Addictions
Alberta and opioids III: You can’t always just stop
Monty Ghosh at Highlevel Diner, May 30. Photo: Paul Wells
By Paul Wells
This is the concluding installment in a series on drugs in Alberta. Previously:
i. “Worse Than I’ve Ever Seen,” June 4
ii. “Alberta’s System Builder,” June 7
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A matter of expectations
Street family
My tour guide for much of my visit to Edmonton was Dr. Monty Ghosh, a clinician who’s on faculty at the University of Calgary and the University of Edmonton. He seems to talk to everybody who works with substance users in Alberta, from his own patients to front-line clinicians to the Alberta government. His relations with the latter go up and down, but he urged me to talk to Marshall Smith, the chief of staff to premier Danielle Smith.
On my first night in Edmonton Ghosh walked me around a neighbourhood that included the George Spady Society supervised-consumption site, the Hope Mission’s Herb Jamieson Centre, and the Royal Alexandra Hospital, which has a supervised-consumption service on its premises.
A lot of people use the services these places provide. Other people don’t. Shelters in particular are tricky: they’re usually for single people who arrive alone. “The Hope, the Herb, the Navigation Centre, offering the world,” one Edmonton Police Service officer told me. “But all these places have one thing in common: rules.” If you have a spouse or a pet, you want to keep your drug supply or you want to stay close to your “street family” — the community spirit in neighbourhoods like this is striking, and might be surprising to people who prefer to stay away — a shelter’s probably not for you.
Several of the places we visited weren’t ready to welcome us when we showed up unannounced. To say the least, they’re busy. That was the case at Radius Community Health and Healing, an institutional building in a more residential part of the neighbourhood. Radius is a drop-in clinic and, as we’ll see, quite a bit more.
On a sunny weekday afternoon, more than a dozen people stood, sat or lay on the building’s front steps and truncated lawn. One lay on his back, shirtless, not moving visibly. Ghosh asked the man whether he was all right, asked again, finally nudged him. The man stirred, looked around. Ghosh apologized mildly for bothering him, then checked in on two other people who also weren’t moving. They turned out to be all right too.
Francesco Mosaico, Radius’s medical director, was on his way home for the day when we arrived, but we made plans to talk the next day. When I returned, I met Mosaico and Radius’s executive director, Tricia Smith, in her office.
I think it’s important to hear them out, because when drug use becomes the object of political debate, it’s natural to talk as though policy decisions are the main thing keeping people from getting well. This can lead to a lot of blame on one hand, and to excessive optimism on the other. In fact the biggest thing that keeps people from getting well is often the entire sum of their lives until now, compounded by the influence of drugs that are more potent than anything earlier generations had to deal with.
The most complex patients
Radius offers primary care to people “experiencing multiple barriers,” Smith said. That can include homelessness, addiction, severe mental health problems, criminal records. The centre’s team includes 12 family physicians and three psychiatrists. They currently see about 3,000 patients.
Radius has Western Canada’s only non-profit dental clinic. The centre runs a respite program for people who are not sick enough to be in acute care but are too sick to be managing independently on their own. It has a program for pregnant women experiencing homelessness. It runs on a harm-reduction model, so they don’t need to be drug-free to go into the program. It has an interdisciplinary Assertive Community Treatment team to help people with mental-health and substance problems find and stay in market apartments, with frequent assistance. There’s a supervised consumption site in the basement.
“In fact,” Smith said, “we actually have an exemption from the College of Physicians and Surgeons of Alberta to filter out and keep the most complex patients. The least complex, we refer elsewhere.” I couldn’t get care in Radius if I tried; they’d politely refer me elsewhere. They’re for the people who need the most help.
After my visit, Smith wrote to me to add another program to the list: Kindred House, which for more than 25 yearss has supported women and Trans women sex workers. “The women we see are from age 18 to 50, predominantly Indigenous, have intergenerational trauma, past/current trauma, substance use issues, often houseless or couch surfing,” Smith wrote.
Smith has been at Radius for three and a half years. While I was there, I asked her how work at Radius is going. “It’s going fabulously, honestly,” she said. She arrived early in the COVID pandemic, after eight years in Alberta government departments — which in turn followed 20 years as a Canadian Forces army nurse, including in combat zones. “I’m in the right place,” she said of Radius. “It felt like coming home.”
