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Addictions

There’s No Such Thing as a “Safer Supply” of Drugs

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9 minute read

By Adam Zivo

Sweden, the U.K., and Canada all experimented with providing opioids to addicts. The results were disastrous.

[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research. We encourage our readers to subscribe to them for high-quality analysis on urban issues]

Last August, Denver’s city council passed a proclamation endorsing radical “harm reduction” strategies to address the drug crisis. Among these was “safer supply,” the idea that the government should give drug users their drug of choice, for free. Safer supply is a popular idea among drug-reform activists. But other countries have already tested this experiment and seen disastrous results, including more addiction, crime, and overdose deaths. It would be foolish to follow their example.

The safer-supply movement maintains that drug-related overdoses, infections, and deaths are driven by the unpredictability of the black market, where drugs are inconsistently dosed and often adulterated with other toxic substances. With ultra-potent opioids like fentanyl, even minor dosing errors can prove fatal. Drug contaminants, which dealers use to provide a stronger high at a lower cost, can be just as deadly and potentially disfiguring.

Because of this, harm-reduction activists sometimes argue that governments should provide a free supply of unadulterated, “safe” drugs to get users to abandon the dangerous street supply. Or they say that such drugs should be sold in a controlled manner, like alcohol or cannabis—an endorsement of partial or total drug legalization.

But “safe” is a relative term: the drugs championed by these activists include pharmaceutical-grade fentanyl, hydromorphone (an opioid as potent as heroin), and prescription meth. Though less risky than their illicit alternatives, these drugs are still profoundly dangerous.

The theory behind safer supply is not entirely unreasonable, but in every country that has tried it, implementation has led to increased suffering and addiction. In Europe, only Sweden and the U.K. have tested safer supply, both in the 1960s. The Swedish model gave more than 100 addicts nearly unlimited access through their doctors to prescriptions for morphine and amphetamines, with no expectations of supervised consumption. Recipients mostly sold their free drugs on the black market, often through a network of “satellite patients” (addicts who purchased prescribed drugs). This led to an explosion of addiction and public disorder.

Most doctors quickly abandoned the experiment, and it was shut down after just two years and several high-profile overdose deaths, including that of a 17-year-old girl. Media coverage portrayed safer supply as a generational medical scandal and noted that the British, after experiencing similar problems, also abandoned their experiment.

While the U.S. has never formally adopted a safer-supply policy, it experienced something functionally similar during the OxyContin crisis of the 2000s. At the time, access to the powerful opioid was virtually unrestricted in many parts of North America. Addicts turned to pharmacies for an easy fix and often sold or traded their extra pills for a quick buck. Unscrupulous “pill mills” handed out prescriptions like candy, flooding communities with OxyContin and similar narcotics. The result was a devastating opioid epidemic—one that rages to this day, at a cumulative cost of hundreds of thousands of American lives. Canada was similarly affected.

The OxyContin crisis explains why many experienced addiction experts were aghast when Canada greatly expanded access to safer supply in 2020, following a four-year pilot project. They worried that the mistakes of the recent past were being made all over again, and that the recently vanquished pill mills had returned under the cloak of “harm reduction.”

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Most Canadian safer-supply prescribers dispense large quantities of hydromorphone with little to no supervised consumption. Patients can receive up to 40 eight-milligram pills per day—despite the fact that just two or three are enough to cause an overdose in someone without opioid tolerance. Some prescribers also provide supplementary fentanyl, oxycodone, or stimulants.

Unfortunately, many safer-supply patients sell or trade a significant portion of these drugs—primarily hydromorphone—in order to purchase more potent illicit substances, such as street fentanyl.

The problems with safer supply entered Canada’s consciousness in mid-2023, through an investigative report I wrote for the National Post. I interviewed 14 addiction physicians from across the country, who testified that safer-supply diversion is ubiquitous; that the street price of hydromorphone collapsed by up to 95 percent in communities where safer supply is available; that youth are consuming and becoming addicted to diverted safer-supply drugs; and that organized crime traffics these drugs.

Facing pushback, I interviewed former drug users, who estimated that roughly 80 percent of the safer-supply drugs flowing through their social circles was getting diverted. I documented dozens of examples of safer-supply trafficking online, representing tens of thousands of pills. I spoke with youth who had developed addictions from diverted safer supply and adults who had purchased thousands of such pills.

