Brief submitted to the Special Senate Committee on Illegal Drugs
Setting public policy on drugs: a question of social values
What do we in Canada want?
By: Line Beauchesne
Department of Criminology
University of Ottawa
In the first part of this brief, the author sets out the guiding principles of public drug policy under the three main options identified by the Le Dain Commission in its report on cannabis. This will spark a debate over the primary social values in each of those options and will clearly show that drug policy is not based solely on an examination of the toxicity of drugs. It also takes into consideration the issue of citizenship and the values on which citizenship is based.
In the second part, the author will provide concrete examples of that situation by analysing current Quebec policy on alcohol and smoking and policies on illegal drugs. This will demonstrate the importance of basing the objectives of our drug policies on clear choices of social values.
To feed someone and not love them is the same as dealing with swine.
To love someone but not respect them is like raising domesticated animals.
Mencius, Chinese philosopher, 300 B.C.
A public policy is an articulation by the government or its institutions of a set of guiding principles for consistent action in a given area.
These principles and guidelines for action may be established through force and violence. In that case, we have a dictatorship.
Alternatively, these principles may be established through debate intended to maximize their credibility with the public, allowing use of administrative, economic, social and legal strategies for implementation that are recognized as legitimate and consistent, with criminal law and force as a last resort. In that case, we have a democracy.
Of course, in many matters of public policy, the lines are not so clearly drawn.
One of the jobs of criminology is to study criminal law to determine whether it is being used in different areas as the method of last resort. The premise here is that criminal law represents a grave act of institutional violence whose use must be limited to cases of threats to social order that cannot otherwise be managed in the short term. Criminal law is first and foremost a mechanism of social exclusion and stigmatization (Pires, 1995). Recurrent use of criminal law to maintain a policy is considered to signify a failure of its content, an absence of consensus among those affected by the policy, or a lack of sufficient government support to ensure its implementation. To view criminal law as a component of a policy and not an exceptional measure amounts to accepting the legitimacy of violence as a fundamental aspect of the governments role and a means of forcing the public to comply with its decisions.
But how can we determine whether criminal law is being used to enforce a policy as a method of last resort? To answer that question, we must examine the social values that we wish to promote as citizens. This is the exercise we shall conduct in this brief on drug policies.
1 Social values and public policies
The report of the Le Dain Commission (Le Dain, 1972) was the product of a detailed study of the use of drugs for non-medical purposes in which, for the first time, experts from different disciplines joined forces to advise the government on public drug policy through a royal commission of inquiry. Little effort has been made to analyse the reports various political options as indicative of the social values that underlie its conclusions and recommendations, as opposed to the issue of drugs. In this regard, the first volume of the report on cannabis is particularly interesting: the commissioners all recognize that cannabis has few harmful effects, but fail to agree on a public policy with regard to this drug. As we shall see, the dissension stems primarily from differing visions of the social values that should underlie relations between the government and its citizens.
1.1 Legal moralism: imposing the values of specific groups through force of law
The first minority report submitted to the Le Dain Commission was written by Ian Campbell. Taking his cue from the political philosophy of Lord Devlin (1968 ã 1965), Campbell asks not only that the current prohibition against cannabis be maintained, but that repression of its users be increased through police raids, compulsory medical treatment, long-term monitoring with urine tests, control of associations, and so forth. It is essential, explains Campbell, to stop crime-inducing elements from "contaminating" young people from good families, whose parents may lose all hope of a productive future for their offspring because of drugs, including cannabis.
Campbell explains that the government has not only the responsibility to use its public policies to be a guardian of public order and protector of non-independent persons, but also the responsibility to maintain a common morality within society. The government may therefore have recourse to criminal law in response to behaviour that threatens the "established morality", regardless of the dangers such behaviour presents for the individual or society. The goal is to prevent the disintegration of our existing society through loss of a "common morality", an essential element of social cohesion and economic prosperity.
Although Campbell recognizes that cannabis has few harmful effects, he says the criminal prohibition against its use should be maintained as an embodiment of the moral prohibition:
It seems to me to be an unassailable proposition that the majority may properly prohibit through the law conduct that is manifestly offensive or disturbing to them whether or not that conduct inflicts an injury on any particular person beyond the actor. This principle is recognized in our laws against public nudity. There is every reason to think that the public use of cannabis is offensive and disturbing to the vast majority of Canadians. There is even more reason to think that public use by young people is particularly offensive. Hence, it appears not inappropriate that such behaviour should be forbidden by law.
. . . To whatever extent youthful experience of intoxication predisposes to chronic adult intoxication or acts to limit the full and healthy development of human potential it lessens the capacity of the individual for a full, rich and creative life and lessens his potential contribution to his society . . . .
. . . But it seems to me that recently we have been far too little concerned with the consequences of placing too many rights and freedoms on the shoulders of the young. (Le Dain, 1972:313-314)
From the perspective of legal moralism, the government intervenes in drug use in the name of its responsibility to preserve "common values" that are vital for the well-being of society. This makes it legitimate to wage a battle, by force if necessary, against the "contaminants" attacking our society; the government may apply drug controls and prohibitions, and even target specific minority groups, without raising an outcry from other segments of the population if the latter consider those groups to be outside the "common morality". Moreover, legal policies and practices are both coloured by this moralistic vision since users, whether or not they are capable of handling their consumption, may be condemned for their choice of "vice" over "virtue". This approach justifies drug prohibitions on the basis of morality rather than public health.
Legal moralism dominates current discourse supporting the maintenance of prohibitions against drugs. It is deeply rooted in the history of the Protestant culture as it developed in North America and, as such, it is not surprising that the United States originated the war on drugs and is the main spokesperson for the argument that perpetuates that war.
The assumption that underlies this position is that there exists a common morality, which must be protected by the powers that be. Yet the science of morality has been seeking common denominators on which to base a universal morality for centuries:
[Translation] When it comes to universal standards, although almost all philosophical doctrines claim the same objective the happiness of humanity there is great disparity as to how to achieve that goal and what values to uphold: their relative importance varies from one doctrine to another, from one culture to another, from one individual to another and often, in one individual, from one moment to another as circumstances dictate.
. . . In other words, our morality ebbs and flows in accordance with our personal ethics, where our ethics are the ideal and morality is the means by which we approach that ideal.
Morality and ethics are rooted, therefore, in a relativism of situations, sentiments and values. (Rosenzweig, 1999: 3-4)
In fact, there is no common morality other than the refusal to respect the very real pluralism of values held by the individuals and groups in society.
The reasoning behind legal moralism is valid: when everyone thinks the same way, social management is simpler, in the way that a dictatorship is a simpler method of political management than the democratic search for consensus. Anyone who has had the experience of repeated meetings knows this. Democracy is a long and sometimes arduous process. But would we, as citizens, prefer to remain uninformed and instead allow the political authorities to decide which social values to promote and impose on us, by force if necessary?
If we choose the search for consensus, the process of constructing our drug policy is necessarily going to involve an encounter with the pluralism of values. And to arrive at a policy that respects that pluralism, we must take the time to inform the public properly about the foundations of the policies we advocate. To impose a drug policy in the name of a common morality, is to impose the morality of certain specific groups.
This leads us to the first question concerning social values: to what extent does the prohibition of drugs, under the current public policy, represent an imposition of the values of certain groups in society? We will answer some aspects of this question in the second part of this brief. For now, let us continue examining other positions on cannabis policy from the Le Dain report.
1.2 Legal paternalism:
mandatory protection under threat of criminal sanctions
The majority report of the Le Dain Commission, which is based on the political philosophy of H. L. A. Hart (1969ã 1963), presents a mixed position, combining treatment and punishment. It calls for decriminalization of cannabis because of its relative harmlessness, but not legalization, stating that the law should not encourage the use of products harmful to health of our young people. The commissioners explain that they understand the need to preserve individual liberties at any price but take the view that the government, in addition to being the guardian of public order, has a paternalistic function that allows it to use certain forms of legal constraint to prevent non-independent persons from harming themselves. The government therefore has a responsibility to use criminal law to restrict the availability of cannabis, particularly for young people.
This position, common in countries where the Catholic culture dominates, opened the door to medical control over drug use in the name of public health protection, assuming that the experts have the necessary knowledge to protect individuals who do not know better.
This position is more complex than the previous one. First, there is the entire question of non-independent persons. Who designates these individuals? Second, there is the significance of the term "protection", a key issue when it comes to drugs. Does it include protecting individuals against their will, and by force, if need be? And protecting them from what?
