Connect with us

Break The Needle

Canada follows Iceland’s lead on drug prevention

Published

10 minute read

By Alexandra Keeler

Canada is betting on the Icelandic Prevention Model to reduce youth drug use. But does it fit Canada’s opioid crisis and diverse communities?

Since 2020, Canada has been piloting a new strategy to prevent youth from using drugs and alcohol.

The strategy is based on a highly successful model pioneered in Iceland in the 1990s — one that helped cut Iceland’s youth substance use from among Europe’s highest to the lowest.

But in Canada, the effectiveness of the Icelandic model remains unproven — and some experts say Canada needs a strategy that is better targeted to Canada’s unique culture.

“The [Icelandic Prevention Model] was originally developed to address alcohol and tobacco use in Iceland in the 1990s,” Leslie Buckley, chief of addictions at the Centre for Addiction and Mental Health (CAMH), told Canadian Affairs in an email.

“It was not designed with opioids or mental health in mind and doesn’t appear to incorporate trauma-informed practices,” she said.

The Icelandic model

The Icelandic Prevention Model aims to deter youth substance use by treating “society as the patient.”

The model is implemented through entire communities by a range of organizations, including town councils, schools, health providers, youth organizations and parent groups.

Its aim is to strengthen the social conditions that affect youth substance use, such as peer pressure, parental influence, extracurriculars and community ties. For example, parents are encouraged to have their children at home in the evenings.

In Iceland, the strategy has yielded impressive results.

Between 1998 and 2013, the share of 15-16-year-olds who reported getting drunk in the past 30 days fell from 42 per cent to five per cent. Daily smoking dropped from 23 per cent to one per cent, and lifetime cannabis use fell from 17 per cent to six per cent.

Given its success, the model has been broadly adopted in countries around the world, and is today used on five continents.

But its founders stress that the model must always be adapted to a country’s own culture.

“We don’t tell people what to do, but we provide this framework, and always it has to be culturally adapted,” said Jon Sigfusson, chairman of Planet Youth, the organization that created the Icelandic Prevention Model.

“What works in Iceland doesn’t work in Canada or anywhere else.”

In an email to Canadian Affairs, Planet Youth emphasized the importance of understanding the unique dynamics of the community in which the strategy is being rolled out.

“The key strategies include building a strong coalition that works in the community for the community, using survey data that looks into risk and protective factors and specific community challenges, guiding decision-making based on data,” the Planet Youth team told Canadian Affairs in an email.

Subscribe to Break The Needle for free to get BTN’s latest news and analysis – or donate to our investigative journalism fund.

‘The entire community’

In Canada, the Icelandic Prevention Model was first piloted in 2020 among Grade 10 students in Lanark County, Ont.

Today, it is being piloted in seven communities across the country, including in Cape Breton, N.S., Mississauga, Ont., and the Grand Erie region of Ontario.

Canada’s adoption of the Icelandic Prevention Model marks a major shift from Canada’s pre-2020 approach to substance use prevention. That approach relied on short-term, targeted education campaigns to help youth recognize and resist peer pressure.

“The ‘just say no to drugs’ approach does not work and has been proven ineffective time and time again,” said Sefin Stefura, project manager of the Icelandic Prevention Model in Cape Breton.

Buckley, of CAMH, says the Icelandic Prevention Model’s focus on the entire community is one of its strengths.

“One positive aspect of the Icelandic Model is that it involves an entire community — and bringing people together to work on a common goal,” she said in her email.

At the same time, experts caution that the Icelandic Prevention Model — which was first implemented in the 1990s — was not designed to address the complex challenges Canadian youth face today.

The model needs rigorous evaluation in Canada due to its “different population, different sociocultural landscape, and differing substance[s],” Buckley said.

“We cannot highlight enough the importance of evaluation in the early pilots,” she said.

A recent consultation by the Canadian Centre on Substance Use and Addiction found that Canadian youth want mental health support, peer-led education and non-judgmental tools for coping with stress and trauma.

“Youth often start using substances for social reasons — to fit in and socialize more effortlessly — but often continue because they are using it to cope with stress, mental health challenges or pain,” the report says.

Cape Breton, one of the cities currently piloting the Icelandic Prevention Model, is adapting its strategy to ensure all research and interventions put mental health, accessibility and lived experience at the forefront, says project manager Stefura.

