Addictions
Safe supply opioids based more on ideology than evidence?
From the Frontier Centre for Public Policy
Those who advocate for them always claim the moral high ground because of ‘evidence-based studies.’ But such studies appear to be in short supply.
That’s probably why 72 BC doctors recently signed a letter that argues against safer supply, saying the evidence underlying the philosophy is “weak or inadequate.”
Almost three years into the experimental opiate “safer supply” program in British Columbia and no one, including those handing out the pills, seems to know if it is working or making the problem worse. There are no shortage of opinions arguing on either side of the debate, but recent reports suggest that the facts remain in short supply.
Safe supply initiatives fall under the broad category of harm reduction programs. For opiate addiction, the program typically involves the prescription and distribution of pills like hydromorphone, a medical-grade opioid that is as potent as heroin, to addicts. The underlying hope is that addicts will then forgo possibly-tainted, illicit street drugs in favour of the ‘safer’ government-provided pills.
More than 40,000 Canadians have lost their lives to opioid overdoses since 2016 and British Columbia is one of the world’s first jurisdictions to take the ‘safer supply’ route in an effort to quell opioid overdoses.
But BC’s Auditor General just released a report on the trial program and, so far, it remains unclear as to whether the program has made any progress. Opioid deaths are still increasing and, while the report doesn’t criticize the underlying philosophy of ‘safer supply,’ it does note “deficiencies in key areas.”
According to the report, the government is conducting the program in a rather haphazard way. BC health authorities failed to maintain basic standards for administering an experimental trial and neglected their obligation to publish data on how the program is doing. The data was supposed to be publicly available by September 2022, more than 18 months ago.
Instead, the report found that health authorities are overly reliant on incomplete and out-of-date fact sheets about the program’s performance. It also cited authorities for major failings in the management and delivery of the program.
The bureaucrats in charge claim that they have the data to support their claims about the success of the program, yet one has to wonder why — three years in — no data is available to support those claims.
A similar dearth of data has been noted in Ottawa where the House of Commons Health Committee has been exploring the opioid epidemic and toxic drug crisis. One doctor who leads a safer supply program in London, Ontario, appeared to be a strong advocate for safer supply programs, claiming that safe supply clinicians “rely on good research and published evidence.”
But Dr. Marcus Powlowski, a Liberal MP and medical doctor who also has a master’s degree in health law and policy from Harvard, had apparently looked at the papers that she proclaimed as evidence, and soundly renounced the studies as “basically a bunch of anecdotes.”
So where is this rigorous scientific evidence for safer supply programs?
Those who advocate for them always claim the moral high ground because of ‘evidence-based studies.’ But such studies appear to be in short supply.
That’s probably why 72 BC doctors recently signed a letter that argues against safer supply, saying the evidence underlying the philosophy is “weak or inadequate.” They called for all safer supply programs to be “tightly controlled, rigorously monitored, and meticulously documented.”
A lack of medical evidence is likely related to another major issue outlined in the Auditor General’s report – “prescriber hesitancy.” That is, there are only a limited number of doctors who are willing to write prescriptions for the potent opioids used in safer supply.
However, there is plenty of evidence for one disturbing aspect of this program – diversion. This is a practice whereby safer supply pills (primarily hydromorphone) given to addicts are subsequently sold (or diverted) to drug traffickers and/or organized crime groups to obtain more potent and illicit drugs like fentanyl.
In early March, the RCMP in Northern BC revealed that thousands of safe supply opiate pills had been seized as part of organized crime busts in Prince George and Campbell River. It was considered to be solid evidence that diversion of safer supply drugs was occurring. According to the RCMP spokesperson, “Organized crime groups are actively involved in the redistribution of safe supply and prescription drugs,” and “what has been deemed safe is not being kept safe.”
It is simply not realistic to expect that such practices are not occurring in our major cities. The National Post, the CBC and an independent filmmaker have all previously published evidence of diversion occurring in London, Ottawa and Vancouver, respectively.
Drug policies such as safe supply have long bypassed appropriate scientific scrutiny because they supposedly save lives. But the question still remains – do they? And at what cost to addicts and the rest of society?
Susan Martinuk is a Senior Fellow with the Frontier Centre for Public Policy and author of Patients at Risk: Exposing Canada’s Health-care Crisis.
