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Canada’s ‘safer supply’ patients are receiving staggering amounts of narcotics

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Image courtesy of Midjourney.

How a Small Population Fuels a Black Market Epidemic, Echoing Troubling Parallels in Sweden

A significant amount of safer supply opioids are obviously being diverted to the black market, but some influential voices are vehemently downplaying this problem. They often claim that there are simply too few safer supply clients for diversion to be a real issue – but this argument is misleading because it glosses over the fact that these clients receive truly staggering amounts of narcotics relative to everyone else.

“Safer supply” refers to the practice of prescribing free recreational drugs as an alternative to potentially-tainted street substances. In Canada, that typically means distributing eight-mg tablets of hydromorphone, an opioid as potent as heroin, to mitigate the use of illicit fentanyl.

There is clear evidence that most safer supply clients regularly sell or trade almost all of their hydromorphone tablets for stronger illicit substances, and that this is flooding communities with the drug and fuelling new addictions and relapses. Just five years ago, the street price of an eight-mg hydromorphone tablet was around $20 in major Canadian cities – now they often go for as little as $1.

But advocates repeatedly emphasize that, even if such diversion is occurring, it must be a minor issue because there are only a few thousand safer supply clients in Canada. They believe that it is simply impossible for such a small population to have a meaningful impact on the overall black market for diverted pharmaceuticals, and that the sudden collapse of hydromorphone prices must have been caused by other factors.

This is an earnest belief – but an extremely ill-informed one.

It is difficult to analyze safer supply at the national level, as each province publishes different drug statistics that make interprovincial comparisons near-impossible. So, for the sake of clarity, let’s focus primarily on B.C., where the debate over safer supply has raged hottest.

According to a dashboard published by the British Columbia Centre for Disease Control, there were only 4,450 safer supply clients in the province in December 2023, of which 4,250 received opioids. In contrast, the 2018/19 British Columbia Controlled Prescription Drug Atlas (more recent data is unavailable) states that there were approximately 80,000 hydromorphone patients in the province that year – a number that is unlikely to have decreased significantly since then.

We can thus reasonably assume that safer supply clients represent around 5 per cent of the province’s total hydromorphone patients – but if so few people are on safer supply, how could they have a profound impact on the black market? The answer is simple: these clients receive astonishing sums of the drug, and divert at an unparalleled level, compared to everyone else.

Safer supply clients generally receive 4-8 eight-mg tablets per day at first, but almost all of them are quickly moved up to higher doses. In B.C., most patients are kept at 14 tablets (112-mg in total) per day, which is the maximum allowed by the province’s guidelines. For comparison, patients in Ontario can receive as many as 30 tablets a day (240-mg in total).

These are huge amounts.

The typical hydromorphone dose used to treat post-surgery pain in hospital settings is two-mg every 4-6 hours – or roughly 12-mg per day. So that means that safer supply clients can receive roughly 10-20 times the daily dose given to acute pain patients, depending on which province they’re located in. And while acute pain patients are tapered off hydromorphone after a few weeks, safer supply clients receive their tablets indefinitely.

Some chronic pain patients (i.e. people struggling with severe arthritis) are also prescribed hydromorphone – but, in most cases, their daily dose is 12-mg or less. The exception here is terminally ill cancer patients, who may receive up to around 100-mg of hydromorphone per day. However, this population is relatively small, so we once again have a situation where safer supply patients are, for the most part, receiving much more hydromorphone than their peers.

Not only do safer supply patients receive incredible amounts of the drug, they also seem to divert it at much higher rates – which is a frequently overlooked factor.

The clandestine nature of prescription drug diversion makes it near-impossible to measure, but a 2017 peer-reviewed study estimated that, in the United States, up to 3 per cent of all prescription opioids end up on the black market.

In contrast, it appears that safer supply patients divert 80-90 per cent of their hydromorphone.

These numbers should be taken with a grain of salt, as there have been no attempts to measure safer supply diversion – harm reduction researchers tend to simply ignore the problem, which means that we must rely on journalistic evidence that is necessarily anecdotal in nature. While this evidence has its limits, it can, at the very least, illustrate the rough scale of the problem.

