New report casts doubt over Canada’s safer supply drug strategy

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According to a new 10,000-word investigative report published by the National Post, Canada’s safer supply drug strategy is failing and is making the national opioid crisis worse.

“Safer supply” refers to the policy of providing drug users with free drugs as substitutes for potentially tainted illicit substances. In Canada, that means distributing hydromorphone, a drug roughly as powerful as heroin.

The new report, which uses interviews with over 20 healthcare experts, including 14 addiction medicine specialists, suggests safer supply recipients and drug dealers are scamming the system. A lot of the hydromorphone being distributed by the government through safer supply programs is being “diverted” to the black market. This is allegedly “flooding” communities with opioids and causing new addictions and relapses, especially among youth.

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Addiction physicians in five Canadian cities (Vancouver, Toronto, Hamilton, London, and Ottawa) claim that, after safer supply was launched in their cities, the street price of hydromorphone dropped by 70% to 95%. For example, an 8 mg tablet of hydromorphone allegedly used to sell for $8 to $10 in Vancouver but now sells for around $0.50 to $1.

Several addiction clinicians have reported rising hydromorphone-related addiction among youth. According to those interviewed for the report, youth underestimate the risks of hydromorphone because the drug is prescribed by a doctor and is marketed as “safe.” However, as hydromorphone is as powerful as heroin, it is clearly dangerous for new opioid users, especially if mixed with alcohol.

Safer supply advocates have often argued that it is acceptable, even beneficial, for youth to have access to diverted, heroin-grade opioids. Ian Cromwell, a safer supply advocate who received approximately 30,000 votes in Vancouver’s municipal election last year, compared opioid diversion to providing youth with condoms.

Many Canadians who were in recovery have also allegedly relapsed because of safer supply. One physician quoted in the report claimed that half of their new patients “either relapsed due to safer supply or initiated an opioid use disorder because of it.” Safer supply advocates have repeatedly claimed that diversion is “fake news.”

However, not only are addiction physicians across Canada hearing from patients that diversion is a common practice, but it has also been repeatedly acknowledged as a problem in reports produced by Health Canada and safer supply providers.

Many drug users have too strong of an opioid tolerance to get high from hydromorphone — although the drug is as powerful as heroin, it is only a tenth as strong as fentanyl. Safer supply recipients therefore often sell their hydromorphone to purchase more fentanyl.

In March 2022, Health Canada published a report detailing early findings from 10 safer supply programs and identified high opioid tolerance among fentanyl usage as a “top challenge.” According to the report, “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.”

Health Minister Carolyn Bennet continues to claim that distributing large quantities of free hydromorphone will fix the fentanyl crisis, even though her own department’s research shows that this is almost certainly not true.

Several addiction clinicians claimed that, because people who develop hydromorphone-related opioid addictions often later abuse fentanyl, safer supply is probably making the fentanyl crisis worse. “I hear from patients, all the time, that they don’t really understand the rationale behind safer supply. They don’t really see it helping people in their community. In fact, they find it harmful,” said Dr. Vincent Lam, medical director of Toronto’s Coderix Addiction Therapy.

According to the report, two Ontario-based addiction physicians, Dr. Sharon Koivu and Dr. Lori Regenstreif, claim that safer supply is causing “excruciating and disfiguring infections that have paralyzed some patients.” Hydromorphone tablets are meant for oral consumption and include materials not meant for intravenous use, but recipients often crush and inject the tablets anyway, leading to serious harm.

The federal government apparently has no plan to combat widespread diversion. When the author of the National Post’s investigative report, Adam Zivo, contacted Health Canada with questions about diversion, he forwarded the government’s response to 10 addiction physicians, who panned Health Canada’s anti-diversion recommendations as “inadequate” and “puzzling.” According to Dr. Lam, Health Canada seemed to be “significantly out of touch with the realities of opioid use disorder and the market for illicit substances, which is concerning.”

Health Canada claims that it doesn’t support the illegal diversion of heroin-strength prescription opioids, but the opposite seems to be true. In 2022, Health Canada funded a document, “Reframing Diversion for Health Care Providers,” which encourages doctors to “appreciate the benefits of diverting prescribed medications” and look the other way if patients are selling their safer supply opioids on the black market.

Dr. Jenn Brasch, the former president of the Canadian Society of Addiction Medicine, said that the majority of addiction physicians feel “somewhere between uncomfortable to reluctant” regarding safer supply. Dr. Koivu said that at least 50 physicians have privately voiced concerns to her about safer supply.

Addiction physicians repeatedly said that critics of safer supply are being bullied into silence. At least four interviewed addiction physicians claimed that researchers are being pressured into ignoring harms or evidence that undermines support for safer supply. One addiction physician who worked at “a BC-based institution that is associated with safer supply” claimed that their job security was threatened after they volunteered to analyze the institute’s data and track safer supply’s potential harms.

Several addiction physicians compared Canada’s safer supply strategy to the Oxycontin crisis of the late 1990s and 2000s, when Purdue Pharma, an American pharmaceutical company, used unethical practices to flood North American communities with opioids, which then triggered an opioid epidemic that would go on to kill hundreds of thousands of people.

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