A B.C. pharmacy scam investigation has led the provincial government to return to a witnessed consumption model for safer supply
More than 60 pharmacies across B.C. are alleged to have participated in a kickback scheme linked to safer supply drugs, according to a provincial report released Feb. 19.
On Feb. 5, the BC Conservatives leaked a report that showed the findings of an internal investigation by the B.C. Ministry of Health. That investigation showed dozens of pharmacies were filling prescriptions patients did not require in order to overbill the government. These safer supply drugs were then diverted onto the black market.
After the report was leaked, the province committed to ending take-home safer supply models, which allow users to take hydromorphone pills home in bottles. Instead, it will require drug users to consume prescribed opioids in a witnessed program, under the oversight of a medical professional.
Gregory Sword, whose 14-year-old daughter Kamilah died in August 2022 after taking a hydromorphone pill that had been diverted from B.C.’s safer supply program, expressed outrage over the report’s findings.
“This is so frustrating to hear that [pharmacies] were making money off this program and causing more drugs [to flood] the street,” Sword told Canadian Affairs on Feb. 20.
The investigation found that pharmacies exploited B.C.’s Frequency of Dispensing policy to maximize billings. To take advantage of dispensing fees, pharmacies incentivized clients to fill prescriptions they did not require by offering them cash or rewards. Some of those clients then sold the drugs on the black market. Pharmacies earned up to $11,000 per patient a year.
“I’m positive that [the B.C. government has] known this for a long time and only made this decision when the public became aware and the scrutiny was high,” said Elenore Sturko, Conservative MLA for Surrey-Cloverdale, who released the leaked report in a statement on Feb. 5.
“As much as I am really disappointed in how long it’s taken for this decision to be made, I am also happy that this has happened,” she said.
The health ministry said it is investigating the implicated pharmacies. Those that are confirmed to have been involved could have their licenses suspended, be referred to law enforcement or become ineligible to participate in PharmaCare, the provincial program that helps residents cover the costs of prescription drugs.
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Witnessed dosing
The leaked report says that “a significant portion of the opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients.” It also says “prescribed alternatives are trafficked provincially, nationally and internationally.”
Critics of the safer supply program say it enables addiction, while supporters say it reduces overdoses.
Sword, Kamilah’s father, is suing the provincial and federal governments, arguing B.C.’s safer supply program made it possible for youth such as his daughter to access drugs.
Madison, Kamilah’s best friend, also became addicted to opioids dispensed through safer supply programs. Madison was just 15 when she first encountered “dillies” — hydromorphone pills dispensed through safer supply, but widely available on the streets. She developed a tolerance that led her to fentanyl.
“I do know for sure that some pharmacies and doctors were aware of the diversion,” Madison’s mother Beth told Canadian Affairs on Feb. 20.
“When I first realized what my daughter was taking and how she was getting it, I phoned the pharmacy and the doctor on the label of the pill bottle to inform them that the patient was selling their hydromorphone,” Beth said.
Masha Krupp, an Ottawa mother who has a son enrolled in a safer supply program, has said the safer supply program in her city is similarly flawed. Canadian Affairs previously reported on this program, which is run by Recovery Care’s Ottawa-based harm reduction clinics.
“I read about the B.C. pharmacy scheme and wasn’t surprised,” Krupp told Canadian Affairs on Feb. 20. Krupp lost a daughter to methadone toxicity while she was in an addiction treatment program at Recovery Care.
“Three years [after starting safer supply], my son is still using fentanyl, crack cocaine and methadone, despite being with Dr. [Charles] Breau and with Recovery Care for over three years,” Krupp testified before the House of Commons Standing Committee on Health on Oct. 22, 2024.
Krupp has been vocal about the dangers of dispensing large quantities of opioids without proper oversight, arguing many patients sell their prescriptions to buy stronger street drugs.
“You can’t give addicts 28 pills and say, ‘Oh here you go,’” she said in her testimony. “They sell for three dollars a pop on the street.”
Krupp has also advocated for witnessed consumption of safer supply medications, arguing supervised dosing would prevent diversion and ensure proper oversight of pharmacies.
“I had talked about witnessed dosing for safe supply when I appeared before the parliamentary health committee last October,” she told Canadian Affairs this week.
“I’m grateful that finally … this decision has been made to return to a witness program,” said Sturko, the B.C. MLA.
In 2020, B.C. implemented a witnessed consumption model to ensure safer supply opioids were consumed as prescribed and to reduce diversion. In 2021, the province switched to take-home models. Its stated aim was to expand access, save lives and ease pressure on health-care facilities during the pandemic.
