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Addictions

Alberta and opioids II: Marshall Smith’s ambitious campaign

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Marshall Smith. Photo: PW

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Alberta’s system builder

The Alberta model, made in BC

“I, as you know, have been everywhere in this field, from eating out of garbage cans to this office,” Marshall Smith said. “So I have a deep respect for everybody who works along that continuum.”

We were sitting in the office at the Alberta Legislature reserved for chiefs of staff to Alberta premiers. That’s Smith’s current job. Premier Danielle Smith was probably nearby, though I didn’t see her on this trip. On a shelf behind Marshall Smith were two coffee mugs of different design, each bearing the inscription WAKE UP. SAVE LIVES. REPEAT.

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Anyway, Marshall Smith (all future uses of “Smith” in this post will refer to him, unless I specify the premier) was talking about the continuum from dumpsters to the centre of power. “Where you work on that continuum obviously colours the way that you enter this conversation,” he said. “When you are standing on a sidewalk with a person in front of you, the solutions to that person’s problem look very different than what you might do to plan a broader system of care, for a large population of people.”

This was his way of anticipating criticisms he faces as a leading strategist behind Alberta’s emerging strategy for handling a deadly progression in opioid doses. Since he entered Alberta’s government as a more junior staffer in the government of former premier Jason Kenney in 2019, Smith has been working to put a much greater emphasis on recovery from addiction than on “harm reduction,” whose valuable goal is to keep drug users alive whether they recover or not. This makes him a bête noire among harm-reduction advocates. (You can read a mild critique of his efforts here; or a real scorcher here).

What Smith was saying was, in effect, If you work on the street, you’re going to be all about harm reduction, and I respect that. But he is working on drug policy for a whole province, and perhaps beyond, so he needs a broader perspective. “I’m a system builder. So I don’t have the luxury of just focusing on one particular substance. I have to worry about the whole population. I have to worry about the disease burden of addiction and drug use more broadly.”

He sees much to worry about. “Over the last 30 years in Canada, successive governments have failed miserably to anticipate and adequately address the type of services — both from a capital investment and an operating investment — to help people do this.” By “this,” he means escaping addiction. “We have not cared about people with mental health and addiction issues. And we had the ability to not care because up until the last six or seven years, the evidence of them was hidden away.”

Smith first started thinking about this when he was in British Columbia, where he began his recovery from a history of drug use. In 2018, at the BC Centre for Substance Use, Smith co-wrote a report with Dr. Evan Wood that called for a large new investment in facilities and programs to help people recover from addiction. The report is no longer on the BCCSU website, but you can download a copy here.

“It was a 39-point strategy to transform the system in British Columbia,” Smith recalled. “The government of British Columbia wasn’t interested in that strategy. They wanted to go a particular direction.

“So that report is now known as the Alberta model.”


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Marshall Smith in the dining hall of the Lakeview Recovery Community, opening in July. Photo: PW

In its first page, the Wood/Smith report said “British Columbia has long suffered because of the lack of an effective system to support individuals in and pursuing recovery from substance use disorders.” The system’s “overwhelming focus” was on keeping people alive rather than helping them get better. Wood and Smith wanted that to change.

The need for major new investments in addiction recovery was essentially uncontroversial in B.C. Indeed governments there still periodically announce they are making such investments. But Smith was perpetually unsatisfied with the scale of that commitment.

A year after BC’s new NDP government could-shouldered his report, Smith began working in the UCP government of Alberta’s then-new premier, Jason Kenney.

“Obviously we started off very modestly,” Smith said. “I worked in an office down in the basement. Mental health and addiction wasn’t a big deal. It really was very much a group of cubicles.”

Today, Alberta’s department of mental health and addiction is the seventh-largest ministry in the provincial government.

“The ROSC transformation that is going on in Alberta is massive. It is one of the most massive whole-of-government system transformations that I’ve seen,” Smith said. The premier chairs a ROSC committee of cabinet with seven ministers.

I guess I’d better unpack that acronym. ROSC stands for “recovery-oriented system of care,” a term that appeared in the 2018 report Smith co-wrote.

So you get the premier and her ministers of mental health and addiction, Indigenous relations, advanced education, health, community and social services, public safety and the attorney general meeting regularly to coordinate recovery policy. The premier’s chief of staff is on the file constantly. As I mentioned on Monday, he devoted a full day to explaining this broad effort to me.