Let us look at the first question. Historically, it has long been maintained that the working class was incapable of handling alcohol, in contrast to the upper class. Today, Aboriginal people are considered inferior to whites in this regard, somewhat in the same way that in the United States, Blacks are less able than whites to handle illicit drugs. This form of discrimination may also be applied to homosexuals, supposedly less able than heterosexuals to handle their sexuality, and women, less capable than men of handling their emotions. These preconceived notions dodge the whole issue of the living conditions of certain populations relative to other, dominant ones, and the values promoted in order to maintain such dominance. Of course, there are more fragile populations in a society with which the government must concern itself. Must this, however, take the form of prohibitions and punishments to ensure their welfare? This leads to the question of "protection".
It is possible to protect people by making them more independent, better able to make choices, and by improving their living conditions and access to services and information. It is also possible to decide that if these people make choices that do not conform to our values, it is because they are unfit to do so, and we must impose choices on them by force.
Every parent can see the difficulty here. There are emergency situations in which, in the short term, a prohibition is most appropriate: "Do not cross the road without Mommy!" Nevertheless, a child must eventually be taught how to cross the road without Mommy, to be aware of the dangers and to take the necessary precautions. A parent will not always be there to hold the childs hand. So we prepare our children by giving them information and teaching them how to judge when it is safe to cross the road, for their own sake and that of others. However, should an unfortunate accident should occur, we would hope that it is not fatal and that the hospital will provide the best possible care.
Now imagine the following scenario: parents forbid their children to cross the road until they are adults, because they are not independent; as adults, if they cross the road, the authorities imprison them for breaking the prohibition whether or not they have crossed the road successfully - , or, if they are involved in an accident, treatment is provided only on condition that they promise never to cross the road again. In legal terms, the argument in favour of prohibition as a way of protecting young people does not make much sense. It is not possible to justify a prohibition that includes adults on the pretext that we wish to protect the health of children, just as we would not prohibit adults from drinking wine on the premise that it is dangerous for children. Protection would be better accomplished by regulating the quality and marketing of a product, and prohibiting its consumption by minors.
The basis for this position, which combines punishment and conditional treatment in the name of paternalism and protection of the weak, is the refusal to consider that the role of the government is to maximize the opportunity for each individual to become a full-fledged, independent citizen. If we accept that this is the governments role, it must be proven, on the legal level, that criminal law is the only way of preventing non-independent persons from harming themselves.
Has this been proven with respect to drugs? (Van Ree, 1999) Rather the opposite. The war on drugs has not only failed to meet the public health objectives of preventing addiction, intoxication and abuse, and prompting an overall decrease in drug use, it has actually aggravated the situation by fostering a black market for drugs and depriving thousands of medical treatment. This situation prevails in Canada as well as elsewhere. (Beauchesne, 1992)
New trends and attitudes to certain illicit drugs over the past thirty years indicate that, despite having been prohibited since the early 20th century, when reasons for their consumption changed, new groups have begun to try them. The most detailed report on the use of legal and illegal drugs in Canada, that of the Canadian Centre on Substance Abuse (CCSA) and the Centre for Addiction and Mental Health (CCSA/CAMH, 1999: 136) reports that in 1994, one out of four Canadians admitted to having used illegal drugs at least once in their lives and 7.7% in the year preceding the survey, the usual drug being cannabis. The following table (CCSA/CAMH, 1999: 143) shows some of this data on drug use:
Lifetime use of illegal drugs, by province, by persons aged 15 years and over, Canada (in percentages)
Canadas Alcohol and Other Drugs Survey, 1994
LSD, speed, heroin
|Prince Edward Island||18.6||2.0||3.0||18.6|
These data cannot be explained solely by lack of information on the potential harmfulness of these drugs, the deviant personalities of the users or the new availability of these products. Of course, the drugs must be available. But availability is not sufficient to explain their consumption. By way of illustration, let us also look at some data on alcohol consumption in Canada.
Quebec has always had a more liberal policy on drinking age and sales outlets for alcohol than the other Canadian provinces. Nonetheless, Quebecs per capita rate of alcohol consumption has been lower than the national average for as long as we have had reliable data, that is, since the early seventies. (Smart and Ogborne, 1986) The most recent data are as follows:
Sales of alcoholic beverages and volume of absolute alcohol per person (litres), by persons aged 15 years and over, Canada and provinces, 1996-97 (CCSA, CAMH, 1999: 36)
|PROVINCE or TERRITORY||beer||wine||spirits||total|
Prince Edward Island
Because there are more liquor outlets in Quebec, people assume that alcohol consumption is greater. In fact, the number of outlets in Quebec did increase from 350 to over 12,500 with the passage of Bill 21 in 1978, a bill that permitted the sale of beer and wine in small grocery stores and considerably longer hours of business (an additional 40 hours). Alcohol consumption before and after passage of the bill was measured: despite the much greater availability of this drug in Quebec under the new law, there was no significant change in its consumption, and the percentage of drinkers in Quebec remained below the national average. (Lamarche, 1987) This example shows that drug consumption is not motivated solely by availability, while restricting availability does not automatically lead to a drop in consumption.
Furthermore, fear of the law has little influence on a persons decision to reduce or stop use of illicit drugs. According to studies conducted by the Addiction Research Foundation, health concerns are more likely to be the determining factor in this decision:
[Translation*] Marijuana possession, for example, is the most studied drug offence. Many studies have come to the same conclusion: fear of punishment or its severity have little deterrent effect on users. Similarly, cocaine users consider the threat of the law insignificant. What appears to be much more important, in contrast, and contributed to a reversal of the trend toward illicit drug use in the seventies is the growing perception that certain methods of drug use are harmful, a perception that also contributed to increasing social disapproval of these methods of use. If we weigh concern regarding the legal risks and concern over the health risks for drug users, health concerns clearly come out ahead.
. . . As a preventive tool, criminal law is particularly ineffective in deterring young, first-time users. The decline in illicit drug use is independent of criminal law, therefore, and will not be significantly affected by greater criminalization. (Erickson, 1990: 565-566.)
In short, studies to determine how effective the law is at decreasing public health problems related to drug use show that criminal law has little effect; at most, the law may decrease the consumption of specific drugs by limiting their availability. There is no proof, however, that use of one drug is not simply replaced by use of other, sometimes more dangerous, drugs. This is what happens with the black market fostered by the war on drugs. In the absence of a legal market, the black market meets the demand for illicit drugs. Drug trafficking networks have developed that do not allow for regulation of product quality or distribution:
Illegal street-drugs have a set of risks all their own. Users of street-drugs can never know exactly what they are taking. Dealers may not know (or reveal) exactly what they are selling. Some drugs are laced with other drugs or chemicals which can be harmful. Often one drug is sold in place of another.
In 1988 nearly two-thirds of all street-drug samples tested by the Addiction Research Foundation of Ontario were found to be different from what they were alleged to be by the seller. That means that about two out of every three times a drug was bought on the street, it was not what the buyer thought it was.
Many bad drug reactions, including fatal overdoses, are caused by the users ignorance of exactly what drug and how much of it they are taking. (Health and Welfare Canada, 1990:7)
Sellers of illict drugs are found everywhere schools, clubs, the streets, workplaces, and so on, usually offering either adulterated products to increase their profits, or highly concentrated ones to encourage sales and even dependence, and, in the case of some drugs, promoting such "hard" methods as injection. This harks back to the days of alcohol prohibition, from which we seem to have learned little. (Nadeau, 1989)
In fact, the current drug laws present a much greater danger than Prohibition. Since these laws are international, the black market operates in more than 60 countries, and its size has attracted major players with much greater means; prohibitions have made the illicit drug trade into a flourishing international market.
Dealers in this market have the same objectives as in any lawful market: identifying a potential clientele, ensuring its regularity, creating new clienteles, and so forth. However, since the trade, concentration and quality of products are not regulated, any effort to expand the market is permissible, whether it be the sale of drugs to children or the sale of highly toxic products. Some dealers even attempt to create lifetime customers, by encouraging methods of consumption that can more easily create dependence than other, safer ones. In addition, dealers vary their products from time to time in order to keep their clients interest, and create fads with the regular introduction of new products, such as crack, ice, Ecstasy and so on. Dealers also try to reach a broad market by offering drugs at various prices; depending on the locale, cocaine, amphetamines or crack will dominate. Dealers similarly seek to extend their markets geographically by dumping drugs in previously unexplored areas so as to attract new clients. None of this should be surprising. Right now the drug trade is a highly profitable one that operates worldwide. It is worthwhile for traffickers to use the best possible techniques for distributing and promoting their products. The result is that the black market is much more effective than a lawful, regulated market would be in promoting use of drugs, with hundreds of thousands of dealers actively penetrating all segments of society. (de Choiseul-Praslin, 1991) We have had a sample of this situation with the black market for tobacco, which saw highly active dealers in all locales, dealers who in many cases were young people in school. There was also violence associated with this market, not because of the nicotine, but because of the operating rules of the black market.