Stefura says the community also plans to create a youth congress to co-lead decisions with schools and municipal leaders.

“There is really no way to separate [trauma and mental health] from primary prevention,” she said.

In Ontario’s Grand Erie region, health promoters Lina Hassen and Josh Daley say they view the Icelandic Prevention Model as a valuable framework — but only when part of a larger approach.

“We don’t pretend or believe that this is a silver bullet,” said Daley. “We know it’s a complex issue, so it’s going to have a complex solution, and we think this is complementary to what’s going on.”

“We have a local drug and alcohol strategy,” Hassen added.

“We are recognizing the need to embed mental health components — such as training for schools and community leaders on trauma-informed care — and aligning the model with local mental health resources.”

Dagmar Morgan-Sinclair, the executive director of the team implementing the Icelandic Prevention Model in Mississauga, says the model complements, but should not replace, other targeted substance use prevention programs.

In Canada, one such program is PreVenture. PreVenture is an evidence-based Canadian program used primarily in schools and universities that helps youth identify and mitigate behavioural traits that can correlate with substance use disorders.

“Our strategy is a ‘yes, and’ to some of these individualized-focused programs,” said Morgan-Sinclair. “This is something that works in tandem.”

Buckley agrees that the Icelandic Prevention Model’s broad, community-based approach should be paired with targeted programs like PreVenture, which have been proven to work in the Canadian context.

“Health Canada says the [Icelandic] program allows for local adaptation — but most of the funded communities are in smaller or rural areas, and don’t include places with the highest rates of youth drug use like Vancouver or Toronto,” she said.

Canada’s efforts to reduce youth substance use have, so far, been modest. Health Canada, for example, committed just $20 million to the Icelandic Prevention Model over five years, while the opioid crisis is estimated to cost the country about $40 billion a year.

“We have not invested in primary prevention as much as we should,” said Buckley.

“We need to consider, invest in and test these upstream prevention practices in Canada,” Buckley said.


This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.


Launched a year ago

Break The Needle provides news and analysis on addiction and crime in Canada.

Todayville is a digital media and technology company. We profile unique stories and events in our community. Register and promote your community event for free.

Follow Author

Addictions

Canada must make public order a priority again

Published on

A Toronto park

Public disorder has cities crying out for help. The solution cannot simply be to expand our public institutions’ crisis services

[This editorial was originally published by Canadian Affairs and has been republished with permission]

This week, Canada’s largest public transit system, the Toronto Transit Commission, announced it would be stationing crisis worker teams directly on subway platforms to improve public safety.

Last week, Canada’s largest library, the Toronto Public Library, announced it would be increasing the number of branches that offer crisis and social support services. This builds on a 2023 pilot project between the library and Toronto’s Gerstein Crisis Centre to service people experiencing mental health, substance abuse and other issues.

The move “only made sense,” Amanda French, the manager of social development at Toronto Public Library, told CBC.

Does it, though?

Over the past decade, public institutions — our libraries, parks, transit systems, hospitals and city centres — have steadily increased the resources they devote to servicing the homeless, mentally ill and drug addicted. In many cases, this has come at the expense of serving the groups these spaces were intended to serve.

For some communities, it is all becoming too much.

Recently, some cities have taken the extraordinary step of calling states of emergency over the public disorder in their communities. This September, both Barrie, Ont. and Smithers, B.C. did so, citing the public disorder caused by open drug use, encampments, theft and violence.

In June, Williams Lake, B.C., did the same. It was planning to “bring in an 11 p.m. curfew and was exploring involuntary detention when the province directed an expert task force to enter the city,” The Globe and Mail reported last week.

These cries for help — which Canadian Affairs has also reported on in TorontoOttawa and Nanaimo — must be taken seriously. The solution cannot simply be more of the same — to further expand public institutions’ crisis services while neglecting their core purposes and clientele.

Canada must make public order a priority again.

Without public order, Canadians will increasingly cease to patronize the public institutions that make communities welcoming and vibrant. Businesses will increasingly close up shop in city centres. This will accelerate community decline, creating a vicious downward spiral.

We do not pretend to have the answers for how best to restore public order while also addressing the very real needs of individuals struggling with homelessness, mental illness and addiction.

But we can offer a few observations.