“You’re really fighting against a group of people … working within the bureaucracy of [the B.C. NDP] government … who have been making efforts to work towards the legalization of drugs and, in doing that, have looked only for opportunities to bolster their arguments for their position, instead of examining their approach in a balanced way,” said Sturko.
“These are foreseeable outcomes when you do not put proper safeguards in place and when you completely ignore all indications of negative impacts.”
Sword also believes some drug policies fail to prioritize the safety of vulnerable individuals.
“Greed is the ultimate evil in society and this just proves it,” he said. “We don’t care about these drugs getting into the wrong hands as long as I get my money.”
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 leaked audit shows from 2022 to 2024, a staggering 22,418,000 doses of opioids were prescribed by doctors and pharmacists to approximately 5,000 clients in B.C., including fentanyl patches.
A confidential investigation by British Columbia’s Ministry of Health, Financial Operations and Audit Branch has uncovered explosive allegations of fraud, abuse, and organized crime infiltration within PharmaCare’s prescribed opioid alternatives program. Internal audit findings, obtained by The Bureau, suggest that millions of taxpayer dollars are being diverted into illicit drug trafficking networks rather than serving harm reduction efforts.
The leaked documents include photographs from vehicle searches that show collections of fentanyl patches and Dilaudid (hydromorphone) apparently packaged for resale after being stolen from the taxpayer-funded “safer supply” program. This program expanded dramatically following a federal law change implemented by Prime Minister Justin Trudeau’s government in 2020, which broadened circumstances in which pharmacy staff could dispense opioids, according to the document’s evidence.
“Prior to March 17, 2020, only pharmacists in BC were permitted to deliver [addiction therapy treatment] drugs,” the audit says.
B.C.’s safer supply program was launched in March 2020 as a response to the opioid overdose crisis, declared in 2016. It allows people with opioid-use disorder to receive prescribed drugs to be used on-site or taken away for later use.
The Special Investigations Unit and PharmaCare Audit Intelligence team identified a disturbing link between doctors, pharmacists, assisted living residences, and organized crime, where prescription opioids meant to replace illicit drugs are instead being diverted, sold, and trafficked at scale.
“A significant portion of the opioids being freely prescribed by doctors and pharmacists are not being consumed by their intended recipients,” the document states.
It suggests that financial incentives have created a business model for organized crime, asserting that “prescribed alternatives (safe supply opioids) are trafficked provincially, nationally, and internationally,” and that “proceeds of fraud” are being used to pay incentives to doctors, pharmacists, and intermediaries.
BC Conservative critic Elenore Sturko, a former RCMP officer, began raising concerns about the program two years ago after hearing anecdotes about prescribed opioids being trafficked. She asserts that the program is a failure in public policy and insists that Provincial Health Officer Dr. Bonnie Henry be dismissed for having “denied and downplayed” problems as they emerged. Sturko also argues that B.C. must change its drug policy in light of U.S. President Donald Trump’s stance linking the trafficking of fentanyl and other opioids to potential trade sanctions against Canada.
The document shows that PharmaCare’s dispensing fee loophole has incentivized pharmacies to maximize billings per patient, with some locations charging up to $11,000 per patient per year—compared to just $120 in normal cases.
Perhaps most alarming is the deep infiltration of B.C.’s safer supply program by criminal networks. The Ministry of Health report lists “Gang Members/Organized Crime” as key players in the prescription drug pipeline, which includes “Doctors, pharmacies, and assisted living residences.”
This revelation confirms long-standing fears that B.C.’s “safe supply” policy—originally designed to prevent deaths from contaminated street drugs—is instead sometimes supplying criminal organizations with pharmaceutical-grade opioids.
The leaked audit shows from 2022 to 2024, a staggering 22,418,000 doses of opioids were prescribed by doctors and pharmacists to approximately 5,000 clients in B.C., including fentanyl patches.
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Beyond organized crime’s direct involvement, pharmacies themselves have exploited regulatory gaps to generate massive profits from PharmaCare’s policies:
- Pharmacies offer kickbacks to doctors, housing staff, and medical professionals to steer patients toward specific locations.
- Financial incentives fuel fraud, with multiple investigations identifying 60+ pharmacies offering incentives to clients.
- Non-health professionals, including housing staff, are witnessing OAT (opioid agonist treatment) dosing, violating patient safety protocols.
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