By Liam Hunt

“It seems to be motivated by a very small, vocal, and well-connected group of advocates” says Dr. Michael Lester

Dr. Michael Lester, a Toronto-based addiction physician with 30 years of experience, says Canada’s “safer supply” programs are “inherently dangerous” and causing “dystopian” community harms due to widespread fraud.

These programs claim to reduce overdoses and deaths by distributing free addictive drugs—typically 8-milligram tablets of hydromorphone, an opioid as potent as heroin—to dissuade addicts from consuming riskier street substances. Yet experts across Canada say recipients regularly divert (sell or trade) their safer supply on the black market to acquire stronger illicit drugs, which then fuels addiction and organized crime.

“I have a couple dozen patients in my practice who were drug-free prior to the advent of safe supply, and they’ve gone back to using opioids in a destructive way because of the availability of diverted hydromorphone,” said Lester. “Every single day that I go to work, people tell me they’re struggling with the temptation not to take diverted safe supply. They don’t want to take it, but they take it anyway just because it’s cheap and available.”

After safer supply programs became widely accessible across Canada in 2020, Lester’s patients reported an influx of 8-milligram hydromorphone tablets on the black market, coinciding with a crash in the drug’s street price from $15–$20 per pill to just $2. He now estimates that 80 percent of his patients struggling with opioid addiction have relapsed due to diverted safer supply, leading some to abandon treatment entirely.

“Even if it’s sold at the rock-bottom price of $2 or $3 a pill, a person would make tens of thousands of dollars a year, which would have a tremendous impact on their ability to buy other drugs,” he explained. “Selling hydromorphone is too tempting not to do it, which keeps them entrenched in the whole world of dealing with opioid users and having opioids in their premises.”

Lester said safer supply is evidently “fueling organized crime” because drug seizures in Ontario now commonly include hydromorphone, “which wasn’t happening before.” He added that some individuals who try these diverted drugs later transition to stronger opioids, such as fentanyl.

In July, for example, the London Police Service announced that seizures of hydromorphone had increased by more than 3,000 percent in the city since 2020. According to London Police Chief Thai Truong, “Diverted safer supply is being resold into our community. There’s organized drug trafficking at the highest levels of organized crime, and there’s drug trafficking at the street level. We’re seeing all of it.”

While Lester acknowledges that safer supply can be useful as a “treatment of last resort, after traditional treatments have been tried and failed,” he said it is now being offered immediately to a wide variety of patients, which has “decimated” uptake of traditional addiction therapies, such as methadone and Suboxone.

As a result, conventional addiction clinics are now at risk of shutting down, meaning some communities could lose access to gold-standard treatments (i.e., methadone and Suboxone) while highly profitable, but unscientific, safer supply programs take over instead.

Lester said the evidence supporting safer supply is biased and “misleading” because, generally speaking, these studies simply interview enrolled patients and ask them to self-report whether they benefit from the programs. He noted that many safer supply researchers are public health academics, not doctors, meaning they lack clinical experience with the communities they study.

“It seems to be motivated by a very small, vocal, and well-connected group of advocates that has completely changed the landscape in addiction medicine treatment in a very short time,” he said.

Lester argues that some safer supply researchers seem to purposefully design their study methodologies to favor the programs and disregard systemic harms. He said this flawed science is then propagated by credulous journalists who fail to adequately scrutinize agenda-driven research.

While he personally knows “a couple dozen” colleagues in addiction medicine who regularly express skepticism about safer supply, many have been reluctant to speak out, fearing backlash from activist groups that “terrorize” critics.

“The stories are common of people being harassed and insulted on social media. We’ve heard of doctors being threatened [and] dropped from committees because they spoke out.”

For example, after Lester and his colleagues published two open letters criticizing safer supply in late 2023, they were targeted by a series of articles by Drug Data Decoded, a popular Canadian harm reduction Substack, which compared the doctors to Nazis and eugenicists. The articles were then widely shared on social media by safer supply activists.

Lester recalled an incident in which harm reduction activists targeted a doctor’s daughter at her high school in retaliation for her parent’s public criticism of safer supply.

“It’s just something that seems so unscientific and so bizarre in medicine,” he said. “Physicians just aren’t used to a powerful political lobby changing a treatment protocol.”

After Lester and more than a dozen of his colleagues wrote several public letters calling for reform and requested a meeting with Ya’ara Saks, the federal Minister of Mental Health and Addictions, they found themselves “sidelined and ignored.”

After months of delays, they were able to present their clinical observations to Saks, only to have her disregard them and incorrectly claim, weeks later, that criticism of safer supply is rooted in “fear and stigma.”

“The insults aren’t a big enough consequence to keep me from speaking my mind,” he declared.

After a short reflection, he then added, “If anyone doesn’t have a stigma against this population, it’s me. I’ve dedicated my life to helping them.”

Liam Hunt is a Canadian writer and journalist with an interest in humanism, international affairs, and crime and justice. This story is produced by the Centre For Responsible Drug Policy’s “Experts Speak Up” series in partnership with the Macdonald-Laurier Institute.

By Alexandra Keeler

The US has had a drug czar for decades. Experts share how this position has shaped US drug policy—and what it could mean for Canada

Last week, Canada announced it would appoint a “fentanyl czar” to crack down on organized crime and border security.

The move is part of a suite of security measures designed to address US President Donald Trump’s concerns about fentanyl trafficking and forestall the imposition of 25 per cent tariffs on Canadian goods.

David Hammond, a health sciences professor and research chair at the University of Waterloo, says, “There is no question that Canada would benefit from greater leadership and co-ordination in substance use policy.”

But whether Canada’s fentanyl czar “meets these needs will depend entirely on the scope of their mandate,” he told Canadian Affairs in an email.

