What is Legal Regulation?
“Legal regulation” refers to policies and practices that eliminate all criminal penalties for purchasing, possessing, consuming, and, in some cases, distributing drugs (legalization). In their place, mechanisms for acquiring medical-grade drugs from a licensed producer are implemented (regulation).1 These drugs are sealed, packaged, and stored through rigorous quality-control procedures comparable to those required by law for all government-regulated consumer goods. There are many possible implementation frameworks for legal regulation. The ideal model is debated and may be context-specific, but each shares the following principles:
- Promoting public health and reducing harms
- Protecting vulnerable populations, including youth
- Supporting human rights
- Promoting social justice
- Supporting participatory democracy2
Advocacy for legal regulation is founded on the philosophies and ethics of harm reduction. This is a movement for social justice that aims to reduce not just the dangers of drug use but also those derived from policy, drug-related and otherwise. Initiatives prioritize the dignity and autonomy of all people who use drugs (PWUD) while strategically enhancing knowledge, skills, and resources through direct action, mutual aid, and peer-to-peer support.3 Through this lens, drug use is a morally neutral behaviour that should be as safe as possible whether done medically, recreationally, compulsively, or some combination thereof.
Examples of legal regulation are everywhere. Presently, alcohol, tobacco, cannabis (in Canada), prescription-grade narcotics, over-the-counter medications, psychiatric medications, medications prescribed for conditions such as attention deficit hyperactivity disorder (ADHD), dietary supplements, and vitamins—all drugs—are legalized and regulated. Death from these substances is rare, not because they are intrinsically safer than currently illegal drugs, but because consumers know precisely what they are using and in what quantities. Moderate use of these drugs is also normalized: consumers can disclose their use without fear of criminal repercussions, and being open about one’s consumption is less associated with discrimination and status loss. Some people do develop problematic relationships with one or more legal drugs (and behaviours), but accessing support does not expose one to arrest, incarceration, or criminal justice surveillance. Legal regulation is thus a pragmatic, humane approach rooted in the tenets of public health and human rights.
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Evidence for Legal Regulation: Distinctions Between Decriminalization and Legal Regulation
Legal regulation is not synonymous with decriminalization. Both have benefits but are distinct in their premises, routes to implementation, and outcomes. Some of these varying outcomes are as follows:
1. Drug Toxicity and Death
Without a regulated supply of drugs, those purchased on the illegal market remain contaminated with one or multiple toxic additives. Their potency and pharmacologic profiles are random. Current rates of accidental overdose and death, including among recreational users, reflect this: in British Columbia, street-based fentanyl has been linked to drug-related death since 2016. Though illicit drug toxicity deaths trended down between 2016 and 2019, this changed in 2020 when COVID-19 pandemic restrictions began.4 Since then, there has been a sharp increase in the variance of fentanyl and carfentanyl concentrations found in the illegal drug supply.5 Moreover, the emergence of synthetic benzodiazepines makes detecting and reversing overdose more difficult. According to the BC Coroners Service, benzodiazepines were detected in nearly 60% of suspected overdose deaths in May 2021, which is four times higher than the percentage reported ten months prior, in July 2020 (15%).6 Overdoses of this nature may not be responsive to naloxone. Finally, whereas overdose and death were once most frequent among opioid users, now consumers of all drugs, including cocaine, methamphetamine, and other stimulants, are at risk of drug contamination and death.4 In 2021, the BC Coroners Service continuously recorded record-breaking rates of death, including in regions where “de-facto” (informal) decriminalization is in effect.7
We will not have comprehensive data about the effects of legal regulation until this model is adopted. However, the results of preliminary or related initiatives have been promising. For instance, injectable opioid agonist treatment (iOAT)—though a substitution therapy versus safe supply—is associated with dramatic reductions in rates of overdose and death.8 More directly, the Providence Crosstown Clinic in Vancouver prescribes medical-grade diacetylmorphine (heroin) and the analgesic hydromorphone to 140 clients who consume the drug on-site. No deaths have been documented, and this is also true of the 11 clients prescribed take-home heroin through the COVID-19 pandemic.9 To date, the best demonstration of legal regulation’s efficacy has been the Drug User Liberation Front (DULF) Fulfillment Club and Compassion Club Model. Since spring, 2020, DULF, alongside the Vancouver Area Network of Drug Users (VANDU) has obtained street drugs (e.g., crack cocaine, heroin, and methamphetamine) from darknet (online) markets, tested the contents of the drugs, and returned the drugs to the street market in sealed packaging with clearly labeled contents.10 No deaths have occurred as a result, and we can extrapolate that producing medical-grade drugs with exact dosages would reduce rates of overdose and death, particularly if combined with robust poverty reduction initiatives and social supports for multiply-marginalized users.
