Ruminations: The Great Compassionate Progress in Safe Injection Sites

"Patients who diverted [hydromorphone given to addicts at Safe Injection Sites entering the street market for sale to enable the sellers to afford the more potent and desirable fentanyl] 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."
Dr. Sharon Koivu, addiction physician, London Health Sciences Centre

"[Diversion is an issue; high opioid tolerance among fentanyl users was a] top challenge."
"[Safer supply program staff said] 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 Canada report findings from safer supply pilot projects

A needle outside of The Hamilton Clinic.

Compassionate progressives want to believe that by providing drug users with government-funded substitutes for what is often potentially tainted illicit substances, people can be saved from overdosing with ultra-potent street drugs such as fentanyl and even worse, carfentanil. Unfortunately theory doesn't match human idiosyncracies leading people to value brief and fleeting mood changes brought by psychotropics, an excess of which could usher them out of this world.

An opioid crisis in Canada has been responsible for the death of over 35,000 people since 2016. The safer supply drugs distributed through government-funded programs are frequently left unconsumed by the recipients who choose to sell them on the black market at irresistible prices which then goes on to fund the procurement of fentanyl, preferred by the recipients of the 'safer' drugs. The black market resale is formally referred to as 'diversion'. The result of this situation is that across Canada communities are being flooded with cheap opioids.

Fentanyl addicts sell their safer supply at bargain prices

Hydromorphone, the primary opioid dispensed at such supply sites has dropped in price significantly in cities that operate safer supply programs. Addiction physicians are being informed by drug users that diverted hydromorphone leaves these cities to enter other markets where opioids are less accessible, to sell for higher prices. This has attracted the attention and invited the presence of gangs and drug dealers.

A 2017 study published in Psychopharmacology establishes that hydromorphone produces "similar subjective and physiological effects as heroin", but is "more potent than heroin", while another 1990 study published in The Journal of the International Association for the Study of Pain estimated hydromorphone is in fact, five times stronger than heroin.

Relating to the increases in availability and affordability of hydromorphone as a black market drug, there have been negative consequences where physicians report a new wave of opioid addictions pronounced among youth. Addiction physicians also report that many patients once thriving in recovery now relapsing as patients, either abandon treatment to enroll in safer supply programs or are drawn to return into addiction by the abundance and cheap cost of hydromorphone on the streets.

Drug users looking for a quicker rush often crush hydromorphone tablets meant for oral consumption in favour of injecting them intravenously, leading to excruciating, disfiguring infections where paralysis has resulted for some patients. The Canadian government saw virtue in investing almost $80 million in 28 safer supply projects. According to Dr. Koivu of the London Health Sciences Centre, fentanyl was not seen widely in London in 2016, then over ensuing years spread and with it came the abuse of safer supply programs.

The typical 8-milligram tablet of hydromorphone delivers four times the dose generally used in hospital settings, yet it is still not as powerful as fentanyl. Since users prefer to sell their government-provided hydromorphone pills in favour of using the sale funds to supply themselves with fentanyl, the safer supply program, whose primary benefits include mitigation of fentanyl use, is actually in reality, subsidizing fentanyl usage.