Photo Illustration of Robert Mann
Robert Mann

Drugs Other Than Cannabis Are Too Hazardous to Legalize

Not many people use cocaine, heroin or meth. Prohibition helps keep it that way

Robert Mann is a professor at the Dalla Lana School of Public Health. Read a different view of drug legalization by Akwasi Owusu-Bempah, a professor in the department of sociology at U of T Mississauga.

Last month, by legalizing cannabis, Canada launched a massive, country-wide experiment. While the results won’t be known for years, some advocates are already calling for a broader push to decriminalize or legalize all recreational drugs. 1

I believe this is a mistake. We need to spend at least a decade studying the impact of cannabis legalization on public health and society before considering additional action. Then, if the results from these studies give us reason to move forward, it would be crucial to examine all other recreational drugs one by one. We would need to consider the potential harms each drug can cause to individuals, to those around them and to society. We’d need to consider the addiction potential of each drug, the acute effects of each drug and its chronic, long-term effects. We’d have to consider how likely people are to overdose from the drug.

Cannabis isn’t as harmful as some other recreational drugs. In 2010, David Nutt, a former chief drug adviser to the British government, published a paper with input from drug-harm experts and clinicians about the hazards associated with 20 legal and illegal drugs. 2 Cannabis ranked around the middle of the list – significantly lower than illegal drugs such as heroin and crack cocaine in terms of the risk to individual users and society. 3 It’s important to keep this in mind when we’re talking about legalizing cannabis in the context of a broader push for drug legalization.

Cannabis stands out in another way. Before legalization in Canada, use of the drug was increasing. 4 By contrast the use of stimulants, hallucinogens and other recreational drugs (with the exception of opioids) is low and appears to be declining in both student and adult populations. 5 Current rates of drug use are important to consider. If we’re not seeing high usage rates of drugs that we’re concerned about from a health perspective, then it’s likely that prohibition is one of the factors that deters people from using them. 6

I believe public health needs to be the singular and paramount concern

The risk is especially high where young people are concerned. Greater use of harder drugs among adults can boost their use among youth. We saw this with prescription opioid pain relievers. As more doctors prescribed these drugs, resulting in more people having them in the home, use among young people grew. In 2007, a survey of student drug use by the Centre for Addiction and Mental Health (CAMH) in Toronto, where I work, found that about one in five students in grades 7 to 12 had used prescription opioids for a non-medical use in the past year. This finding helped to draw attention to the problem of non-medical opioid use in Canada and stimulate control efforts, which led to improvement. A decade later, the rate had declined to about one in 10 students, although non-medical use of these drugs remains a very serious problem.

The effect of drugs on youth can be more damaging and long-lasting than on adults. Research tells us that the earlier you begin to use a drug, the more likely you are to have problems with it later in life. And greater use among youth can lead to a higher risk of injury through impaired driving or overdose.

Legalization creates additional headaches. I’d be concerned about the possibility of governments adopting a free market approach where the focus is on sales and profits, as opposed to health and public health, and advertising and promotion are permitted – or use can be encouraged in other, more subtle, ways.

As a scientist who studies the factors that elevate or decrease alcohol and drug problems, I believe public health needs to be the singular and paramount concern in these circumstances.

People are often inadequately informed about the risks of drug use (or are informed about some drugs but not others). And if they do seek information, there are plenty of conflicting opinions and misinformation online to confuse them. This is a concern particularly when the substances are hazardous. For example, the 2017 CAMH Ontario Student Drug Use and Health Survey revealed that about one per cent of Ontario students said they had used fentanyl recreationally. This shocked me. Fentanyl is a perilous drug; you can overdose very quickly. One per cent may be low, but it’s deeply concerning. It leads me to ask whether young people lack – or are ignoring – information about a drug for which the dangers have been well publicized.

I suspect most Canadians know someone who has experienced health issues related to drug use or abuse. It’s a common problem. We know, for example, that tobacco is the leading cause of preventable death in this country. Some of my own family members have died from tobacco-related disease. Almost 80 per cent of us drink alcohol. It’s the leading risk factor for premature mortality among adolescents and young adults. I knew people when I was young who were killed in drinking-and-driving collisions. Heavy drinking causes chronic liver disease and cirrhosis. Alcohol abuse is associated with violence, domestic assault and workplace problems.

And yet: alcohol and tobacco are both legal drugs. They’re the drugs people use most. Do we want to risk legalizing drugs that are more dangerous, such as cocaine and heroin, with all the potential health hazards that this entails? Can we accept those risks for ourselves – and for our children?

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  1. 6 Responses to “ Drugs Other Than Cannabis Are Too Hazardous to Legalize ”

  2. Matthew Elrod says:

    "Do we want to risk legalizing drugs that are more dangerous, such as cocaine and heroin, with all the potential health hazards that this entails?"

    Or do want to leave them under the control of criminals and teenagers who sell a myriad of drugs of unknown provenance, potency and purity, on commission, tax free, to anyone of any age, anytime, anywhere, no questions asked?

    Legalization is merely a precondition to a spectrum of regulatory models. Heroin, for example, is already legally prescribed in Canada.

  3. Helen Hoy says:

    Among the harms of alcohol, and often omitted from discussion, is the risk of Fetal Alcohol Spectrum Disorder.

  4. Tristan Snider says:

    "Not many people use cocaine, heroin or meth." *Citation needed*

  5. University of Toronto Magazine says:


    There is a citation in a footnote in the story: Cocaine use among Canadians aged 15 and older fell to 1.2 per cent in 2015, from 1.6 per cent in 2008, according to the Canadian Centre on Substance Use and Addiction. This chart, from the Canadian government, shows lifetime use among Canadians of various drugs in 2017: one in nine Canadians had used cocaine in their lifetime; fewer than one in 25 had used speed/meth and fewer than one in 100 had used heroin.

  6. Ben M says:

    Most of the concerns raised in this column can be addressed with a sensible regulatory scheme.

    And if public health is the primary concern, what could be more concerning than the three to four thousand deaths by unintentional overdose (mainly due to fentanyl-related toxicity) now occurring annually?

    This number might fluctuate, but it won't ever revert to the much lower figure of ten years ago because fentanyl is here to stay: it's impossible to stop at the border, and it's vastly more profitable to criminal dealers than heroin.

    If legalization produced more addictions, which is far from certain, it's very likely that those addictions would be dramatically less fatal than at current since legalized opioids would rarely cause unintentional overdoses.

    You can't treat someone for addiction once they've died.

  7. Donald M. Bartlett says:

    Definitely NO to making all drugs legal. For 25 years, I was a narcotic auditor and inspector, headquartered in Vancouver for 12 years and responsible for staff in B.C., Alberta and the Yukon. I walked East Hastings in Vancouver every two weeks or so between 1961 and 1972. My job involved the pharmacies in that area, but I saw many young people standing on that street asking for handouts. Usually, they were gone within several months -- not home but dead. To take all controls off hard drugs is too easy a solution. The legalization of cannabis alone has left Canadians at risk on our roads and highways of serious injury and death.