Toronto’s chief medical officer is calling for the decriminalization – and potential legalization – of all drugs for personal use as a way to curb rising opioid-related deaths and overdoses.

In a report released on Monday, Medical Officer of Health Eileen de Villa recommended the federal government scale up harm-prevention strategies, including the removal of legal penalties for small amounts of drugs, and convene a task force to look at the possibility of regulating all drugs, such as alcohol.

Dr. de Villa made those recommendations to the Toronto Board of Health, asking it to put pressure on the provincial and federal governments.

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“Our belief, based on the evidence, is that the criminalization of people who take drugs actually is contributing to this opioid-overdose emergency in our city, because it forces people into unsafe drug practices and actually presents a barrier to those who might be interested in seeking help for addressing opioid-use disorders,” she said.

The report is based on dozens of interviews with people who use drugs, their friends, family and community, as well as independent research. It found that criminalization leads to drug users being forced into high-risk behaviours to avoid detection; increased overdoses and infections from sharing needles; the proliferation of the violent illegal drug market; and billions of dollars wasted in police, courts and prisons enforcing drug laws.

Drug problems can affect everyone, Dr. de Villa said, but marginalized people are hit the hardest – those experiencing poverty, homelessness and mental-health issues, and people of colour. Drug problems should be treated as public-health issues, not criminal ones, she said.

The report comes as cities across Canada rush to implement harm-reduction strategies to curb the spiking death toll from the opioid crisis. But the future of supervised injection sites in the city will face a major hurdle in the provincial government – Premier Doug Ford has said he is “dead against” them and that the government should focus on rehabilitation instead. He has pledged to spend $1.9-billion over 10 years on mental health and addiction.

Toronto saw 303 opioid-overdose deaths in 2017, a 63-per-cent increase from the year before, and more than double the amount from 2015. The drug fentanyl, or an analogue, were involved in three-quarters of opioid-overdose deaths in Ontario between August and October 2017.

A June report from Toronto Public Health also called on the province to add legal protection for the city’s supervised injection sites for 12 months at a time as opposed to six, and add more “managed opioid programs,” which would prescribe controlled amounts of opioids to people who would otherwise use street drugs potentially laced with fentanyl.

Multiple studies, including dozens on Vancouver’s premier supervised injection site, Insite, have found that supervised injection sites mean fewer overdose deaths and infectious diseases from sharing needles, among other benefits. Fatal overdoses in the area around Insite decreased 35 per cent in the eight years after it opened in 2003. In 2015, more than half of the 464 people who were referred to addiction-treatment programs from Insite completed them.

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After Portugal decriminalized drugs for personal use in 2001, new cases of HIV and AIDS among people with addictions declined year after year, and drug-related deaths dropped by 27.5 per cent from 1999 to 2006.

The overdose crisis, Dr. de Villa said, is a public-health issue and deaths stemming from it can be prevented.

“These are our friends, they’re our family members, they’re our colleagues,” she said. “We have scientific evidence to support the right actions and I think that it’s beholden on us to make sure that we use the best available scientific evidence to inform actions to prevent these untimely deaths.”