“We spend enormous amounts of time and energy,” Smith said. “All of us live and breathe this. Anybody out there that thinks that we’re just, from a conservative perspective,  just cavalierly doing this, that just couldn’t be more untrue. We we are in this completely and totally. We monitor almost everything that goes on in the system.”

What are they working on? Smith said the “recovery” part of that “recovery-oriented system of care” jargon-ball gets most of the attention, because it draws attention to the contrast between harm-reduction and abstinence-based recovery models. But Smith is a wonk, and if anything he is more interested in the “system of care” part. His goal is to ensure that every interaction an opioid user has with the modern government apparatus is designed to encourage recovery from dependency. Since people who use drugs tend to bump up against the state a lot, Alberta’s emerging system has a lot of moving parts. The goal is to hook the parts up more effectively.

One of the other men in Smith’s office, Dr. Nathaniel Day, chimed in. He’s been the lead strategist on substance use at Alberta Health Services. He’s an important Smith collaborator.

“Across Canada,” he said, “the system of care for people with addiction has been fragmented, poorly thought out — convenient.” He meant services had generally only been provided when, and where, it was easy for government to provide them. “If you look at opioid dependency treatment, if you lived in a suburban or rural community, it didn’t matter that you had an opioid use disorder. Tough. We had no services for you.”

Day designed the Virtual Opioid Dependency Program, which provides online consultations to patients anywhere in Alberta, and if needed, prescriptions to medications that can be filled at local pharmacies. For patients without coverage, the medication is free and if their local pharmacist has it in stock, available on the day of the call.

“We went in and said, enough is enough,” Day said. “What would be good enough for you and your family? And how do we take that to everybody?”

Which medication? “In this province, we’re huge fans of gold-standard opioid-replacement medications, and we use it a lot,” Smith said. “We have Sublocade, which is something that other provinces don’t have because it’s very expensive. It’s the injectable version of Suboxone. It’s a subcutaneous injection, it goes under the skin, it lasts for 30 days, where the oral is 24-hour. So that’s a thousand bucks a shot, and we pay for that.”

An obvious point about this is that these so-called opioid agonist treatments, or OATs, are big-time harm reduction. They greatly reduce both withdrawal symptoms and highs. One question that I still have, after watching everything Smith and the Alberta government are doing on drug recovery, is whether other provinces could afford to match it.


Running into those institutions

VODP is useful for people who are able to reach out for help from home. But other potential beneficiaries are distracted, or in distress. Very often they run into the police.

“So we took that technology” — the virtual access to physicians and treatment — “and we gave it to the 34 police agencies that we have in the province,” Smith said.

“We said to the officers, ‘If you encounter somebody who has an opioid-use disorder, you can get them started on opioid-use medication. You can, officer. Here’s the phone number to call. Put them on. We make the arrangements. They go to the pharmacy, right then and there. If they’re on the street, that can be done right in the back of a police car.

“If they are in custody at the cell block and they go into the cell block, we have put paramedics in every cell block in Alberta. So the first thing that happens to somebody when they’re arrested and they go into into municipal cells, they’re met by a paramedic that says, ‘Let’s talk about your substance use. Are you an opioid user? We can offer you immediate treatment right now. Right here. Would you like to do that?’ Through our police programs, we’re probably up to like 4,000 people who have taken us up on that.”

That’s what you can get done in a police cruiser or a holding pen. Lots of people go much further into the correctional system than that. So does Smith’s system of care.

“[Alberta’s] focus on corrections and police right now, admittedly, is the opposite of what some other jurisdictions are focusing on,” Smith said. If anything this was an understatement. A major argument for decriminalization and safe supply is that the last thing a drug user needs is the stigma of a criminal record. Other jurisdictions, Smith said, “are running away from those institutions when they should be running into those institutions.

“I’ll give you a very direct example why.

“We know, from the 2017 coroner’s report in Alberta that 40 percent of the people who died [of opioid-related causes] were in custody in the year prior to their death. That’s a really important piece of information, because it tells me I have a big chunk of population there that — if I can get at them, and if we can change the way that they experience this process — we can make a big dent in these numbers.”

A lot of people in the correctional system have substance-use disorder, even if that’s not what they’re in for. “We said, ‘Let’s really do a different way of thinking on this,’” Smith said. “Even though Corrections is a public-safety agency, we want the Ministry of Mental Health and Addiction to take over all Corrections health care.”