The provincial government has considered that prohibition interferes with attempts to develop a clear evidence base for regulation. It is gradually modernizing its approach. For example, a July 2021 “policy direction” issued jointly by BC’s Ministry of Mental Health and Addictions and Ministry of Health instructs regional health authorities to expand prescribed safer supply through a phased implementation model. It endorses an enabling framework for the provision of pharmaceutical-grade alternatives to illicit drugs while noting that monitoring and outcome evaluation are crucial aspects of the data-gathering process. This may eventually lead to more liberal drug policies.
2. The Role of Enforcement
Under decriminalization, drug possession, consumption, production, and distribution are legally prohibited even if criminal penalties for these activities are not enforced. Police can still stop and search individuals they suspect of possessing drugs and are authorized to confiscate drugs and drug-use paraphernalia. “Discretionary” policing, which enables police forces to engage with citizens based on suspicion of criminal activity, exacerbates unequal outcomes based on class, race, gender and disability.11 Those who use drugs openly (e.g., unhoused populations) are more likely to encounter police, while data shows that racialized groups are disproportionately targeted for “street checks.”12,13 This promotes secretive use, discourages consumers from accessing safe consumption sites, and may promote acquisitive crime to re-obtain drugs that have been taken.14 In a study of urban neighbourhoods, greater police activity was positively associated with higher rates of drug overdose mortality.15 On a wider scale, substantial state resources are dedicated to law enforcement. Police budgets are not decreased under decriminalization, and police are still required to disrupt the supply chain to the best of their abilities. Illegal drugs or additives may be seized on the street or during importation attempts, which can, paradoxically, increase the potency of the illegal market.16 “Drug busts” do not reduce rates of use, but they do increase the cost and dangerousness of drug use17, destabilize economies in the global south,18 and criminalize mid-level drug sellers who may have few or no alternatives to selling drugs.19
That said, the effects of enforcement do shift under decriminalization. In Portugal, where partial decriminalization has been a national policy since 2001, the profile of the prison population has changed. Before decriminalization, 40% of the sentenced prison population were held for drug offences and 70% had been convicted of drug-related offences, most minor.20 By 2019, the proportion of people sentenced for drug offences in Portuguese prisons had fallen to 15.7% and law enforcement priorities had shifted to trafficking versus simple possession.Ibid Though a substantial improvement, this is still problematic.
If all currently illegal drugs were legalized and regulated, most drug possession, consumption, production, and distribution would cease being criminal justice issues. Consumers could engage in these activities without fear of persecution, but within demarcated boundaries established by the government. As with cannabis and alcohol, some consumers will still consume illicit versions of legal drugs. This is most common among those who are priced out of the legal market. Decriminalization is therefore valuable to pursue alongside legal regulation.
3. Enduring Importance of Transnational Organized Crime
Presently, drug trafficking is the world’s most lucrative illegal business. Massive investments into the "war on drugs" has in fact fuelled it. This is particularly true in recent years as borders get more porous.21 The outcomes of decriminalization would thus vary depending on which regions, drugs, and drug-related activities were decriminalized. Regardless, without a supply of drugs legally available to Canadian consumers, decriminalization alone would not fundamentally alter international dynamics of drug importation—drugs have to come from somewhere.
Legal regulation would not end transnational organized crime. It is a complex geopolitical problem influenced by western imperialism, colonialism, and localized political corruption, among other factors. However, legal regulation in Canada would reduce much of the violence, instability, and corruption that takes place within national borders linked to the illegal drug trade. Legal regulation globally, though not imminently likely, would have enormous implications for safety, micro- and macro-level economies, and the social organization of populations who are most harmed by prohibition (see for e.g., Afghanistan22). Internationalist analyses are thus necessary for promoting justice and equity for all.
