Canada’s struggle with substance use isn’t just a public health emergency—it’s also a communication crisis. According to Dr. Kwame McKenzie, a leading psychiatrist and health equity advocate, the core failure of Canada’s drug policy lies in its criminalized approach and the stigmatizing language that still dominates the national conversation.
Speaking on the Global Health Matters podcast, Dr. McKenzie—CEO of the Wellesley Institute and Director of Health Equity at the Centre for Addiction and Mental Health—argued that meaningful progress hinges on shifting how Canadians think and talk about substance use. The term “substance use,” he explains, is not just semantics; it reframes the issue as a health condition rather than a moral failing.
“Words matter,” McKenzie emphasized. “The way we talk about substance use influences how people access care and how policy is made.”
While opioids have drawn the spotlight, McKenzie pointed out that alcohol remains the most commonly misused substance in Canada, affecting around 16% of the population. In contrast, fewer than 3% of Canadians use illegal drugs regularly. However, the opioid crisis has intensified dramatically.
Before the COVID-19 pandemic, an average of 11 people died daily from opioid-related causes. That number surged to over 21 per day by 2022, driven largely by the contamination of the drug supply with deadly substances like fentanyl.
Efforts to decriminalize drug use—most notably in British Columbia—have faced significant political resistance and public backlash. Critics argue that such policies increase drug use, but McKenzie points to international evidence that suggests otherwise. In Portugal, for instance, drug use didn’t drop significantly after decriminalization—but access to treatment improved dramatically.
“The aim is not necessarily to reduce use right away, but to reduce the harm and get people into care,” McKenzie said.
He was unequivocal in his assessment: Canada’s criminal justice approach to substance use has failed. Rather than dismantling drug cartels or curbing addiction, it has deepened both problems. By criminalizing drug users, the system discourages people from seeking help and fuels the very networks it aims to eliminate.
“If you want to create cartels, if you want to create an ingrained substance use problem that just gets worse, then have a war against it,” McKenzie warned. “It will not work.”
He concluded that policymakers must make hard, evidence-based choices and accept that progress may come with trade-offs. A health-first approach, grounded in compassion and science, offers the most promising path forward.