Perhaps four in five detainees, he said, “have alcoholism, addiction and mental-health issues. They’re all pooled up in one place and they’re not doing anything. They’ve got nothing but time on their hands. And I don’t have to build a new building? You’re kidding me! This is fantastic! Why wouldn’t I just put therapists in? So we now have treatment programs inside correctional centers.”

Of course a lot of places do programs for inmates. “But what they’re going to show you when you unpack that is, ‘Well, we give them this workbook,’” Smith said. “What they’re not doing is the deep transformative, therapy work that is necessary. And honestly, Paul, our Therapeutic Living Units are probably the best treatment programs we have in Alberta.”

With that, we piled into Smith’s SUV — Smith, Day and the third member of Smith’s team that day, a physician and consultant named Dr. Paul Sobey. A half-hour later we arrived at the Fort Saskatchewan Correctional Centre, northeast of Edmonton.

Here we visited the Therapeutic Living Unit, a full-time addiction-recovery program for 21 women who are housed separately from the general inmate population. That’s about 10% of the total population of women at Fort Saskatchewan. The program opened in February. Participants, who must apply, run through a 12-hour daily program of activity: morning check-in meetings, physical exercise, twice-daily smudge ceremonies reflecting the large Indigenous population in the correctional system, frequent meetings of Alcoholics Anonymous and Narcotics Anonymous as well as the more recently developed SMART Recovery system. Participants are rarely alone during daylight hours. The program is designed to last for months, which struck me as an unusually long time for a recovery program.

Four of the program’s participants sat on a sofa and talked about their experience in the program. “I’ve been wondering and wondering if a program like this was going to happen,” one said.

“It’s like an answered prayer, honestly,” said another. “So I would just encourage you to keep opening places like this.”

That’s the plan. “We’ve got 12 correctional centers in Alberta,” Smith told me before our road trip. “Our goal is to have Therapeutic Living Units [in all of them]. There will come a time where we have whole correctional centers that are working on this model, right? This requires massive intervention, not tinkering around the edges. This is generational change in the way that we do corrections in Alberta.”


Connections

All of the four young women we heard from said they’re nervous about what happens when they get out of detention. Old acquaintances can encourage a return to old habits. Which is part of the reason why Alberta is also building a network of live-in Recovery Communities, long-term residential rehab programs to reinforce the lessons learned in the TLUs — or to help other people begin recovery if they didn’t arrive via the correctional system.

Once the system is fully built in 2027, “every correctional centre will have a sister Recovery Community,” Smith said. “That’s why we’re building 11 of them around the province. Five of them are on First Nations, in partnership with the First Nations.”

Here’s where the system starts to look like a system. After all, in the broadest outlines nothing’s new here. People in prisons have long received addiction counselling, and the Alberta government and various private groups have long run rehabs. But for the longest time, these assorted parts of the system could barely talk to one another. So the chances of a seamless transition from the correctional system to recovery care were lousy. They’re still not great, because the system is still being built, but the goal is a seamless network of care.

“Services in 2018, 2019 were very disconnected,” Warren Driechel, the Edmonton Police Service deputy chief we met the other day, told me. The bureaucratic runaround that we all have to face can be brutal on people with high needs and impaired function. Say you want to get on AISH, an income-support program for people with a medical condition. To do that, you need a doctor’s appointment. To get one, you need identification. To get ID, you need an address.

Public officials are working to provide services that match that complexity.

In January 2021, the EPS launched a “HELP Unit” to refer people to social services instead of just arresting them.

In September 2023, the police replaced the old holding cells where intoxicated people could dry out and then get dumped back on the street with an Integrated Care Centre where they could connect with social services that operate right in the centre.

And in January 2024, after many of the tent encampments were dismantled, a new Navigation and Support Centre became the city’s hub for providing medical, legal and bureaucratic help for people who have often been bereft.

The Nav Centre has nine shelter beds in the back where people can rest, if needed, while on-site staff and volunteers process their files. (Pets are welcome, unlike in some of the city’s shelters.) The centre has the province’s only on-site Service Alberta photo-ID station. On the day I visited, the Nav Centre assisted 50 people, with 24 visiting the desk run by the Hope Mission, 10 being helped by staff from Radius Health, 12 by the provincial department of mental health and addiction.


Everything old is new

Our final stop was the Lakeview Recovery Community outside Gunn, northwest of Edmonton. When it opens in July, it’ll be the third or fourth in a network of such long-term residential programs. Lethbridge and Red Deer have been open for a while. The goal is to have 11 centres up and running across the province by 2027. Smith hopes that once the full network of centres is open, long wait times in Red Deer and Lethbridge will shrink, perhaps to the point where some beds will be available on-demand.

