By Adam Zivo
May 9, 2023
Source: National Post
Photo Source: Unsplash,
Opioids Series: Opioids in London
In this special report, columnist Adam Zivo details how drugs handed out for free are being sold on the black market to fund fentanyl addictions
London pilot project
Canada’s first safer supply program — a pilot project at the London Inter Community Health Centre (LIHC) in London, Ont. — began operating in 2016. The program primarily distributes hydromorphone tablets for addicts to take at home and was quickly proclaimed a success. For example, a 2022 report produced by the program showed few negative outcomes associated with safer supply.
As the pilot project appeared to be working, Health Canada began directly funding safer supply programs all across the country starting from the late 2010s. To date, the federal government has invested at least $77.8 million into 28 safer supply projects.
But in a London hospital not too far away from LIHC, on-the-ground realities looked very different from what was being said in official reports.
Dr. Sharon Koivu, an addiction physician with the London Health Sciences Centre (LHSC), began to notice an increase in serious infections relating to intravenous drug use. Speaking with her patients, she learned that many of them were buying hydromorphone diverted from the nearby safer supply program, and then crushing and injecting it.
Other patients told her that they were diverting hydromorphone to make money. “Patients who diverted were able to have an increase in their standard of living. What I saw at the very beginning was absolutely that. But as fentanyl became more available in the community, I’ve seen more and more people divert to get fentanyl,” she said.
According to Dr. Koivu, fentanyl wasn’t widely available in London in 2016, but as it spread throughout the city over the ensuing years, the abuse of safer supply programs took on a new character. Rather than reselling free hydromorphone to fund higher living standards, a new class of users began to sell the drug so they could buy fentanyl off the street.
But why would drug users sell their hydromorphone to buy riskier street fentanyl?
Fentanyl is a stupendously powerful synthetic opioid that leaves users with a formidable drug tolerance. Those who use fentanyl generally don’t find that other, comparatively weaker, opioids give them a satisfying high.
According to the addiction physicians I interviewed, although the typical 8-milligram tablet of hydromorphone given to addicts is four times the dose generally used in hospital settings, its effect relative to fentanyl is like holding a candle to the sun.
With little incentive to switch to hydromorphone, fentanyl addicts sell their safer supply at bargain prices to buy their substance of choice. Safer supply thus often ends up subsidizing illicit fentanyl use, rather than preventing it.
One hundred per cent of all of the people I’ve met who are on safer supply sell their safer supply. I’ve never met anybody who’s taken all of it RECOVERY ADVOCATE GIUSEPPE GANCI
The federal government is aware of this problem, as are staffers working at safer supply programs. Last year, Health Canada published a report detailing early findings from 10 safer supply pilot projects spread across three provinces. The report acknowledged that diversion was an issue and stated that high opioid tolerance among fentanyl users was a “top challenge.”
According to the report, safer supply program staff said that, “Even maximal doses of (hydromorphone) have little effect except withdrawal management. This leads people to continue to use street fentanyl, as (hydromorphone does) not approximate the effect they get from fentanyl.”
The federal government has generally ignored this fact in its public messaging about safer supply, even though one of the program’s primary benefits is supposed to be the mitigation of fentanyl use.
For several years, safer supply pilot programs slowly expanded throughout the country, though they remained limited in scope. Then, in March 2020, as the COVID-19 pandemic hit, safer supply was abruptly ramped up when the British Columbia Centre on Substance Use (BCCSU) published its risk mitigation guidelines (RMG).
The BCCSU is a highly influential research institution that, according to several experts I interviewed, exerts outsized influence over Health Canada and the B.C. government. The addiction physicians I spoke to routinely criticized it for producing inadequate research, which gives the appearance that safer supply is successful, when, in reality, there is little statistically significant evidence that it actually works.
The BCCSU’s RMG recommended that safer supply be rapidly expanded to address the “dual public health emergencies” of COVID-19 and opioid overdose deaths. Shortly afterwards, federal funding for safer supply programs grew and doctors say they began receiving encouragement to prescribe safer supply.
As the RMG was ostensibly published in response to the COVID-19 pandemic, it was framed as an interim document that, having been put together quickly, could not include a review of research literature about safer supply. Dr. Green, a B.C.-based addictions physician with experience in drug policy advocacy, called the RMG the “originator of safer supply” and said that colleagues were “shocked” when the document came out.
“Preparation of these documents takes months. As such, the document was likely prepared long prior to COVID,” said Dr. Green, who believes that the pandemic was used as a pretext to expand safer supply without appropriate debate or oversight.
In an email exchange, the BCCSU wrote that it began working on the RMG after March 14, 2020, and then published the document later that month, on March 26. “Those who were a part of the provincial working group worked outside of normal typical hours to ensure rapid development and release as part of the public health emergency response,” they wrote in their response.
They also stressed that “The RMG is not a policy document, it is clinical guidance. Policy is developed by federal and provincial governments and not by the BCCSU.”
When asked about how long it typically takes to prepare documents like this, the BCCSU said that, due to the pandemic, no typical comparison can be made.
However, the BCCSU explained that, when it published an update to the RMG in February 2022, it took approximately six months of preparation just to get the document submitted to the B.C. government for review. This, perhaps, gives a sense of the scale of work needed to responsibly produce this type of clinical guidance.
Yet for two years before this update, safer supply was scaled up based on a document that allegedly had been prepared and approved in 12 days or less.
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