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Addictions

“Safer supply” reminiscent of the OxyContin crisis, warns addiction physician

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Dr. Lori Regenstreif, MD, MSc, CCFP (AM), FCFP, MScCH (AMH), CISAM, has been working as an addiction medicine physician in inner city Hamilton, Ontario, since 2004. She co-founded the Shelter Health Network in 2005 and the Hamilton Clinic’s opioid treatment clinic in 2010, and helped found the St. Joseph’s Hospital Rapid Access Addiction Medicine (RAAM) clinic.

[This article is part of Break The Needle’s “Experts Speak Up” series, which documents healthcare professionals’ experiences with Canada’s “safer supply” programs] By: Liam Hunt

Dr. Lori Regenstreif, an addiction physician with decades of experience on the frontlines of Canada’s opioid crisis, is sounding the alarm about the country’s rapidly expanding “safer supply” programs.

While proponents of safe supply contend that providing drug users with free tablets of hydromorphone – a pharmaceutical opioid roughly as potent as heroin – can mitigate harms, Dr. Regenstreif expresses grave concern that these programs may inadvertently perpetuate new addictions and entrench existing opioid use.

She sees ominous similarities between safer supply and the OxyContin crisis of the late 1990s, when the widespread overprescribing of opioids flooded North American communities with narcotics, sparking an addiction crisis that continues to this day. Having witnessed the devastating consequences of OxyContin in the late 1990s, she believes that low-quality and misleading research is once again encouraging dangerous overprescribing practices.

Flashbacks to the OxyContin Crisis

Soon after Dr. Regenstreif received her medical license in Canada, harm reduction became the primary framework guiding her practice in inner-city Vancouver. This period coincided with Health Canada’s 1996 regulatory approval of oxycodone (brand name: OxyContin) based on trials, sponsored by Purdue Pharma, that failed to assess the serious risks of misuse or addiction.

Dr. Regenstreif subsequently witnessed highly addictive prescription opioids flood North American streets while Purdue and its distributors reaped record profits at the expense of vulnerable communities. “That was really peaking in the late 90s as I was coming into practice,” she recounted during an extended interview with Break The Needle. “I was being pressured to prescribe it as well.”

Oxycodone addiction led to the deaths of tens of thousands of individuals in the United States and Canada. As a result, Purdue Pharma faced criminal penalties, fines, and civil settlements amounting to 8.5 billion USD, ultimately leading to the company’s bankruptcy in 2019.

During the OxyContin crisis, patients would regularly procure large amounts of pharmaceutical opioids for resale on the black market – a process known as “diversion.” Dr. Regenstreif has seen alarming indications that safer supply hydromorphone is being diverted at similarly high levels, and estimated that, out of her patient pool, “15 to 20 out of maybe 40 people who have to go to a pharmacy frequently” have reported witnessing diversion.

Between one to two thirds of her new patients have told her that they are accessing diverted hydromorphone tablets – in many cases, the tablets almost certainly originate from safer supply.

Injecting crushed hydromorphone tablets pose severe health risks, including endocarditis and spinal abscesses. “I’ve seen people become quadriplegic and paraplegic because the infection invaded their spinal cord and damaged their nervous system,” said Dr. Regenstreif. While infections can be mitigated by reducing the number of times drug users inject drugs into their bodies, she says that safer supply programs do not discourage or reduce injections.

She further noted, “I’ve seen a teenager in [the] hospital getting their second heart valve replacement because they continue to inject after the first one.” The pill that nearly stopped the patient’s heart was one of the tens of thousands of hydromorphone tablets handed out daily via Canadian safe supply programs.

Her experiences are consistent with preliminary data from a scientific paper published by JAMA Internal Medicine in January, which found that safe supply distribution in British Columbia is associated with a “substantial” increase in opioid-related hospitalizations, rising by 63% over the first two years of program implementation — all without reducing deaths by a statistically significant margin.

While Dr. Regenstreif has worked in a variety of settings, from Ontario’s youth correctional system to Indigenous healing facilities in the Northwest Territories, her experiences in Australia, where she worked during a sabbatical year from 2013 to 2014, were particularly educational.