After months of public queries, the police department of London, Ontario—where safer supply was first piloted—revealed last summer that annual hydromorphone seizures rose over 3,000 percent between 2019 and 2023. The department later held a press conference warning that gangs clearly traffic safer supply. The police departments of two nearby midsize cities also saw their post-2019 hydromorphone seizures increase more than 1,000 percent.

The Canadian government quietly dropped its support for safer supply last year, cutting funding for many of its pilot programs. The province of British Columbia (the nexus of the harm-reduction movement) finally pulled back support last month, after a leaked presentation confirmed that safer-supply drugs are getting sold internationally and that the government is investigating 60 pharmacies for paying kickbacks to safer-supply patients. For now, all safer-supply drugs dispensed within the province must be consumed under supervision.

Harm-reduction activists have insisted that no hard evidence exists of widespread diversion of safer-supply drugs, but this is only because they refuse to study the issue. Most “studies” supporting safer supply are produced by ideologically driven activist-scholars, who tend to interview a small number of program enrollees. These activists also reject attempts to track diversion as “stigmatizing.”

The experiences of Sweden, the United Kingdom, and Canada offer a clear warning: safer supply is a reliably harmful policy. The outcomes speak for themselves—rising addiction, diversion, and little evidence of long-term benefit.

As the debate unfolds in the United States, policymakers would do well to learn from these failures. Americans should not be made to endure the consequences of a policy already discredited abroad simply because progressive leaders choose to ignore the record. The question now is whether we will repeat others’ mistakes—or chart a more responsible course.

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Addictions

Addiction experts demand witnessed dosing guidelines after pharmacy scam exposed

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By Alexandra Keeler 

The move follows explosive revelations that more than 60 B.C. pharmacies were allegedly participating in a scheme to overbill the government under its safer supply program. The scheme involved pharmacies incentivizing 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.

An addiction medicine advocacy group is urging B.C. to promptly issue new guidelines for witnessed dosing of drugs dispensed under the province’s controversial safer supply program.

In a March 24 letter to B.C.’s health minister, Addiction Medicine Canada criticized the BC Centre on Substance Use for dragging its feet on delivering the guidelines and downplaying the harms of prescription opioids.

The centre, a government-funded research hub, was tasked by the B.C. government with developing the guidelines after B.C. pledged in February to return to witnessed dosing. The government’s promise followed revelations that many B.C. pharmacies were exploiting rules permitting patients to take safer supply opioids home with them, leading to abuse of the program.

“I think this is just a delay,” said Dr. Jenny Melamed, a Surrey-based family physician and addiction specialist who signed the Addiction Medicine Canada letter. But she urged the centre to act promptly to release new guidelines.

“We’re doing harm and we cannot just leave people where they are.”

Addiction Medicine Canada’s letter also includes recommendations for moving clients off addictive opioids altogether.

“We should go back to evidence-based medicine, where we have medications that work for people in addiction,” said Melamed.

‘Best for patients’

On Feb. 19, the B.C. government said it would return to a witnessed dosing model. This model — which had been in place prior to the pandemic — will require safer supply participants to take prescribed opioids under the supervision of health-care professionals.

The move follows explosive revelations that more than 60 B.C. pharmacies were allegedly participating in a scheme to overbill the government under its safer supply program. The scheme involved pharmacies incentivizing 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.

In its Feb. 19 announcement, the province said new participants in the safer supply program would immediately be subject to the witnessed dosing requirement. For existing clients of the program, new guidelines would be forthcoming.

“The Ministry will work with the BC Centre on Substance Use to rapidly develop clinical guidelines to support prescribers that also takes into account what’s best for patients and their safety,” Kendra Wong, a spokesperson for B.C.’s health ministry, told Canadian Affairs in an emailed statement on Feb. 27.

More than a month later, addiction specialists are still waiting.

 

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According to Addiction Medicine Canada’s letter, the BC Centre on Substance Use posed “fundamental questions” to the B.C. government, potentially causing the delay.

