Canada's 'Safer Supply' Drug Addiction Mitigation Program

"We quickly assembled health-care teams to dish out and prescribe mass quantities of opioids and it wasn't very long until gangs infiltrated the hotels."

"These are disabled people. Old people. Little women. So very early on, we knew it was happening."

"My colleagues have had some high-profile overdoses -- a 12-year-old and a 14-year-old, fatally over-dosed. We've never seen kids that young overdosing before."

Dr. Caroline Ferris, front-line addiction physician, Victoria, British Columbia

Greg Sword with a picture of his 14-year-old daughter Kamilah, who died of a drug overdose last August. Photo by Jason Payne /PNG

"As in many Canadian cities, the pandemic created a homelessness crisis in Victoria, which lead to the rise of several dangerous encampments, whose residents were eventually relocated to hotels that had been converted into supportive housing."

"At first, Dr. Ferris thought it was  beneficial that dirt-cheap, diverted hydromorphone was flooding into Canadian communities, as she assumed that it would mitigate fentanyl consumption. However, Dr. Ferris said that 'it hasn't really gone that way' and that diverted hydromorphone is going to youth and to 'regular Joes who would never use opioids unless their colleague was offering them one for a buck a pill'."

"She now believes that it's 'a bit facile' to argue that hydromorphone diversion mitigates fentanyl consumption, especially given the increasing number of fentanyl overdoses in British Columbia."

"Though safer-supply advocates claim that the strategy's critics are merely fringe voices, Dr.Ferris said that half of the health-care professionals she knows have been 'passionately lamenting this since the start of the pandemic'.

Adam Zivo, Investigative Journalist, National Post

Canada's 'safer supply' drug strategy has come under some intense scrutiny of late, and deservedly so. Front-line addiction physician Dr. Caroline Ferris prescribes safer supply hydromorphone, an opioid more potent than heroin, where she works in community settings in British Columbia's capital city, Victoria. The idea behind safer supply was to reduce the incidences of overdoses and deaths. British Columbia has been experiencing an alarming increase in both.

Making free pharmaceutical opioids available to drug users was seen as an attractive and life-saving alternative to street drugs which could be tainted with, for example fentanyl and carfentanil, two potentially deadly drugs mostly manufactured in China, entering the illicit market to capture ever increasing numbers of users as merchants of death, drug dealers, bring it to the streets and adulterating less potent drugs with the potentially lethal products.

Dr. Ferris initially was taken with the thought that progressive drug policies inclusive of drug legalization would be of benefit. It was during the coronavirus pandemic when the initiative was taken to increase safer supply across the country that she began to have second thoughts. She would be informed by vulnerable patients their experiences of gang members confiscating their drugs. And so it became understood within the profession that criminals were acquiring hydromorphone and shipping it across Canada.

 

Artwork about harm reduction adorns an appointment room at Parkdale Queen West Community Health Centre in Toronto. Laura Proctor for STAT

Now, she and some of her colleagues meet to discuss the issue, all of whom are "concerned by the number of youth using hydromorphone, or who started with it and then moved on to fentanyl." Youth whose ages between 12 and 14, are "unprecedentedly young". The number of patients of all ages also alarms Dr. Ferris for those who have relapsed or have developed new addiction issues resulting from hydromorphone use. She conducted a survey of her patients to discover that of 41 current patients requiring assistance for opioid use disorder five used hydromorphone alone, but another ten were using hydromorphone along with another drug.

She has seen and recognized some benefit to the safer supply program among patients in the early stages of recovery-oriented treatments, like methadone. Because many patients expect they will receive hydromorphone in perpetuity, however, they occasionally become abusive when informed they must discontinue the drug once it has performed its required function to bring them to the next stage of recovery.

As well, patients suffering from chronic pain and who as a result of prescribing restrictions cannot access the opioids they need for pain-free living, can benefit from safer supply. "True" safer supply for fentanyl users requires pharmaceutical fentanyl options, she feels, which should be provided with caution. A very limited model of safer supply differing dramatically from the grossly irresponsible 'one-size-fits-all' in use in Canada today, has its attractions. The current safer supply, she feels, represents an inadequate solution for chronic pain management, and the diversion crisis must be addressed since it serves to add fuel to the opioid epidemic.

“We know that there has been an issue with diversion, but we really do believe that safe supply is an evidence-based approach in saving lives,” insists Minister of Mental Health and Addictions Carolyn Bennett. Photo by Darryl Dyck  /The Canadian Press

"The anecdotal evidence precedes the data collection. Somebody sounds an alarm and then we collect data. With the OxyContin crisis and fentanyl, we in the field knew what was happening before there was data to support it."

"It's disrespectful to discount our observations."

"It's disrespectful to ignore the concerns of prescribers and communities who see this happening."

"A lot of these folks are, in fact, older people who have chronic pain conditions and have been de-prescribed due to fear from our professional college [as a result of onerous prescribing restrictions implemented after the OxyContin crisis], or they've lost their family physician and can't find anybody to prescribe, because, of course, the optics of going around to clinics and asking for Dilaudid [hydromorphone] are very poor."

Dr. Caroline Ferris, front-line addiction physician, Victoria, British Columbia

 

Booths for supervised consumption services. Laura Proctor for STAT