Not only have prohibitive drug laws failed to diminish the consumption of illicit drugs therefore, they have also prompted the development of a black market in which lack of control over drug quality, concentration and places of distribution promote intoxication and make it extremely difficult for users to learn how to handle drugs. Moreover, they deprive thousands of sick people of drugs that could ease their suffering, as demonstrated by many studies on therapeutic use of illicit drugs. Finally, the war on drugs deprives illicit drug users of appropriate medical treatment for problem habits. Such users, especially young people, are often reluctant to seek medical assistance for fear of encountering repression, lack of understanding, and discrimination. The result is that many users come to treatment with very serious problems because no intervention took place earlier, a result of the governments decision to spend money on repression rather than assistance, education and social programs.
In short, who does prohibition protect if it leads to a higher incidence of public health problems? At present, there can be no doubt that the cure is not only ineffective against the disease, but that, to use a familiar metaphor, its effects are worse than the disease itself.
Simply stated, drugs are more dangerous because they are illegal. Just as tens of thousands of people died or were blinded or poisoned by bad bootleg liquor 60 years ago, perhaps the majority of overdose deaths today are the result of drug prohibition.
Ordinarily, heroin does not kill. It addicts people and makes them constipated. But people overdose because they dont know what they are getting; they dont know if the heroin is 4 percent or 40 percent, or if it is cut with bad stuff, or if it is heroin at all it may be a synthetic opiate or an amphetamine-type substance.
Just imagine if every time you picked up a bottle of wine, you didnt know whether it was 8 percent alcohol or 80 percent alcohol, or whether it was ethyl alcohol or methyl alcohol. Imagine if every time you took an aspirin, you didnt know if it was 5 milligrams or 500 milligrams.
. . . Fewer people might take those drugs, but more would get sick and die. That is exactly what is happening today with the illicit drug market. (Nadelmann, 1990:27.)
Furthermore, a war on drugs implies the use of violence to achieve its goals. The violence will be even worse if the adversaries have been encouraged to assume a "warrior mentality" through lack of public information and the consequent fear. Those deemed "non-independent", on whose behalf this prohibition has been justified are likely to pay dearly:
War mentality cleaves the world into noble allies and despicable enemies; justifies any measures necessary to prevail, including violence to innocent bystanders; and disdains accommodation, compromise, or any questioning of authority until total victory is achieved. In essence, war mentality suspends normal human compassion and intelligence. This mentality pervades current Canadian drug-control efforts. (Alexander, 1990:3.)
What social values underlie the legal paternalism inherent in maintaining a prohibition that has created a context of violence, more serious public health problems and a black market that actively recruits young people?
1.3 Legal liberalism:
humanism, social responsibility and respect for citizens
A second minority report to the Le Dain Commission, that of Marie-Andrée Bertrand, uses the political philosophy of J. S. Mill (1974 ã 1859) to support its call for the legalization of cannabis. This report takes the position that the government, as a guardian of public order, must restrict its actions to those areas that disturb the public peace in general, such as road safety, and limit its actions so as to preserve civil rights to the greatest extent possible. Penal repression and mandatory treatment of cannabis users represent an abuse of the power of the government and its institutions since this relatively harmless drug could be handled properly by consumers if the government regulated its marketing and quality. From this standpoint, the fact that many people find certain methods of drug use morally suspect does not make it legitimate for the government to regulate them by prohibition, unless such use constitutes in itself a threat to others.
Does this mean that in a context of legal liberalism, the government has no responsibilities with respect to drugs unless such a threat exists? Quite the opposite. Prohibition is not the only form of intervention. For a better understanding of the role of the government in a context of legal liberalism, some terms must be clarified.
First, we must distinguish legal liberalism from economic liberalism. Economic liberalism implies a withdrawal by the government to let market forces play; this ultimately results in rampant capitalism in which the strongest get stronger while the weakest are left to themselves, with no means of changing their condition or achieving a satisfactory quality of life. In legal liberalism, the government maintains its responsibility for management of public order by providing the safest possible environment for its citizens, as well as ensuring the social conditions most conducive to each individuals development; however, its preferred style of management preserves individual rights and liberties to the maximum extent possible. In other words, when it comes to drugs, the government is responsible for ensuring the safest possible context for drug use and for establishing the conditions needed to minimize any harmful effects of such use.
Does this mean that the government promotes drug use or abandons its capacity to intervene in order to prevent abuse? On the contrary. This is confusing legal liberalism with libertarianism, which does not grant the government any social or political responsibility nor any legitimate authority to limit individual freedoms in any way whatsoever. This philosophy, which has its supporters in relation to drug use, is quite distinct from legal liberalism.
In the area of drugs, defining precisely what is meant by legal liberalism and the social values that underlie this philosophy requires explanation and discussion of the harm reduction approach.
1.3.1.- Harm reduction and drugs:
a different practice and approach
The harm reduction approach to drugs has two components: reducing high-risk use and reducing the negative consequences associated with problem use. Reducing high-risk use may involve efforts to decrease demand for the product itself if any use of that product is high-risk (as in the case of tobacco), or may involve discouraging high-risk use or methods of use that are risky (such as drinking and driving). With respect to reducing the negative consequences of problem use, intervention may involve decreasing the problems associated with such use (for example, teaching abstinence or controlled drinking) or decreasing the environmental conditions that increase problem use (for example, through public policies that ensure a safe market).
This approach is characterized by two principles: pragmatism and humanism. Brisson (1997: 43-45) defines this pragmatism by the following maxim: "since drugs are here to stay, lets limit the problems they cause for users and their family and friends"; and humanism by the motto: "the drug user is a whole person, worthy of respect, with the same rights and power to act as any other citizen".
While the "cultural" roots of the harm reduction approach are connected with drug use itself, through the transmission of the knowledge and know-how that will enable users to benefit from drugs while minimizing the harmful effects, the political roots of this approach, which led the government to give it some support, are essentially health-related, associated with the advent of AIDS in the 1980s. Since the middle of that decade, however, the concept of harm reduction has broadened in scope and led to profound changes in intervention philosophies, as one major rehabilitation centre, the Centre Dollard Cormier in Montreal, attests:
[Translation] . . . it is no longer the act of using (or over-using) drugs that is the clients problem, it is the development of a significant problem in the clients life that signals abuse. In other words, the drug problem in itself does not have consequences, it is the consequences that signify a drug problem . . . . From this perspective, the primary target for intervention is not the drug use itself but rather the negative consequences the harm stemming from the clients drug use. (Boilard, 1995: 5).
This change of philosophy has also led a growing number of workers in the field to reject the paradoxical discourse of the law and call for drug users to receive the same treatment as any other citizen. According to Dr Mino, then chief physician of the Division pour toxicodépendants de la psychiatrie publique [psychiatric division for people with chemical dependencies] in Geneva:
[Translation] Paradoxically, we thought that drugs annihilated any capacity for choice and, at the same time, that using drugs was essentially a free choice. Our patients had freely chosen their lives of poverty, delinquency and physical degradation. AIDS was only one particularly horrible consequence of that choice. We could, using this reasoning, evade our responsibility for perpetuating the epidemic. (Mino and Arever, 1996: 34)
The claim that drug users should be treated the same as any other citizen means that the function of doctors is to keep them alive and in the best possible health. According to a pioneer of this approach in Great Britain, Dr. John Marks (Henman, 1995), when doctors cure ulcers or perform bypass surgery, they do not make their patients treatment conditional on their changing their habits, eating better, avoiding stress or exercising more, even though they may encourage such changes. A doctor offers care and advice and accepts that it is up to the individual to modify his or her lifestyle. For many professionals, this role implies, in the case of drug addiction, first, that addicts have their own opinions regarding their needs and second, that they can be prescribed any drug that can help them and keep them alive, including heroin. This is now an accepted practice in certain clinics in Switzerland, England and the Netherlands. We are also beginning to consider this approach in Canada.
