Addictions
Safe supply opioids based more on ideology than evidence?
From the Frontier Centre for Public Policy
Those who advocate for them always claim the moral high ground because of ‘evidence-based studies.’ But such studies appear to be in short supply.
That’s probably why 72 BC doctors recently signed a letter that argues against safer supply, saying the evidence underlying the philosophy is “weak or inadequate.”
Almost three years into the experimental opiate “safer supply” program in British Columbia and no one, including those handing out the pills, seems to know if it is working or making the problem worse. There are no shortage of opinions arguing on either side of the debate, but recent reports suggest that the facts remain in short supply.
Safe supply initiatives fall under the broad category of harm reduction programs. For opiate addiction, the program typically involves the prescription and distribution of pills like hydromorphone, a medical-grade opioid that is as potent as heroin, to addicts. The underlying hope is that addicts will then forgo possibly-tainted, illicit street drugs in favour of the ‘safer’ government-provided pills.
More than 40,000 Canadians have lost their lives to opioid overdoses since 2016 and British Columbia is one of the world’s first jurisdictions to take the ‘safer supply’ route in an effort to quell opioid overdoses.
But BC’s Auditor General just released a report on the trial program and, so far, it remains unclear as to whether the program has made any progress. Opioid deaths are still increasing and, while the report doesn’t criticize the underlying philosophy of ‘safer supply,’ it does note “deficiencies in key areas.”
According to the report, the government is conducting the program in a rather haphazard way. BC health authorities failed to maintain basic standards for administering an experimental trial and neglected their obligation to publish data on how the program is doing. The data was supposed to be publicly available by September 2022, more than 18 months ago.
Instead, the report found that health authorities are overly reliant on incomplete and out-of-date fact sheets about the program’s performance. It also cited authorities for major failings in the management and delivery of the program.
The bureaucrats in charge claim that they have the data to support their claims about the success of the program, yet one has to wonder why — three years in — no data is available to support those claims.
A similar dearth of data has been noted in Ottawa where the House of Commons Health Committee has been exploring the opioid epidemic and toxic drug crisis. One doctor who leads a safer supply program in London, Ontario, appeared to be a strong advocate for safer supply programs, claiming that safe supply clinicians “rely on good research and published evidence.”
But Dr. Marcus Powlowski, a Liberal MP and medical doctor who also has a master’s degree in health law and policy from Harvard, had apparently looked at the papers that she proclaimed as evidence, and soundly renounced the studies as “basically a bunch of anecdotes.”
So where is this rigorous scientific evidence for safer supply programs?
Those who advocate for them always claim the moral high ground because of ‘evidence-based studies.’ But such studies appear to be in short supply.
That’s probably why 72 BC doctors recently signed a letter that argues against safer supply, saying the evidence underlying the philosophy is “weak or inadequate.” They called for all safer supply programs to be “tightly controlled, rigorously monitored, and meticulously documented.”
A lack of medical evidence is likely related to another major issue outlined in the Auditor General’s report – “prescriber hesitancy.” That is, there are only a limited number of doctors who are willing to write prescriptions for the potent opioids used in safer supply.
However, there is plenty of evidence for one disturbing aspect of this program – diversion. This is a practice whereby safer supply pills (primarily hydromorphone) given to addicts are subsequently sold (or diverted) to drug traffickers and/or organized crime groups to obtain more potent and illicit drugs like fentanyl.
In early March, the RCMP in Northern BC revealed that thousands of safe supply opiate pills had been seized as part of organized crime busts in Prince George and Campbell River. It was considered to be solid evidence that diversion of safer supply drugs was occurring. According to the RCMP spokesperson, “Organized crime groups are actively involved in the redistribution of safe supply and prescription drugs,” and “what has been deemed safe is not being kept safe.”
It is simply not realistic to expect that such practices are not occurring in our major cities. The National Post, the CBC and an independent filmmaker have all previously published evidence of diversion occurring in London, Ottawa and Vancouver, respectively.
Drug policies such as safe supply have long bypassed appropriate scientific scrutiny because they supposedly save lives. But the question still remains – do they? And at what cost to addicts and the rest of society?
Susan Martinuk is a Senior Fellow with the Frontier Centre for Public Policy and author of Patients at Risk: Exposing Canada’s Health-care Crisis.
Addictions
‘Our Liberal Government Is Acting Like A Drug Lord’: A Mother’s Testimony
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
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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