Canada’s struggle with substance use is more than a health issue—it’s a matter of language, policy, and public trust, said Dr. Kwame McKenzie in the latest episode of the Global Health Matters podcast with Dr. Garry Aslanyan.

McKenzie, CEO of the Wellesley Institute and Director of Health Equity at Canada’s Centre for Addiction and Mental Health, stressed that terms like “substance abuse” are outdated.

“People tend to talk about substance use, not abuse,” he explained. “It’s a useful term because it focusses on health rather than illness.”

Canada’s biggest problem isn’t illegal drugs—it’s alcohol.

“Heavy drinking is 16% of the population,” said McKenzie.

Illegal drugs? Just 3%. Yet the opioid crisis has been devastating.

“Before COVID, Canada averaged 11 daily deaths from opioid toxicity. By 2022, that number increased to more than 21,” he said, attributing the spike to a more toxic, unpredictable supply chain disrupted by the pandemic.

While some Canadian provinces moved toward decriminalisation, political headwinds have pushed back. “We have seen a return to non evidence-based political arguments, which are again trying to say that substance use is a moral failing,” he warned.

McKenzie contrasted Canada’s path with Portugal, where health—not criminality—is the focus.

“There’s lots of evidence to show that [Portugal’s model] increased the number of people going into rehabilitation,” he said. “Has it decreased the number of people taking substances? No. But that wasn’t the intention.”

The main takeaway?

“Criminalising substance use has not been very successful,” McKenzie said. “If you want to create cartels … and an ingrained substance use problem that just gets worse, then have a war against [drugs]. It will not work.”

McKenzie’s final advice for policymakers: “There are no silver bullets. We have to make choices, and we might have to make sacrifices in order to get where we want to go.”

Listen to more episodes of the Global Health Matters podcast on Health Policy Watch.

Image Credits: Global Health Matters Podcast.