This new philosophy, both among health practitioners and the community, has led to a call for the harm reduction approach to expand from a situational strategy linked with the advent of AIDS to strategies legitimized by public health policy. What does this mean in terms of social values? To answer this question, we must first identify the difference between an emergency strategy and a public policy.
1.3.2.- Harm reduction and drugs:
from an emergency strategy to a public policy
The harm reduction approach has united players with very different motivations. Some are still essentially fighting against AIDS, and if a vaccine were available, their involvement would probably be limited to an HIV vaccination program. Others have seen the problem of AIDS as an opportunity to help a neglected and often misunderstood clientele that has been difficult to reach. Although AIDS has brought together people with varying motivations and many different approaches to drug users, it is still the case that traditional morality dominates public policy, and harm reduction strategies essentially represent an emergency response to AIDs rather than a change in social values. Actually, these emergency strategies have brought about a change from an uncompromising legal moralism to greater willingness to provide medical treatment for some clients, in a context of legal paternalism. The status of some addicts has therefore changed from that of "offender" to that of a potentially contagious patient, from whom all "upstanding" citizens must be protected. By assigning the status of medical patient to the IDU (injection drug user), public policy has maintained the illusion that the users lifestyle has essentially been caused by the drug and has no relation to the conditions of use caused by prohibition. (Mary, 1998)
The status of medical patient also perpetuates the public perception that AIDS programs for IDUs will be needed only until these individuals make the "right" choice to solve their problems, namely abstinence. In this connection, these programs are perceived as a social defence strategy protecting "good" citizens from being contaminated by drug users rather than a social protection strategy reducing the harmful effects of drug use by people who are considered full-fledged citizens (Cauchie, 2000; Colle, 1996, 1999; Perron, 1999) As IDU groups have pointed out, people dependent on tobacco are not viewed as drug-addicted patients, because the black market does not oblige them to adopt a lifestyle based on their addiction; in the case of dependence on an illegal drug, this lifestyle with the risks and difficulties that it implies is not caused by disease but by the black market. By viewing the user as sick, this issue can be ignored, along with all the other desires and needs felt by the addict, like any other individual:
[Translation*] Like other drug users, we have a life outside our drug use and, if we had the choice, we would not let the drug define our lives. Unfortunately, in the hostile environment we live in, our drug use is considered the most important thing about us by those who have power over our lives . . . . It is not what we want, but it is forced on us even though we do everything we can to survive. (Balian and White, 1998: 392.)
In short, although the harm reduction approach can legitimately translate into multiple forms of intervention in response to emergencies in the field, while keeping silent about the law and its effects, it cannot be called a public drug policy nor seek to become one unless the choice of social values that allows us to consider drug users full-fledged citizens creates obligations for the government. In fact, this approach cannot become a true public drug policy unless it is associated with a philosophy of legal liberalism based on humanism, social responsibility and respect for all citizens, including drug users.
These values create obligations for the government. What are these obligations? First, just as the government is responsible for ensuring that consumption of food and other products is as safe as possible for the public, it is also responsible for ensuring a safe context for drug consumption. To do so, certain tools designed to reduce high-risk use are essential:
* regulations to control product quality. These regulations, if necessary, may lead to modification of some of the components and growing or manufacturing conditions of a drug to reduce its toxicity;
* regulations to ensure that the marketing of a drug is accompanied by proper consumer information, including precise labelling;
* regulations on distribution of a drug, such that, if necessary, its availability can be restricted to certain locations or clienteles;
* the availability of the funds needed to establish prevention programs designed to inform the public about the benefits and risks of use, for each product, method of use, context and so forth.
Further, efforts to reduce the negative consequences associated with problem use must also be made, by means of the following:
* availability of the funds needed to set up a varied range of treatments;
* availability of the funds needed to train workers in the field so that they can provide the best possible treatment;
* availability of the funds needed to pursue research in this area to improve understanding of the products, the risks associated with different forms of use, methods of use by different populations and the best treatment for the different needs.
These elements, essential to the realization of a public harm reduction policy, represent government obligations in a context of legal liberalism which seeks increased autonomy for each citizen in relation to the choices offered. Bearing in mind this social responsibility on the part of the government, and the need for humanism and respect for the drug user as a citizen, we are now going to analyse some of our current public policies.
2.- Analysis of our current policies
2.1.- Public policies on legal drugs
Recent studies on alcohol clearly demonstrate that a public policy aimed at decreasing consumption, regardless of its method of management, can result in failure to reach the ultimate objective of reducing problems. In other words, an average decline in alcohol consumption does not necessarily translate into a decrease in drinking problems, as is shown by studies done in Australia, England, Ontario and Quebec. In an interview in this regard, Louise Nadeau gave a clear explanation of this phenomenon (Denis, 1996):
[Translation] In other words, there are two categories of drinkers that should not be confused.
A typical example of the first category, Mr. or Mrs. X always drinks two glasses of wine at dinner. His or her physician approves: alcohol, taken regularly in moderate doses read: no more than two glasses a day reduces the risk of heart disease. Numerous studies indicate that moderate drinkers are healthier than abstainers, even after excluding the influence of such variables as age and physical activity. In short, for Mr. or Mrs. X., alcohol is a source of pleasure and health, not problems.
It is a different story for Mr. or Mrs. Y, who drinks the same amount of alcohol in a week, but all on one or two occasions. The physician disapproves, and the social worker is starting to take an interest. Why? A significant portion of those who drink too much alcohol drink because they have problems . . . and they have problems because, among other things, they drink . . . .
This is where we discover a flaw in the statistics published by Quebecs health department. The number of moderate drinkers has shrunk while the number of abstainers has grown. Returning to our example, Mr. or Mrs. X has replaced wine with mineral water. If drinking was not politically incorrect, his or her doctor might be somewhat critical of this. The drop in consumption has a perverse effect, therefore.
But it gets worse. The same data show that the heavy drinkers, the ones who get drunk, are not drinking any less...
In Quebec, the drinkers who still overdo it form a hard core. To reach them, according to Louise Nadeau, we must change the message. But first we must change our objective:
[Translation] Given what we now know, if we wanted to make sensible recommendations to the department, we would no longer set the objective in terms of overall volume [demand reduction], says the researcher. We would try to decrease the incidence of excessive drinking [harm reduction]. (Denis, 1996: 53-54)
In 1997, a similar observation led Quebecs Comité permanent de lutte à la toxicomanie [standing committee on addictions] (CPLT, 1997) to recommend that the Department of Health and Social Services change the objective of Quebecs 1992 policy on alcohol "[Translation] reduce alcohol consumption in Quebec by 15% within 10 years" to the following: "reduce the number of people who engage in high-risk alcohol consumption and reduce the harm associated with that consumption, for the users, their family and friends and society as a whole".
In fact, from the standpoint of legal liberalism, it is an abuse of power for the government to seek to regulate alcohol-related behaviour on a moral basis or to decrease alcohol consumption regardless of its management. However, the government has a duty to provide a safe environment and the official mechanisms needed to implement programs to reduce both heavy use of this drug and the harmful consequences that result. As for any drug, light and heavy use present different levels of risk. This distinction between light and heavy use has been very slow to make an impact in the political sphere: the issue of alcohol use is still strongly associated with the idea of abstinence as a moral ideal for all citizens. These are the social values revealed in the virulent debate on controlled drinking programs (see Tucker, Donavan and Marlatt, 1999), and in the recent debate on criminalization of drinking and driving which sees recourse to criminal law gaining in popularity. This last statement merits further discussion.
Educational campaigns intended to change the behaviour of people who drive motor vehicles while their faculties are impaired focus primarily on alcohol consumption. Similarly, criminal infractions for impaired driving apply almost exclusively to drunk driving. The Criminal Code contains a specific charge for those who drive with more than 80 mg of alcohol per 100 ml of blood. Defining the penalty in terms of alcohol level means that no preventive effort is focused on other factors:
[Translation] Alcohol consumption is not the only possible factor in an automobile accident; there are many others, including road and weather conditions, speed limits, mechanical failure, sudden health problems, and so on. In the case of young people, we must remember that they are usually very inexperienced drivers. They may not be skilful enough because they have not had enough opportunities to drive. In addition, they may not be as aware of how alcohol affects them and their ability to drive as an older driver with more experience. (Cormier, Brochu and Bergevin, 1991: 209)
The focus on drinking and driving allows the government to avoid costly measures relating to road safety (economical and convenient public transit, road repairs, improved signalling and safety standards for automobile manufacture, and so on) and fails to teach drivers the importance of not driving while impaired, regardless of the cause: fatigue, cold medications that reduce attentiveness, strong emotions following an argument, and so forth. Instead of teaching members of the public to assess whether they can drive well enough to ensure the safety of themselves and others, they are taught to be afraid of the police, since "drinking and driving is criminal!!"
