Addictions
Reckless: British Columbia’s “safe supply” fentanyl tablet experiment
From the MacDonald Laurier Institute
By Adam Zivo
While safer supply sounds nice in theory, addiction experts have found that drug users are reselling (“diverting”) a significant portion of their free hydromorphone on the black market to purchase harder substances. This has fuelled new addictions while generating handsome profits for organized crime.
Adam Zivo reviews the latest drug protocols adopted by the BC government and reports on their alarming lack of evidence and accountability.
British Columbia’s new drug protocols allow doctors throughout the province to prescribe “safer supply” drugs in a reckless manner.
In a new report titled Reckless: British Columbia’s “safe supply” fentanyl tablet experiment, Adam Zivo reviews the newest drug protocols adopted by the BC government, documenting the evolution of “safe supply” opioid programs in Canada since 2020. Zivo reports on the concerning lack of evidence behind the protocols, how they undermine recovery, drive diversion to the black market, and ruin the lives of young Canadians.
The new protocols not only avoid any requirement for drug users to first try evidence-based recovery programs before receiving high-potency opioids, but also allow minors to receive them, with no reference to the rights and roles of parents or even a minimum age for safer supply clients.
Of deep concern is also the BC government’s approach of continually increasing access to “safe” opioids despite openly admitting that there is no evidence of proven benefits or safety. The protocols also require that clients be told that their access to free fentanyl and sufentanil will almost certainly be cut off if they are hospitalized, or if they attend withdrawal management or substance use treatment facilities.
Zivo explains: “The prospect of free fentanyl and sufentanil creates powerful incentives to sign away one’s rights to evidence based treatment, so the province is essentially exploiting clients’ addictions so that it can experiment on them without taking legal responsibility for potential harms.”
Zivo adds that “one can reasonably expect that a significant portion of the fentanyl tablets being distributed by the BC government will end up being traded or resold on the black market,” explaining how mass diversion is already a major issue for weaker “safer supply” opioids like hydromorphone.
While addiction experts have been overwhelmingly critical of unsupervised safer supply, Zivo notes that many believe that the solution is not to abolish but to reform the program so that drugs can be provided more responsibly. By receiving safer supply as a temporary intervention, addicted users can transition to recovery-oriented treatments such as opioid agonist therapy (OAT.)
“It would not take much to reshape BC’s safer supply fentanyl and sufentanil programs into something more responsible and genuinely safe,” concludes Zivo. “There is nothing preventing the province from redesigning safer supply as a recovery-oriented intervention.”
To learn more, read the full paper here:
Executive Summary
This past August, British Columbia’s government quietly launched new protocols that allow doctors to prescribe “safer supply” fentanyl tablets and liquid sufentanil. Fentanyl is at least 10 times stronger than hydromorphone and sufentanil, which is derived from fentanyl, is a further 5 to 10 times more potent than its parent drug. While in theory these drugs could save lives if provisioned cautiously, the way the province has chosen to distribute these dangerous opioids is nothing short of reckless.
There is evidence to support the use of opioid agonist therapy (“OAT”) medications, such as methadone, buprenorphine, and slow release oral morphine in addiction treatment, but the government’s new protocols extrapolate OAT-related evidence to support “safer supply” fentanyl even though the two therapies have little in common. In fact, the government’s protocols stress that providing safer supply fentanyl or sufentanil is “not a treatment for opioid use disorder” and that “there is no evidence available supporting this intervention, safety data, or established best practices for when and how to provide it.” It is deeply concerning that the BC government has, over the past several years, significantly increased access to “safe” fentanyl and sufentanil despite openly admitting that there is no evidence showing that these interventions provide any benefits and can be implemented safely.
“Safer supply” programs claim to reduce overdoses and deaths by providing free pharmaceutical-grade drugs as alternatives to potentially tainted illicit substances. While safer supply sounds nice in theory, addiction experts have found that drug users are reselling (“diverting”) a significant portion of their free hydromorphone on the black market to purchase harder substances. This has fuelled new addictions while generating handsome profits for organized crime. Some patients have even been coerced into securing safer supply they didn’t need. Pimps and abusive partners pressure vulnerable women into securing as much hydromorphone as possible for black market resale. Other vulnerable patients, such as the geriatric and disabled, have been robbed of their safer supply outside of pharmacies.
There are other issues with the protocols, too. They require that clients be told that their access to free fentanyl and sufentanil will almost certainly be cut off if they are hospitalized, or if they attend withdrawal management or substance use treatment facilities. This creates powerful disincentives for drug users to seek life-saving health care. Further, none of the safer supply protocols by the British Columbia Centre on Substance Use (BCCSU) discuss the rights and roles of the parents of minors struggling with addiction. It appears that health care providers can give fentanyl and sufentanil to minors regardless of whether parents are aware of, or consent to, this intervention. The protocols do not specify a minimum age for safer supply clients.
It would not take much to reshape BC’s safer supply fentanyl and sufentanil programs into something more responsible and genuinely safe. There is nothing preventing the province from redesigning safer supply as a recovery-oriented intervention. Experts argue that safer supply could be helpful if used as a temporary intervention that helps severely-addicted users make the transition to recovery-oriented treatments, such as OAT.
There is also nothing stopping the province from fixing many of the issues with the safer supply program – including lax safeguards for youth. Any safer supply model must require supervised consumption. It is the absence of this supervision that has enabled the mass diversion of safer supply drugs onto the black market.
Governments have a duty to provide evidence-based treatment to vulnerable citizens and consider collateral harms to others. Rather than fulfil this duty, the BC government is committing to risky and highly experimental interventions that lack an appropriate evidence base.
Adam Zivo is a freelance writer and political analyst best known for his weekly columns in the National Post. He holds a Master of Public Policy from the Munk School of Global Affairs and Public Policy and recently founded the Centre for Responsible Drug Policy, a nonprofit advocacy organization.
Addictions
Ontario to restrict Canadian government’s supervised drug sites, shift focus to helping addicts
From LifeSiteNews
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.
‘No’ new drug sites in Ontario, vows Health Minister
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.
Addictions
BC Addictions Expert Questions Ties Between Safer Supply Advocates and For-Profit Companies
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.
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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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