And The Solution to the Scourge of Drug Addiction Is .... ?

"We are regularly seeing and hearing in our practices that diverted hydromorphone is causing harm to both adults and children."

"We call on the government to ensure that all hydromorphone prescribed to people with opioid addiction is provided in a supervised fashion or that funding be ceased for the current harmful practice."

"[The] Unsupervised Free Government Funded Hydromorphone [is] causing further harm to our communities by increasing the total amount of opioids on the streets and providing essentially unlimited amounts of opioids to vulnerable people with addiction."

"As a result of this practice, we are witnessing new patients suffering from opioid addiction, and additional unnecessary overdoses and death."

Open letter to government of Canada from 17 addiction specialists

A Reuters investigation found 110 examples of children whose mothers used opioids during pregnancy and who later died preventable deaths after they were sent home from the hospital. A federal law meant to protect those children has largely been ignored by states across America.

 

"What is killing people is an increasingly toxic and unpredictable drug supply... The idea in giving people an alternative to that, that is predictable."

"It's not as if our field is in disarray, in disagreement around sort of the more conventional treatment of addictions."

"This is a very specific item which has a lot of controversy associated with it."

Dr. Paxton Bach, co-medical director, B.C. Centre on Substance Use, addiction medicine physician, St.Paul's Hospital, Vancouver

A person injects hydromorphone at a Vancouver clinic in 2016, before the federally-funded safer-supply pilot projects. "As a result of this practice, we are witnessing new patients suffering from opioid addiction, and additional unnecessary overdoses and death," a new open letter signed by 17 addictions doctors warns about the federal program. Photo by Darryl Dyck /The Canadian Press/File

A group of addiction physicians called on the Liberal government to ensure that safe-supply drugs are either not provided entirely, or if they continue to be provided for drug-addicted people, it be in a supervised manner. This, given accounts of people addicted to drugs visiting safe-supply outlets that provide them with free hydromorphone to ensure they have an alternative to the vastly more preferred street-acquired illegal fentanyl which has been implicated in an epidemic of drug overdoses.

The problem has become that those receiving the hydromorphone use it as leverage on street markets by selling it to others and using the profit they gain by so doing, to acquire the more desired fentanyl, thus entirely negating the purpose of the safe supply function, and in the process making more drugs available on the street. Hydromorphone availability has been cited as the cause of inciting more youth to become addicted to drugs, among other untoward consequences.

The pharmaceutical-grade hydromorphone made easily available through the street clinics as a method of reducing drug overdoses from heroin or fentanyl has backfired, the government-funded program of ten pilot projects in British Columbia, Ontario and New Brunswick has simply created a wider and more complicated system of drug use. Despite that a report in the Harm Reduction Journal in June of 2023 concluded enrolment in safer-supply programs leads to "fewer overdoses and overdose-related deaths, reduced drug-related harms, and improved health and social outcomes".

Angelica Richardson McKenney feeds her daughter Lynndaya in December 2012. The snapshot was taken the day before McKenney, high on a trio of drugs, fell asleep on top of Lynndaya and suffocated her. REUTERS/Handout

 

Not, however, in the opinion of critics claiming the programs have led to a number of other problems being created. The letter's authors argue that research of safer supply is "methodologically weak" and the program should be reformed or altogether cancelled. Author of the letter, Dr. Rob Cooper, spoke of a patient receiving safe supply treatment: "She's now dead. She was selling the hydromorphone she was getting and she was buying fentanyl. The problem here is there's no safety measures protecting that person or the public."

Founder of he ACT Addictions Clinic chain in Ontario, Dr. Clement Sun, a signatory to the letter, explains the situation is "almost like we're getting back to the days ... that the source of the drug is not from the illegal dealer [but] is from these safe clinics", resembling how over-prescribed OxyContin fuelled the opioid crisis.

"I'm not against them trying to help addicts, because that's what my job is. But this way, it is reckless", added Dr. Sun. Drug users receive their safer supply drugs, then turn around on the streets and sell them. The "diversion" money is "commonly used to purchase more potent opioids such as fentanyl. There is widespread evidence that this is occurring", the letter adds. In addition to which they argue that the diverted hydromorphine is "creating more children with addiction in our Junior High and High Schools".

Data out of British Columbia indicates hydromorphone to be present in five percent of the opioid deaths that took place in the province. In comparison to fentanyl, which was seen to be present in 88 percent. Dr. Sun believes these deaths might not yet be showing up in statistics. "They're not seeing it, because they're selling it to the kids and they haven't overdosed yet", he stated. "We're not talking about people dying. We're talking about the fact that you're spreading a medication that's addictive and being the supplier to the dealers, to the people who are selling it."

Drs. Cooper and Sun suggest that people who want the pharmaceutical grade opioids could be instructed they must be taken under supervision at a 24-hour pharmacy, while Dr. Bach agreed there are ways that such prescribing could be improved, yet a countrywide reform that addresses all concerns is unlikely to be developed. "I don't think there is going to be any one solution that is universally appropriate. But there is lots of opportunity to be thoughtful about this", he concluded.

A nurse at the Crosstown Clinic, a supervised injection site in Vancouver, British Columbia, handed out a syringe of medical-grade heroin to a patient in May.  Credit...Jackie Dives for The New York Times