4. Access to Addiction Treatment and Other Health Services
Decriminalization expands access to addiction treatment and other health-related services by encouraging frankness about drug use. Portugal is considered a successful example of this. Since adopting a health-based approach to illegal drugs in 2001, morbidity, mortality, and incidence of HIV among drug users have dropped while rates of treatment enrolment have increased.14 Some harm reduction services have also appeared, though safe consumption sites and naloxone are not yet available.Ibid However, Portugal has only partially decriminalized drugs, and a sustained focus on dissuasion means that enrolment in treatment is not always consensual. Currently, being found in possession of illegal drugs that exceed a low threshold is criminalized, while possession of small amounts can be medicalized.23 Drug use is still viewed as evidence of illness, and users are compelled to attend “dissuasion committees” that promote "recovery," including by mandating that a user attend medical treatment. The International Network of People Who Use Drugs (INPUD) writes,
“People who use drugs are now obliged to be supervised by a lawyer and a social worker in this Commission for the Dissuasion of Drug Addiction. Though this is involuntary, failure to comply results in a relatively small fine (though this would have substantially more impact for those who are impoverished), much like an administrative offence such as a parking fine. Drug use, then, results in some sort of intervention, either punitive or medicalised; as noted by drug user rights organisation, CASO, 'there are no fines for alcohol drinkers.'”14
Legal regulation removes drug use from the immediate realm of medicine. Proponents take into account that as with alcohol, most people who use currently illegal drugs do so recreationally. This is not intrinsically indicative of illness.24 That said, as with many substances and behaviours, some people would develop patterns of uncontrolled use even if all drugs were legal. Harm reduction and health-based services would thus still exist, particularly because many are vital points of connection and community for multiply-marginalized users. They may become more accessible because stigma for legal activities is less severe than illegal ones. Indirectly, the elimination of criminalization, expulsion from school, loss of employment and housing, and other issues derived from prohibitionist drug policies would no longer inform decision-making processes. In other words, engaging with the medical system, either to enrol in addiction treatment, procure substitution therapies such as iOAT, or seek other forms of healthcare, would be done more volitionally.
5. Maintaining Social Order
There is a large body of evidence linking site-specific decriminalization (e.g., safe consumption sites) to reductions in negative social outcomes such as drug-related littering, public injections25, interpersonal violence, and general social disorder.26 Two decades of robust analyses of Insite (Vancouver, British Columbia) conclude that the surrounding community has positive or neutral views of its efficacy and wish to see it continue.27 Local police are not antagonistic overall. In other countries, decriminalization is associated with decreases in intimate partner violence, familial conflict, and eviction rates28, whereas a “systematic review on drug market violence and drug law enforcement found that disrupting drug markets through drug law enforcement is unlikely to reduce violence and can paradoxically increase violence.”29
However, without legal regulation, the primary drivers of social disorder remain unaddressed. Each of these intersects and contributes directly and indirectly to negative public outcomes, as do poverty, racism, colonialism, and other systemic oppressions. Very limited data are available on the short- and long-term effects of legal regulation. It is not a singular policy fix, but extrapolating from alcohol and cannabis, we can tentatively assume that legal regulation would mitigate street-based violence and disorder over time.
6. Taxpayer Costs
A 2008 Canadian report estimated that illegal drug use resulted in annual healthcare costs of $1.3 billion.30 Factors considered were cost of medical attention in hospital, cost of ambulance transport, cost of hospitalization, and other, intangible “costs of healthcare for illegal drug users.”ibid This is thus a conservative estimate, as hospital avoidance due to stigma and fear of persecution also leads to indirect burden on the healthcare system. Moreover, the monetary cost of drug policy is distinct from that of drug use; the latter would decline if the former were addressed. The same report concluded that $2 billion is spent annually in justice-related costs (police, courts and correctional services), and that productivity losses due to criminal penalties for drug use amount to about $5.3 billion annually.ibid In 2013, Toronto Public Health also noted that "the social cost of one untreated person dependent on opioid drugs [sic], which is attributed to crime victimization, law enforcement, productivity loss, and healthcare costs, is estimated at $45,000 a year."31 These numbers have increased in the years since these reports were released. It is impossible to calculate the total cost of prohibition’s far-reaching consequences.
