooms, peyote, and ayahuasca, it gets a bit more complicated. Ayahuasca, a hallucinogenic tea, contains the banned substances harmaline and dimethyltryptamine; however Health Canada has been granting more religious exemptions as of late, allowing certain religious groups to import and use the tea as part of spiritual ceremonies. Peyote, a spineless cactus, is legal in Canada but its active ingredient mescaline, which causes hallucinations, is a banned substance. As for mushrooms, one of the most common hallucinogenic drugs, it’s illegal to possess or sell dried ones—aka ones prepared for human consumption—but fresh mushrooms, or wild ones are not illegal.

There is also growing push to research how mushrooms and MDMA can be used to treat people with mental health issues like death anxiety, post-traumatic stress disorder, and depression, with some promising early findings.

How psychedelics could be regulated

Kenneth Tupper, senior policy advisor with the BC Centre on Substance Use, told VICE compared to other substances, psychedelics don’t generally lend themselves to chronic use and addiction and aren’t a big burden on the healthcare system.

He believes the Canadian government could adopt a kind of training program, through which people could become licensed users. Tupper said religious groups, such as the Santo Daime church, already provide an example of how a regulated system could work, with a spiritual leader, or even a therapist, leading ceremonies or sessions. After a few experiences in that setting, people could graduate to consuming substances without the guide.

"The big business side of how the cannabis industry has evolved in Canada is cause for concern."

As for MDMA and ecstasy, Tupper said pharmaceutical grade substances could be made available but without any type of branding.

He also said the “capitalist mentality should be kept in check,” pointing to Big Weed as an example.

“I think the big business side of how the cannabis industry has evolved in Canada is cause for concern in terms of the profit incentives overriding some of the public health concerns.”

For peyote and ayahuasca, Tupper said a safe supply could be secured through fair trade agreements with local growers abroad.

“We try to build into a bit of economic reciprocity,” he added.

Sedatives

Current legal status and challenges

For the purposes of their research, Bernstein and his colleagues looked at GHB, ketamine, and benzodiazepines (well-known benzos include Valium and Xanax). Each group comes with separate risks and challenges, he explained, and their potential regulatory models were therefore assessed individually.

GHB, sometimes referred to as a “date rape drug” because of its sedative effects, comes with a high risk of overdose. It can be prescribed in Canada for conditions like narcolepsy, but is also manufactured and consumed illegally as a party drug. “Using in public can be dangerous because of the small margin between a ‘fun’ dose and a dose which may reduce consciousness,” Bernstein said. GHB consumers can also develop a physical dependency and withdrawal is “very painful and can be dangerous,” he added.

Ketamine is an anesthetic most commonly used during pet surgeries, but it’s also sold and used illegally in powder form. Bernstein said the overdose potential is lower than with GHB, but that “consistent use does take a toll on the body and death can result from general organ damage over time.” It can be very psychologically addictive, he said.

Benzos are unique in that they are most often accessed through medical prescriptions for anxiety and mood disorders, and legal supply is diverted into the black market.

“This said, benzos are actually quite dangerous as they carry a high overdose potential, particularly when mixed with other substances like opioids,” Bernstein said, noting they are also very physically addictive, have painful withdrawal symptoms, and can harm the immune system if used chronically.

How sedatives could be regulated

To address the overdose risk of GHB, Bernstein said a licensed regulatory scheme could work, where consumers received mandatory training about how to control doses and spread them apart to avoid becoming addicted. Bernstein said Canada could consider a two-tiered system, where people who are addicted to GHB would receive greater access than those who haven’t formed a dependency. Emergency supplies should be available for those experiencing withdrawal, he said, though he noted the “social nature” of GHB means it’s unlikely people would only want to use it in a purpose-designed consumption venue (e.g. Insite for opioid users).

For ketamine, similar measures around restricting access for non-dependent consumers could work, Bernstein said. Having peer facilitators around while people are consuming could add security.

Bernstein said consumers should be encouraged to have medical check-ups in order to assess any damage to their bodies resulting from ketamine use.

As for benzos, which are an important tool in treating anxiety and mood disorders, Bernstein it’s difficult to control their distribution in a stricter way than the current prescription model. So the goal would be to educate people who are using benzos legally and illegally on how to do so in the safest way possible.

•••

All of the researchers who spoke to VICE were clear that the war on drugs has been a failure. When it comes to political will, Bernstein said the government needs to balance the risks versus the benefits of having a regulated supply of drugs.

“Right now the risks of having an unregulated supply is several thousands of Canadians are dying every year of preventable overdoses.” Whereas the risk of having a legal supply is that a small percentage of consumers may develop a dependency, but “we have tools to fix that.”

Bernstein sees legal regulation as a very Canadian solution because we’re comfortable with the government playing a big role in controlling the risks.

“We almost allow people to die to serve as a warning.”

Tupper said the government has to recognize that in the age of the dark net and cryptocurrency, the idea of law enforcement officials heading up drug policy is “game over.”

“Anyone can buy anything they want.”

He said drugs are the one area where the “buyer beware” mentality has prevailed in society, instead of trying to build some safety into the supply chain.