For example, in London, Ontario, I interviewed six former drug users last summer who said that, of the safer supply clients they knew, 80 per cent sold almost all of their hydromorphone – just one interviewee placed the number closer to 50 per cent. More recently, I interviewed an addiction outreach worker in Ottawa who estimated that 90 per cent of safer supply clients diverted their drugs. These numbers are consistent with the testimony of dozens of addiction physicians who have said that safer supply diversion is ubiquitous.

Let us take a conservative estimate and imagine that only 30 per cent of safer supply hydromorphone is diverted – even this would be potentially catastrophic.

So we can see why any serious attempt to discuss safer supply diversion cannot narrowly focus on patient numbers – to ignore differences in doses and diversion rates is inexcusably misleading.

But we don’t need to rely on theory to make this point, because the recent parliamentary testimony of Fiona Wilson, who is deputy chief of the Vancouver Police Department and president of the B.C. Association of Chiefs of Police (BCACP), illustrates the situation quite neatly.

Wilson testified to the House of Commons health committee earlier this month that half of the hydromorphone recently seized in B.C. can be attributed to safer supply. As she did not specify whether the other half was attributed to other sources, or simply of indeterminate origin, the actual rate of safer supply hydromorphone seizures may actually be even higher.

As, once again, safer supply clients constitute roughly 5 per cent of the total hydromorphone patient population, Wilson’s testimony suggests that, on a per capita basis, safer supply patients divert at least 18 times more of the drug than everyone else.

This is exactly what one would expect to find given our earlier analysis, and these facts, by themselves, repudiate the argument that safer supply diversion is insignificant. When a small population is at least doubling the street supply of a dangerous pharmaceutical opioid, this is a problem.

The fact that so few people can cause substantial, system-wide harm is not unprecedented. In fact, this exact same problem was observed in Sweden, which, from 1965-1967, experimented with a model of safer supply that closely resembled what is being done in Canada today. A small number of patients – barely more than a hundred – were given near-unlimited access to free recreational drugs under the assumption that this would keep them “safe.”

But these patients simply sold the bulk of their drugs, which caused addiction and crime rates to skyrocket across Stockholm. Commentators at the time referred to safer supply as “the worst scandal in Swedish medical history,” and, even today, the experiment remains a cautionary tale among the country’s drug researchers.

It is simply wrong to say that there are too few safer supply clients to cause a diversion crisis. People who make this claim are ignorant of contemporary and historical facts, and those who wish to position themselves as drug experts should be mindful of this, lest they mislead the public about a destructive drug crisis.

This article was originally published in The Bureau, a Canadian publication devoted to using investigative journalism to tackle corruption and foreign influence campaigns. You can find this article on their website here.

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Should fentanyl dealers face manslaughter charges for fatal overdoses?

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Tyler Ginn prior to his death from a fentanyl overdose in 2021. [Photo credit: Gayle Fowlie]

By Alexandra Keeler

Police are charging more drug dealers with manslaughter in fentanyl overdose deaths. But the shift is not satisfying everyone

Four years ago, Tyler Ginn died of a fentanyl overdose at the age of 18. Tyler’s father found his son unresponsive in the bedroom of their Brooklin, Ont., home.

For Tyler’s mother, Gayle Fowlie, the pain of his loss remains raw.

“He was my kid that rode his bike to the store to buy me a chocolate bar on my birthday, you know?” she told Canadian Affairs in an interview.

Police charged Jacob Norn, the drug dealer who sold Tyler his final, fatal dose, with manslaughter. More than three years after Tyler’s death, Norn was convicted and sentenced to six years in prison.

“I don’t think you can grasp how difficult going through a trial is,” Fowlie said. “On TV, it’s a less than an hour process. But the pain of it, and going over every detail and then going over every detail again … it provides details you wish you didn’t know.”

But Fowlie is glad Norn was convicted. If anything, she would have liked him to serve a longer sentence. Lawyers have told her Norn is likely to serve only two to four years of his sentence in prison.