Decriminalization would affect some of these costs. However, the healthcare system would still be tasked with funding inpatient hospitalizations, presentations to the emergency department, ambulance transport, physician time, treatment for those labeled with SUD, and other indirect outcomes of the unregulated drug market. It is difficult to predict how this would change through a legal regulatory framework. We can assume that reduced overdose rates and less drug-related stigma would further lessen the total taxpayer burden for healthcare. This is particularly true if resources were redirected to fact-based drug education, social services, and poverty reduction initiatives.
As discussed above, decriminalizing drugs also does not meaningfully limit police powers to enforce prohibitionist policies, nor does it eliminate the annual cost of justice system responses to all illegal drug use (e.g., courts, correctional services, drug task forces). However, legalization and regulation, though not a "silver bullet" for crime and crime victimization, would. Similarly, legal regulation would influence costs associated with economic productivity loss, poverty, and homelessness. It would both prevent the cascading consequences of prohibition (e.g., incarceration and/or job loss leading to homelessness and healthcare costs) and could enhance the total state resources available for mitigating social problems. This could be done through reallocating some of the local, provincial, and federal enforcement budgets currently devoted to prevention and enforcement, as well as by introducing pragmatic controls on drug availability.
Policy Options for Legal Regulation
To date, an international collaboration of drug policy organizations advocating for legalization and regulation have proposed different ways to implement these policies. The content below will focus on pathways to legal regulation in Canada; however, facilitating global cooperation (e.g., by importing substances from where they naturally occur; see for e.g., opium gum32) will optimize opportunities for equity and justice in countries excluded from drug policy debates in the West. To do so, it is necessary to promote shifts in transnational policies, treaties, laws, and cultural attitudes.
Regulatory Levers that Shape Consumer Experience
The academic literature identifies several regulatory levers that shape the “front-end” or consumer experience of a legally regulated market. Each has implications for the accessibility of the substance(s) being regulated and can mitigate or exacerbate the overall risks of drug taking. The possible regulatory models developed on the bases of these levers range from most to least restrictive. Five key levers identified by Scott Bernstein (MAPS Canada) et al. are33:
1) Who has access to the drug
Some consumer products have no age limit. With currently legal drugs (e.g., alcohol, cannabis, tobacco), minimum age requirements in Canada are informed by the age of provincial majority (e.g., 18 or 19). Ideally, this minimizes risks to youth by providing opportunity for fact-based education before they can legally purchase and consume. While some choose to do so before they reach the age of majority, criminal penalties for this are uncommon compared to those issued for consuming illegal drugs. Implementing a minimum age requirement without imposing further limits is one of the least restrictive possibilities for a regulated market.
On the other end of the restrictiveness spectrum is “medicalized safe supply.” This is the current state of affairs in Canada. In most cases, only those diagnosed with a substance use disorder can obtain safe supply, which creates barriers for those who are not willing or able to engage regularly with the medical system and for whom use is recreational.
2) What must a person do to access the drug
In the most lenient market, the only barrier to accessing a drug(s) is cost. However, most advocates for legal regulation endorse controls such as having to provide proof of legal age for acquisition. Increasingly restrictive controls include education and training in safer use; introducing a licensing system; registration in a non-governmental, governmental, or commercial body (e.g., at a dispensary); or enrolment in a specific program. Currently, those who consume legal safe supply must obtain a prescription from a healthcare provider. Many prescriptions are provided within primary care-based programs that involve ongoing assessments, monitoring (e.g., via urinalysis screenings), and mandatory engagement with health and social services.34 Through this framework, participants are viewed as “patients” and most have “substance use disorder” designations.
3) Where can a person obtain the drug
Presently, substances that are deemed lowest risk are available in several licensed establishments (e.g., one can purchase tobacco at gas stations while liquor is available at specialized stores as well as restaurants, cafes, and some corner stores). Higher-risk substances could be available via this model, but more restrictive options for procurement include pharmacies, safe consumption sites, or through secure dispensing machines requiring identification (e.g., biometrics) following enrollment in a program.