Australia has far fewer opioid-related deaths than Canada – in 2021, opioid mortality rates were 3.8 per 100,000 in Australia and 21 per 100,000 in Canada (a difference of over 500%). Dr. Regenstreif credited this difference to Australia’s comparatively controlled opioid landscape, where access to pharmaceutical narcotics is tightly regulated.

“Heroin had been a long-standing street opioid. It was really the only opioid you tended to see, because the only other ones people could get a prescription for were over-the-counter, low-potency codeine tablets,” she said. To this day, opioid prescriptions in Australia require special approval for repeat supplies, preventing stockpiling and street diversion.

No real evidence supports “safer supply”

Critics and whistleblowers have argued that Canadian safe supply programs, which have received over $100 million in federal funding through Health Canada’s Substance Use and Addictions Program (SUAP), were initiated without adhering to the rigorous evidentiary standards typically required to classify medication as “safe.”

Dr. Regenstreif shares these concerns and says that no credible studies show that safer supply saves lives, and that little effort is invested into exploring its possible risks and unintended consequences – such as increased addiction, hospitalization, overdose and illicit diversion to youth and vulnerable individuals.

Most studies which support the experiment simply interview recipients of safer supply and then present their answers as objective evidence of success. Dr. Regenstreif criticized these qualitative studies as methodologically flawed “customer satisfaction surveys,” as they are “very selective” and rely on small, bias-prone samples.

“If you have 400 people in a program, and you get feedback from 12, and 90% of those 12 said X, that’s not [adequate] data,” said Dr. Regenstreif, criticizing the lack of follow-up often shown safer supply researchers. “Nobody seems to track down the […] people who were not included. Did they get kicked out of the program? [Did they engage in] diversion? Did they die? We’re not hearing about that. It doesn’t make any sense in an empirical scientific universe.”

Safe supply advocates typically argue that opioids themselves are not problematic, but rather their unregulated and illicit supply, as this allows for contaminants and unpredictable dosing. However, studies have found that opioid-related deaths rise when narcotics, legal or not, are more widely available.

Dr. Regensteif is calling upon harm reduction researchers to build a more robust evidence base before calling for the expansion of safer supply. That includes more methodologically rigorous and transparent quantitative research to evaluate the full impact of Canada’s harm reduction strategies. Forgoing this evidence or adequate risk-prevention measures could lead to consequences as catastrophic as those resulting from Purdue’s deceptive marketing of OxyContin, she said.

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Critics propose solutions despite bullying

Dr. Regenstreif has faced pressure and exclusion for speaking out against safe supply. She estimates that while only a quarter of her local colleagues shared her doubts a few years ago, “now I would say more than half” harbor the same concerns. However, many are reluctant to voice their reservations publicly, fearing professional or social repercussions. “People who don’t want to speak out don’t want to be labeled as right-wing […] they don’t want to be labeled as conservative.”

While she acknowledges that safe supply may play a limited role for a small subset of patients, she believes it has been oversold as a panacea without adequate safeguards or due evaluation. “It doesn’t seem as if policymakers are listening to the people on the ground who have experience in doing this,” she said.

She contends that the solution to Canada’s addiction crisis lies in a more holistic, recovery-oriented approach that includes all four pillars of addiction: harm reduction, prevention, treatment, and enforcement. Her vision includes a national network of publicly-funded, rapid-access addiction medicine clinics with integrated counseling and wraparound services.

Additionally, Dr. Regenstreif stresses the importance of building upon established opioid agonist treatments (OAT), like methadone and buprenorphine, rather than solely relying on novel approaches whose social and medical risks are not yet fully understood.

At the core of Dr. Regenstreif’s advocacy lies a profound dedication to her patients and to the science of addiction medicine. “I like to think I kind of am fear-mongering with my patients, [by] trying to make them afraid of not getting better,” she explains. “I don’t want them to end up in the hospital and not come back out. I don’t want them to end up dead.”


[This article has been co-published with The Bureau, a Canadian media outlet that tackles corruption and foreign influence campaigns through investigative journalism. Subscribe to their work to get the latest updates on how organized crime influences the Canadian drug trade.]

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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

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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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