Emphasis on the danger of getting caught drinking and driving rather than a more comprehensive attempt to prevent driving while impaired creates perverse effects. For example, a person has had a few drinks; for fear of police roadblocks, he or she takes an alternative route or waits a few hours, without drinking, before leaving. Finally, the person drives, without necessarily being sober, but practically falling asleep at the wheel. Where is the prevention of impaired driving in this situation? This person has not made a choice based on his or her ability to drive, but solely based on the possibility of getting caught. Statistics may indicate a decline in drunk driving, but would road safety have increased as much if social values regarding the responsibility to drive unimpaired had not changed? Not necessarily.
If the true objective of the law is to prevent driving while impaired in order to decrease the presence on the roads of drivers who represent a potential danger to themselves or others, someone who is very tired, has taken cold medication, has just quarrelled with his wife, has worked overtime, is too elderly and so on, may have impaired faculties and constitute a potential danger to himself and others. Why isolate one of the causes and give the government the right to forceful use of criminal law in that case only? Is there driving with "good" impaired faculties and driving with "bad" impaired faculties? The good old reflex tests used in the past and perhaps some additional skill tests are excellent instruments for measuring a persons ability to drive. In terms of road safety, the issue is to determine whether a person is in a state to drive, regardless of the reasons, not to determine whether he or she has consumed alcohol. From this standpoint, would we be as quick to resort to criminal law as a way of "correcting" all impaired drivers? Probably not.
What makes the use of criminal law so easy as a solution to the problem is the perception that it is "immoral" to drink and drive, an argument that is difficult to uphold if the definition of impaired faculties no longer focuses solely on alcohol consumption before driving but on better road safety in general. It is particularly important to rethink how to reduce the problems caused by impaired driving now that new tests, such as urine and blood tests, have been developed to detect drivers who have consumed other drugs. These tests could represent a major abuse of power, especially since the drug-testing industry is seeking to expand its market. (Hanson, 1992)
As for the governments responsibilities with regard to road safety, it is just as important to ensure that criminal law is used as a last resort and not as compensation for the governments failure to assume its responsibilities in this area (road safety network, adequate regulation of car manufacture, availability of public transportation and a comprehensive prevention program).
In short, this first case study reveals two major difficulties hampering the implementation of a true public drug policy based on legal liberalism: first, the moral ideal of abstinence that still impregnates our culture, even when it comes to legal drugs, and second, the governments interest in translating this moral ideal into legal standards punishing an immoral individual, the root of all evil - and avoiding examination of its obligation to protect its citizens. In fact, legal moralism is still a major part of public policies on alcohol.
On June 17, 1998, Quebecs National Assembly passed Bill 444, the Tobacco Act, to replace the Act respecting the protection of non-smokers. This statute sets out the rules applicable to tobacco use, sale and advertising and promotion. Among other things, it prohibits smoking in many public places (health and social services institutions, schools, day care and preschool centres), and establishes standards for the construction, ventilation and design of smoking areas in many other places.
The target of this legislation is smoking rather than smokers; that is why it clearly avoids any general prohibition of tobacco consumption, rejecting the "zero tolerance" spirit of some anti-tobacco groups. That the government avoided moralism in this policy is good. That it established that reducing high-risk use amounts to reducing the overall demand for tobacco, given the harmfulness of this drug, is also consistent.
However, in the context of a policy based on the values of legal liberalism, the government is also responsible for reducing the harmfulness of this drug, considering the fact that many people still use it. But, faced with a powerful tobacco lobby, the capacity of the government to regulate product quality by altering the growing or manufacture of this drug to reduce its toxicity and addictiveness, is quite limited. That battle is not yet over, however. (Beauchesne, 1998)
Second, in a policy consistent with legal liberalism, preventing tobacco use should involve much more than prohibitions and coercion, or it opens the door to a moralism that discriminates against smokers. And such moralism does indeed exist. Harm reduction for heroin addicts, on one hand, and a witch hunt for smokers, on the other.
Tobacco policies reveal two other problems with a drug policy based on legal liberalism; first, the governments limited ability to impose safe manufacturing standards on the industry. Second, the problem of considering global reduction in demand and the ideal of abstinence without associating these objectives with intolerance of the users of this drug. The debate over the possibility of refusing to perform cardiac surgery on smokers is a sign of this intolerance. Would we refuse to treat people who do not get enough exercise, eat a proper diet, reduce their level of stress, and so forth? These are all high-risk behaviours that could potentially be changed. Why should tobacco use be treated any differently? Because it has become an immoral drug.
2.2 Public policies on illegal drugs
In Quebec, the Comité permanent de lutte à la toxicomanie [standing committee on addictions] called for a public harm reduction policy for illegal drugs in 1997 (CPLT, 1997).
In its recommendations to the department, the committee explains that the objectives of the Quebec policy on illegal drugs are still based on the moralistic goal of reducing drug use, regardless of the risks involved. It clearly calls for the government to abandon the federal strategy of zero tolerance supported by the law, and for recognition of the fact that repression is the main source of harm for users of these drugs. It recommends a complete switch to a harm reduction approach that would involve recognizing, both for alcohol and for a number of illegal drugs, that most users do not have problems and that the departments money and energy would be better spent on preventing high-risk use and reducing the negative consequences of problem use. The CPLT suggests changing the 1992 objective, "[Translation] increase the number of people who never use illegal drugs", to the following: "reduce the number of people who make excessive or inappropriate use of illegal drugs and reduce the harm associated with use of these drugs, for the users, their family and friends and all of Quebec society".
These recommendations by the CPLT are echoed in the Plan daction en toxicomanie 1999-2001 [1999-2001 addictions action plan] released by the Department of Health and Social Services (1998a). However, in contrast to the CPLTs recommendations, this document does not discuss the harmful effects of the law, with the result that the actual public policy does not represent a harm reduction approach based on legal liberalism, but "wartime medicine" based on moralism and legal paternalism. Wartime medicine is actually needed in the current context; but to give it the status of public policy is to legitimize the harmful effects of this war as "normal", without questioning the basis of the war itself. It is like establishing a public environmental policy involving distribution of gas masks to people living in the vicinity of industries that are major polluters. It would send a message that such industrial pollution is a normal situation to which the public must adapt and that the government is graciously supplying gas masks to those segments of the population who cannot afford to live elsewhere.
In his 1994 report, Chief Coroner J. V. Cain of British Columbia (Cain, 1994) emphasizes that repression is extremely expensive, both in terms of implementation and outcome. He is referring, of course, to the staggering costs of police intervention and the involvement of the criminal justice system, particularly in the case of simple possession (cost of arrests, court appearances and in some cases, prison sentences). In addition, there are those who are introduced to injection drugs and high-risk use in prison, who go into debt for drugs and must pay the cost upon release, physically, socially and financially.
To these direct costs of repression he adds the indirect costs that fall on the health system and social services agencies in general. There are, for example, the injection drug users who, fearing this repression, delay treatment, with the tragic result that much more serious intervention is needed; there is also the rise in cases of HIV, hepatitis, and the much more serious deterioration in living conditions caused by the black market.
Finally, the increase in the harmful effects of repression for addicts is not limited to the individual, but extends to his or her family (particularly children) and society in general (criminality, deterioration of the neighbourhood, growing numbers of dealers on the street trying to support their habits, and so on). Moreover, addicts who are HIV-positive or have Hepatitis A or B have sexual contact with non-addicts, thus increasing the incidence of these diseases in the rest of the population. Prostitutes, of course, engage in thousands of unprotected contacts, at the clients request (Bibeau and Perrault, 1995), but such sexual contact also occurs in all the usual settings since, contrary to the mythical image of injection drug users, they are not necessarily on their last legs, suffering from AIDS and easily identifiable. On the contrary. Many are occasional users and can be found at work, at school, in clubs and bars, and so forth.