First, Canadians must be willing to critically examine our policies.

Harm-reduction policies — which correlate with the rise of public disorder — should be at the top of the list.

The aim of these policies is to reduce the harms associated with drug use, such as overdose or infection. They were intended to be introduced alongside investments in other social supports, such as recovery.

But unlike Portugal, which prioritized treatment alongside harm reduction, Canada failed to make these investments. For this and other reasons, many experts now say our harm-reduction policies are not working.

“Many of my addiction medicine colleagues have stopped prescribing ‘safe supply’ hydromorphone to their patients because of the high rates of diversion … and lack of efficacy in stabilizing the substance use disorder (sometimes worsening it),” Dr. Launette Rieb, a clinical associate professor at the University of British Columbia and addiction medicine specialist recently told Canadian Affairs.

Yet, despite such damning claims, some Canadians remain closed to the possibility that these policies may need to change. Worse, some foster a climate that penalizes dissent.

“Many doctors who initially supported ‘safe supply’ no longer provide it but do not wish to talk about it publicly for fear of reprisals,” Rieb said.

Second, Canadians must look abroad — well beyond the United States — for policy alternatives.

As The Globe and Mail reported in August, Canada and the U.S. have been far harder hit by the drug crisis than European countries.

The article points to a host of potential factors, spanning everything from doctors’ prescribing practices to drug trade flows to drug laws and enforcement.

For example, unlike Canada, most of Europe has not legalized cannabis, the article says. European countries also enforce their drug laws more rigorously.

“According to the UN, Europe arrests, prosecutes and convicts people for drug-related offences at a much higher rate than that of the Americas,” it says.

Addiction treatment rates also vary.

“According to the latest data from the UN, 28 per cent of people with drug use disorders in Europe received treatment. In contrast, only 9 per cent of those with drug use disorders in the Americas received treatment.”

And then there is harm reduction. No other country went “whole hog” on harm reduction the way Canada did, one professor told The Globe.

If we want public order, we should look to the countries that are orderly and identify what makes them different — in a good way.

There is no shame in copying good policies. There should be shame in sticking with failed ones due to ideology.

 

Our content is always free – but if you want to help us commission more high-quality journalism,

consider getting a voluntary paid subscription.

Continue Reading

Addictions

No, Addicts Shouldn’t Make Drug Policy

Published on

By Adam Zivo

Canada’s policy of deferring to the “leadership” of drug users has proved predictably disastrous. The United States should take heed.

[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]

Progressive “harm reduction” advocates have insisted for decades that active users should take a central role in crafting drug policy. While this belief is profoundly reckless—akin to letting drunk drivers set traffic laws—it is now entrenched in many left-leaning jurisdictions. The harms and absurdities of the position cannot be understated.

While the harm-reduction movement is best known for championing public-health interventions that supposedly minimize the negative effects of drug use, it also has a “social justice” component. In this context, harm reduction tries to redefine addicts as a persecuted minority and illicit drug use as a human right.

This campaign traces its roots to the 1980s and early 1990s, when “queer” activists, desperate to reduce the spread of HIV, began operating underground needle exchanges to curb infections among drug users. These exchanges and similar efforts allowed some more extreme LGBTQ groups to form close bonds with addicts and drug-reform advocates. Together, they normalized the concept of harm reduction, such that, within a few years, needle exchanges would become officially sanctioned public-health interventions.

The alliance between these more radical gay rights advocates and harm-reduction proponents proved enduring. Drug addiction remained linked to HIV, and both groups shared a deep hostility to the police, capitalism, and society’s “moralizing” forces.

In the 1990s, harm-reduction proponents imitated the LGBTQ community’s advocacy tactics. They realized that addicts would have greater political capital if they were considered a persecuted minority group, which could legitimize their demands for extensive accommodations and legal protections under human rights laws. Harm reductionists thus argued that addiction was a kind of disability, and that, like the disabled, active users were victims of social exclusion who should be given a leading role in crafting drug policy.

These arguments were not entirely specious. Addiction can reasonably be considered a mental and physical disability because illicit drugs hijack users’ brains and bodies. But being disabled doesn’t necessarily mean that one is part of a persecuted group, much less that one should be given control over public policy.