How come? “The staff, the team, the work, the dedication. It just feels like family. I missed that. Being in the military was a big thing. This work that this group does is just really amazing. The team is amazing and it’s hard, but it’s good work.”
And how’s the workload evolving? “Unfortunately, for this population, the struggles are only increasing, and the number of individuals that are experiencing those challenges is not getting less,” she said. “The workload isn’t going anywhere. It’s getting more difficult.”
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“Especially in the last couple years, I don’t think things have ever been worse for the vulnerable population,” Mosaico, Radius’s medical director, added. The same housing crunch that has made homes less affordable for everyone has put thousands of the most vulnerable on the street. Results: more frequent frostbite or burns from lamps lit to keep from freezing. Body lice. Trauma from watching friends die. And to Mosaico’s astonishment, frequent shigella outbreaks.
“Shigella’s a bacteria that causes torrential bloody diarrhea. It can be treated with a single dose of antibiotics. But if you’re homeless and you don’t have a place to take care of yourself… 70 percent of the cases have had to be hospitalized in the last two years…. I mean, they’re talking about potentially calling it an endemic disease, and it’s a disease of destitution. You see it in refugee camps in developing countries, not in the capital of Alberta, you know?”
Ten thousand times deadlier
Radius also works closely with the Alberta government to integrate its services with the “recovery-oriented system of care” that I told you about last week. There are two Radius staffers working at the Integrated Care Centre the police set up to replace the old, passive holding cells for overnight detention. There are two more at the Navigation Centre, which steers people toward social and government services. If there’s an Alberta model, they’re part of it. So I was fascinated by the response when I asked my hosts the basic question that sent me to Alberta: Why are so many people dying?
“I think it’s the nature of the drugs,” Mosaico said. “You know, people used to overdose and die. But I’ve been here 17 years. I think in the first 10 or 11 years it wasn’t very common to hear about overdoses by opioids. Every once in a while you’d hear about it, but it wasn’t a daily thing. Whereas now with fentanyl and carfentanil, it’s really dangerous.”
Carfentanil is 10,000 times more potent than morphine, 100 times more than fentanyl. The Edmonton Police won’t return stolen cars they recover until they’ve scrubbed them thoroughly, because even trace amounts of these drugs are too dangerous. “We’re finding clients who use methamphetamines and swear up and down they’re not taking opioids,” Mosaico said. “And then we do urine tests and it’s there. We think their dealers are lacing methamphetamine with fentanyl because it increases the addiction.”
The other big thing on his mind, Mosaico said, is that any program to guide users into recovery will bump up against the fact that different people have often lived starkly different lives.
93% 4+
“I don’t know if you’re familiar with Adverse Childhood Experiences — the ACEs study,” Mosaico said. I was, barely, but I needed a refresher.
The original study began in 1985 in San Diego, under Vincent Felitti, who ran an obesity clinic, and Rob Anda from the Centres for Disease Control. (If you want to learn more about the study, this article and this speech on Youtube are good places to start.)
“They surveyed 17,000 people,” Mosaico said. “They found, you know, if people had developmental trauma — so, trauma between the ages of 0 and 18 — and there are 10 different forms of trauma that the study bore out as being detrimental. Things like physical, emotional, sexual abuse; physical, emotional neglect; substance use in the family; untreated mental illness in the family; separation from biological parents; maternal figure being treated violently; and a household member going to jail.
“If those things occurred, you would just tally up the number of types of trauma and you’d get a score out of 10. What they found was, if you scored four or greater, that there seem to be adverse health effects in adulthood. And it wasn’t just the presence of addictions or mental illness. It was lung disease, heart disease, liver disease, certain forms of cancer, diabetes, obesity.” This is almost folk wisdom today, but at the time, Felitti and Anda were amazed at the strength of the correlations between childhood trauma and adult physical and mental health.
The original test has been widely replicated, and it usually finds that the proportion of people in a sample who’ve had four or more adverse childhood experiences is about 12%. So something like every eighth person you meet had a really difficult childhood, and while you can’t predict for individuals from statistical trends, there’s a good chance they’re still living with the fallout.