Cain refers to all these costs and openly raises the question of our repressive approach to drugs, as well as the laws that embody this approach. Cains report is one of the few in Canada that have explicitly stated that legalization of drugs is essential to a true public harm reduction policy. Even if there is increasingly open recognition in some public documents that repression, or enforcement of the law, is the main source of harm for drug users, it is less clearly stated that prohibition and the laws themselves are the main source of the black market and repression.
Cain makes the following recommendation in his report:
[Translation*] In this connection, I recommend the establishment of a commission to study and analyse these legal issues, among many other things. The problem should be considered not only in light of the deaths associated with heroin and cocaine, but with reference to all illicit drugs available, the so-called "hard" and "soft" drugs alike. (p. 6)
Legalization should not be considered the panacea or solution to substance abuse problems plaguing British Columbia and the rest of the country. It would not solve all the anti-social and criminal acts committed by confirmed addicts. Nor do I believe legalization would increase the incidence of those acts. On the contrary, what it would do is create that necessary "window of opportunity" for the addicts who have lost hope and freedom of choice. (p. 88)
In Canada and Australia, as well as several European countries (Déviance et société, 1998, 1999; Caballero, 1992; Erickson et al., 1997), the traditional repressive approach has been maintained in response to U.S. pressure through the international Conventions, as well as pressure from certain industries and bureaucracies that benefit from the current prohibition against some drugs.
In Canada, for example, this recently resulted in a new Controlled Drugs and Substances Act (May 1997), a statute that expands the governments power of repression. (Beauchesne, 1997)
The advocates of this statute justified this expansion of power by the need for more effective weapons against clandestine laboratories manufacturing synthetic drugs. But, as the Canadian Bar and the Ontario Criminal Lawyers Association noted during the hearings preceding its passage, and as legal statistics on drugs show, the clientele targeted by drug laws are more likely to be users or small dealers in disadvantaged neighbourhoods than major traffickers. (Canadian Foundation for Drug Policy website)
There are still 65,000 drug-related criminal charges in Canada each year, and Canada is second, after the United States, in terms of incarceration of drug users. This must not be forgotten.
Moreover, it has been noted that the more cannabis is considered a harmless drug with no addictive power, no longer a priority for repression, the statistics in this regard say something else, both in Canada and elsewhere. In Canada, 45,000 of these criminal charges are related to cannabis, and 30,000 represent cases of simple possession. While it is true that police priorities have changed, so that private consumption is disregarded at the investigation level, and that the judicial system gives few prison sentences for simple possession, cannabis charges have actually increased since 1990 while cocaine and heroine charges have dropped. Furthermore, these thousands of people still have criminal records. To date, more than 600,000 Canadians have criminal records because of cannabis. (Boyd, 1998)
Groups lobbying in support of this new statute also justified its increased powers of repression by stating that we had to conform to the International Conventions and had little flexibility as a result. This is false. The Conventions oblige us to have certain prohibitions, but leave significant flexibility in how to apply them. (Beauchesne, 2000)
The recent decisions in favour of repression convey to the public not only that intervention to counter the harmful effects of this war is normal, but also that drug users have the primary responsibility in this regard, encouraging hostility toward them; it also perpetuates the host of contradictions surrounding the development of harm reduction strategies because of the official priority given to health budgets for HIV prevention. In fact, without any explicit challenge to prohibition, we are left with the legal moralism and legal paternalism that so thoroughly permeate the issue of legal and illegal drugs, preventing the government from assuming its responsibilities in this area: to normalize use, recognize the benefits as well as the harmful effects, treat users as full-fledged citizens and conduct prevention and intervention activities in a safe context where criminal law is used as the method of last resort. (Roelandt, 1996)
We must no longer consider it normal for public health activities to correct the actions of our justice system. We must refuse to restrict the harm reduction approach to a wartime medicine. We must examine the social values we wish to promote in our drug policies in order to better define the governments responsibilities in this regard.
What values should underlie Canadian drug policy?
Drug policies are currently being developed amid tremendous anarchy, as there has been no debate over the objectives of drug policy and the underlying social values. As a result, initiatives are being taken today to stop people from using drugs, yet at the same time safe places are being set up for people to use intravenous drugs, and some drug users are being locked up, yet at the same time, sterile needles are being handed out in prisons. This state of affairs means that counselors who want to help integrate drug users into society have to work surrounded by the damaging effects of prohibition and ensuing efforts to stop people from using drugs and to constantly justify themselves to a public that is hostile toward their clients. Workers in the field are growing more and more uncomfortable, because it is difficult in the circumstances to clarify priorities and the ethical boundaries of their intervention, overcome operational problems and set adequate criteria for evaluating program results. This explains why many people are beginning to find that the argument that drug use prevention fights AIDS exacts a heavy toll in dealing with drug addicts, and drug addicts, as stated earlier, are starting to claim to be something other than a possible source of contamination or are challenging the political status of the requirement that they be labelled "sick" in order to receive assistance and support.
In the course of considering Canadas drug policy, everyone ought to take another look at the options for the role of the government set out at the beginning of this brief in order to make a final determination as to which social values are important. This will not bring about change overnight, but it will provide some direction and help in choosing more consistent and more credible actions. To quickly recap those values:
Legal moralism. Taking the view that one of the governments roles is legitimately to preserve a common morality, independent of the imperatives of public order, amounts to taking the view that the powers that be can legitimately keep the upper hand by imposing values that meet their needs. This line of thinking leads to drug users being blamed for their own economic, health and criminal problems. And the solution is to deal with their moral failings through the criminal justice system without exploring the governments responsibilities in that regard.
Legal paternalism. Taking the view that one of the governments roles is to protect non-independent persons, without questioning what constitutes a non-independent person or the meaning of the word protection, amounts to letting the powers that be declare non-independent people who have been unable to adapt to current living conditions and thereby disregard the effects of measures to eliminate drug use and the black market among the harmful consequences of drugs. Drug users who do not know what they are doing and find themselves awash in legal, economic and health problems thus come to bear sole responsibility for their plight. If they fail to see that their problems arose because drugs rendered them unable to manage their lives, and if they refuse to be declared "sick" so that they can get help, the solution is to punish them as criminals, without exploring the governments responsibilities in that regard.
Legal liberalism. Taking the view that one of the governments responsibilities is to create a safe environment in managing public order and at the same time preserve civil rights as much as possible amounts to taking the view that the powers that be cannot legitimately keep the upper hand other than by maximizing opportunities for everyone to become a full-fledged citizen. The government has to account for the opportunities it gives people to use drugs safely by compiling and providing access to information on soft and hard drug use, setting up adequate high-risk drug use prevention programs and by offering the most appropriate services and care for people who have developed drug problems. In terms of principles, this means two things: pragmatismdrugs are here to stay, and that is something we have to deal with; and humanismdrug users are full-fledged citizens. The same principles underlie the harm reduction approach. But if civil rights are to be given maximum respect, this also means that criminal proceedings should be the method of last resort for handling problems encountered in the course of harm reduction.
Opting for legal liberalism in dealing with drugs, as in any other area, is a necessary ideal in a democratic society. Everyone, from the lowest of the low to the highest of the high, has a duty to use whatever forum he or she is afforded to state how drugs should be addressed. And one thing is certain: in todays prohibitionist world, it takes a great deal of courage and imagination to articulate the steps in that process. But only if we pay that price will be able to say that we have implemented a Canadian drug policy which is based on humanism, social responsibility and respect for drug users as full citizens. In short, that is the price of democracy and the way to reduce the public health problems caused by drugs.
______________(1998) Débat: politiques (criminelles) et problème de drogue: évolution et tendances en Europe Déviance et société, Vol.22(1)
______________(1999) Politiques publiques et usage de drogues illicites Déviance et société, Vol.23(2).
_____________(1999) Special Issue: Regulating Cannabis: Comparative Perspectives International Journal of Drug Policy Vol.10(4)
ALBRECHT, P.-A. (1997) La politique criminelle dans létat de prévention Déviance et société Vol.21(2) 123-126.
BACHMANN, C., COPPEL, A. (1989). Le dragon domestique. Paris: Albin Michel. (Paru en 1991, sous un nouveau titre: La drogue dans le monde, hier et aujourd'hui).
BALIAN, R. et C. WHITE (1998). Defining the drug user. International Journal of Drug Policy. No.9: 391-396.
BALLON, D. (1998). Mixed response to prison methadone program. The Journal of Addiction and Mental Health. Vol.1(2), p.5.