“My son’s never coming back [and] his whole family has a life sentence of missing him the rest of our lives,” she said. “So do I think four years is fair? No.”

Norn’s case reflects a growing trend of drug dealers being charged with manslaughter when their drug sales lead to fatal overdoses.

But this shift has not satisfied everyone. Some would like to see drug dealers face harsher or different penalties.

“If we say that it was 50 per cent Tyler’s fault for buying it and 50 per cent Jacob’s fault for selling it … then I think he should have a half-a-life sentence,” said Fowlie.

Others say the legal system’s focus on prosecuting low-level drug dealers misses the broader issues at play.

“[Police] decided, in the Jacob Norn case, they were going to go one stage back,” said Peter Thorning, who was Norn’s defence lawyer.

“What about the person who gave Jacob that substance? What about the person who supplied the substance to [that person]? There was no investigation into where it came from and who was ultimately responsible for the death of that young man.”

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Manslaughter charge

At least 50,000 Canadians have died from drug overdoses since 2016. Last year, an average of 21 individuals died each day, with fentanyl accounting for nearly 80 per cent of those deaths.

Fentanyl, a synthetic opioid, is up to 50 times stronger than heroin and 100 times stronger than morphine. A dose as small as a few grains of salt can be lethal.

Given its potency, police and prosecutors have increasingly turned to manslaughter charges when a dealer’s product results in a fatal overdose.

A recent study in the Canadian Journal of Law and Society found that the number of manslaughter charges laid for drug-related deaths in Canada surged from three cases in 2016 to 135 in 2021.

Individuals can be convicted of manslaughter for committing unlawful, reckless or negligent acts that result in death but where there was no intention to kill. Sentences can range from probation (in rare cases) to life.

Murder charges, by contrast, require an intent to kill or cause fatal harm. Drug dealers typically face manslaughter charges in overdose cases, as their intent is to distribute drugs, not to kill those who purchase them.

Joanne Bortoluss, a spokesperson for the Durham Regional Police, which charged Norn, said that each of their investigations follows the same fundamental process.

“Investigators consider the strength of the evidence, the dealer’s level of involvement, and applicable laws when determining whether to pursue charges like manslaughter,” she said.

The Canadian Journal of Law and Society study also found that prosecutions often target low-level dealers, many of whom are drug users themselves and have personal connections to the deceased.

Norn’s case fits this pattern. He struggled with substance abuse, including addiction to fentanyl, Xanax and Percocet. Tyler and Norn were friends, the judge said in the court ruling, although Fowlie disputes this claim.

“[Those words] are repulsive to me,” she said.

The Crown argued Norn demonstrated “a high degree of moral blameworthiness” by warning Ginn of the fentanyl’s potency while still selling it to him. In a call to Ginn, he warned him “not to do a lot of the stuff” because he “didn’t want to be responsible for anything that happened.”

Fowlie’s outrage over Norn’s lenient sentencing is compounded by the fact that Norn was found trafficking fentanyl again after her son’s death.

“So we’ve killed somebody, and we’re still … trafficking? We’re not worried who else we kill?” Fowlie said.

Trafficking

Some legal sources noted that manslaughter charges do not necessarily lead to harsh sentences or deterrence.

“If you look at how diverse and … lenient some sentences are for manslaughter, I don’t think it really pushes things in the direction that [victims’ families] want,” said Kevin Westell, a Vancouver-based trial lawyer and former chair of the Canadian Bar Association.

Westell noted that the term “manslaughter” is misleading. “Manslaughter is a brutal-sounding title, but it encapsulates a very broad span of criminal offences,” he said.

In Westell’s view, consistently charging dealers with drug trafficking could be more effective for deterring the practice.

“What really matters is how long the sentence is, and you’re better off saying, ‘We know fentanyl is dangerous, so we’re setting the sentence quite high,’ rather than making it harder to prove with a manslaughter charge,” he said.

Trafficking is a distinct charge from manslaughter that involves the distribution, sale or delivery of illicit drugs. The sentencing range for fentanyl trafficking is eight to 15 years, Kwame Bonsu, a media relations representative for the Department of Justice, told Canadian Affairs.

