The History Behind Drug Prohibition and a Conversation with Two Long-time Opioid Users
Written by Laura Morales Padilla (She/They) // EIC
Visuals by Anya Ali-Mulzet (They/them) // Crew Illustrator
Think of something that makes life tolerable during a challenging day. Then, think of what a challenging day looks like for you. A student who is struggling to pass their courses while working full time, a burnt-out physician going home after a 24 hour shift, someone who is experiencing homelessness, someone living in a violent household or a person with chronic pain. They all have different answers to these questions. Moreover, the day-to-day struggles are layered on top of other crises happening in the background—unaffordable cities, climate change, genocides—which affect people in disproportionate ways.
Whether it is sugar, coffee, cigarettes, weed, alcohol, opioids, stimulants, gambling or scrolling through reels, what would you do if that something helping you cope was illegal? A case could be made that most people would be better off without some of the items on this list. For instance, two out of three Canadians consume more sugar than recommended by health guidelines, putting them at an increased risk for chronic health conditions like type two diabetes and heart disease.
In other words, if that something puts you at risk for heart issues, your mental health or your attention span, why isn’t it illegal to consume it? If it’s because some substances are more problematic than others, why is alcohol legal when impaired driving remains one of the leading criminal causes of death and injury in Canada?
The answer lies with a different question: does criminalizing a substance truly stop people from using it?
What if alcohol was illegal?
A very strong prohibitionist movement believed that a better version of society would come by stopping the suffering caused by alcoholism. In 1920, the U.S. prohibited alcohol—their fifth largest industry at the time—via a constitutional amendment. As a result, alcohol became illegal, but enforcing it became a challenge.
The Prohibition started to lose popularity when alcohol-related crime and violence escalated along with bootlegging. According to the National WWI Museum and Memorial, “Millions of Americans had stopped drinking, but those who continued to drink, drank more and of questionable substance, even deadly, ingredients.” Then, the U.S. stock market crashed and triggered the Great Depression. Democrats argued that making alcohol legal would create jobs and raise revenue for the federal government. In 1932, the Prohibition amendment was repealed.
Ironically, current moderation laws, such as having a legal drinking age, “make consumption of alcohol in America today much less accessible than during Prohibition,” according to the National WWI Museum.
This failed attempt is also an example of the concept introduced by economist Richard Cowan: the Iron Law of Prohibition. “The harder the enforcement, the harder the drugs,” explained Cowan in his 1986 essay titled How the narcs created crack: a war against ourselves. He was referring to the dynamic by which the illegal drug supply produced more potent drugs, since more compact chemical formulations eased the logistical challenges created by increased enforcement.
According to a 2019 policy brief by the Canadian Civil Society Working Group on the UN Drug Policy, this dynamic is quite familiar with the appearance of fentanyl, a powerful synthetic opioid that is 50 to 100 times more potent than morphine. It describes the attempts of enforcement efforts to catch up with increasingly potent and easier to smuggle substances as an “arms race.” This race leads to actions that “undermine public health and human rights, including the presence of a drug supply that is not only illegal but also toxic and deadly.”
Why are opioids different?
Drug prohibition in Canada started in Vancouver, “driven largely by anti-Chinese racism,” according to the Canadian Drug Policy Coalition (CDPC) based out of Simon Fraser University’s Faculty of Health Sciences. After many of the Chinese men who worked on the Canadian Pacific Railway in the 1880s settled in Vancouver, moral reformers successfully linked them to smoking opium . While Britain’s free trade in opium was largely overlooked, opioid-use was branded as a “threat to white, moral, Christian society.”
After Parliament passed the Opium and Drug Act in 1911, enforcement expanded and targeted Chinese men. Punitive drug laws, according to the CDPC, “were connected to a system opposing drug maintenance programs in favour of abstinence and jail.”
The Courier reached out to a physician who has been working in substance use services for over a decade and who preferred to remain anonymous. According to them, “Addiction was seen as a moral failing and not a disease.” An example they provided that reinforced this perception, dates back to the time when soldiers came back from the Vietnam war with addiction issues. The “moral failing” approach allowed the government to avoid providing support.
As a result, explained the physician, 12-step programs remained increasingly popular after being developed in the 1930s. They are mutual aid recovery programs that have the goal of improving the lives of people with substance use disorders. “The language of ‘this is the only treatment and nothing else works’ persists, because for 50 years no one offered any help,” emphasized the physician. “They came to believe that the goal of complete abstinence was the best strategy,” they added.
Understanding sobriety
“I’ve been very blessed,” said Howard as he flicked his cigarette. He always wanted to have twins, and now they are my age. We were sitting comfortably in the open upstairs space of the Vancouver Area Network of Drug Users (VANDU). With the commitment to increase the capacity of people who use illicit drugs to live healthy and productive lives, VANDU is an organization that saves lives by promoting harm reduction education and interventions.
“He also has 13 grandkids,” added Dominic, who earlier described Howard as being like a brother. I didn’t notice an accent, but I later found out that his first language is French. He said he is of Métis and Italian descent. They both ran the meeting of the British Columbia Association of People on Opiate Maintenance (BCAPOM), which takes place on Wednesday afternoons. In more recent years, they have witnessed the membership of their group shrink.
Having dealt with chronic pain for over two decades, Howard and Dominic have first-hand experience with different opioid agonists and the context in which they were prescribed. Opioid agonists treatments use medications that activate opioid receptors, reducing cravings, preventing withdrawal and lowering the risk of overdose, according to Island Health.
