Public health for whom? Unpacking the assumptions and silences in Canada's public health approach to substance use.
Background: In 2016, Canada's new national drug strategy adopted a public health focussed approach to addressing substance use. This shift opened the door for other significant drug policy changes, including the adoption of a regulated legal market for the non-medical use of cannabis in 2018 and, more recently, the temporary decriminalization of several drugs in the province of British Columbia in 2023. While many scholars, members of civil society, and people who use drugs have shown support and advocated for governments to adopt public health approaches to substance use, careful consideration of what exactly is a public health approach and potential unintended consequences, is needed. Some scholars in Canada have begun this important work (Crepault et al., 2023). In their review of 272 articles from 25 countries, the authors found no consensus on the definition of a public health approach to substance use and conclude by urging policymakers to be specific about their aims, objectives, and the assumptions underlying them (Crepault et al., 2023). Building on this work, this oral presentation will share findings from my PhD research project, which highlights the inherent tensions, contradictions, and unintended consequences of Canada’s public health approach.
Methods: I analyzed my data using Carol Bacchi’s What is the Problem Represented to Be (WPR) analytical framework to uncover the underlying assumptions, unspoken objectives, hidden agendas, and strategic silences in Canada’s drug policy discourse. I analyzed this drug policy discourse in two forms: policy documents and interview transcripts with policy actors, from interviews conducted in 2023 and early 2024. For policy documents, I analyzed documents associated with Canada’s 2016 national drug strategy. I also condcuted semi-structured interviews with 35 policy actors, including from government, academia, and civil society, who either previously or currently worked on Canada’s drug policy.
Findings: My research findings reflect the tension and ambiguity within Canada’s public health approach. Interviewed policy actors also highlighted several concerns related to Canada’s public health approach, including (1) overly-medicalized language, (2) the continued stigmatization of certain people who use drugs, (3) the heightened stigmatization of people who sell drugs, and (4) the policy silence around drug use for recreational purposes. Despite these concerns, most policy actors stressed that public health approaches were an improvement on prohibitionist policies. Furthermore, several policy actors, including people with lived and living experience of substance use, highlighted a newly emerging public health framework that presents substance use health as a spectrum, which could help to address some of the identified concerns.