“Courts must impose sentences that are proportionate to the gravity of the offence and the degree of responsibility of the offender,” Bonsu said, referencing a 2021 Supreme Court of Canada decision. Bonsu noted that aggravating factors such as lack of remorse or trafficking large quantities can lead to harsher sentences.

‘Head of the snake’

Some legal experts noted the justice system often fails to target those higher up in the drug supply chain.

“We don’t know how many hands that drug goes through,” said Thorning, the defence lawyer.

“Are the police going to prosecute every single person who provides fentanyl to another person? Jacob [Norn] was himself an addict trafficker — what about the person who supplied the substance to him?”

Thorning also questioned whether government agencies bear some responsibility. “Is some government agency’s failure to investigate how that drug came into the country partly responsible for the young man’s death?”

Westell, who has served as both a Crown prosecutor and criminal defence lawyer, acknowledged the difficulty of targeting higher-level traffickers.

“Cutting off the head of the snake does not align very well with the limitations of the international borders,” he said.

“Yes, there are transnational justice measures, but a lot gets lost, and as soon as you cross an international border of any kind, it becomes incredibly difficult to follow the chain in a linear way.”

Bortoluss, of the Durham police, said even prosecuting what appear to be obvious fentanyl-related deaths — such as Tyler Ginn’s — can be challenging. Witnesses can be reluctant to cooperate, fearing legal consequences. It can also be difficult to identify the source of drugs, as “transactions often involve multiple intermediaries and anonymous online sales.”

Another challenge in deterring fentanyl trafficking is the strong financial incentives of the trade.

“Even if [Norn] serves two to four years for killing somebody, but he could make a hundred thousand off of selling drugs, is it worth it?” Fowlie said.

Thorning agreed that the profit incentive can be incredibly powerful, outweighing the risk of a potential sentence.

“The more risky you make the behaviour, the greater the profit for a person who’s willing to break our laws, and the profit is the thing that generates the conduct,” he said.

A blunt instrument

Legal experts also noted the criminal justice system alone cannot solve the fentanyl crisis.

“Most people who have [lost] a loved one [to drug overdose] want to see a direct consequence to the person that’s responsible,” said Westell. “But I think they would also like to see something on a more macro level that helps eliminate the problem more holistically, and that can’t be [achieved through] crime and punishment alone.”

Thorning agrees.

“These are mental health .. [and] medical issues,” he said. “Criminal law is a blunt instrument [that is] not going to deal with these things effectively.”

Even Fowlie sees the problem as bigger than sentencing. Her son struggled with the stigma associated with therapy and medication, which made it difficult for him to seek help.

“We need to normalize seeing a therapist, like we normalize getting your eyes checked every year,” she said.

“Pot isn’t the gateway drug, trauma is a gateway drug.”


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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The Fentanyl Crisis Is A War, And Canada Is On The Wrong Side

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From the Frontier Centre for Public Policy

By Brian Giesbrecht

Drug cartels, China, and Canada’s negligence are fueling the deadliest epidemic of our time

It took the threat of U.S. tariffs for Canada to wake up to the horrors of the fentanyl epidemic that is destroying young lives and shattering families. Canadians, who panicked over COVID-19 deaths, have hardly noticed that far more healthy Canadians and Americans are now dying from fentanyl overdoses than ever died from COVID.

Yet while Americans confront this deadly epidemic, Canada remains oblivious to how deeply the crisis has infiltrated our borders.

A grim milestone came in 2021 when U.S. opioid overdose deaths exceeded 100,000 in a single year. More than a million Americans have died from opioid overdoses since these highly addictive drugs first entered the market. Today, fentanyl overdose is the leading cause of death for Americans aged 18 to 25.

Behind every kilogram of fentanyl lies half a million potential deaths. Behind every pill—a game of Russian roulette.

Fentanyl is a synthetic opioid so powerful that one kilogram can kill 500,000 people. Its extreme potency makes it both highly dangerous and easy to smuggle. A single backpack thrown across the border can carry $1 million worth of the drug. It is easy to see why so many opportunists are willing to risk their lives producing and selling it. Overdose statistics fail to capture the bodies found in deserts or those murdered in the vicious drug trade.

