Health-Based Approaches to Substance Abuse

The Catholic duty of participation requires that we inform ourselves of social developments, particularly those of civic interest, and that we fully consider those developments in light of the Church’s social doctrine.

This month we review a government-sponsored Bill currently being considered by the Canadian Parliament, intended to eliminate mandatory minimum sentences for certain drug-related crimes, as a part of a federal policy to treat drug abuse as a health problem, rather than a criminal matter.

The Act summarized below is intended at least partly to advance the government’s shift toward treatment of addictions and substance abuse as health issues, rather than criminal matters.  A broad range of health professionals, police officers, and others have spoken in support of the change.

Presumably, at least Bill C-5 is intended to implement a part of the framework laid out by the government in its policy backgrounder Strengthening Canada’s Approach to Substance Use Issues, published in September 2018.

Bill C-5 – An Act to amend the Criminal Code and the Controlled Drug and Substances Act

• Government Bill, introduced in Commons on December 7, 2021. 
• The summary reads: “This enactment amends the Criminal Code and the Controlled Drugs and Substances Act to, among other things, repeal certain mandatory minimum penalties, allow for a greater use of conditional sentences and establish diversion measures for simple drug possession offences.”
• Status: The Bill’s first reading was completed December 7, 2022. The Bill is in the process of undergoing Second Reading.
• Charter Statement:
  
  Overview of Bill
  Bill C-5 would make a number of amendments to the Criminal Code and the Controlled Drugs and Substances Act that seek to fulfill the Government of Canada’s commitment to address systemic inequities, including the overrepresentation of Indigenous Peoples, Black, and marginalized Canadians, in the criminal justice system. There are three areas of proposed reform in the Bill: (1) the repeal of all mandatory minimum penalties of imprisonment (MMPs) for offences under the Controlled Drugs and Substances Act and the repeal of MMPs for a tobacco offence and some offences involving the possession or use of firearms under the Criminal Code; (2) changes to increase the availability of conditional sentences under the Criminal Code; and, (3) changes to the Controlled Drugs and Substances Act to promote the use of diversion for simple possession of drugs.
  
  The minister assessed impact of the bill on two Charter provisions:  Section 12 protections against cruel and unusual treatment or punishment; and Section 7 rights to liberty.  The minister concluded that the bill comports with Charter rights.

Catholic Social Teaching

Like all other social initiatives, policy developments pertaining to substance abuse and addictions should be considered in light of the full range of the Church’s social doctrine, including particularly the fundamental values of truth, freedom, justice, and charitable love; the principles of life and human dignity, the common good, subsidiarity, and solidarity; and Christian virtues such as wisdom, humility, prudence, and good stewardship.

• Life & human dignity, solidarity, charitable love
  From the Compendium of the Social Doctrine of the Church: “ So many needy brothers and sisters are waiting for help, so many who are oppressed are waiting for justice, so many who are unemployed are waiting for a job, so many peoples are waiting for respect.  How can it be that even today there are still people dying of hunger? Condemned to illiteracy? Lacking the most basic medical care? Without a roof over their head? The scenario of poverty can extend indefinitely, if in addition to its traditional forms we think of its newer patterns. These new patterns often affect financially affluent sectors and groups which are nevertheless threatened by despair at the lack of meaning in their lives, by drug addiction, by fear of abandonment in old age or sickness, by marginalization or social discrimination…” (Section 5)
  
  
• Social institutions, subsidiarity, the common good
  From the Compendium of the Social Doctrine of the Church: “The family is the primary unit in society. It is where education begins and the Word of God is first nurtured. The Church considers the family as the first natural society, with underived rights that are proper to it, and places it at the centre of social life.   Relegating the family to a subordinate or secondary role, excluding it from its rightful position in society, would be to inflict grave harm on the authentic growth of society as a whole.”  (Sections 209-211).
  
  The proper role of government and other human institutions is to foster human life and dignity by maintaining social conditions that enable and encourage us to serve God in one another, and thereby to promote that which is truly in the common interest. In virtue of the principle of subsidiarity, public authorities have no right to take away from the family tasks which it can accomplish well by itself or in free association with other families; on the other hand, these same authorities have the duty to sustain the family, ensuring that it has all the assistance that it needs to fulfil properly its responsibilities.
  
  
• Freedom, justice, humility
  Pope Francis, in Fratelli tutti: “Some people are born into economically stable families, receive a fine education, grow up well nourished, or naturally possess great talent. They will certainly not need a proactive state; they need only claim their freedom. Yet the same rule clearly does not apply to a disabled person, to someone born in dire poverty, to those lacking a good education and with little access to adequate health care. If a society is governed primarily by the criteria of market freedom and efficiency, there is no place for such persons, and fraternity will remain just another vague ideal.” (Section 109)

The Canadian Conference of Catholic Bishops has stated that:

• “The Catholic Bishops of Canada are deeply troubled by the devastating effects of [drugs such as opioids like fentanyl and carfentanyl], in particular their ability to extinguish human life in an instant. Even when they do not kill directly, their addictive power creates what Pope Francis recently referred to as “a new form of slavery.” Persons suffering from addiction often have a distorted perception of reality and of what should be desired; the addiction itself is neither representative of who they really are nor is it an authentic expression of their will.
  