Each recovery community has its quirks. Lakeview will be for men only. Five of the centres will be on Indigenous land. The minimum stay will be four months, with some residents staying for up to a year. That’s a long stint for a rehab; in some private rehabs, it’s unusual to stay for even a month. In theory every day you spend with a combination of counselling, group therapy, twelve-step programs and medical care will increase your chances of success. No resident will pay for their stay at any recovery community. It’s covered by the government.

Work crews have been renovating the Lakeview site since 2022. It’s an impressive place, roomy and bright, with rooms where residents can meet visiting family, a huge kitchen where residents will learn cooking skills, and a dispensary for opioid agonist treatment. Residents will share bungalows while they’re in the program, five or six to a house.

But it didn’t just come into existence. What’s now Lakeview began its existence as the McCullough Centre for homeless World War II veterans. It had been operating for years as an addiction rehab centre when Jason Kenney’s government closed it in 2021. When the government announced the site’s eventual reopening barely a year later, observers were baffled. Closing the centre fit a narrative about a government that put the bottom line over Albertans’ wellbeing. Refurbishing and reopening it was.. harder to explain. Fitting it into a network of nearly a dozen such centres that will, themselves, be better connected to street-level services and to the corrections system… well, we’ll see, won’t we?

I’m conscious of ending this installment in my series on opioids in Alberta on an ambivalent note. I simply don’t know how this will turn out. My first article, earlier this week, was about the scale of the challenge. This one is about the scale of the response. It’s impressive. It’s getting attention across the country. Sobey, the physician who was the third member of our little party as we toured the region’s facilities, has a consulting firm whose aim is to design recovery-oriented systems of care to any government that wants to start the conversation. His phone pinged with an inquiry from another provincial government while we were visiting the Fort Saskatchewan prison. These ideas may come soon to a province near you.

What we don’t know yet is whether they’ll work, or how well. In the third and final installment in this series, I’ll discuss a few reasons to reserve judgment.

But what Alberta is trying is, in many ways, not heretical. Nobody thinks it’s great design to leave desperate people to wander helplessly thorugh a piecemeal hodge-podge of social services and treatment options, with police and corrections hovering over it all as an aloof menace. Smith, his boss the premier, and several government departments are trying to build a better system.

There is room for many devils in the details. But if federalism is supposed to be a laboratory for testing different approaches to thorny problems, Alberta is testing this approach ambitiously. Watching Marshall Smith, I found myself wondering what other intractable governance problems could benefit from the sustained attention of an empowered senior staffer, a supportive head of government, and ministers and public servants working in close coordination.

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Addictions

‘Our Liberal Government Is Acting Like A Drug Lord’: A Mother’s Testimony

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By Adam Zivo

“As soon as [my son] was put on safe supply, he started diverting his safe supply” Mom tells Parliament safer supply isn’t working

“The whole purpose of the safer supply program was to divert addicts from using harmful street drugs, but that’s not happening,” testified Masha Krupp, an Ottawa-based mother, at the House of Commons Health Committee last week. Exhausted and blunt, she described how her son has, in the past, diverted his “safer supply” drugs to the black market and how she has personally witnessed widespread diversion, by other patients, outside the clinic her son attends.

Safer supply programs distribute free addictive drugs – typically hydromorphone, a heroin-strength opioid – under the belief that this stabilizes addicts and dissuades them from consuming riskier street substances. Addiction experts and police leaders across Canada, however, say that recipients regularly divert these taxpayer-funded drugs to the black market, fueling new addictions and gang profits.

The Liberals and NDP have denied that widespread safer supply diversion is occurring, despite ample evidence to the contrary – but Krupp’s lived experiences underline the folly of their willful blindness.

“As soon as he was put on safe supply, he started diverting his safe supply,” she testified. “You’ve got drug dealers – I know this for a fact through my son; I’ve seen it – they will come to your home, 24/7, you can call two in the morning. They take your hydromorphone pills.”

According to Krupp, her son’s addiction issues have not improved despite him being enrolled in a safer supply program for more than two years. He still uses fentanyl and crack cocaine, which led to yet another overdose just last month, she said, adding that diversion and a lack of recovery-oriented services contribute to his instability.

“The Dilaudid (brand name hydromorphone) is a means of currency for my son to continue using crack cocaine – so it’s not safe, because he’s still using unsafe street drugs,” she said in parliament.

