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Addictions

Bennett backs supervised consumption sites day after Manitoba bill on licensing them

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The federal minister of mental heath and addictions says she is concerned some may misunderstand the role harm reduction plays in reducing overdose deaths.

Carolyn Bennett’s remarks come a day after Manitoba’s Progressive Conservatives proposed legislation that would require supervised drug consumption sites to apply for licensing.

She says the large number of overdoses that have been reversed at such sites across the country shows the sites are a form of harm reduction backed by evidence and not rooted in ideology.

The Manitoba government has long opposed calls to allow them, saying people facing addiction need to be guided toward treatment.

The province shifted its stance this week when it introduced a bill in the legislature that would require supervised consumption sites, addiction centres with beds and withdrawal-management services to apply for provincial licences.

Bennett says it’s too soon to tell what this means for service providers, but she looks forward to speaking with the province about the bill.

Bennett was in Winnipeg to announce $13 million for harm reduction and treatment services projects across the Prairies, the Northwest Territories and Yukon.

This report by The Canadian Press was first published March 15, 2023.

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Addictions

B.C.’s provincial health officer should be fired

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Dr. Bonnie Henry has been British Columbia’s provincial health officer since 2014. She has used her position to advocate for expanded legal access to addictive drugs.

By Rahim Mohamed

If Premier Eby has little faith in Dr. Bonnie Henry’s radical drug legalization agenda, why keep her on the job?

B.C.’s Provincial Health Officer Dr. Bonnie Henry has been one of Canada’s leading advocates for radical “harm reduction” policies — but Premier David Eby cast an unmistakable vote of non-confidence in her judgment last month when he called her position on safer supply a “non-starter.

Eby’s remarks came just days after Dr. Henry told a parliamentary committee in Ottawa that she supported the “legalization and regulation” of illicit street drugs. The public disagreement suggested a sidelining of the doctor within the provincial government — especially after Eby further distanced himself from her by announcing that he’d appointed a separate medical expert, Dr. Daniel Vigo, to advise him on the province’s toxic drug crisis.

It is great to see that Eby is starting to treat Dr. Henry’s activist-driven recommendations with the scepticism they deserve. But he needs to go farther. The doctor should be fired.

Yet Eby has thus far rebuffed calls to remove Dr. Henry from her post. To the contrary, Eby insists that he has “huge confidence” in her ability to continue on as B.C.’s top public health official, despite his disagreements with her on how to combat the overdose crisis.

To reiterate, the premier’s current position is that he trusts his provincial health officer to effectively do her job, despite being fundamentally and irreconcilably at odds with her over the province’s most pressing public health issue — which, might we remember, kills roughly seven British Columbians each day.

This is not some minor quibble that the premier can simply gloss over with a new advisor and a few scolding words. If Eby cannot abide by Dr. Henry’s views on safer supply, as he claims to be the case, he has a professional and moral obligation to find a new provincial health officer who shares his vision on beating back the scourge of illicit drugs.

And while Dr. Henry’s latest parliamentary remarks alone were egregious enough to justify her firing, what’s even more concerning is that they fell in line with a pattern of ideological and unscientific statements on drug policy.

Two years ago, Dr. Henry stunned many in the recovery community by publicly stating that abstinence “does not work for opioid addiction.”

By implying that it is unrealistic to expect opioid users to kick their habit, and dismissing abstinence-based treatment programs in a carte blanche manner, Dr. Henry not only devalued the lived experiences of scores of British Columbians who’ve recovered from opioid addiction, she also betrayed a profound ignorance of decades of scientific research that shows that ex-addicts can, and often do, attain long-term abstinence from opioid drugs through community-based treatment programs.

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Surrey, B.C.-based addictions specialist Dr. Jenny Melamed said in an email that it was “disingenuous” for Dr. Henry to “differentiate opioid addiction from other forms of addiction with respect to the ability (of addicts) to recover.”

“I have devoted my medical career to working with individuals with addiction.  I witness recovery on a daily basis from all addictions,” wrote Dr. Melamed.

Instead of helping drug users obtain recovery, Dr. Henry has fixated on ideological policies that only enable and entrench addiction.