  “Moreover, the social ramifications of drug addiction are many. It can be the cause of family breakdown and all kinds of impoverishment (social, educational, economic, emotional, spiritual, etc.). During pregnancy, the use of narcotics can result in miscarriage as well as infant chemical dependency and congenital health problems. Beyond the measurable effects of the crisis today, there are others that we do not yet know: effects that are passed down to the children of those afflicted by addictions or that linger in families and communities for years to come.
  
  “A drug addiction crisis is a complex reality involving a combination of diverse narcotics, people, backgrounds, and contemporary pressures.”

Our Bishops also remind us that:

• The Gospels chronicle how he [Jesus] cured the sick, restored sight to the blind, raised the dead, and cast out demons. He also brought hope to the burdened and brokenhearted. His message extends also to caregivers, for he taught that when we care for the sick, we care for Christ himself. We are called, therefore, to bring hope and healing to those enslaved by drug addiction as well as to their families and communities.

Points to Ponder

Consider discussing the following questions with your local candidates, elected officials, and the parties, and with your family, friends, neighbors, coworkers, and fellow parishioners.  On prayerful reflection, consider sharing your conclusions with your elected representatives by writing respectful and informative letters.

• These bills are steps in a broader National Approach to Substance Use initiative, which calls for amendment of several acts, and changes in the operations of several ministries, in order to shift substance abuse from a problematic, potentially criminal issue to a healthcare matter. For example, C-286 would direct the national minister of health to begin developing a strategy for treatment of substance abuse.
  • It is prudent to enact one part of the strategy before other parts are in place and ready also? It seems possible that decriminalization of possession might have significant effects on markets for commonly misused substances, and therefore the amount of substances available for misuse.  Might that influence the number of users requiring care and assistance? 
  • If true, could these consequences be adequately offset by increased access of affected individuals to mental and health care professionals?

• As noted by the Canadian bishops and by Pope Francis, among others, substance abuse is a complex issue which has many, often interrelated causes and effects. For example, identified causes of substance abuse include family breakups, economic troubles such as job loss or unsatisfying work, loss of individual purpose or sense of purpose tied to communal or national life, other mental health challenges or personal tragedies. There would seem to be many causes of individuals losing hope.
  • Does our national strategy effectively and justly address all of the causes of substance abuse? For example, what about the availability of fulfilling, dignified work, and affordable, dignified housing?
  • It is generally conceded that contributing causes of substance abuse includes family breakdown and an unjust economic system. Is Canada, as a nation, establishing a social and economic framework that is truly supportive of families? If not, what more could be done?
• Is our national healthcare system ready for any increased burdens these proposals might place on it? Numerous government officials at all levels have already noted that our healthcare system is overburdened, inefficient, and too expensive, and unable to serve the population now.  This has been particularly true during the pandemic and is reported to have resulted in many deaths due to lack of available healthcare services. 
  
  Moreover, our Canadian bishops have noted that a significant contributing cause to the rising number of abuse-related deaths has been mis-prescription of opioid painkillers.
   
  • Is our healthcare system prepared to properly administer prescriptions, including alternative substances intended to help users end their addictions?
  • What is the plan for offering effective and appropriate health care and mental care for those seeking help for addictions? Should a broad range of addictions specialists be called together to craft proposals, and should there exist a process for funding those proposals?
    
    
• Some are concerned that the legislation would work to de-stigmatize drug abuse, by striking references to abuse and attempting to make those who may be addicted feel more welcome to seek treatment, and thereby contribute to increased levels of abuse.
  • Do proposals include adequate educational efforts to warn children and others of the dangers of substance misuse, for example by campaigning for support for former addicts, or inclusion of expert descriptions of the real stories of addicts, in order to minimize addiction, with its massive personal and social costs?

• A stated goal of Bill C-5 is to “address the overrepresentation of Indigenous people, Black Canadians, and members of marginalized communities [in Canada’s criminal justice system]. Bill C-5 focuses on existing laws that have exacerbated underlying social, economic, institutional, and historical disadvantage and which have contributed to systemic inequities at all stages of the criminal justice system, from first contact with law enforcement all the way through to sentencing.” The government states that mandatory minimum sentencing laws—those which this Bill would eliminate—have led to over-incarceration of these communities in Canada. The government further argues that the sorts of individuals affected by these mandatory minimum sentencing laws are the least likely to re-offend once released and deserve a second chance.
  • Will the proposal make a positive contribution to addressing these real issues as the government argues?

• The opposition argues that the Bill would remove mandatory minimum sentences for very serious crimes (like robbery with a firearm, drug trafficking, importing and exporting drugs, and others), and that the Bill would therefore not achieve its intended affect of reducing inequities while helping those struggling with addiction.
  • Will the proposal help to address the addictions crisis facing so many Canadians, or are more—or different—tactics needed?

Sources:

• Legal Scan
• Canadian Federal Government
• Compendium of the Social Doctrine of the Church