“We’re stuck in a place where the government publicly has said it’s told BCCSU to make guidance, and BCCSU has said it’s waiting for government to tell them what to do,” Melamed told Canadian Affairs.

This lag has frustrated addiction specialists, who argue the lack of clear guidance is impeding the transition to witnessed dosing and jeopardizing patient care. They warn that permitting take-home drugs leads to more diversion onto the streets, putting individuals at greater risk.

“Diversion of prescribed alternatives expands the number of people using opioids, and dying from hydromorphone and fentanyl use,” reads the letter, which was also co-signed by Dr. Robert Cooper and Dr. Michael Lester. The doctors are founding board members of Addiction Medicine Canada, a nonprofit that advises on addiction medicine and advocates for research-based treatment options.

“We have had people come in [to our clinic] and say they’ve accessed hydromorphone on the street and now they would like us to continue [prescribing] it,” Melamed told Canadian Affairs.

A spokesperson for the BC Centre on Substance Use declined to comment, referring Canadian Affairs to the Ministry of Health. The ministry was unable to provide comment by the publication deadline.

Big challenges

Under the witnessed dosing model, doctors, nurses and pharmacists will oversee consumption of opioids such as hydromorphone, methadone and morphine in clinics or pharmacies.

The shift back to witnessed dosing will place significant demands on pharmacists and patients. In April 2024, an estimated 4,400 people participated in B.C.’s safer supply program.

Chris Chiew, vice president of pharmacy and health-care innovation at the pharmacy chain London Drugs, told Canadian Affairs that the chain’s pharmacists will supervise consumption in semi-private booths.

Nathan Wong, a B.C.-based pharmacist who left the profession in 2024, fears witnessed dosing will overwhelm already overburdened pharmacists, creating new barriers to care.

“One of the biggest challenges of the retail pharmacy model is that there is a tension between making commercial profit, and being able to spend the necessary time with the patient to do a good and thorough job,” he said.

“Pharmacists often feel rushed to check prescriptions, and may not have the time to perform detailed patient counselling.”

Others say the return to witnessed dosing could create serious challenges for individuals who do not live close to health-care providers.

Shelley Singer, a resident of Cowichan Bay, B.C., on Vancouver Island, says it was difficult to make multiple, daily visits to a pharmacy each day when her daughter was placed on witnessed dosing years ago.

“It was ridiculous,” said Singer, whose local pharmacy is a 15-minute drive from her home. As a retiree, she was able to drive her daughter to the pharmacy twice a day for her doses. But she worries about patients who do not have that kind of support.

“I don’t believe witnessed supply is the way to go,” said Singer, who credits safer supply with saving her daughter’s life.

Melamed notes that not all safer supply medications require witnessed dosing.

“Methadone is under witness dosing because you start low and go slow, and then it’s based on a contingency management program,” she said. “When the urine shows evidence of no other drug, when the person is stable, [they can] take it at home.”

She also noted that Suboxone, a daily medication that prevents opioid highs, reduces cravings and alleviates withdrawal, does not require strict supervision.

Kendra Wong, of the B.C. health ministry, told Canadian Affairs that long-acting medications such as methadone and buprenorphine could be reintroduced to help reduce the strain on health-care professionals and patients.

“There are medications available through the [safer supply] program that have to be taken less often than others — some as far apart as every two to three days,” said Wong.

“Clinicians may choose to transition patients to those medications so that they have to come in less regularly.”

Such an approach would align with Addiction Medicine Canada’s recommendations to the ministry.

The group says it supports supervised dosing of hydromorphone as a short-term solution to prevent diversion. But Melamed said the long-term goal of any addiction treatment program should be to reduce users’ reliance on opioids.

The group recommends combining safer supply hydromorphone with opioid agonist therapies. These therapies use controlled medications to reduce withdrawal symptoms, cravings and some of the risks associated with addiction.

They also recommend limiting unsupervised hydromorphone to a maximum of five 8 mg tablets a day — down from the 30 tablets currently permitted with take-home supplies. And they recommend that doses be tapered over time.

“This protocol is being used with success by clinicians in B.C. and elsewhere,” the letter says.

“Please ensure that the administrative delay of the implementation of your new policy is not used to continue to harm the public.”


