Health officials and advocates in British Columbia and Toronto have joined a growing list of groups calling for drug decriminalization in Canada as a tool to treat substance use and addiction, which killed more than 4,000 people across the country last year.

The Toronto Board of Health and the BC Nurses’ Union both called for decriminalization this week, while the Canadian Centre on Substance Use and Addiction (CCSA) issued a paper outlining various ways to implement such a policy.

“We need to start looking at alternative and innovative approaches,” said CCSA director of policy Rebecca Jesseman, who authored the brief with Doris Payer. “It really comes down to the fact that we are dealing with a health issue here, so we need to look at solutions that are better tailored to addressing substance use as a health issue.”

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The three groups join the likes of the World Health Organization, the United Nations and the Global Commission on Drug Policy, all of whom are of the view that removing criminal penalties for minor drug crimes would combat stigma and improve access to health care for vulnerable populations.

Prime Minister Justin Trudeau and Health Minister Ginette Petitpas Taylor have repeatedly ruled the option out.

“It’s not an issue that we’re looking at,” Ms. Petitpas Taylor told reporters last fall. “We are exploring other avenues right now.”

The CCSA policy brief notes that there is a growing body of evidence to support the efficacy of decriminalization, but that it doesn’t involve a single model or approach.

The brief cites national “de jure” approaches such as the oft-referenced Portugal model, which replaced criminal penalties for the purchase, possession and consumption of all psychoactive drugs for personal use with noncriminal sanctions such as a referral to treatment.

But it also looks at several de facto approaches, in the form of police diversion, that cities can take independently. In England, Bristol’s Drug Education Programme, for example, allows police officers to provide those caught possessing illicit drugs with the option to attend a half-day drug education course to have criminal charges dropped.

Australia has numerous police diversion programs in place that often “have a therapeutic focus through assessment, education and treatment components, but also include warnings, confiscation and civil penalties,” the brief stated. Seattle’s Law Enforcement Assisted Diversion (LEAD), meanwhile, gives people accused of low-level drug and prostitution crimes the option of case management and community supports rather than going through the criminal justice system.

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The brief noted that, compared with criminal charges, diversion programs can reduce criminal justice system costs and reduce adverse social and economic consequences for the individual. A 2008 study from Australia found that the majority of participants without prior offences did not commit further offences and those with prior offences had reduced rates for reoffending after participating in the program.

Under decriminalization, which is different from legalization, it would remain illegal to manufacture, sell and distribute illicit drugs.

In Vancouver, where on average one person fatally overdosed every day last year, outgoing Mayor Gregor Robertson recently joined those calling for decriminalization, but stopped short of saying police in his city should cease arrests for petty drug crimes. The Vancouver Police Department says its enforcement efforts target those who manufacture and distribute illicit drugs, and that the number of charges it recommends for possession without the presence of another substantive offence, such as assault or a break and enter, is “historically very low.”

But they do happen. Figures obtained by The Globe and Mail show that the Vancouver police recommended 30 charges last year for possession of a prohibited/controlled substance, in the absence of other charges. There were 43 such charges in 2016, 65 in 2015 and 48 in 2014.

Asked about this on Tuesday, Vancouver Police Chief Adam Palmer said the figures almost amount to de facto decriminalization.

“There’s not very much enforcement of possession laws for many years in Vancouver,” he said. “That is the amount of importance that we put on it.”

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He added that “there is always more context” to the charges that police recommend for possession alone: “It could be a case that somebody’s doing something near a school or a playground, or youth are involved.”