The team at Radius surveyed a large sample of the population under their care. The prevalence of high-risk ACE scores was about 93 percent, compared to 12 in the general population,” Mosaico said.
“Harvard has a center on the developing child, which has pulled together a lot of the science that explains the neurobiological link between the adverse trauma and the adverse health effects. They talk about limitations in the development of executive function, of decision-making, emotional regulation. Impulse control is underdeveloped, neuroanatomically in the brain. And instead what over-develops is the fight-or-flight response.
“So you’re dealing with a population that, because of their experiences, isn’t the same as the general population . And then that’s compounded by the fact that a high percentage of those clients who have high ACE scores also have traumatic brain injuries from living rough on the street. They also have adult trauma that compounds the childhood trauma. They have [fetal alcohol spectrum disorder], which impairs executive function even further.
“I hear these success stories and I think they’re wonderful, when you hear about people who have a difficult life and then they straighten up. And then, you know, they go back to their jobs and their families and they become leaders in their communities. But this is a population which is over-represented in every aspect of society, negatively as it were. In the prisons and child family welfare services. In the health system, you know, prevalence of HIV, tuberculosis, Hepatitis C, STIs, all that.
“And you look at them and you think, even if they managed to wait, you know, six months to get into an addiction recovery bed, after waiting for weeks to get into detox and they go through the program, what do they go back to? Most of them had to drop out of school. They have criminal records, which makes it hard to get a job. They’re disconnected and estranged from their families. They haven’t learned social skills.
“I had a client who lived in dumpsters for two and a half years. The fact that he just stayed housed — on income support — for the rest of his life was a huge win, right? It was important for his dignity, his quality of life. It’s just a matter of adjusting your expectations of what might actually be realistic.”
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Dr. Larson writes
The idea for these stories goes back to February, when it first became clear to me that 2023 would be Alberta’s worst year for overdose fatalities. I asked the communications team at the University of Calgary for names of people to talk to. Many weeks went by, because sometimes it’s ridiculous how hard it is to extract myself from Ottawa routine. After I published the second article in this series, the one where Marshall Smith showed me all the stuff Alberta is building, I received an email from Dr. Bonnie R. Larson, who’s on faculty at the University of Calgary. She thought I should have talked to her, and she thought I was too credulous in reporting the Alberta government’s side. I asked if I could publish part of her email. Here it is.
What cannot be taken for granted is Mr. Smith’s view that his goals are different, somehow nobler, than those of us on the front line. Smith paints a picture that front line providers’ priorities are at odds with his own. His perspective is at once undemocratic, insulting, and arrogant, belittling those who are doing the hard work of keeping people alive every day.
I will not have Smith speak for me in his suggestion that front liners lack system knowledge and that is why we support harm reduction. This ignores the excellent evidence supporting harm reduction interventions at the population level. Smith seems to think he knows from whence I “enter this conversation”. If so, why does he not engage me and my expert colleagues? Where I “enter this conversation” is at 20 years of working with the affected community and 13 years of post-secondary education. The only reason I am what Smith likes to dismiss as a “radical harm reduction activist”, is because the UCP, immediately upon taking office, set out to destroy harm reduction in Alberta. Nobody would have ever needed to fight this soul-destroying battle in the first place if Smith hadn’t put Alberta squarely on its current path of destruction. Yes, we should hope for a better tomorrow but that doesn’t excuse ignoring the past and present.
I would ask you to think about several additional factors that your analysis appears to ignore, including who actually benefits, in power and wealth, from Smiths’ system of so-called care? DId you consider the other ways that the UCP policy direction is moving the entire publicly-funded system steadily towards profit? Gunn (McCullough Centre) was a wonderful non-profit facility that helped many of my patients find their way to recovery from substance use disorders. While I agree that people should not have to pay for treatment, the question remains: in whose pockets do those tax dollars ultimately land?
You report that Smith indicates that they are “monitoring” the entire system. Where is the data from that monitoring? They have had five years now to show some outcomes, but who am I, just a lowly street doctor, to ask for population data? What I do know is that if deaths begin to decline, it is because so many are already gone. You should ask to see the data about which Smith so proudly boasts.