Dr. Henry’s mission to legalize drugs has been particularly concerning. In a 2019 report titled, “Stopping the Harm: Decriminalization of people who use drugs in BC,” she wrote in an executive summary that B.C. cannot “treat its way out of the overdose crisis.” The report recommended that provincial authorities “urgently move to decriminalize people who possess controlled substances for personal use,” following the then-fashionable hands-off approach to drug use.

Her solutions have catastrophically failed in jurisdictions across North America, most recently in the State of Oregon, whose leaders now acknowledge that legalizing hard drugs was a mistake. But Dr. Henry shows no capacity for this sort of hard self-reflection — despite the mayhem that decriminalization, a policy she aggressively championed, caused in B.C. over the last year.

She is instead choosing to double down on an ideological dogma that is fast losing popularity with both experts and lay citizens.

Dr. Henry’s inability to admit she was wrong when confronted with new information is perhaps the most damning indictment of her fitness to lead. British Columbians deserve a provincial health officer who will follow the evidence, especially when it leads them to reconsider strongly held beliefs.

One public figure who hasn’t minced words about Dr. Henry’s unsuitability as B.C.’s top doc has been South Surrey MLA Elenore Sturko, a newly minted BC Conservative, tweeted last week that “David Eby needs to fire Dr. Henry immediately.”

In a phone interview, Sturko said that while Dr. Henry has done some good work as provincial health officer, she believes it’s time to change directions.

“Given the lack of improvement, and the complexity of the overdose public health emergency, I believe that we need a change of approach. Perhaps it’s time to appoint an addictions specialist with front line experience as well as a research background lead this emergency,” Sturko said.

“In a statement last week NDP Premier David Eby said he’s not in agreement with Dr. Henry’s push to legalize drugs,” Sturko added. “If she is focusing her work and response to a public emergency in a direction that isn’t supported by the premier, this conflict will perpetuate his government’s ineffectiveness at saving lives.”

With drug-related deaths on the rise for three consecutive years, B.C.’s near decade-long drug crisis shows no signs of abating. The time for half-measures has long since passed. David Eby must take a clear stand against the failed drug policies of yesteryear by removing Dr. Bonnie Henry from her post as provincial health officer.

The stakes, both political and human, are frankly too high for the premier to keep the intransigent doctor in her current job.

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Addictions

Leading addiction doctor warns of Canada’s ‘safer supply’ disaster

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A man considers using a prescription opioid. Credit: Dreamstime

By Liam Hunt

Addiction physician Dr. Sharon Koivu has seen the effects of safer supply programs in her clinical practice and personal life — and is sounding the alarm

Dr. Sharon Koivu, an addiction physician and parent, believes her son might not have survived to adulthood if Canada’s “safer supply” programs had been in effect during his adolescence.

Having worked on the front lines of Ontario’s opioid crisis, she views these programs as a catastrophic failure.

In an extended interview, Koivu explained the unintended consequences of these programs, which offer free tablets of hydromorphone — an opioid about as strong as heroin – to vulnerable patients with a history of addiction. While advocates of safer supply claim it mitigates the use of more dangerous illicit substances, there is evidence that most users divert — that is, sell or trade — their hydromorphone to acquire stronger substances.

Safer supply was first piloted in London, Ont., in 2016, before being widely expanded across Canada in 2020 with the help of generous federal grants. While the program looked good on paper, Koivu, who provides comprehensive addiction consultation services at a London-based hospital, saw a different reality: her patients were destabilizing, relapsing and fatally overdosing because of safer supply.

Koivu says that “one hundred percent” of her colleagues working in addiction medicine have noticed safer supply diversion. Some patients have told her they have been threatened with violence if they do not procure and divert these drugs. She estimates that, because of safer supply, tens of thousands of diverted hydromorphone pills — also known as “Dilaudid,” “dillies” or “D8s” — are flooding into Canadian streets every day.

For context, just two or three of these pills, if snorted, are enough to induce an overdose in a new user.

This influx has caused the drug’s street price to crash by as much as 95 per cent. While 8-milligram hydromorphone pills used to sell for $20 each several years ago, they can now be bought for as little as a dollar or two. These rock-bottom prices have ignited a new wave of addictions and relapses, and lured opioid-naive individuals into experimenting with what is essentially pharmaceutical heroin.

