On Saturday, November 9, five panelists convened to discuss the topic “Legalize All Drugs?! Exploring Options for Legal Regulation in a Post-Prohibition World.” Following are excerpts from the discussion. Moderator: Why do you think we should legalize and regulate all drugs? What are the harms that we’re trying to address? Zoe Dodd: The high number of individuals from black and indigenous communities who are incarcerated disproportionately in Canada is one reason. The other is the overdose crisis. We have thousands of people who are dying. Scott Bernstein: In Canada we have rolled out harm reduction quite robustly. We have over 40 supervised consumption sites in the country now. But we’re not seeing dramatic declines in overdose deaths. When we decriminalize, we only take care of half of the problem, and legalizing would allow us to actually create a safer supply that could address it. Steve Rolles: The distinction between legalization and decriminalization can be confusing and unhelpful. They’re all part of the same piece for me. So many of the harms that people are dealing with are the result of illegal supply and prohibition. So for me, regulation and legalization is part of harm reduction. Moderator: What would legalization look like? Rolles: We can propose four or five options ranging from medical prescription models, like heroin assisted therapy, through a kind of pharmacy sales model. We could have a trained vendor who gives medical advice. Or more conventional licensed retailing like cannabis dispensaries. Or a model with vending and consumption on the premises, like a bar or a cannabis coffee shop in the Netherlands. We have to look at the risks of particular drugs and the regulatory tools that we have, and try and match them up in a reasonable way. The more dangerous drugs would be more regulated, the less risky drugs less so: we can create a kind of risk/availability gradient. In doing that, we could begin to shepherd people towards safer products and safe behaviors. Prohibition does the complete opposite. It is crazy that we can get heroin laced with fentanyl on the streets really easily, but we can’t get smokable opium. All of the weed in the U.K. at the moment is super strong. If you want to get milder weed or hash, you can’t. It’s just not there. Prohibition does that. It tilts the market towards the most dangerous products, the most dangerous behaviors. And regulation can tilt the market the other way if we do it sensibly. Bernstein: We regulate all kinds of harmful or risky activities from driving to sky-diving to foods and drinks and all kinds of things. And so it’s really just drugs and a few other things that are left out of this regulated system. Moderator: Are there examples of jurisdictions where specific drugs have been legalized that we can look to as models? Rolles: The most obvious ones are the medical prescription models. In many countries in Europe and elsewhere in the world, they prescribe injectable heroin. Now, because it’s a medical intervention, it doesn’t have to be legalized as such because it’s legal anyway. Dodd: In Canada, we have what’s called “safer supply”—the Canadian Association of Safer Supply, the Canadian Association of People Who Use Drugs. We have injectable heroin programs. They are very hard to get into. You have to come in every day, so you’re kind of really chained to a clinic. But people like it; it’s changed their lives. There’s a doctor in London, Ontario who is giving people hydromorphone. She has 190 patients in her program. She’s been running it for three years. She prescribes to them. People can take their doses at home. Nobody has died in her program. We are in the midst of this devastating overdose crisis but none of the 190 people have died of overdose in her program. Rolles: There are traditional plants that are used in a quasi-legal informal space in many countries, whether in Africa, whether in Southeast Asia, whether it’s some of the psychedelics like mushrooms and peyote in the Americas. They’re regulated much more by social norms than by legal infrastructure but there’s certainly a lot we can learn from those drugs as well. Moderator: Legalization may be scary to a lot of people concerned about increased use or overdose. So what should be the response to people who have those concerns? Bernstein: There are a lot of myths around legalization. I’m coming to think about this as mostly a knowledge translation problem for the public. One myth is that legalization means easy access to drugs or increased use. Another is government control of all aspects. Government has to set some rules, but there could be a variety of models. We have RegulationProject.org to move away from “should we legalize all drugs” to how we do it in a way that is very digestible to people and allows them to engage in the planning. Moderator: What can we learn from already legal and regulated substances? Rolles: Big tobacco, big pharma, big cannabis have been responsible for horrible things we need to learn from and not repeat. But there are examples of good practice. Tobacco regulation has moved in the last 20 years towards a much more appropriate level of regulation. We’ve prevented branding and marketing and advertising almost completely in the U.K. You can now buy as much tobacco as you like, but it’s in plain packages with health warnings. There are bans on smoking in public places. With alcohol regulation, we’re still some way behind. Alcohol brands in the U.K. are sponsoring our Olympic team, which is completely inappropriate. And so we need to be not doing a lot of those things. But we also need to learn from good practice in alcohol, tobacco, and pharmaceutical regulation. Snapp: In Mexico and Colombia, the public health crisis is around violence. We’re concerned with countries that are having overdose crises, but we’re also concerned about people who are just being outright killed. For me, going back to the question of “how do you change, how do you convince people,” you have conversations with them. When you explain to people what’s going on, they get it. They’re not stupid; it’s just that nobody’s talked to them about this. And nobody’s told them the truth. Moderator: In the next decade, what you would like to see with respect to legalization and regulation? Bernstein: I think the horizon on legalizing all drugs is probably 10 to 15 years away in Canada. It’s a big lift, but I think we actually have a system supportive of social and racial justice. Dodd: For me, it looks like people not dying. It looks like getting out of this overdose crisis. It looks like demilitarization. It looks like friends being free. Like some of my friends in prison right now haven’t even had their trials and they’ve been sitting, waiting for 18 months. It looks like people who also sold drugs getting amnesty. You can’t legalize drugs and say, “It’s okay now, but it was bad then. You have to sit inside prison and serve out your term.” Black and indigenous people overrepresent the prison population for Canada’s drug users. Those people need out and their communities need reparations. Rolles: Cannabis has been the first drug to legalize. It is not culturally frightening because it is widely used and relatively low risk. As you move towards more risky drugs, legalization becomes more politically difficult. But the big health gains are probably going to be with the more risky drugs. The conversation does now feel like it is beginning. The Abridged Medical Journal and the American Public Health Association now advocate openly for legalization and regulation of all drugs. Amnesty International, one of the largest NGOs in the world, soon will be looking at this through a human rights lens. So it is entering the kind of mainstream political discourse. We all need to encourage that to move forward. If there’s one thing I’ve learned, it’s that exposure to this debate only ever moves people in one direction—and it’s not towards a War on Drugs.