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Addictions

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.

Addictions

Ontario to restrict Canadian government’s supervised drug sites, shift focus to helping addicts

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From LifeSiteNews

By Anthony Murdoch

Doug Ford’s Progressive Conservative government tabled the Safer Streets, Stronger Communities Act that will place into law specific bans on where such drug consumption sites are located.

Ontario Premier Doug Ford is making good on a promise to close so-called drug “supervision” sites in his province and says his government will focus on helping addicts get better instead of giving them free drugs.

Ford’s Progressive Conservative government on Monday tabled the Safer Streets, Stronger Communities Act that will place into law specific bans on where such drug consumption sites are located.

Specifically, the new bill will ban “supervised” drug consumption sites from being close to schools or childcare centers. Ten sites will close for now, including five in Toronto.

The new law would prohibit the “establishment and operation of a supervised consumption site at a location that is less than 200 meters from certain types of schools, private schools, childcare centers, Early child and family centers and such other premises as may be prescribed by the regulations.”

It would also in effect ban municipalities and local boards from applying for an “exemption from the Controlled Drugs and Substances Act (Canada) for the purpose of decriminalizing the personal possession of a controlled substance or precursor.”

Lastly, the new law would put strict “limits” on the power municipalities and local boards have concerning “applications respecting supervised consumption sites and safer supply services.”

“Municipalities and local boards may only make such applications or support such applications if they have obtained the approval of the provincial Minister of Health,” the bill reads.

The new bill is part of a larger omnibus bill that makes changes relating to sex offenders as well as auto theft, which has exploded in the province in recent months.

In September, Ford had called the federal government’s lax drug policies tantamount to being the “biggest drug dealer in the entire country” and had vowed to act.

In speaking about the new bill, Ontario Minister of Health Sylvia Jones said the Ford government does not plan to allow municipal requests to the government regarding supervised consumption sites.

“Municipalities and organizations like public health units have to first come to the province because we don’t want them bypassing and getting any federal approval for something that we vehemently disagree with,” Jones told the media on Monday.

She also clarified that “there will be no further safe injection sites in the province of Ontario under our government.”

Ontario will instead create 19 new intensive addiction recovery to help those addicted to deadly drugs.

Alberta and other provinces have had success helping addicts instead of giving them free drugs.

As reported by LifeSiteNews, deaths related to opioid and other drug overdoses in Alberta fell to their lowest levels in years after the Conservative government began to focus on helping addicts via a recovery-based approach instead of the Liberal-minded, so-called “safe-supply” method.

Despite public backlash with respect to supervised drug consumption sites, Health Canada recently approved 16 more drug consumption sites in Ontario. Ford mentioned in the press conference that each day he gets “endless phone calls about needles being in the parks, needles being by the schools and the daycares,” calling the situation “unacceptable.”

The Liberals claim their “safer supply” program is good because it is “providing prescribed medications as a safer alternative to the toxic illegal drug supply to people who are at high risk of overdose.”

However, studies have shown that these programs often lead an excess of deaths from overdose in areas where they are allowed.

While many of the government’s lax drug policies continue, they have been forced to backpedal on some of their most extreme actions.

After the federal government allowed British Columbia to decriminalize the possession of hard drugs including heroin, cocaine, fentanyl, meth and MDMA beginning January 1, 2023, reports of overdoses and chaos began skyrocketing, leading the province to request that Trudeau re-criminalize drugs in public spaces.

A week later, the federal government relented and accepted British Columbia’s request.

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Addictions

BC Addictions Expert Questions Ties Between Safer Supply Advocates and For-Profit Companies

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By Liam Hunt

Canada’s safer supply programs are “selling people down the river,” says a leading medical expert in British Columbia. Dr. Julian Somers, director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University, says that despite the thin evidence in support of these experimental programs, the BC government has aggressively expanded them—and retaliated against dissenting researchers.

Somers also, controversially, raises questions about doctors and former health officials who appear to have gravitated toward businesses involved in these programs. He notes that these connections warrant closer scrutiny to ensure public policies remain free from undue industry influence.

Safer supply programs claim to reduce overdoses and deaths by distributing free addictive drugs—typically 8-milligram tablets of hydromorphone, an opioid as potent as heroin—to dissuade addicts from accessing riskier street substances. Yet, a growing number of doctors say these programs are deeply misguided—and widely defrauded.