More fundamentally, advocates were wrong to argue that the stigma associated with drug addiction was senseless persecution. In fact, it was a reasonable response to anti-social behavior. Drug addiction severely impairs a person’s judgement, often making him a threat to himself and others. Someone who is constantly high and must rob others to fuel his habit is a self-evident danger to society.

Despite these obvious pitfalls, portraying drug addicts as a persecuted minority group became increasingly popular in the 2000s, thanks to several North American AIDS organizations that pivoted to addiction work after the HIV epidemic subsided.

In 2005, the Canadian HIV/AIDS Legal Network published a report titled “Nothing about us without us.” (The nonprofit joined other groups in publishing an international version in 2008.) The 2005 report included a “manifesto” written by Canadian drug users, who complained that they were “among the most vilified and demonized groups in society” and demanded that policymakers respect their “expertise and professionalism in addressing drug use.”

The international report argued that addiction qualified as a disability under international human rights treaties, and called on governments to “enact anti-discrimination or protective laws to reduce human rights violations based on dependence to drugs.” It further advised that drug users be heavily involved in addiction-related policy and decision-making bodies; that addict-led organizations be established and amply funded; and that “community-based organizations . . . increase involvement of people who use drugs at all levels of the organization.”

While the international report suggested that addicts could serve as effective policymakers, it also presented them as incapable of basic professionalism. In a list of “do’s and don’ts,” the authors counseled potential employers to pay addicts in cash and not to pass judgment if the money were spent on drugs. They also encouraged policymakers to hold meetings “in a low-key setting or in a setting where users already hang out,” and to avoid scheduling meetings at “9 a.m., or on welfare cheque issue day.” In cases where addicts must travel for policy-related work, the report recommended policymakers provide “access to sterile injecting equipment” and “advice from a local person who uses drugs.”

The international report further asserted that if an organization’s employees—even those who are former drug users—were bothered by the presence of addicts, then management should refer those employees to counselling at the organization’s expense. “Under no circumstances should [drug addicts] be reprimanded, singled out or made to feel responsible in any way for the triggering responses of others,” stressed the authors.

Reflecting the document’s general hostility to recovery, the international report emphasized that former drug addicts “can never replace involvement of active users” in public policy work, because people in recovery “may be somewhat disconnected from the community they seek to represent, may have other priorities than active users, may sometimes even have different and conflicting agenda, and may find it difficult to be around people who currently use drugs.”

Subscribe for free to get BTN’s latest news and analysis – or donate to our investigative journalism fund.

The messaging in these reports proved highly influential throughout the 2000s and 2010s. In Canada, federal and provincial human rights legislation expanded to protect active addicts on the basis of disability. Reformers in the United States mirrored Canadian activists’ appeals to addicts’ “lived experience,” albeit with less success. For now, American anti-discrimination protections only extend to people who have a history of addiction but who are not actively using drugs.

The harm reduction movement reached its zenith in the early 2020s, after the Covid-19 pandemic swept the world and instigated a global spike in addiction. During this period, North American drug-reform activists again promoted the importance of treating addicts like public-health experts.

Canada was at the forefront of this push. For example, the Canadian Association of People Who Use Drugs released its “Hear Us, See Us, Respect Us” report in 2021, which recommended that organizations “deliberately choose to normalize the culture of drug use” and pay addicts $25-50 per hour. The authors stressed that employers should pay addicts “under the table” in cash to avoid jeopardizing access to government benefits.

These ideas had a profound impact on Canadian drug policy. Throughout the country, public health officials pushed for radical pro-drug experiments, including giving away free heroin-strength opioids without supervision, simply because addicts told researchers that doing so would be helpful. In 2024, British Columbia’s top doctor even called for the legalization of all illicit drugs (“non-medical safer supply”) primarily on the basis of addict testimonials, with almost no other supporting evidence.

For Canadian policymakers, deferring to the “lived experiences” and “leadership” of drug users meant giving addicts almost everything they asked for. The results were predictably disastrous: crime, public disorder, overdoses, and program fraud skyrocketed. Things have been less dire in the United States, where the harm reduction movement is much weaker. But Americans should be vigilant and ensure that this ideology does not flower in their own backyard.

Subscribe to Break The Needle.

Our content is always free – but if you want to help us commission more high-quality journalism,

consider getting a voluntary paid subscription.

Continue Reading

Trending

X