By Adam Zivo
May 9, 2023
Source: National Post
Photo Source: Unsplash,
Opioids Series: Canada Pilot Project
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
Canadian safer supply
To understand Canada’s safer supply opioid crisis, it’s vital to know the difference between safer supply and opioid agonist therapy (OAT), as the two are often mixed up.
OAT is a recovery-oriented therapy, which alleviates the torturous, but rarely deadly, withdrawal symptoms that opioid addicts experience when they stop using. These symptoms are a major barrier to recovery if left untreated.
With OAT, recovering addicts are given long-lasting, milder opioids (usually methadone or buprenorphine) that, at typical doses, stave off withdrawal without providing a euphoric high.
In contrast, safer supply drugs are intended to mimic the euphoric effects of illicit opioids, not manage withdrawal, and to prevent overdoses and death until the user is ready to enter a treatment program. For this reason, safer supply is often framed as a backup therapy that helps patients who don’t respond well to OAT.
The surface-level similarities between safer supply and OAT can be confusing for those who aren’t familiar with addiction medicine and drug policy.
According to the addiction physicians I interviewed, safer supply advocates often conflate the two treatments and inaccurately claim that evidence in support of OAT applies to safer supply, as well. Some advocates say that safer supply is acceptable because the health-care profession has decades of experience administering safe opioids, but that comparison is both misleading and inaccurate.
Unlike safer supply, the administration of OAT is tightly controlled. Methadone patients generally must come to a pharmacy every day for supervised consumption. Take-home use is strictly monitored. However, because less experienced drug users can get high from OAT opioids by consuming them in larger quantities, diversion of these drugs can pose a serious issue. Though buprenorphine is relatively safe, many people have died from overdosing on methadone.
According to Meldon Kahan, medical director of the substance use service at Women’s College Hospital in Toronto, methadone diversion can be as dangerous as the diversion of safer supply drugs.
“The difference is that OAT clinicians take steps to prevent diversion, such as giving take-home doses only if patients are stable. In contrast, safer supply clinicians have taken no meaningful steps to prevent diversion and give take-home doses to all patients right from the start of treatment,” he said.
In addition to knowing the difference between safer supply and OAT, it’s important to understand that there are different models of safer supply.
Safer supply programs that encourage supervised consumption, strict access criteria and careful patient monitoring have been promising and likely warrant further investigation. Switzerland’s safer supply strategy, which is often hailed as a success, fits that definition. The Swiss supplement safer supply with heavy investment in drug prevention, treatment and law enforcement.
Unfortunately, Canada has taken the opposite approach by recklessly prioritizing “reducing barriers.” By maximizing the ease and comfort of consuming safer supply, it’s believed that the program will be used more widely, thus reducing the use of riskier illicit substances.
Canadian safer supply recipients are generally not required to consume their drugs under supervision and are free to take their drugs home. Few, if any, accountability measures guarantee that at-home consumption actually happens.
In some cases, doctors can impose accountability by denying safer supply prescriptions to patients suspected of diversion. However, many of Canada’s safer supply programs minimize interactions with doctors and other health-care professionals.
In Vancouver’s Downtown Eastside (DTES), a neighbourhood plagued with a multi-decade addiction crisis, addiction physicians claim that it is now possible to walk up to some providers, give a fake name and receive free, potent opioids with few questions asked. Efforts to improve accountability, such as urine tests, are allegedly condemned as “stigmatizing.”
Predictably, a lot of these drugs end up being sold on the black market.
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