Criminalizing the use of marijuana and other tough on crime approaches haven't worked, say public health doctors from across Canada who propose taxation and regulation instead.

The chief medical health officers in British Columbia, Nova Scotia and Saskatchewan wrote a paper reviewing the evidence on Canada's current illicit drug policies in Wednesday's issue of the journal Open Medicine.

The paper comes as the federal government is set to table its budget amid funding questions for its new anti-crime legislation, which includes mandatory minimum sentences for minor drug offences.

Looking at illegal drugs solely based on a criminal justice approach has failed, said Dr. Robert Strang, Nova Scotia's chief medical health officer, a co-author of the paper.

"For the last decade, Portugal has decriminalized all drug use and they have some of the lowest rates of drug use in Europe and they have some of the least amounts of harm from drug use," Strang said.

In contrast, drug use hasn't decreased since the $1-trillion US "war on drugs" in North America was declared and aggressive drug law enforcement began.

With tough drug enforcement policies, organized crime has profited, incarcerated drug users have suffered HIV and hepatitis outbreaks and gun violence problems have grown, a group of Canadian doctors say. (Noah Berger/Associated Press)

In the U.S., New York, Michigan and Massachusetts and Connecticut are now repealing minimum legislation for non-violent drug offences, said Dr. Evan Wood, co-director of the Urban Health Research Initiative at the B.C. Centre for Excellence in HIV/AIDS, another co-author of the paper.

With tough drug enforcement policies, organized crime has profited, incarcerated drug users have suffered HIV and hepatitis outbreaks and gun violence problems have grown, the doctors said.

Minimizing harms of drug use

Strang, Dr. Perry Kendall, chief provincial medical health officer for B.C. and Dr. Moira McKinnon, who holds the same job in Saskatchewan, wrote that opponents to drug policy reform commonly argue drug use would increase if health-based models were stressed over drug law enforcement.

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But they said a recent study by the World Health Organization concluded that countries with stringent illegal drug policies for users did not have lower levels of use than those with liberal policies.

"The Safe Streets and Communities Act goes after the source of the illicit drug trade — the drug traffickers," said Julie Di Mambro, press secretary for Justice Minister Rob Nicholson.

"The kinds of offenders we are targeting are those who are involved in exploiting the addictions of others for personal profit. In our legislation, we included a specific exemption to allow for the use of drug treatment courts so that those who are unfortunately addicted can get the help that they need."

The authors, who were giving their personal opinions, said governments need to consider other approaches that include public health objectives that minimize health and social harms, such as:

Taxing marijuana as alcohol and tobacco are.

Licensing cannabis dispensaries and issuing prescriptions for medical marijuana.

Implementing age limits and other sales restrictions like those used to reduce alcohol use.

Regulating and controlling the availability of potent substances to reduce the illegal market.

"We're even calling for taxation and regulation of marijuana under a public health framework as a strategy not only to reduce the availability of marijuana to young people, but to get away from all of the public health and organized crime concerns related to all of the gang violence," said Wood.

Needle exchanges

The chief medical officers of health in Canada's 18 largest cities have also endorsed the Vienna Declaration, a global statement calling for illicit drug use policies to incorporate scientific evidence, such as studies on the effectiveness of needle exchange programs and methadone maintenance therapy.

The 2005 renewal of the national drug strategy aimed to incorporate scientific evidence into drug policy.

In 2007, the federal government removed support for evidence-based harm reduction programs recommended by the WHO, the doctors said.

Wood has also questioned the effectiveness of anti-drug public service announcements.