Smith’s entire premise that he is fixing the ‘addiction crisis’ is a fallacy. Addictions are not increasing. Deaths by drug poisonings are, however, and Smith’s circus is only making that worse. Allow me to spell it out for you: harm reduction addresses the drug poisoning crisis that is, no question, taking a horrific toll in Alberta and nationally. Smith’s ROSC, in contrast, addresses a figmentary addictions crisis.
One last tip. Medications used for opioid agonist treatment are not harm reduction, they are treatment. Nobody here is against treatment or recovery. But Marshall Smith is against harm reduction. Why can’t we just have the full spectrum of care??? Polarization is created by politicians to benefit politicians.
I don’t endorse everything Dr. Larson writes here. The data, or a lot of it, seems to me to be publicly available on the province’s impressive dashboard website. Use the tabs at the top of the page to navigate. And indeed, the story the dashboard tells is alarming, which, as I explained in this series’ first instalment, is why I flew west. But Larson’s years of front-line work has earned her, at the very least, a right of rebuttal.
Synthesis
On my last day in Edmonton, I met Monty Ghosh at Highlevel Diner, at the outer edge of the hip Strathcona neighbourhood on the south of the North Saskatchewan River. Highlevel is famous for its cinnamon buns, which, if I’m going to be honest, are noteworthy mostly for being large.
If the Alberta government and its most vociferous critics are thesis and antithesis, Ghosh tries to provide synthesis. He helped design the National Overdose Response Service, or NORS, which provides some of the emergency-response capability supervised consumption sites offer to people who aren’t near such a site or can’t use it for other reasons. He’s been critical of the Alberta government, but both sides keep lines of communication open.
I asked him about diverted safe supply — the idea that pharmaceutical opioids used in safe-supply programs in BC, principally hydromorphone tablets, are being sold or distributed away from their intended use. “I know it happens,” Ghosh said. “We sometimes get clients from British Columbia who come to Alberta to try to escape BC, because they’re looking for a fresh start. They’re looking for support and they’ll tell me themselves that they’ve diverted their safe supply.”
But what are the quantities? Trivial so far, Ghosh maintains. “Have I seen hydromorphone come into our province? Not at all, not yet.” This is the same thing I heard from Warren Driechel, the Edmonton deputy police chief.
Why do people divert their prescribed safe supply anyway? The answer Ghosh gave me was the answer I heard from everyone I asked. “They never used it. It just was not effective. The potency of the hydromorphone that they’re getting was nowhere near touching the fentanyl that they were using. It wasn’t dealing with the cravings, it wasn’t dealing with withdrawals, they felt it was useless. So what did they do? They sold it. They’re incredibly poor, they cannot afford their substance-use concerns and so therefore they supplement with revenue from hydromorphone.”
Before I flew to Edmonton, when Ghosh and I were trying to gauge on the phone what each of us thought of this infernal crisis, he figured out that I was interested in the differences between government policy in British Columbia and Alberta. “I’m not sure you want to hear this,” he said, “but I think it’s going to be bad everywhere.” I said that’s what I think too. Perhaps I surprised him.
I don’t know what happens next. Maybe things just stop getting worse everywhere on their own, for big complex reasons that resist easy analysis. Overdose deaths were lower last year in the United States, the capital of this hellscape, than the year before.
If not… well, we shall see. I wonder what happens in year six or seven of the effort the Alberta government is building. Is there resentment among people in ordinary hospitals and correctional facilities, who don’t have access to bespoke programs and personal attention? Does the ROSC system become bureaucratized after the first generation of administrators moves on?
Or does it start to win converts? David Eby, the NDP premier of British Columbia, has started putting distance between himself and his public-health advisors on legalization and safe supply. A new appointment in BC is being closely watched in Edmonton.
Or, conversely, does the Alberta recovery effort bump up against the limits imposed by the substances involved and by human nature? Reported recovery rates from addiction vary widely, depending in part on how you measure them. This paper puts the rate at less than 30%. If you even manage to double it, that still leaves a large cohort who aren’t getting better. Would their neighbours see them as people who “failed recovery” or “blew their chance?”
I won’t claim to know. I do hope that in the year ahead, more Canadians check their assumptions and stow their cheap certainties. Especially those who aspire to positions of leadership.
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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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