An additional, semi-restrictive model is compassion clubs. These may be cooperatively owned and operated by consumers and could have varying degrees of governmental oversight. Here, substances may be ordered directly from a licensed producer and stored securely on-site. Risk of diversion is higher with compassion clubs than it is when obtaining drugs at pharmacies, SCS, or dispensing machines, but this could be mitigated by broadening accessibility of safe supply to ensure that the unique needs of all consumers are adequately met. Hybrid models (e.g., medicalized safe supply for those who feel it most appropriate in conjunction with compassion clubs) are possible.
4) What quantity of the drug could someone get
The least restrictive regulatory models have no limits on acquisition. However, most public health strategists—and some consumers—prefer "ceilings" on the quantities of currently illegal drugs one could obtain daily, weekly, or monthly. Limits may reduce risk of diversion, but it is also important to develop them through meaningful collaboration with consumers. Otherwise, it will be difficult to attract and retain those who patronize the unregulated market. Thus, unlike "thresholds" that restrict the amount of drugs one can possess in government exemption requests for decriminalization, ceilings should prioritize the needs of high-intensity users who are most vulnerable to accidental overdose under prohibition.
5) Where can the drug be consumed
The most lenient models allow consumption anywhere. Alcohol, tobacco, and cannabis are regulated by laws and local ordinances that permit some public use (e.g., drinking alcohol in bars or cafes, smoking tobacco outdoors) but prohibit consumption in public outside of designated spaces (e.g., it is illegal to drink alcohol outside of licensed outdoor spaces or smoke tobacco in most indoor spaces). These laws are contested and may be enforced unevenly. Use of currently illegal drugs could be regulated similarly or have additional restrictions placed on use such as mandatory use in a designated venue (e.g., no off-site consumption) including pharmacies (most restrictive), safe consumption sites, or licensed venue resembling a bar (least restrictive). Legal consumption could also entail the presence of a trained facilitator who could be a medical professional (most restrictive), non-medical staff member, or peer (least restrictive).
Finally, another, more detailed series of regulatory considerations includes choices related to production, profit motive, power to regulate, promotion, prevention and treatment, policing and enforcement, penalties, prior criminal records, product types, potency, purity, price, preferences for licenses, and permanency.36 Considering these and other regulatory choices, Transform Drug Policy Foundation summarizes five basic models for regulation from most to least restrictive as follows:
- medical prescription;
- specialist pharmacy sale;
- licensed sale for consumption on the premises (“on-sale”);
- licensed sale for consumption off the premises (“off-sales”); and
- unlicensed sale.37
It is generally accepted that currently illegal drugs are not “ordinary commodities.” Their psychoactive properties and potential to engender physical dependence differentiate them from substances that are not associated with patterns of compulsive use (e.g., headache medication). As such, responsible legalization takes into account the risks of drug-taking and seeks to minimize these risks with drug-specific controls. Beyond this, most advocates caution against the commercialization and corporate influence that characterize the free market.37 While prohibition encourages unregulated, criminal markets, complete freedom has similar outcomes because producers and distributors are motivated by profit. A pragmatic model of legal regulation is between these two extremes. It will emphasize public health, maximize human rights, and promote social equity, including by improving development opportunities and meaningfully consulting with those most impacted by prohibition at every stage of policy development.
- 2009. Rolles, S. After the War on Drugs: Blueprint for Legal Regulation. Transform Drug Policy Foundation. URL: https://transformdrugs.org/assets/files/PDFs/blueprint-for-regulation-fulltext-2009.pdf
- 2020. Bernstein, S. E., Amirkhani, E., Werb, D., & MacPherson, D. The Regulation Project: Tools for Engaging the Public in the Legal Regulation of Drugs. International Journal of Drug Policy, 86, 102949.
- 2008. Buxton, J. A., Haden, M., & Mathias, R. G. “The Control and Regulation of Currently Illegal Drugs.” In: Heggenhougen, K., & Quah, S. (Eds.) International Encyclopedia of Public Health (Volume 2). Pp 7 - 16. San Diego: Academic Press.