BEAUCHESNE, L. (2000) Droit 101 et drogues illégales, L'Intervenant , juillet, 7-11.
BEAUCHESNE, L. (2000). La culture protestante américaine: influence sur les politiques en matière de drogues. Histoire sociale/Social History. Vol.XXXIII (66), novembre.
BEAUCHESNE, L. (1999) À propos du cannabis: que faire ? Écho-toxico, vol.9, novembre.
BEAUCHESNE, L. (1998) Les politiques actuelles sur les drogues: tendances contradictoires Options politiques Vol.19(8) , 24-27.
BEAUCHESNE, L. (1998) Culture et notion de plaisir: impact sur l'appréhension de la réduction des méfaits en matière de drogues Les cahiers de Prospective Jeunesse Bruxelles Vol.3(3) 14-19.
BEAUCHESNE, L. (1998) Tobacco harm reduction policies: the debate in Québec International Journal of Drug Policy Vol.9, 247-253.
BEAUCHESNE, L. (1997a). Un sujet dactualité: la loi C-8. LÉcho-toxico. 8(1):7-10.
BEAUCHESNE, L. (1997b). La politique de tolérance néerlandaise: 20 ans plus tard. LÉcho-toxico. 8(2):7-8.
BEAUCHESNE, L. (1997c) Responsible Action Toward Health Promotion and Efficient Harm Reduction Strategies dans Harm Reduction Strategies P.G. Erickson, D.M. Rieley, Y.W. Cheung et P. A. OHare (eds) Toronto: University of Toronto Press 1997, p.40-57.
BEAUCHESNE, L. (1994a). Le projet de loi C-7: plus quun mauvais souvenir? LIntervenant. vol.11(1) 11-13.
BEAUCHESNE, L. (1994b) Les tests de dépistage de drogues dans lentreprise: programme daide ou de contrôle des employé-e-s>> dans Relation demploi et droits de la personne: évolution et tensions Pelletier, B. (sous la direction de) Montréal: Yvon Blais, 1994, p.19-32
BEAUCHESNE, L. (1992, 2e éd.). La légalisation des drogues pour mieux en prévenir les abus. Montréal\Suisse: Le Méridien\Georg.
BIANCHI, A. (1999) Un groupe de travail propose une trousse de réduction des méfaits pour les usagers de crack Le Journal de toxicomanie et de santé mentale, Vol.2(3) p.9.
BIBEAU, G. et M. PERREAULT (1995). Dérives montréalaises. À travers des itinéraires de toxicomanies dans le quartier Hochelaga-Maisonneuve. Québec: Boréal.
BOGGIO, Y. (2000) De lindifférence à lacceptation de la complexité, la trajectoire suisse en matière de drogues, GRD Psychotropes, politique, société, sous presse.
BOILARD, J. (1995). La réadaptation à Domrémy-Montréal La réduction des méfaits LÉcho-toxico. Vol.6(2) 4-7.
BÖLLINGER, L. (ed.) (1994) De-Americanizing Drug Policy Frankfurt: Peter Lang.
BOYD, N. (1998). Rethinking our policy on cannabis Options politiques. octobre, 31-33.
BRISSON, P. (1997). La réduction des méfaits: sources, situation, pratiques. Gouvernement du Québec: CPLT.
CABALLERO, F. (sous la direction de) (1992). Drogues et droits de l'homme. Paris: Les empêcheurs de tourner en rond.
CAIN, J.V. (1994). Report of the Task Force into Illicit Narcotic Overdose Deaths in British Columbia. Office of the Chief Coroner: Province of British Columbia, Ministry of Attorney General.
CAUCHIE, J.-F. (2000) Impact des contrats de sécurité sur le secteur de lintervention psycho-médico-sociale en toxicomanie dans Kaminski D. et Van Campenhoudt L. (dir.) Analyse de limpact des politiques sécuritaires en Belgique Bruxelles: Labor, à paraître.
CCLAT (Centre canadien de lutte contre l'alcoolisme et les toxicomanies) / CTSM (Centre de toxicomanie et de santé mentale) (1999) Profil canadien: l'alcool, le tabac et les autres drogues Canada: CCLAT/CTSM.
CENTRE DE COORDINATION SUR LE SIDA (1999) Les programmes de prévention du VIH chez les utilisateurs de drogues par injection au Québec: une démarche collective dévaluation Gouvernement du Québec: Ministère de la santé et des services sociaux.
CENTRE DE COORDINATION SUR LE SIDA (1998) Monitorage des clientèles et des services des programmes de prévention du VIH chez les utilisatuers de drogues par injection du Québec Gouvernment du Québec: Ministère de la santé et des services sociaux.
CENTRE DE COORDINATION SSUR LE SIDA (1994) Lusage de drogues et lépidémie du VIH, cadre de référence pour la prévention Gouvernement du québec: Ministère de la santé et des services sociaux.
CHAYER, L. (1999) Le discours de détenus québécois sur la consommation de drogues en pénitencier Les Cahiers de Prospective Jeunesse, vol.4(4) 10-14.
CHOISEUL PRASLIN (de), C.H. (1991). La drogue, une économie dynamisée par la répression. Paris: CNRS.
COHEN, P. (1999) Shifting the main purposes of drug control: from suppression to regulation of use, reduction of risks as the new focus for drug policy International Journal of Drug Policy Vol.10(3) 223-234.
COLLE, F.-X. (1999) Prohibition, propagande, prévention La revue THS, no.2, 43-44.
COLLE, F.-X. (1996). Toxicomanies, systèmes et familles où les drogues rencontrent les émotions Paris: Éditions Érès.
COMITÉ PERMANENT DE LUTTE À LA TOXICOMANIE (1999) Avis sur La double problématique toxicomanie et négligence parentale CPLT: MSSS
COMITÉ PERMANENT DE LUTTE À LA TOXICOMANIE (1999). Avis sur La déjudiciarisation de la possession simple de cannabis Gouvernement du Québec: CPLT
COMITÉ PERMANENT DE LUTTE À LA TOXICOMANIE (1997). Avis sur lobjectif de la politique de la santé et du bien-être de 1992 qui porte sur lalcoolisme et lusage abusif de psychotropes au Québec. Gouvernement du Québec: CPLT.
CONCERTATION EN TOXICOMANIE, Hochelaga-Maisonneuve (1999), Faire sa veine vidéo produite grâce au soutien du Centre québécois de coordination sur le sida.
CORBEIL, Y. (1999) Passage à tabac Québec: Lanctôt éditeur.
CORMIER, D., BROCHU, S. et J.P. BERGEVIN (1991). Prévention primaire et secondaire de la toxicomanie. Montréal: Le Méridien.
De JONG, W. et U. WEBER (1999) The professional acceptance of drug use: a closer look at drug consumption rooms in the Netherlands, Germany and Switzerland International Journal of Drug Policy Vol.10 (2) 99-108.
DENIS, E. (1996) La modération a bien meilleur goût, mais... Interface Vol.XVII(1) 53-55.
DEVLIN, P. (baron), (1968 ã 1965). The Enforcement of Morals. London, New York: Oxford University Press.
DION, G.A. (1999). Les pratiques policières et judiciaires dans les affaires de possession de cannabis et autres drogues, de 1995 à 1998: portrait statistique. Montréal: CPLT.
DION, G.A. (1997). Les pratiques policières et judiciaires dans les affaires de possession de cannabis et autres drogues: portrait statistique. Montréal: CPLT.
DÔ, S. (2000) Les vrais chiffres ! Protégez-vous, Janvier, 4-7.
DRUCKER, E. (1999) Drug prohibition and public health: 25 years of Evidence The Drug Policy Letter no.40 4-18.
DWORKIN, G. (ed) (1994) Morality, Harm and the Law Westview Press: USA
DYSENHAUS, D. et A. RIPSTEIN (eds) (1996) Law and Morality University of Toronto Press: Toronto.
ERICKSON, P.G., D.M. RILEY, Y.W. CHEUNG et P.A. O,HARE (1997). Harm Reduction: A New Direction for Drug Policies & Programs. Toronto: University of Toronto Press.
ERICKSON, P.G. et Y.W. CHEUNG (1999) Harm reduction among cocaine users: reflections on individual intervention and community social capital International Journal of Drug Policy Vol.10(3) 235-246.
FAUGERON, C. (sous la direction de) (1999) Les drogues en France, politiques, marchés, usages Genève: Georg.
