Issue #31 January 2024
[This issue includes a modified and updated excerpt from “Buzz Kill: The Corporatization of Cannabis”. NOW AVAILABLE at https://blackrosebooks.com/products/buzz-kill-michael-r-devillaer or at your local independent bookstore. They could really use the support.
In the previous issue I described methods that social scientists use to describe the extent and nature of drug use and related harm. In this issue, I’ll report some data on some of those harms related to four separate settings: the general population, the health care system, the workplace, and the criminal justice system. Each setting has its distinct manifestation of drug problems. There are also striking commonalties.
Before we get into the data, I’d like to make a couple important contextual points. These will be known to those familiar with my work, but perhaps not for others. The first point is that most drug use does not lead to harm. It would be disrespectful of drug users who lead happy, productive lives not to offer that acknowledgment. However, some drug use does lead to harm. It would be equally disrespectful to the victims to ignore that reality. The second point is that when I use the word “drug”, I use it to include alcohol, tobacco, all the illegal drugs, psychoactive pharmaceutical products, and other psychoactive substances of uncertain status. I call them all drugs because that is what they are. But please do not ask me if sugar is a drug. I once posed the question to a pharmacologist – an expert on such matters. She winced and quickly changed the subject.
The General Population
The CAMH Monitor reported that in 2023, 18.9% of Ontario adults reported hazardous or harmful drinking in the past twelve months. It also reported that 16.7% of Ontario adults identified problems related to their use of cannabis in the past three months. The figures for alcohol and cannabis would likely converge had the same time frame been used for both drugs. The cannabis estimate represents a substantial increase from pre-legalization estimates of 4.7% in 2012, and 10.2% in 2017.
During the same period, estimates of alcohol risk and harm remained relatively stable, while tobacco use & dependence continued to decline. Tobacco use generally does not lead to the kind of personal and social disruption that we see with alcohol and other drugs, so surveys do not assess it. The surveys do assess for indications of dependence on tobacco, and I will explore some data on that in a future issue which will focus more on drug dependence.
In 2021, The Canadian Alcohol and Drugs Survey (CADS) published data from 2019 showing that adverse consequences from use of illegal or prescribed drugs were reported by 4.1% of survey respondents. The survey’s previous incarnation, The Canadian Tobacco, Alcohol and Drugs Survey (CTADS) reported similar or lower figures going back to 2013.
Based upon general population data, only cannabis-related problems appear to be increasing during therapeutic and recreational legalization of cannabis. There is legitimate concern about this increase. We should continue to monitor.
The Healthcare System
Canadian Substance Use Costs and Harms (CSUCH) reported alarming numbers of drug-related encounters with Canada’s health care system in its most recent release of data for 2020. A substantial proportion of those drug-related encounters arose from alcohol and tobacco use which together accounted for:
- 89.1% of 262,490 drug-related inpatient hospitalizations
- 81.0% of 1,008,674 drug-related visits to the emergency department
- 98.7% of 63,681 drug-related day surgeries.
The take home messages are that drug problems pose a substantial burden on Canada’s healthcare system, and our long-term legal drug industries, alcohol and tobacco, account for almost all of it – this, in an under-resourced healthcare system that is increasingly struggling for sustainability. Add a lingering covid pandemic to the mix, and well, I think you get the picture. It’s not a pretty one. This burden on public health and safety and on the public purse is what is referred to within industry as an “externality” – someone else’s problem. That perspective needs to change in industry. It also needs to change in government, and even among some drug policy reformers who maintain a soft on corporate crime perspective.
The Workplace (Lost Productivity)
There are also statistical records on the role of drugs on lost productivity for the workplace. CSUCH provided a drug-related long-term disability count for 2020 of 54,518 – 84.0% of which were related to alcohol and tobacco. It is interesting that use of alcohol and tobacco is commonly referred to as recreational drug use. Like some other forms of recreation such as car racing, alpine skiing, sky diving, martial arts, football and hockey – recreational drug use, especially the legal kind, also has its risks.
The Criminal Justice System (Policing)
We also have data on drug-related offences from the criminal justice system. CSUCH’s report showed that drugs played a significant role in this system as well. The data for the criminal justice system paint a different picture than do the indicators for the general population, health care system and the workforce. The illegal drugs take on much more prominence while the prominence of tobacco is significantly diminished. But alcohol is still dominant. In 2020, alcohol accounted for 39.7% of police incidents, with cocaine a distant second at 22.7%. CSUCH also reports that violent crime accounted for nearly 50% of all criminal justice costs attributable to alcohol. I will cover costs of drug use to the Canadian economy more comprehensively in an upcoming issue.
We might consider that the correlation between alcohol and violent crime would call for a sobering warning on the otherwise deceptively benign face of alcohol product labels and alcohol advertisements. Imagine these warnings prominently emblazoned upon the label of an alcohol beverage or in a magazine print ad:
Warning: indiscriminate use may lead to acts of violence
Warning: indiscriminate use may contribute significant costs to the Canadian economy
Those messages brandish a sharper point than does the customarily timid prompt to “Please use responsibly” that occasionally cowers in a barely legible font in a bottom corner of an alcohol print ad. Even such a polite message is usually granted less than 1% of the glamour-dominated space in a typical alcohol print ad. Compare that to tobacco packaging which now requires that much more on-point messages and graphic images cover 75% of the package area. The tobacco industry did not go gently into that arrangement – it was dragged kicking and screaming all the way. And it took decades. The current norm for alcohol messaging is what we can anticipate when governments grant large-scale self-regulation to an industry. There’s no kicking and screaming because there is little pushing and pulling from government. However, there is currently a bit of a nudge coming from Canadian Senator Patrick Brazeau. Best wishes with your efforts, Senator. And thanks!
As demonstrated in the various sources visited in this issue, alcohol and tobacco – our long-term legal drug industries – prevail in the amount of drug-related harm. This makes one wonder what the war on drugs (the illegal ones) was all about. It also prompts us to consider what the impact might be of cannabis joining the ranks of the legal recreational commercialized drugs. Ultimately, the impact is likely to have as much to do (maybe more) with the manner in which we regulate cannabis as it does with its intrinsic properties.
The problem of permissive drug industry regulation will continue to be a major theme of future issues in Drug Policy Alternatives. I hope you will stay along for the ride. And I appreciate your comments, including most of the divergent ones! mike@drugpolicyalt.ca
Mike DeVillaer
Hamilton Ontario Canada
January 28 2024