What does recovery mean to you? I asked, thinking this would be the most interpretive question in my list, but I got a clear-cut answer from Howard. There is “total recovery,” which means being completely off drugs, and “maintenance,” which makes people ‘functional’ through drug-assisted treatments. “Enough to allow them to go back to the world,” he said.
After being on multiple opioid agonist treatments, they came to learn multiple drugs’ short and long-term effects and became aware of how different medications interact. They also recalled a couple of instances in which they had trouble getting that information across to their doctors.
For instance, Howard told his doctor that he was starting to have trouble with his teeth and suspected it was related to being on Suboxone. “She didn’t want to believe it because the pharmacy told her something else,” he said. There is currently a Canada-wide class action lawsuit against Suboxone’s manufacturer, according to the Consumer Law Group firm, given that it “poses a serious risk of causing dental erosion, decay and infections.”
Howard’s wife was prescribed 16 different drugs at one point. He recalled asking her doctor if they knew how those drugs interacted. The doctor’s answer was no.
“Doctors had become pharmaceutical industry pushers,” said Dominic, explaining that most drugs have side effects, and you are often given more drugs to address those. “I don’t take all the drugs they give me,” he added.
Another important instance brought up by both Howard and Dominic came in 2014, when a large number of patients receiving methadone were forced to switch to Methadose, a stronger version of methadone but with a shorter life time, meaning that withdrawal symptoms would kick in much sooner. This change, according to the journal of the College of Family Physicians in Canada, destabilized patients and caused “a significant rise in opioid-related morbidity and mortality,” as some people had to rely on illicit street supply once again. According to Dominic, the switch took place around the same time fentanyl started to appear on the streets, a coincidence reflected in the rising death toll, though the province did not declare a public health emergency until years later.
They both agreed that hydromorphone is one of the best opioid substitutes they have tried. “They don’t cloud your mind like morphine,” explained Howard.
When asked how come only one out of five people with Opioid Use Disorder were on opioid agonist treatment, they explained that it’s probably because it imprisons people.
“It’s very hard to get a carry,” explained Howard, meaning that people have to go to a specific pharmacy every day to get their dose. According to them, the daily trips to the pharmacy only used to last for one month and then you received your dose for multiple days, which allowed you to travel. “They are treating people like criminals just because they have a problem,” said Dominic.
Since our conversation was cut short, I met with Howard, Dominic and another VANDU board member at the Blarney Stone the next day. As we raised our glasses to toast, Dominic said, “to sobriety.” This prompted some laughs, but then he clarified that the word in French has less to do with abstinence and more to do with “clarity of mind.” That made me realize that when I asked about what recovery meant to them, what I was trying to understand was what sobriety meant. I’m sure many have found abstinence to be the best approach, but that doesn’t mean others can’t recover and find the right balance through maintenance. Thanks to Howard and Dominic, I now know that bodies don’t need to be “clean” for minds to be clear.
Addiction vs Dependence
We wouldn’t tell someone with diabetes to try harder to get off insulin and find a better way to regulate their blood sugar, because we don’t consider them addicted to insulin, but rather dependent on it. Their lives don’t revolve around it as long as it’s available to them as needed. For instance, we don’t think about how much we need water to stay alive because we have multiple sources of water at our disposal every day, but if that was not the case, survival mode would kick in and make our day-to-day about finding sources of water.
The physician interviewed by the Courier explained how there is often a double standard when it comes to opioid users. “For an average person who quits smoking successfully, it takes nine attempts for it to finally stick,” he stated, pointing out that we don’t treat smokers like they are weak and incapable of change. “It’s going to take some repetition and the person can definitely succeed; but along the way there will be slip-ups. You don’t say that’s great but you also don’t say that’s terrible—you know this is how change happens,” he added.
We wouldn’t take away nicotine patches, used as recovery aids, from people who want to quit smoking but struggle with insomnia and irritability whenever they try. Still, when it comes to people with Opioid Use Disorder (OUD), opioid agonist treatments are often framed as substituting one addiction for another, despite the severe physical and mental pain that comes from opioid withdrawal and “the enormous benefits to individuals’ health and quality of life” these treatments have, as stated by the physician.
In other words, people with OUD are often expected to become abstinent, as if getting “clean” was the only legitimate path to recovery.
This belief is dangerous and is already jeopardizing drug users’ constitutional rights with involuntary treatment facilities being introduced in provinces like Alberta. In 2025, the United Nations Committee on the Rights of Persons with Disabilities recommended that Canada ensures “the repeal of federal, provincial and territorial mental health and substance-use treatment laws and policies allowing for involuntary detention and treatment,” and have “harm-reduction and safe-supply programmes that respond to the intersecting identities of persons who use drugs.”
Taking away the drugs without addressing the pain that leads to drug-use is cruel. Dr. Garth Mullins, longtime activist and drug user, shared about his experience trying to quit drugs in an episode of CBC’s On Drugs podcast. “Just because you stop using, all the reasons that you started using are still there and they still come screaming back at you,” said Mullins, noting that people’s lives are often in a far worse state. “Sometimes you don’t have anything to help you weather that storm,” he added.
Pain is invisible and often comes from trauma, which makes each patient the best source of knowledge to address it. Creating barriers such as prescriptions and witnessed ingestions lead to people relying on the illicit, toxic drug supply. For them, a slip-up after trying to recover can be fatal. It took Dr. Mullins eight years to make the transition to using only methadone. This was a difficult enough transition for a former heroin user, and according to him, the fentanyl mixed with benzos that is currently on the streets will be much more difficult to kick.