By Liam Hunt

“It seems to be motivated by a very small, vocal, and well-connected group of advocates” says Dr. Michael Lester

Dr. Michael Lester, a Toronto-based addiction physician with 30 years of experience, says Canada’s “safer supply” programs are “inherently dangerous” and causing “dystopian” community harms due to widespread fraud.

These 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 consuming riskier street substances. Yet experts across Canada say recipients regularly divert (sell or trade) their safer supply on the black market to acquire stronger illicit drugs, which then fuels addiction and organized crime.

“I have a couple dozen patients in my practice who were drug-free prior to the advent of safe supply, and they’ve gone back to using opioids in a destructive way because of the availability of diverted hydromorphone,” said Lester. “Every single day that I go to work, people tell me they’re struggling with the temptation not to take diverted safe supply. They don’t want to take it, but they take it anyway just because it’s cheap and available.”

After safer supply programs became widely accessible across Canada in 2020, Lester’s patients reported an influx of 8-milligram hydromorphone tablets on the black market, coinciding with a crash in the drug’s street price from $15–$20 per pill to just $2. He now estimates that 80 percent of his patients struggling with opioid addiction have relapsed due to diverted safer supply, leading some to abandon treatment entirely.

“Even if it’s sold at the rock-bottom price of $2 or $3 a pill, a person would make tens of thousands of dollars a year, which would have a tremendous impact on their ability to buy other drugs,” he explained. “Selling hydromorphone is too tempting not to do it, which keeps them entrenched in the whole world of dealing with opioid users and having opioids in their premises.”

Lester said safer supply is evidently “fueling organized crime” because drug seizures in Ontario now commonly include hydromorphone, “which wasn’t happening before.” He added that some individuals who try these diverted drugs later transition to stronger opioids, such as fentanyl.

In July, for example, the London Police Service announced that seizures of hydromorphone had increased by more than 3,000 percent in the city since 2020. According to London Police Chief Thai Truong, “Diverted safer supply is being resold into our community. There’s organized drug trafficking at the highest levels of organized crime, and there’s drug trafficking at the street level. We’re seeing all of it.”

While Lester acknowledges that safer supply can be useful as a “treatment of last resort, after traditional treatments have been tried and failed,” he said it is now being offered immediately to a wide variety of patients, which has “decimated” uptake of traditional addiction therapies, such as methadone and Suboxone.

As a result, conventional addiction clinics are now at risk of shutting down, meaning some communities could lose access to gold-standard treatments (i.e., methadone and Suboxone) while highly profitable, but unscientific, safer supply programs take over instead.

Lester said the evidence supporting safer supply is biased and “misleading” because, generally speaking, these studies simply interview enrolled patients and ask them to self-report whether they benefit from the programs. He noted that many safer supply researchers are public health academics, not doctors, meaning they lack clinical experience with the communities they study.

“It seems to be motivated by a very small, vocal, and well-connected group of advocates that has completely changed the landscape in addiction medicine treatment in a very short time,” he said.

Lester argues that some safer supply researchers seem to purposefully design their study methodologies to favor the programs and disregard systemic harms. He said this flawed science is then propagated by credulous journalists who fail to adequately scrutinize agenda-driven research.

While he personally knows “a couple dozen” colleagues in addiction medicine who regularly express skepticism about safer supply, many have been reluctant to speak out, fearing backlash from activist groups that “terrorize” critics.

“The stories are common of people being harassed and insulted on social media. We’ve heard of doctors being threatened [and] dropped from committees because they spoke out.”

For example, after Lester and his colleagues published two open letters criticizing safer supply in late 2023, they were targeted by a series of articles by Drug Data Decoded, a popular Canadian harm reduction Substack, which compared the doctors to Nazis and eugenicists. The articles were then widely shared on social media by safer supply activists.

Lester recalled an incident in which harm reduction activists targeted a doctor’s daughter at her high school in retaliation for her parent’s public criticism of safer supply.

“It’s just something that seems so unscientific and so bizarre in medicine,” he said. “Physicians just aren’t used to a powerful political lobby changing a treatment protocol.”

After Lester and more than a dozen of his colleagues wrote several public letters calling for reform and requested a meeting with Ya’ara Saks, the federal Minister of Mental Health and Addictions, they found themselves “sidelined and ignored.”

After months of delays, they were able to present their clinical observations to Saks, only to have her disregard them and incorrectly claim, weeks later, that criticism of safer supply is rooted in “fear and stigma.”

“The insults aren’t a big enough consequence to keep me from speaking my mind,” he declared.

After a short reflection, he then added, “If anyone doesn’t have a stigma against this population, it’s me. I’ve dedicated my life to helping them.”

Liam Hunt is a Canadian writer and journalist with an interest in humanism, international affairs, and crime and justice. This story is produced by the Centre For Responsible Drug Policy’s “Experts Speak Up” series in partnership with the Macdonald-Laurier Institute.