Krupp further explained that, on multiple occasions, she witnessed and photographed patients selling their safer supply in front of the clinic where her son has been a patient since June 2021. The transactions were not subtle: she could see them counting and exchanging white pills.

Over time, Krupp corroborated these observations by acquainting herself with some of these patients, who would admit to selling their safer supply: “I get to know all these people that are diverting and using right in front of the clinic, in front of all the tourists, parents walking by with kids.”

She believes that safer supply could have a role in addiction care if it were better regulated, but feels that the current model, where supervised consumption of these drugs is rarely required, is only “flooding the market, using taxpayers’ dollars, with lethal opiates…”

“It’s unsafe supply, in my view, as a mother with lived experience,” said Krupp. “Our Liberal government, right now, is acting like a drug lord.”

Her testimony was consistent with what was described in a CBC investigative report published last February, wherein Ottawa’s police officers confirmed that safer supply diversion is rampant.

One constable quoted in the story, Paul Stam, said that virtually anytime police would pull up to Rideau and Nelson street, where the clinic Krupp’s son attends is located, “they would observe people openly trafficking in diverted hydromorphone.” The officer further told the CBC that the “street is flooded with this pharmaceutical grade hydromorphone” and that there has been a dramatic, province-wide reduction in the drug’s blackmarket price – from $8-9 per 8-mg pill to just $1-2 today.

Although Krupp gave her parliamentary testimony last week, I interviewed her in July and kept her story private at her request – at the time, she worried that going public could interfere with her son’s attempts at recovery.

In the July interview, Krupp explained that, not only had her son told her that safer supply diversion is ubiquitous, she had also heard this from two acquaintances of his, who were also on the program: “The information that I’ve received is that the drug dealers have operations set up 24/7 across the city, buying legal dillies (the slang term for hydromorphone).”

She explained that she had been able to witness and document safer supply diversion because, on most Friday mornings, she would take her son to his clinic appointments and wait for him outside in her car. As she was often parked just two or three metres away from where many drug deals occurred, she had a line of sight into what was going on: clearly-identifiable dillies being handed over for other drugs.

She estimated that, by that point, she had cumulatively witnessed at least 25 safer supply patients engage in diversion.

“[Safer supply patients] would trade their dillies for fentanyl and/or crack cocaine and smoke or inject it right in front of me. They would just huddle in a corner. It’s all done very openly,” she said. “What I witness, to me, is a human tragedy on the sidewalks of the nation’s capital, with Parliament Hill eight or nine blocks away, and all the politicians sitting there singing praises to safer supply.”

She pushed back on the narrative, popular among Liberal and NDP politicians, that criticism of safer supply is conservative fear mongering and said that she had voted NDP in the past, and had even voted for Trudeau in 2015. Her disgust with safer supply was simply her “speaking from the heart as a mother.”

While harm reduction activists claim that safer supply is a form of compassionate care, Krupp vehemently disagreed: “How is it compassionate to fuel somebody’s addiction? How is it humane to keep a perpetual cycle of drug abuse and dependence?”

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Addictions

New documentary exposes safer supply as gateway to teen drug use

Published on

By: Alexandra Keeler

In a new documentary, Port Coquitlam teens describe how safer supply drugs are diverted to the streets, contributing to youth drug use

Madison was just 15 when she first encountered “dillies” — hydromorphone pills meant for safer supply, but readily available on the streets.

“Multiple people walking up the street, down the street, saying ‘dillies, dillies,’ and that’s how you get them,” Madison said, referring to dealers in Vancouver’s Downtown Eastside.

Madison says she could get pills for $1.25 each, when purchased directly from someone receiving the drugs through safer supply — a provincial program that provides drug users with prescribed opioids. Madison would typically buy a whole bottle to last a week.

But as her tolerance grew, so did her addiction, leading her to try fentanyl.

“The dillies weren’t hitting me anymore … I tried [fentanyl] and instantly I just melted,” she said.

Kamilah Sword, Madison’s best friend, was just 14 when she died of an overdose on Aug. 20, 2022 after taking a hydromorphone pill dispensed through safer supply.

Madison, along with Kamilah’s father, Gregory Sword, are among the Port Coquitlam, B.C., residents featured in a documentary by journalist Adam Zivo. The film uncovers how safer supply drugs — intended as a harm reduction measure — contribute to harm among youth by being highly accessible, addictive and dangerous.

Through emotional interviews with teens and their families, the film links these drugs to overdose deaths and explores how they can act as a gateway to stronger substances like fentanyl.

