Compassion clubs have resurfaced in recent years as a response to the toxic unregulated drug crisis in British Columbia (BC), and more specifically the need for community-based safer supply programs and models that meet the needs of people who use drugs.
Compassion clubs – membership-based and community-run organizations that provide compassionate access to a range of substances and other resources – have historically acted as life-saving initiatives. Compassion clubs in North America emerged in the 1980s and 1990s primarily in response to the AIDS crisis and the role of medicinal cannabis in relieving symptoms, improving health and quality of life, and supporting end-of-life care. Research conducted at the time found cannabis compassion clubs to be beneficial and aligned with community needs. This was the case in the United States and in Canada, specifically in BC.
Calls for community-run compassion clubs have emerged based on an urgent need to increase access to safer supply and explore alternatives to the default models of medicalization and criminalization. Compassion clubs have been compared to drug user-led overdose prevention sites, which were a novel and nimble solution that significantly reduced rates of overdose and death in BC through increased access to supervised consumption and overdose response.
In 2019, the BC Centre on Substance Use published a comprehensive report outlining the need for heroin compassion clubs and the steps to implement a non-medical safer supply model in BC – a member-driven cooperative (co-op) model inspired by the cannabis compassion clubs that originated in the 1980s and '90s.
A few years later, the Office of BC’s Provincial Health Officer and the BC’s Chief Coroner Death Review Panel both recommended compassion club trials to reduce deaths caused by the toxic drug supply.
In 2021, the Drug User Liberation Front (DULF) became the first community-based organization in Canada to implement a compassion club for substances other than cannabis, including heroin, cocaine, and methamphetamine. In accordance with the original community-run compassion club model, DULF ran a membership-based system that provided safer access to substances that were tested and labelled for safety, content, and quality and provided access to a safer consumption space onsite. And much like the original cannabis compassion clubs of the 1980s and '90s, this club was found to be life-saving while contributing to the health and wellbeing of its members. A full description of DULF’s history, operations, and impact (as well as recent legal challenges) are beyond the scope of this piece. More information can be found in peer-reviewed papers, news coverage, and explainers.
There is a tendency to sensationalize DULF based on the substances it made available to members. The media, politicians, and the general public have all treated this compassion club as somehow drastically different from the cannabis compassion clubs that operated in plain sight for decades in BC prior to legalization. I consider this to be a trap and a missed opportunity.
Heroin-assisted treatment has been successful in the context of medical research in Canada (with a Health Canada exemption) and in Europe, for example. In other words, the same substance was considered acceptable by Health Canada in a medicalization model but criminalizable in a community model, irrespective of the real life-saving benefits widely documented and experienced. The results of DULF’s evaluation demonstrated that the community model works: fewer overdoses, fewer hospitalizations, and not one death among its membership. This alone is a net positive, against the backdrop of a toxic unregulated drug supply that kills more than five people per day in BC.
Focusing on the substances offered by DULF limits our ability to engage in rigorous analysis of policy failures and public health solutions. It also prevents us from considering the benefits of the community-run compassion club model as a regulatory pathway to safer supply and engaging with the evidence. Finally, it deters us from recognizing biased and political policy-making patterns and from demanding better.
One of those policy-making patterns is Health Canada’s consistent rebuff of compassion clubs over time, irrespective of the substance and its legal status.
In other words, compassion clubs in Canada have a shared experience of being unable to secure a section 56 exemption from the federal Minister of Health under the Controlled Drugs and Substances Act – an exemption which would allow these clubs to operate without risk of criminal sanction. This exemption is what allows drug checking services and supervised consumption services to operate. It also allows researchers to conduct studies involving controlled substances. The same exemption could be used to allow a compassion club to operate, though this has never happened – despite recent efforts made by DULF.
Health Canada’s decision to deny DULF’s request for an exemption is currently undergoing judicial review, a process wherein the federal court reviews Health Canada’s decision and decision-making process to ensure laws and procedures were followed. As we wait for the outcome of those 2024 legal proceedings, here are three points to consider as we continue to monitor what happens to DULF:
1. Health Canada has a record of issuing section 56 exemptions to individuals based on medical need. In the early days of constitutional cases brought forward by people medicating with cannabis, when cannabis was illegal, Health Canada issued interim guidance that outlined a process for approving individual-based exemptions. However, despite attempts by exempted individuals to advocate for that exemption to extend to their caregivers and care providers (i.e., people who were able and willing to grow cannabis for their medical use), Health Canada has consistently refused to extend this exemption to another person, to groups, and to organizations such as compassion clubs. It is unclear why Health Canada has refused to create guidance for exempting community-based safer supply providers, individually and collectively, for cannabis or other substances.
2. Following cannabis legalization, Health Canada has refused to issue section 56 exemptions to cannabis compassion clubs to allow them to continue to operate as non-profits serving people who medicate with cannabis. For example, around the same time that DULF was denied its exemption request, Health Canada denied the exemption request of the Victoria Cannabis Buyers Club – an organization that has been openly providing compassionate access to medical cannabis since 1996. Concretely, this means that cannabis compassion clubs are not allowed in Canada, despite cannabis being legal and despite several constitutional court decisions recognizing the right to medicate with cannabis. It is unclear why Health Canada would adopt the stance that it cannot exempt cannabis compassion clubs and prefer their closure despite well documented concerns and public health impacts associated with those closures.
3. Health Canada’s approach to compassion clubs differs from other jurisdictions, including jurisdictions that have legalized cannabis (e.g., Uruguay and Malta). Even jurisdictions that have not legalized cannabis, in Europe for example, have a greater tolerance and acceptance of community-run club models such as cannabis social clubs. Considering that compassion clubs share a non-profit ethos and function as a closed system for the safer supply of a substance to be consumed for medical purposes by consenting adults, it is unclear why Health Canada would opt to close existing compassion clubs and deny emerging ones the opportunity to operate, evaluate their work, and contribute to the development of a regulatory scheme that meets a medical need while also allowing for compassionate access to safer substances.
This is a crucial moment for DULF and a critical juncture for the future of compassion clubs in Canada. It is also an opportunity to demand better from Health Canada.
Marilou Gagnon, RN, ACRN, LLM, PhD, is a Professor in nursing at the University of Victoria and Affiliate Scientist at the Canadian Institute for Substance Use Research