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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2025 Federal Election

Poilievre to invest in recovery, cut off federal funding for opioids and defund drug dens

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From Conservative Party Communications

Poilievre will Make Recovery a Reality for 50,000 Canadians

Conservative Leader Pierre Poilievre pledged he will bring the hope that our vulnerable Canadians need by expanding drug recovery programs, creating 50,000 new opportunities for Canadians seeking freedom from addiction. At the same time, he will stop federal funding for opioids, defund federal drug dens, and ensure that any remaining sites do not operate within 500 meters of schools, daycares, playgrounds, parks and seniors’ homes, and comply with strict new oversight rules that focus on pathways to treatment.

More than 50,000 people have lost their lives to fentanyl since 2015—more Canadians than died in the Second World War. Poilievre pledged to open a path to recovery while cracking down on the radical Liberal experiment with free access to illegal drugs that has made the crisis worse and brought disorder to local communities.

Specifically, Poilievre will:

  1. Fund treatment for 50,000 Canadians. A new Conservative government will fund treatment for 50,000 Canadians in treatment centres with a proven record of success at getting people off drugs. This includes successful models like the Bruce Oake Recovery Centre, which helps people recover and reunite with their families, communities, and culture. To ensure the best outcomes, funding will follow results. Where spaces in good treatment programs exist, we will use them, and where they need to expand, these funds will allow that.
  2. Ban drug dens from being located within 500 metres of schools, daycares, playgrounds, parks, and seniors’ homes and impose strict new oversight rules. Poilievre also pledged to crack down on the Liberals’ reckless experiments with free access to illegal drugs that allow provinces to operate drug sites with no oversight, while pausing any new federal exemptions until evidence justifies they support recovery. Existing federal sites will be required to operate away from residential communities and places where families and children frequent and will now also have to focus on connecting users with treatment, meet stricter regulatory standards or be shut down. He will also end the exemption for fly-by-night provincially-regulated sites.

“After the Lost Liberal Decade, Canada’s addiction crisis has spiralled out of control,” said Poilievre. “Families have been torn apart while children have to witness open drug use and walk through dangerous encampments to get to school. Canadians deserve better than the endless Liberal cycle of crime, despair, and death.”

Since the Liberals were first elected in 2015, our once-safe communities have become sordid and disordered, while more and more Canadians have been lost to the dangerous drugs the Liberals have flooded into our streets. In British Columbia, where the Liberals decriminalized dangerous drugs like fentanyl and meth, drug overdose deaths increased by 200 percent.

The Liberals also pursued a radical experiment of taxpayer-funded hard drugs, which are often diverted and resold to children and other vulnerable Canadians. The Vancouver Police Department has said that roughly half of all hydromorphone seizures were diverted from this hard drugs program, while the Waterloo Regional Police Service and Niagara Regional Police Service said that hydromorphone seizures had exploded by 1,090% and 1,577%, respectively.

Despite the death and despair that is now common on our streets, bizarrely Mark Carney told a room of Liberal supporters that 50,000 fentanyl deaths in Canada is not “a crisis.” He also hand-picked a Liberal candidate who said the Liberals “would be smart to lean into drug decriminalization” and another who said “legalizing all drugs would be good for Canada.”

Carney’s star candidate Gregor Robertson, an early advocate of decriminalization and so-called safe supply, wanted drug dens imposed on communities without any consultation or public safety considerations. During his disastrous tenure as Vancouver Mayor, overdoses increased by 600%.

Alberta has pioneered an approach that offers real hope by adopting a recovery-focused model of care, leading to a nearly 40 percent reduction in drug-poisoning deaths since 2023—three times the decrease seen in British Columbia. However, we must also end the Liberal drug policies that have worsened the crisis and harmed countless lives and families.

To fund this policy, a Conservative government will stop federal funding for opioids, defund federal drug dens, and sue the opioid manufacturers and consulting companies who created this crisis in the first place.

“Canadians deserve better than the Liberal cycle of crime, despair, and death,” said Poilievre. “We will treat addiction with compassion and accountability—not with more taxpayer-funded poison. We will turn hurt into hope by shutting down drug dens, restoring order in our communities, funding real recovery, and bringing our loved ones home drug-free.”

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