Some last names are omitted to respect the victims’ desire for privacy.

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‘Not a myth’

Safer supply aims to reduce overdose deaths by providing individuals with substance use disorders access to pharmaceutical-grade alternatives, such as hydromorphone.

But some policy experts, health officials and journalists are concerned these drugs are being diverted onto the streets — particularly hydromorphone, which is often sold under the brand name Dilaudid and nicknamed “dillies.”

Zivo, the film’s director, points out the disinformation surrounding safer supply diversion, highlighting that some drug legalization activists downplay the issue of diversion.

In 2023, B.C.’s then-chief coroner Lisa Lapointe dismissed claims that individuals were collecting their safer supply medications and selling them to youth, thereby creating new opioid dependencies and contributing to overdose deaths. She labeled such claims an “urban myth.”

In the film, Madison describes how teen substance users would occasionally accompany people enrolled in the safer supply program to the pharmacy, where they would fill their prescriptions and then sell the drugs to the teens.

“It’s not a myth, because my best friend died from it,” she says in the film.

Fiona Wilson, deputy chief of the Vancouver Police Department, testified on April 15 to the House of Commons health committee studying Canada’s opioid crisis that about 50 per cent of hydromorphone seizures by police are linked to safer supply.

Deputy Chief of the Vancouver Police Department, Fiona Wilson, testified on April 15 during the House of Commons ‘Opioid Epidemic and Toxic Drug Crisis in Canada’ health committee meeting.

Additionally, Ottawa Police Sergeant Paul Stam previously confirmed to Canadian Affairs that similar reports of diverted safer supply drugs have been observed in Ottawa.

“Hopefully, by giving these victims a platform and bringing their stories to life, the film can impress upon Canadians the urgent need for reform,” Zivo told Canadian Affairs.

‘Creating addicts’

The teens featured in the film share their experiences with the addictive nature of dillies.

“After doing them for like a month, it felt like I needed them everyday,” says Amelie North, one teen featured in the documentary. “I felt like I couldn’t stand being alive without being on dillies.”

Madison explains how tolerance builds quickly. “You just keep doing them until it’s not enough at all.”

Madison started using fentanyl at the age of 12, leading to a near-fatal overdose after just one hit at a SkyTrain station. “It took five Narcan kits to save my life,” she says in the film.

Many of her friends use dillies or have tried fentanyl, she says. She estimates half the students at her school do.

“Government-supplied hydromorphone is a dangerous domino in the cascade of an addict’s downward spiral to ever more risky behaviour,” said Madison’s mother, Beth, to Canadian Affairs.

“The safe drug supply is creating addicts, not helping addicts,” Denise Fenske, North’s mother, told Canadian Affairs.

“I’m not sure when politicians talk about all the beds they have opened up for youth with drug or alcohol problems, where they actually are and how do we access them?”

Sword, Kamilah’s father, expressed his concern in an email to Canadian Affairs. “I want the people [watching the film] to understand how easy this drug is to get for the kids and how many kids it is affecting, the pain it causes the loved ones, [with] no answers or help for them.”

Screenshot: Dr. Matthew Orde reviewing Kamilah Sword’s toxicology report during his interview for the filming of ‘Government Heroin 2: The Invisible Girls’ in March 2024.

Autopsy

Kamilah’s death raises further concerns.

According to Dr. Matthew Orde, a forensic pathologist featured in the film, Kamilah’s toxicology report revealed a mix of depressants and stimulants, including flualprazolam (a benzo), benzoylecgonine (a cocaine byproduct), MDMA and hydromorphone.

Orde criticizes the BC Coroners Service for not following best practices by focusing solely on cardiac arrhythmia caused by cocaine and MDMA, while overlooking the potential role of benzos and hydromorphone.

Orde notes that in complex poly-drug deaths, an autopsy is typically performed to determine the cause more accurately. He says he was shocked that Kamilah’s case did not receive this level of investigation.

B.C. has one of the lowest autopsy rates in Canada.

Zivo told Canadian Affairs he thinks a public inquiry into Kamilah’s case and other youth deaths involving hydromorphone since 2020 is needed to assess if the province is accurately reporting the harms of safer supply.

“That just angers me that our coroners did not do what most of Canada would have done,” Sword told Canadian Affairs.

“It also makes me question why they didn’t do an autopsy, what is our so-called government hiding?”

Government Heroin 2: The Invisible Girls is available for free on YouTube.


This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.

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