Fentanyl is produced for a few cents per pill but sold on the street for many times that, making it both profitable and a cheap high. Incredibly addictive, it is found in virtually all street drugs, giving “the most bang for the buck.” Made by amateurs, these drugs are carelessly laced with lethal doses. And because the pills look identical, users never know whether a dose will get them high—or kill them.

But Canada is not just a bystander in this crisis. A loophole in our border laws—the “de minimis” exemption—has turned Canada into a gateway for fentanyl entering U.S. communities. This exemption allows exporters to ship small packages valued at less than $800 directly to customers with minimal border inspection. Chinese exporters exploit this loophole to ship fentanyl precursors into Canada, where they are processed into pills or moved to Mexico under the supervision of Mexican drug cartels.

The Trump administration has pressed Canada to close this loophole. That it has existed for years, almost unnoticed, should shock us to the core.

The problem of fentanyl production within Canada should not be minimized. The RCMP reports that fentanyl labs are appearing across B.C., often producing methamphetamine alongside fentanyl. These small labs supply both domestic and international markets. The threat is real, and it is growing.

Exactly how many Canadians have died from fentanyl overdoses is unclear. However, with Canada’s population roughly one-ninth of the U.S., it is reasonable to estimate that Canadian deaths are approximately one-ninth of U.S. numbers.

But overdose numbers alone don’t tell the whole story. The number of lives wrecked by this drug is staggering. Parents watch their children—once vibrant and full of promise—disappear before their eyes. Their beauty fades, their minds unravel, and their lives collapse into the desperate cycle of chasing the next fix. Some escape. Many don’t. Until death takes them, that is.

The new Trump administration has promised to confront this carnage. “This is a drug war,” Peter Navarro, assistant to the president and director of the Office of Trade and Manufacturing Policy, recently told reporters. “The Mexican cartels have expanded up to Canada, making fentanyl there and sending it down to the U.S. The Chinese are using Canada to send in small parcels below the radar. It’s important that Canadians understand we are trying to stop the killing of Americans by these deadly drugs.”

But while the U.S. acts, Canada hesitates. Trump is addressing the problem—Canada is enabling it.

The Trump administration also views Canada’s lax drug laws and casual attitude toward buying and selling even the most dangerous drugs as an exacerbating factor. However, on the fentanyl issue, it is clear Trump is determined to tackle a problem Canada has largely ignored. He should be commended for this, and Canada should start cleaning up its own mess.

Yet fentanyl smuggling from Canada is only part of a larger issue. Behind the drug trade lies an even more insidious enemy: the Chinese Communist Party (CCP).

The importation of fentanyl precursors from China, facilitated by Mexican cartels, has turned Vancouver into a money-laundering hub for the CCP. Investigative reporters like Sam Cooper and Terry Glavin have revealed the depth of this corruption, despite the Hogue Commission’s failure to expose it fully.

Ryan P. Williams, president of the Claremont Institute, warns that “The fentanyl crisis is part of a larger campaign by the CCP to destabilize Western nations. They flood our streets with poison while corrupting our institutions from within. If Canada doesn’t confront this threat, it will lose not only lives—but its sovereignty.”

Our new “fentanyl czar,” appointed by Prime Minister Justin Trudeau, should not only address the drug crisis but also expose how deeply a hostile CCP has compromised Canada.

Tackling the fentanyl problem will be enormously difficult—likely impossible— for the Trump administration without cooperation from China, Mexico and even Canada. And forcing that cooperation is likely the first part of Trump’s plan.

Canada’s role may be small, but it must take full responsibility for securing its borders and confronting the fentanyl crisis. Trump has forced us to act. Now, if we are serious about restoring our nation’s integrity, we must break the CCP’s grip on our institutions.

In doing so, we will save Canadian lives.

Brian Giesbrecht is a retired Manitoba judge. He is a Senior Fellow at the Frontier Centre for Public Policy. He was recently named the ‘Western Standard Columnist of the Year.’

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