Koivu estimates that 80 per cent of her opioid-using patients now take diverted hydromorphone.

“The biggest harm is that we’ve turned on the tap and we’ve made everything cheap, which is leading to a large increase in the number of people becoming addicted and suffering,” she said.

“It is the most serious issue that I’ve seen in my lifetime.”

Safer supply programs seem to regularly overprescribe opioids without considering patients’ actual needs, Koivu says. Patients have come into her hospital with prescriptions that provide 40 eight-milligram hydromorphone pills a day, even though they can only tolerate 10 pills.

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‘That attraction is horrific’

Throughout the first few decades of Koivu’s career, almost “everyone” in her patient pool developed addictions due to childhood traumas or from mishandling opioids prescribed for chronic pain.

Since the advent of safer supply, the origins of new opioid addictions have shifted toward social or recreational exposure. Concerningly, this exposure often occurs in patients’ adolescent years.

“I’m seeing an increase in youth becoming addicted,” said Koivu, who has had patients as young as 15 tell her their addictions began through diverted hydromorphone.

“Almost everyone I see who’s started since 2018 started recreationally. It started as something that was at a party. It’s now a recreational drug at the youth level.”

Parents often seem completely unaware of the problem. Some have told Koivu they overheard their children discussing the availability of “D8s” at their highschools, only to later realize — when it was too late — they were referring to opioids.

“You can’t walk into your house with a six-pack of beer. If you’re smoking weed, people can smell it. But you can walk into your house with a lot of [tablets] in your pocket. So, it’s cheap, really easy to hide, and is even called ‘safe’ by the government. I think that attraction is horrific.”

“Our youth are dying at a higher rate … and we have a lot more hydromorphone found in [their bodies] at the time of death.”

While safer supply programs claim to make communities safer, Koivu’s lived experiences suggest the opposite. She used to reside in London’s Old East Village, where the city’s first safer supply program opened in 2016, but moved away after watching her neighbourhood deteriorate from widespread crime, overdoses and drug trafficking.

“I moved there to support a supervised injection site,” said Koivu. “Then I watched that community drastically change when safer supply was implemented. … I would go for walks and directly see diversion taking place. Homelessness is very complicated, but this has absolutely fueled it in ways that are unconscionable.”

Dr. Sharon Koivu

Koivu characterizes the evidentiary standards used by advocates of safer supply as “deeply problematic.” She says many of the studies supporting safer supply are qualitative — meaning they rely on interviews — and use anecdotal data from patients who have a vested interest in perpetuating the program.

While Koivu has been blowing the whistle on safer supply programs for years, her concerns largely went unnoticed until recently. She has faced years of harassment and denigration for her views.

“When I came to say I’m concerned about what I’m seeing: the infections, the suffering, the encampments … I was literally told that I was lying,” she said.

Last month, the London Police Service provided the National Post with data showing that annual hydromorphone seizures increased by 3,000 per cent after access to safer supply was significantly expanded in 2020. The newspaper has since raised questions about why this data was not released earlier and whether the police stonewalled attempts to investigate the issue.

Koivu considers herself a lifelong progressive and has historically supported the New Democratic Party. But she is concerned many left-leaning politicians have ignored criticism of safer supply. Many seemingly believe that opposition to it is inherently conservative.

“I went to a hearing in Ottawa of a standing committee to talk about addiction,” she said. “We had five minutes to give a talk, and then two hours to answer questions, [but] I didn’t receive any questions from the NDP or the Liberals.”

Although Koivu believes safe supply can play a role in the continuum of care for opioid addiction, she says it must be executed in a meticulous manner that prevents diversion and emphasizes pathways to recovery.

“It needs to be part of a comprehensive strategy to help people get their lives back. And right now, it’s not.”

Above all, it is Koivu’s experience as a mother that drives her to criticize safer supply. One of her sons struggled with opioid addiction as a young adult. Although he eventually recovered, the experience could have killed him.

“Had this program been around … my family could have been another statistic from an opioid death. That drives me. Because it’s very real, and it’s very personal.”

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