In early May, 68-year-old Ronald Schilling of Nanaimo, B.C., was sentenced to three years in prison for trafficking street drugs such as fentanyl and meth — as well as government-supplied opioids.

When authorities had arrested Schilling two years earlier, they had found him in possession of more than 80 government-supplied opioid pill bottles labeled with other patients’ names.

Those pills had been dispensed to patients under B.C.’s “prescribed alternatives” program, more commonly known as safer supply. The program aims to reduce overdose deaths by dispensing pharmaceutical opioids to drug users as an alternative to toxic street drugs.

In Schilling, patients of this program had found a drug dealer who was willing to give them harder drugs — such as fentanyl — in exchange for their prescription opioids. Schilling would in turn sell their prescription opioids to others.

“Mr. Schilling preyed upon people who were taking the safe supply drug,” Provincial Court Judge Karen Whonnock said during the sentencing hearing.

Schilling’s case is further evidence that safer supply opioids are making their way to the streets — and having unintended negative consequences. However, some sources say even diverted pills reduce harm if they flood the market with safer drugs.

‘Upside Down’

Schilling, a former charity worker, developed a cocaine addiction after the sudden death of his partner. He ultimately turned to drug trafficking to fund his addiction, according to his lawyer.

In court, the prosecution described Schilling as operating a mid-level drug trafficking scheme that exploited B.C.’s safer supply program.

Schilling coordinated with multiple dealers to source both illicit and prescription drugs, and had at least three individuals working under him. His text messages showed he would arrange to meet clients near Nanaimo’s Outreach Pharmacy to trade potent street drugs for the prescribed medications they had just received.

He operated under the name “Upside Down Inc.” — “down” being a street reference to fentanyl — and had business cards to match. To reassure users that the street drugs were safe, he would have them tested at a local overdose prevention site.

‘Predatory behaviour’

While Schilling’s case is unusual, it adds to the growing body of evidence that provincial safer supply programs are not always being used as intended.

In one example, a B.C. government report released in February revealed that more than 60 pharmacies were involved in a kick-back scheme, offering patients cash or rewards to fill safer supply prescriptions they did not need. Some of those drugs were then sold on the black market.

Collen Middleton, a co-founder of the Nanaimo Area Public Safety Association, refers to safer supply drugs as the “perfect consumer product.”

“They are a product that produces its own demand, because it’s addictive,” said Middleton, whose neighbourhood association is a vocal critic of safer supply.

One of Middleton’s concerns is that safer supply drugs are presented as safe, despite being addictive themselves. He says this makes them an effective gateway to more dangerous street drugs like fentanyl.

“Those drugs are being marketed as safe to kids … [so] you’re bringing more people into using addictive drugs, more abuse, more predatory behaviour toward a vulnerable segment of the population,” he said.

The B.C. Ministry of Health told Canadian Affairs in an emailed statement that it takes the “diversion of prescription medications … very seriously.”

“The unauthorized distribution is illegal and puts the public at risk,” it said.

In response to the B.C. pharmacy scandal, the province tightened its protocols for dispensing prescription opioids. All new and most existing patients must take prescription opioids under the supervision of health-care professionals, a protocol known as witnessed dosing. In rare cases, existing clients may continue to take their doses offsite if the prescriber views the risk of diversion as low.

Mixed evidence

In its statement to Canadian Affairs, B.C.’s health ministry also said its safer supply program “plays an important role in reducing substance use-related harms” and can lower overdose risk by as much as 91 per cent.

This figure comes from a 2024 B.C. study published in the British Medical Journal. That study found individuals prescribed pharmaceutical opioids early in the pandemic were 91 per cent less likely to die from any cause in the week after receiving at least four days of safer supply opioids, compared to a control group.

The study only tracked outcomes during the week following prescription fills. It did not verify whether individuals took the opioids as prescribed.

A study published in April in The Lancet Public Health shows B.C.’s safer supply programs are linked to improved short-term health outcomes, including fewer overdoses and hospital visits.

However, a population-level study in JAMA Health Forum found no significant reduction in overdoses or mortality associated with B.C.’s safer supply and decriminalization policies. It also suggested possible increases in emergency department visits and hospitalizations.

Comprehensive long-term research on the health impacts of Canadian safer supply programs is limited.

Creating a market

Some sources say the diversion of prescription opioids may be less harmful than the alternatives.

“If you could replace [street] drugs with safer pharmaceutical alternatives, people’s needs would be met,” said Perry Kendall, B.C.’s former provincial health officer and a long-time harm reduction advocate.

“They wouldn’t have to turn to the illicit market, and their risk of a toxic drug overdose would be significantly reduced.”

In Kendall’s view, Schilling was in some ways functioning as a harm-reduction worker.

“[Schilling] was kind of offering a harm reduction service, as well as supplying people with the drugs they wanted,” Kendall said.

Kendall’s views are echoed in a 2023 B.C. government review that notes diversion of safer supply drugs to people already at risk of drug poisoning may be beneficial. But the review also acknowledges that diversion to users who would not otherwise use unregulated drugs is harmful.

Still, Kendall acknowledged a fundamental issue: “[Safer supply opioids don’t] really give you the same high [as fentanyl]. So if you can trade [them] to … get what you’re looking for, which is fentanyl, then that’s what you will do.”

Leonard Krog, the mayor of Nanaimo, says it is clear that, within Nanaimo, B.C.’s policies to help drug users are making it easier for dealers to sell their toxic drugs.

“We have a safe injection site next to City Hall, and there’s no question dealers are coming down here and they’re selling their stuff, because the market’s right here,” said Krog.

But Kendall warns that pulling back on decriminalization and safer supply programs creates a dangerous gap.

“The daftest thing you can do is create a market of desperate people and then fail to fill it,” said Kendall. “Somebody’s going to meet those needs — and they’re not going to be law-abiding citizens.”

Krog is unconvinced.

“If we make it easier for the wolves to successfully exploit the sheep, is that a good thing?”

This article was produced through the Breaking Needles Fellowship Program, which provided a grant to Canadian Affairs, a digital media outlet, to fund journalism exploring addiction and crime in Canada. Articles produced through the Fellowship are co-published by Break The Needle and Canadian Affairs.