Toronto updated its 14-month-old decriminalization request to the federal government Friday, clarifying it wants a Health Canada exemption to cover young people as well as adults, and all drugs for personal use.
The city's submission, an update to its initial January 2022 request, indicates Toronto wants the federal agency to go further than the exemption it recently granted to British Columbia under the Controlled Drugs and Substances Act.
It makes clear the city wants its exemption to apply to all drugs for personal use and shield young people from criminalization, a departure from the B.C. exemption, which only applies to adults and lists a select number of substances.
Medical Officer of Health Dr. Eileen de Villa says the submission sent to Health Canada, co-signed by the city's police chief and city manager, is a "made-in-Toronto" model reflective of a months-long consultation process.
"We're talking about a matter of health and a matter of human rights, not one that really is meant to be addressed or is best addressed with a criminal justice approach," she said in an interview. "That's why we're pursuing this route."
B.C.'s three-year exemption under the Act was granted in June and came into force Jan. 31. While that exemption caps possession at 2.5 grams, the Toronto submission does not outline a specific threshold for what constitutes personal use.
Drug use and purchasing patterns are "exceptionally diverse," the submission said, and can vary based in part on a person's tolerance. All trafficking and drug production would remain illegal.
Whereas the B.C. exemption only applies to people 18 and older, the Toronto model would also apply to young people. A 2019 survey conducted by the Canadian Association of Mental Health indicated around 11 per cent of Ontario students in Grades 7 to 12 reported the nonmedical use of opioids in the past year.
Eight people aged 12 to 17 died from opioid overdoses in Toronto between 2019 to 2021, the submission said.
"Health issues are health issues regardless of the person involved," said de Villa.
"That's why we feel that this is something that does have to apply to all so that we're sure that even the youngest members of our community are having their health issues looked at and addressed through a health lens rather than through something like a criminal justice lens."
The pace of the approval process has garnered criticism from drug users and advocates who say it fails to match the urgency required of an overdose crisis that has killed hundreds of people every year in Toronto.
"They're moving way too slowly. So, it's nice to see movement. It's just whenever you see a little bit of movement, I think, for me at least, it hits home just how slowly this process is going — how much we're dragging our feet," said Dan Werb, director of The Centre on Drug Policy Evaluation at St. Michael's Hospital.
Decriminalization will not make the street supply any less toxic, Werb says, but it could reduce the barriers people face to accessing services that help prevent them from dying of overdoses.
He says a decriminalization policy only works if it covers all drugs since the street supply is often cut with substances not covered by B.C.'s exemption.
"But if we all agree that the primary driver of overdose death in Canada is the unregulated toxic market and all the contaminants that are circulating within it, then it seems to me that the most rational choice would be to engage, directly, intervene on that unregulated market," Werb said.
André Gagnon, a federal government spokesman, said Health Canada cannot comment on exemption requests under review.
"Each exemption request under the Controlled Drugs and Substances Act is carefully reviewed on a case-by-case basis, taking into account all relevant considerations, including evidence of benefits and risks or harms to the health and safety of Canadians," he said in an email.
"We recognize the different approaches cities, provinces, and other organizations are taking. We will continue to work with Toronto Public Health to ensure both public health and public safety is considered."
Better access to services, including 24-7 harm reduction and substance use supports will be "part and parcel" of making the model successful, said de Villa, the medical officer of health. She said there is "no question" that more services are needed.
The submission says the city intends to have several new services in place by the time decriminalization is implemented, including at least one 24-7 support location in the downtown core, to serve as an alternative to emergency departments.
The Canadian Association of Mental Health is "a strong supporter" of the effort to decriminalize the simple possession of substances, said chief of addictions Dr. Leslie Buckley.
"Decrim is one part of the picture," she said. "It will decrease stigma. It will increase the likelihood that youth will reach out for help when they need it because they won't be afraid of a criminal charge.
"That might open up a door of possibility for young people to think about accessing care."
The shift from a criminal to health lens will enable CAMH to focus on providing the care that young people battling addiction require, she said.
She said CAMH believes police who come into contact with youth in possession of certain substances should have the right to confiscate them, but without initiating a criminal file.
"We know that criminalization has not been effective and has certainly disproportionately affected marginalized populations, and so we're ready for this shift."
-- with files from Jessica Smith
This report by The Canadian Press was first published March 24, 2023.
Jordan Omstead, The Canadian Press