Ultimately, Somers argues, safer supply is exacerbating the country’s addiction crisis.

Somers opposed safer supply at its inception and openly criticized its nationwide expansion in 2020. He believes these programs perpetuate drug use and societal disconnection and fail to encourage users to make the mental and social changes needed to beat addiction. Worse yet, the safer supply movement seems rife with double standards that devalue the lives of poorer drug users. While working professionals are provided generous supports that prioritize recovery, disadvantaged Canadians are given “ineffective yet profitable” interventions, such as safer supply, that “convey no expectation that stopping substance use or overcoming addiction is a desirable or important goal.”

To better understand addiction, Somers created the Inter-Ministry Evaluation Database (IMED) in 2004, which, for the first time in BC’s history, connected disparate information—i.e. hospitalizations, incarceration rates—about vulnerable populations.

Throughout its existence, health experts used IMED’s data to create dozens of research projects and papers. It allowed Somers to conduct a multi-million-dollar randomized control trial (the “Vancouver at Home” study) that showed that scattering vulnerable people into regular apartments throughout the city, rather than warehousing them in a few buildings, leads to better outcomes at no additional cost.

In early 2021, Somers presented recommendations drawn from his analysis of the IMED to several leading officials in the B.C. government. He says that these officials gave a frosty reception to his ideas, which prioritized employment, rehabilitation, and social integration over easy access to drugs. Shortly afterwards, the government ordered him to immediately and permanently delete the IMED’s ministerial data.

Somers describes the order as a “devastating act of retaliation” and says that losing access to the IMED effectively ended his career as a researcher. “My lab can no longer do the research we were doing,” he noted, adding that public funding now goes exclusively toward projects sympathetic to safer supply. The B.C. government has since denied that its order was politically motivated.

In early 2022, the government of Alberta commissioned a team of researchers, led by Somers, to investigate the evidence base behind safer supply. They found that there was no empirical proof that the experiment works, and that harm reduction researchers often advocated for safer supply within their studies even if their data did not support such recommendations.

Somers says that, after these findings were published, his team was subjected to a smear campaign that was partially organized by the British Columbia Centre on Substance Use (BCCSU), a powerful pro-safer supply research organization with close ties to the B.C. government. The BCCSU has been instrumental in the expansion of safer supply and has produced studies and protocols in support of it, sometimes at the behest of the provincial government.

Somers is also concerned about the connections between some of safer supply’s key proponents and for-profit drug companies.

He notes that the BCCSU’s founding executive director, Dr. Evan Wood, became Chief Medical Officer at Numinus Wellness, a publicly traded psychedelic company, in 2020. Similarly, Dr. Perry Kendall, who also served as a BCCSU executive director, went on to found Fair Price Pharma, a now-defunct for-profit company that specializes in providing pharmaceutical heroin to high-risk drug users, the following year.

While these connections are not necessarily unethical, they do raise important questions about whether there is enough industry regulation to minimize potential conflicts of interest, whether they be real or perceived.

The BCCSU was also recently criticized in an editorial by Canadian Affairs, which noted that the organization had received funding from companies such as Shoppers Drug Mart and Tilray (a cannabis company). The editorial argued that influential addiction research organizations should not receive drug industry funding and reported that Alberta founded its own counterpart to the BCCSU in August, known as the Canadian Centre of Recovery Excellence, which is legally prohibited from accepting such sponsorships.

Already, private interests are betting on the likely expansion of safer supply programs. For instance, Safe Supply Streaming Co., a publicly traded venture capital firm, has advertised to potential investors that B.C.’s safer supply system could create a multi-billion-dollar annual market.

Somers believes that Canada needs more transparency regarding how for-profit companies may be directly or indirectly influencing policy makers: “We need to know exactly, to the dollar, how much of [harm reduction researchers’] operating budget is flowing from industry sources.”

Editor’s note: This story is published in syndication with Break The Needle and Western Standard.

The Bureau is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

Dr. Julian M. Somers is director of the Centre for Applied Research in Mental Health and Addiction at Simon Fraser University. He was Director of the UBC Psychology Clinic, and past president of the BC Psychological Association. Liam Hunt is a contributing author to the Centre For Responsible Drug Policy in partnership with the Macdonald-Laurier Institute.

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