title: Illicit drug use and harms, and related interventions and policy in Canada: A narrative review of select key indicators and developments since 2000.
abstract: BACKGROUND
  By the year 2000, Canada faced high levels of illicit drug use and related harms. Simultaneously, a fundamental tension had raisen between continuing a mainly repression-based versus shifting to a more health-oriented drug policy approach. Despite a wealth of new data and numerous individual studies that have emerged since then, no comprehensive review of key indicators and developments of illicit drug use/harm epidemiology, interventions and law/policy exist; this paper seeks to fill this gap.
  
  
  METHODS
  We searched and reviewed journal publications, as well as key reports, government publications, surveys, etc. reporting on data and information since 2000. Relevant data were selected and extracted for review inclusion, and subsequently grouped and narratively summarized in major topical sub-theme categories.
  
  
  RESULTS
  Cannabis use has remained the principal form of illicit drug use; prescription opioid misuse has arisen as a new and extensive phenomenon. While new drug-related blood-borne-virus transmissions declined, overdose deaths increased in recent years. Acceptance and proliferation of - mainly local/community-based - health measures (e.g., needle exchange, crack paraphernalia or naloxone distribution) aiming at high-risk drug users has evolved, though reach and access limitations have persisted; Vancouver's 'supervised injection site' has attracted continued attention yet remains un-replicated elsewhere in Canada. While opioid maintenance treatment utilization increased, access to treatment for key (e.g., infectious disease, psychiatric) co-morbidities among drug users remained limited. Law enforcement continued to principally focus on cannabis and specifically cannabis users. 'Drug treatment courts' were introduced but have shown limited effectiveness; several attempts cannabis control law reform have failed, except for the recent establishment of 'medical cannabis' access provisions.
  
  
  CONCLUSIONS
  While recent federal governments introduced several law and policy measures reinforcing a repression approach to illicit drug use, lower-level jurisdictions (e.g., provincial/municipal levels) and non-governmental organizations increasingly promoted social- and health-oriented intervention frameworks and interventions, therefore creating an increasingly bifurcated - and inherently contradictory - drug policy landscape and reality in Canada.
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada; Institute of Medical Science, University of Toronto, Toronto, Canada; Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada. Electronic address: benedikt.fischer@utoronto.ca.
authors.forename: Benedikt
authors.initials: B
authors.lastname: Fischer
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Murphy
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Canada.
authors.forename: Katherine
authors.initials: K
authors.lastname: Rudzinski
authors.affiliation: Canadian Drug Policy Coalition, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
authors.forename: Donald
authors.initials: D
authors.lastname: MacPherson
mesh_terms: D002170:Canada / Q000453:epidemiology; D062787:Drug Overdose / Q000453:epidemiology / Q000517:prevention & control; D006291:Health Policy; D006801:Humans; D013287:Illicit Drugs; D002189:Marijuana Abuse / Q000453:epidemiology / Q000517:prevention & control; D009293:Opioid-Related Disorders / Q000453:epidemiology / Q000517:prevention & control; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control*
chemical_list: D013287:Illicit Drugs
keywords: Canada; Epidemiology; Illicit drugs; Interventions; Policy; Review