FEELEY, M. et J. SIMON (1992) The new penology: notes on the emerging strategy of corrections and its implications Criminology 449-474.
FEELEY, M. et J. SIMON (1994) Actuarial justice: the emerging new criminal law dans D. Nelken (ed.) The futures of criminology Sage Publications: London, 173-201.
FOUCAULT, M. (1976). La volonté de savoir. Paris: Gallimard, 1976.
GREENAWALT, K. (1995) Law Enforcement of Morality The Journal of Criminal Law and Criminology Vol.85(3) 710-725.
GROUPE DE TRAVAIL NATIONAL SUR LA POLITIQUE DU CCLAT (1997). Comprendre la réduction des méfaits. Le Journal Vol.26(4):8
HANSON, A. (1992). Le dépistage des drogues: contrôle des drogues ou des esprits? Psychotropes. Vol.VII(3), p.71-87.
HART, H.L.A., (1969 ©1963) Law, Liberty and Morality. Stanford, Calif.: Stanford University Press.
HENDRY, C. (1999) Politique révisée sur la marijuana Le Journal de toxicomanie et de santé mentale, Vol.2(4) p.5.
HENMAN, A. (1995). Drogues légales. Lexpérience de Liverpool. Paris: Éditions du Lézard.
HUSAK, D. (1997) Drugs and Rights Cambridge: Cambridge University Press.
JÜRGEN, R. et D. RILEY (1997). Responding to aids and drug use in Prisons in Canada. The International Journal of Drug Policy. Vol.8(1) 31-39.
KRAJEWSKI, K. (1999) How flexible are the United Nations Drug Conventions ? International Journal of Drug Policy Vol.10(4) 329-338.
LAMARCHE, P. (1987) The impact of increasing the number of off-premise outlets of alcohol on per capita consumption: the Quebec experience Montréal: GRAP.
LAP, M. (1994) About Netherweed and coffeeshops dans Böllinger, op.cit., 137-150.
LEBEAU, B. (1999) Neurotoxicité de l<<ecstasy>>, la science, la prévention et les jeunes, La revue THS, no.2, 22-25.
LE DAIN G. lHonorable (président de la Commission denquête sur lusage des drogues à des fins non-médicales) (1972). Rapport- Le cannabis. Ottawa: Information Canada.
LIGUE INTERNATIONALE ANTIPROHIBITIONNISTE (1994). Pour une révision de la politique internationale en matière de drogues, rapport sur les possibilités de modifications et-ou de dénonciation des Conventions des Nations Unies Bruxelles: Parlement européen-LIA.
MARY, P. (1998) Délinquant, délinquance et insécurité. Un demi-siècle de traitement en Belgique (1944-1997) Bruxelles: Bruylant.
MICHKA (1993) Le cannabis est-il une drogue ? Suisse: Éditions Georg.
MILL, J.S., (1974 ©1859). On Liberty. New York: Norton.
MINISTÈRE DE LA SANTÉ ET DES SERVICES SOCIAUX (1998). Plan daction en toxicomanie, 1999-2001. Direction des communications, Gouvernement du Québec.
MINISTÈRE DE LA SANTÉ ET DES SERVICES SOCIAUX (1998). Pour une approche pragmatique de prévention en toxicomanie: orientations et stratégie, Gouvernement du Québec. Document de consultation.
MINISTÈRE DES AFFAIRES ÉTRANGÈRES, MINISTÈRE DES AFFAIRES SOCIALES, DE LA SANTÉ ET DES SPORTS, MINISTÈRE DE LA JUSTICE ET MINISTÈRE DE LINTÉRIEUR (1996). Rapport: la politique en matière de drogues aux Pays-Bas, continuité et changement. Parlement des Pays Bas. http://www.minvws.nl
MINO, A. et S. AREVER (1996). Jaccuse, les mensonges qui tuent les drogués. Paris: Calmann-Lévy.
NADEAU, L. (1998) Toxicomanie et réduction des méfaits Conférence douverture présentée au XXVIe colloque de lAITQ, 26 octobre.
NADEAU, L. (1989) L'amérique en guerre des dépendances Autrement no.106, 123-130.
NADELMANN, E. (1990) The solution becomes the problem dans Drug Prohibition and the Conscience of Nations, Wash.D.C.: DPF, 25-28.
NELLES, J., S. BERNASCONI, A. DOBLER-MICCOLA et B. KAUFMANN (1997). Provision of syringes and prescriptions of heroin in prison International Journal of Drug Policy. Vol.8(1) 40-52.
NOTTE, D. (1999) Fumer ou conduire, il faut choisir... Les Cahiers de Prospective Jeunesse Vol. 4(2) 3-6.
PERREAULT, M. (1999) La ville et la toxicomanie: les enjeux de la désintégration des quartiers CPLT: Québec.
PERRON, C. (1999) Le regroupement dusagers dans Recueil des présentations lors de la quinzième rencontre provinciale des intervenant(e)s en prévention de la transmission du VIH chez les UDI, Québec: CQCS.
PIRES, A.P. (1995). Quelques obstacles à une mutation du droit pénal. Revue générale de droit. Vol. 26 133-154.
PROGRAMME EXPÉRIMENTAL DE PRESCRIPTION DE STUPÉFIANTS, (1999) Rapport dactivité 1998, Genève: Suisse.
PROSPECTIVE JEUNESSE (1998-1999) Les cahiers de Prospective Jeunesse Vol.3, nos1-2-3 et Vol.4, no.1.
PROSPECTIVE JEUNESSE (1996). À lécole du risque: un parcours de prévention des toxicomanies à lécole primaire. Bruxelles: Prospective Jeunesse.
RÉSEAU EUROPÉEN SUR PRÉVENTION DU VIH ET DES HÉPATITES EN MILIEU CARCÉRAL (2000) Lusage de drogues en milieu carcéral: une approche épidémiologique Rapport. www: members.aol.com/orspaca/
RÉSEAU JURIDIQUE CANADIEN VIH, SOCIÉTÉ CANADIENNE DU SIDA (projet conjoint).(1996) VIH/sida et prisons: rapport final. Montréal, auteur.
REYNAERT, P. (1996) La prohibition des drogues: un désastre en prison dans Drogues et Prisons: Chronique dun divorce annoncé, Bruxelles: Liaison Antiprohibitionniste, 15-21.
RILEY, D. (1995). Drug Testing in Prisons The international Journal of Drug Policy. http://www.drugtext.nl/IJPD/
ROELANDT, M. (1996) Justice et thérapie ou limpossible alliance Cahiers de Prospective Jeunesse Vol.I (1-2).
ROSENZWEIG, M. (1999) Pour une éthique de la clinique des assuétudes et des addictions Conférence prononcée au Colloque Quelle prise en charge des patients toxicomanes...aujourdhui ... demain ? Société Belge dÉthique et de Morale Médicale, Mons, 23 avril.
ROSENZWEIG, M. (1998) Au-delà de la Cura et du Toxikon: vers une ontologie du plaisir ? Psychotropes vol.4(4) 83-95.
SANTÉ ET BIEN ETRE SOCIAL CANADA (1990). Les drogues, faits et méfaits. Ottawa: Ministère des approvisionnements et services.
SANTÉ ET BIEN-ETRE SOCIAL CANADA (1986). La santé pour tous: plan d'ensemble pour la promotion de la santé. Ottawa: Ministère des approvisionnements et services.
SMART, R.G. et A.C. OGBORNE (1986) Northern Spirits - Drinking in Canada Then and Now Toronto: ARF.
TUCKER, J.A., D.M. DONOVAN et G.A. MARLATT (ed.), Changing Addictive Behavior New York: The Guilford Press.
WAGNER, D (1997) The New Temperance: The American Obsession with Sin and Vice CO: Westview Press.
- Actup: www.actupp.org
- Canadian Foundation for Drug Policy: www.cfdp.ca
- (The) International Journal of Drug Policy: www.elsevier.nl/locate/drugpo
- La librairie internet: www.druglibrary.org/index.htm
- La politique en matière de drogues aux Pays-Bas: www.nederland.drugtext.nl/vws/drugnota/3/drugall.htm
- Le site Lycaeum de diffusion dinformations sur les drogues: www.lycaeum.org
- (The) Lindesmith Center: www.lindesmith.org
- LObservatoire géopolitique des drogues: www.ogd.org
- Mission interministérielle française sur les drogues: www.drogues.gouv.fr
- Prospective Jeunesse: www.prospective-jeunesse.be