Canadian authorities have so far provided few details about the fentanyl czar’s powers and mandate.

A Feb. 4 government news release says the czar will focus on intelligence sharing and collaborating with US counterparts. Canada’s Public Safety Minister, David McGuinty, said in a Feb. 4 CNN interview that the position “will transcend any one part of the government … [It] will pull together a full Canadian national response — between our provinces, our police of local jurisdiction, and work with our American authorities.”

Canada’s approach to the position may take cues from the US, which has long had its own drug czar. Canadian Affairs spoke to several US historians of drug policy to better understand the nature and focus of this role in the US.

The first drug czar

The term “czar” refers to high-level officials who oversee specific policy areas and have broad authority across agencies.

Today, the US drug czar’s official title is director of the Office of National Drug Control Policy. The director is appointed by the president and responsible for advising the president and coordinating a national drug strategy.

Taleed El-Sabawi, a legal scholar and public health policy expert at Wayne State University in Detroit, Mich., said the Office of National Drug Control Policy has two branches: a law enforcement branch focused on drug supply, and a public health branch focused on demand for drugs.

“Traditionally, the supply side has been the focus and the demand side has taken a side seat,” El-Sabawi said.

David Herzberg, a historian at University at Buffalo in Buffalo, N.Y., made a similar observation.

“US drug policy has historically been dominated by moral crusading — eliminating immoral use of drugs, and policing [or] punishing the immoral people (poor, minority, and foreign/traffickers) responsible for it,” Herzberg told Canadian Affairs in an email.

Harry Anslinger, who was appointed in 1930 as the first commissioner of the Federal Bureau of Narcotics, is considered the earliest iteration of the US drug czar. The bureau later merged into the Drug Enforcement Administration, the lead federal agency responsible for enforcing US drug laws.

Anslinger prioritized enforcement, and his impact was complex.

“He was part of a movement to characterize addicts as depraved and inferior individuals and he supported punitive responses not just to drug dealing but also to drug use,” said Caroline Acker, professor emerita of history at Carnegie Mellon University in Pittsburgh, Pa.

But Anslinger also cracked down on the pharmaceutical industry. He restricted opioid production, effectively making it a low-profit, tightly controlled industry, and countered pharmaceutical public relations campaigns with his own.

“The Federal Bureau of Narcotics [at the time could] in fact be seen as the most robust national consumer protection agency, with powers to regulate and constrain major corporations that the [Food and Drug Administration] could only dream of,” said Herzberg.

The punitive approach to drugs put in place by Anslinger was the dominant model until the Nixon administration. In 1971, President Richard Nixon created an office dedicated to drug abuse prevention and appointed Jerome Jaffe as drug czar.

Jaffe established a network of methadone treatment facilities across the US. Nixon initially combined public health and law enforcement to combat rising heroin use among Vietnam War soldiers, calling addiction the nation’s top health issue.

However, Nixon later reverted back to an enforcement approach when he used drug policy to target Black communities and anti-war activists.

“We knew we couldn’t make it illegal to be either against the war or Black, but by getting the public to associate the hippies with marijuana and Blacks with heroin, and then criminalizing both heavily, we could disrupt those communities,” Nixon’s top domestic policy aide, John Ehrlichman, said in a 1994 interview.

Michael Botticelli, Acting Director of the Office of National Drug Control Policy March 7, 2014 – Jan. 20, 2017 under President Barack Obama. [Photo Credit: Executive Office of the President of the United States]

Back and forth

More recently, in 2009, President Barack Obama appointed Michael Botticelli as drug czar. Botticelli was the first person in active recovery to hold the role.

The Obama administration recognized addiction as a chronic brain disease, a view already accepted in scientific circles but newly integrated into national drug policy. It reduced drug possession sentences and emphasized prevention and treatment.

Trump, who succeeded Obama in 2016, prioritized law enforcement while rolling back harm reduction. In 2018, his administration called for the death penalty for drug traffickers, and in 2019, sued to block a supervised consumption site in Philadelphia, Pa.

Trump appointed James Carroll as drug czar in 2017. But in 2018 Trump proposed slashing the office’s budget by more than 90 per cent and transferring authority for key drug programs to other agencies. Lawmakers blocked the plan, however, and the Office of National Drug Control Policy remained intact.

In 2022, President Joe Biden appointed Dr. Rahul Gupta, the first medical doctor to serve as drug czar. Herzberg says Gupta also prioritized treatment, by, for example, expanding access to naloxone and addiction medications. But he also cracked down on drug trafficking.

In December 2024, Gupta outlined America’s international efforts to combat fentanyl trafficking, naming China, Mexico, Colombia and India as key players — but not Canada.

Gupta’s last day was Jan. 19. Trump has yet to appoint someone to the role.

Canada’s fentanyl czar

El-Sabawi says she views Canada’s appointment of a drug czar as a signal that the government will be focused on supply side, law enforcement initiatives.

Hammond, the University of Waterloo professor, says he hopes efforts to address Canada’s drug problems focus on both the supply and demand sides of the equation.

“Supply-side measures are an important component of substance use policy, but limited in their effectiveness when they are not accompanied by demand-side policies,” he said.

The Canada Border Services Agency and Health Canada redirected Canadian Affairs’ inquiries about the new fentanyl czar role to Public Safety Canada. Public Safety Canada did not respond to multiple requests for comment before publication.

El-Sabawi suggests the entire drug czar role needs rethinking.

“I think the role needs to be re-envisioned as one that is more of a coordinator [across] the administrative branch on addiction and overdose issues … as opposed to what it is now, which is really a mouthpiece — symbolic,” she said.

“Most drug czars don’t get much done.”

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.