- 2021. Drug User Liberation Front (DULF). “URGENT REQUEST: Section 56(1) Exemption to the Controlled Drugs and Substances Act (CDSA) Required to Ensure the Equitable Application of Public Health Protections to Vulnerable Canadians.” URL: https://www.dulf.ca/
- 2021. BC Centre on Substance Use. “Monthly Median Fentanyl Concentration and Monthly Variance of Fentanyl Concentration of Fentanyl-Positive Samples in Vancouver, BC. [unpublished data].
- 2021. BC Coroners Service. “Illicit Drug Toxicity: Type of Drug Data to May 31, 2021.” Ministry of Public Safety and Solicitor General. URL: https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit -drug-type.pdf
- 2021. BC Coroners Service. “Illicit Drug Toxicity Deaths: January 1, 2011 - Sept. 30, 2021. Ministry of Public Safety and Solicitor General.” URL: https://www2.gov.bc.ca/assets/gov/birth-adoption-death-marriage-and-divorce/deaths/coroners-service/statistical/illicit-drug.pdf
- 2017. Sordo L, Barrio G, Bravo MJ, et al. Mortality Risk During and After Opioid Substitution Treatment: Systematic Review and Meta-Analysis of Cohort Studies. BMJ. 2017;357:j1550
- See Providence Crosstown Clinic: Health Services. URL:
- 2021. Moakley, P. “The ‘Safe Supply’ Movement Aims to Curb Drug Deaths Linked to the Opioid Crisis. Time. URL: https://time.com/6108812/drug-deaths-safe-supply-opioids/
- 2020. Gaind, L. A. A Rose by Any Other Name: Well-Being Checks, a New Manifestation of Discriminatory Policing? Appeal: Review of Current Law and Law Reform 3, CanLIIDocs 1666
- 2021. Rankin, J., Contenta, S., & Bailey, A. “Toronto Marijuana Arrests Reveal ‘Startling’ Racial Divide. Toronto Star. URL:
- 2020. Mannoe, M. “BC’s New Policing Standards Are Not a Moratorium on ‘Street Stops.” Pivot Legal Society. URL: https://www.pivotlegal.org/street_stops_bc_policing_standards
- 2021. Madden, A., Tanguay, P., & Chang, J. “Drug Decriminalisation: Political Progress Or Red Herring? Assessing the Impact of Current Models of Decriminalisation on People Who Use Drugs.” International Network of People Who Use Drugs. URL: https://www.inpud.net/sites/default/files/INPUD_Decriminalisation%20report_online%20version.pdf
- 2012. Bohnert, A. S. B., Nandi, A., Tracy M. et al. Policing and Risk of Overdose Mortality in Urban Neighborhoods. Drug and Alcohol Dependency, 113(1), 62 – 68
- 2019. UN System Coordination Task Team. “What We Have Learned over the Last Ten Years: A Summary of Knowledge Acquired and Produced by the UN System on Drug-related Matters.” UN System Coordination Task Team on the Implementation of the UN System Common Position on Drug-Related Matters. URL: https://globalinitiative.net/wp-content/uploads/2020/05/FINAL-EN_2020report_web.pdf
- 2014. Pollack, H. A. & Reuter, P. Does Tougher Enforcement Make Drugs More Expensive? Addiction, 109(12), 1959 - 1966.
- See 2018. Lindo, J. M. & Padillo-Romo M. Kingpin Approaches to Fighting Organized Crime and Community Violence: Evidence from Mexico’s Drug War. Journal of Health Economics, 58, 253 - 268.
- 2019. No Author. “Re-Thinking the ‘Drug Dealer.” Drug Policy Alliance. URL: https://drugpolicy.org/sites/default/files/dpa-rethinking-the-drug-dealer_0.pdf#page=57
- 2021. Slade, H. “Drug Decriminalisation in Portugal: Setting the Record Straight.” Transform Drug Policy. URL: https://transformdrugs.org/blog/drug-decriminalisation-in-portugal-setting-the-record-straight
- 2020. Dreifuss, R. et al. “Enforcement of Drug Laws: Refocusing on Organized Crime Elites.” Global Commission on Drug Policy. URL: https://globalinitiative.net/wp-content/uploads/2020/05/FINAL-EN_2020report_web.pdf
- 2021. Landay, J. “Profits and Poppy: Afghanistan’s Illegal Drug Trade a Boon for Taliban.” Reuters. URL: https://www.reuters.com/world/asia-pacific/profits-poppy-afghanistans-illegal-drug-trade-boon-taliban-2021-08-16/
- 2019. Mullins, G. (Host). “The Portugal Paradox.” Crackdown Podcast, Ep. 5. Cited Media Productions Ltd. URL: https://crackdownpod.com/meet-the-team/
- 2021. Hart, C. Drug Use for Grown Ups: Chasing Liberty in the Land of Fear. New York: Penguin Press.
- 2018. No Author. “Perspectives on Drugs: Drug Consumption Rooms: An Overview of Provision and Evidence. European Monitoring Centre for Drugs and Drug Addiction.” URL: https://www.emcdda.europa.eu/publications/pods/drug-consumption-rooms_en
- 2017. Belackova, V., & Salmon, A. M. Overview of International Literature - Supervised Injecting Centers & Drug Consumption Rooms – Issue 1, Uniting Medically Supervised Injecting Center, Sydney. URL: https://www.researchgate.net/publication/323445212_Overview_of_international_literature_-_supervised_injecting_facilities_drug_consumption_rooms_-_Issue_1
- 2008. Minister of Health. “Vancouver’s INSITE Service and Other Supervised Injection Sites: What Has Been Learned from Research? Final Report of the Expert Advisory Committee on Supervised Injection Site Research. Health Canada. URL: https://www.canada.ca/en/health-canada/corporate/about-health-canada/reports-publications/vancouver-insite-service-other-supervised-injection-sites-what-been-learned-research.html#con
- 2016. Hughes, C., Ritter, A., Chalmers, et al. “Decriminalisation of Drug Use and Possession in Australia – A Briefing Note. Sydney: Drug Policy Modelling Program, NDARC, UNSW Australia. URL: https://www.citywide.ie/assets/files/pdf/decriminalisation_briefing_note_feb_2016_final_dpmp.pdf
- 2021. Leger, P., Hamilton, A., Bahji, A., & Martell, D. Policy Brief: CSAM in Support of the Decriminalization of Drug Use and Possession for Personal Use. The Canadian Journal of Addiction, 12(1), 13 - 15.
- 2008. Department of Justice. “National Anti-Drug Strategy Evaluation.” Government of Canada. URL: https://www.justice.gc.ca/eng/rp-pr/cp-pm/eval/rep-rap/12/nas-sna/p4.html
- 2013. Toronto Public Health. “Methadone Maintenance Fact Sheet.” City of Toronto. URL: https://www.toronto.ca/wp-content/uploads/2017/11/9705-tph-mmt-fact-sheet.pdf
- 2021. Snapp, Z., & Herrera Valderrabano, J. Tracing A Path for Opium Gum from Mexico as a Safe Supply Harm Reduction Measure for Canada. International Journal of Drug Policy, 91, 103066.
- The following section, “Regulatory levers that shape consumer experience,” has been adapted from 2020. Bernstein, S. E., Amirkhani, E., Werb, D., & MacPherson, D. The Regulation Project: Tools for Engaging the Public in the Legal Regulation of Drugs. International Journal of Drug Policy, 86, 102949.
- 2021. Nowell, M. “Safe Supply: What It Is and What is Happening in Canada.” Canadian AIDS Treatment Information Exchange. URL: https://www.catie.ca/en/pif/spring-2021/safe-supply-what-it-and-what-happening-canada
- See 2021. Davidson, C. “Government of Canada Supports Expansion of Innovative Safer Supply Project to Operate in Four Cities Across Canada. Government of Canada Health Release. URL: https://www.canada.ca/en/health-canada/news/2021/03/government-of-canada-supports-expansion-of-innovative-safer-supply-project-to-operate-in-four-cities-across-canada.html
- 2019. Kilmer, B. How Will Cannabis Legalization Affect Health, Safety, and Social Equity Outcomes? It Largely Depends on the 14 Ps. The American Journal of Drug and Alcohol Abuse, 45(6), 1–9.
- 2020. Rolles, S., Slade, H., & Nicholls, J. How to Regulate Stimulants: A Practical Guide. Transform Drug Policy Foundation. URL: https://transformdrugs.org/publications/how-to-regulate-stimulants-a-practical-guide