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Addictions

Reckless: British Columbia’s “safe supply” fentanyl tablet experiment

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9 minute read

From the MacDonald Laurier Institute

By Adam Zivo

While safer supply sounds nice in theory, addiction experts have found that drug users are reselling (“diverting”) a significant portion of their free hydromorphone on the black market to purchase harder substances. This has fuelled new addictions while generating handsome profits for organized crime.

Adam Zivo reviews the latest drug protocols adopted by the BC government and reports on their alarming lack of evidence and accountability.

British Columbia’s new drug protocols allow doctors throughout the province to prescribe “safer supply” drugs in a reckless manner.

In a new report titled Reckless: British Columbia’s “safe supply” fentanyl tablet experiment, Adam Zivo reviews the newest drug protocols adopted by the BC government, documenting the evolution of “safe supply” opioid programs in Canada since 2020. Zivo reports on the concerning lack of evidence behind the protocols, how they undermine recovery, drive diversion to the black market, and ruin the lives of young Canadians.

The new protocols not only avoid any requirement for drug users to first try evidence-based recovery programs before receiving high-potency opioids, but also allow minors to receive them, with no reference to the rights and roles of parents or even a minimum age for safer supply clients.

Of deep concern is also the BC government’s approach of continually increasing access to “safe” opioids despite openly admitting that there is no evidence of proven benefits or safety. The protocols also require that clients be told that their access to free fentanyl and sufentanil will almost certainly be cut off if they are hospitalized, or if they attend withdrawal management or substance use treatment facilities.

Zivo explains: “The prospect of free fentanyl and sufentanil creates powerful incentives to sign away one’s rights to evidence based treatment, so the province is essentially exploiting clients’ addictions so that it can experiment on them without taking legal responsibility for potential harms.”

Zivo adds that “one can reasonably expect that a significant portion of the fentanyl tablets being distributed by the BC government will end up being traded or resold on the black market,” explaining how mass diversion is already a major issue for weaker “safer supply” opioids like hydromorphone.

While addiction experts have been overwhelmingly critical of unsupervised safer supply, Zivo notes that many believe that the solution is not to abolish but to reform the program so that drugs can be provided more responsibly. By receiving safer supply as a temporary intervention, addicted users can transition to recovery-oriented treatments such as opioid agonist therapy (OAT.)

“It would not take much to reshape BC’s safer supply fentanyl and sufentanil programs into something more responsible and genuinely safe,” concludes Zivo. “There is nothing preventing the province from redesigning safer supply as a recovery-oriented intervention.”

To learn more, read the full paper here:

PDF of paper

Executive Summary

This past August, British Columbia’s government quietly launched new protocols that allow doctors to prescribe “safer supply” fentanyl tablets and liquid sufentanil. Fentanyl is at least 10 times stronger than hydromorphone and sufentanil, which is derived from fentanyl, is a further 5 to 10 times more potent than its parent drug. While in theory these drugs could save lives if provisioned cautiously, the way the province has chosen to distribute these dangerous opioids is nothing short of reckless.

There is evidence to support the use of opioid agonist therapy (“OAT”) medications, such as methadone, buprenorphine, and slow release oral morphine in addiction treatment, but the government’s new protocols extrapolate OAT-related evidence to support “safer supply” fentanyl even though the two therapies have little in common. In fact, the government’s protocols stress that providing safer supply fentanyl or sufentanil is “not a treatment for opioid use disorder” and that “there is no evidence available supporting this intervention, safety data, or established best practices for when and how to provide it.” It is deeply concerning that the BC government has, over the past several years, significantly increased access to “safe” fentanyl and sufentanil despite openly admitting that there is no evidence showing that these interventions provide any benefits and can be implemented safely.

“Safer supply” programs claim to reduce overdoses and deaths by providing free pharmaceutical-grade drugs as alternatives to potentially tainted illicit substances. While safer supply sounds nice in theory, addiction experts have found that drug users are reselling (“diverting”) a significant portion of their free hydromorphone on the black market to purchase harder substances. This has fuelled new addictions while generating handsome profits for organized crime. Some patients have even been coerced into securing safer supply they didn’t need. Pimps and abusive partners pressure vulnerable women into securing as much hydromorphone as possible for black market resale. Other vulnerable patients, such as the geriatric and disabled, have been robbed of their safer supply outside of pharmacies.

There are other issues with the protocols, too. They require that clients be told that their access to free fentanyl and sufentanil will almost certainly be cut off if they are hospitalized, or if they attend withdrawal management or substance use treatment facilities. This creates powerful disincentives for drug users to seek life-saving health care. Further, none of the safer supply protocols by the British Columbia Centre on Substance Use (BCCSU) discuss the rights and roles of the parents of minors struggling with addiction. It appears that health care providers can give fentanyl and sufentanil to minors regardless of whether parents are aware of, or consent to, this intervention. The protocols do not specify a minimum age for safer supply clients.

It would not take much to reshape BC’s safer supply fentanyl and sufentanil programs into something more responsible and genuinely safe. There is nothing preventing the province from redesigning safer supply as a recovery-oriented intervention. Experts argue that safer supply could be helpful if used as a temporary intervention that helps severely-addicted users make the transition to recovery-oriented treatments, such as OAT.

There is also nothing stopping the province from fixing many of the issues with the safer supply program – including lax safeguards for youth. Any safer supply model must require supervised consumption. It is the absence of this supervision that has enabled the mass diversion of safer supply drugs onto the black market.

Governments have a duty to provide evidence-based treatment to vulnerable citizens and consider collateral harms to others. Rather than fulfil this duty, the BC government is committing to risky and highly experimental interventions that lack an appropriate evidence base.

Adam Zivo is a freelance writer and political analyst best known for his weekly columns in the National Post. He holds a Master of Public Policy from the Munk School of Global Affairs and Public Policy and recently founded the Centre for Responsible Drug Policy, a nonprofit advocacy organization.

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Addictions

Why can’t we just say no?

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From the Frontier Centre for Public Policy

By Susan Martinuk

Drug use and violence have become common place in hospitals. Drug-addicted patients openly smoke meth and fentanyl, and inject heroin. Dealers traffic illicit drugs.  Nurses are harassed, forced to work amidst the toxic fumes from drugs and can’t confiscate weapons. In short, according to one nurse, “We’ve absolutely lost control.”

“Defining deviancy down” is a cultural philosophy that emerged in the United States during the 1990s.

It refers to society’s tendency to adjust its standards of deviancy “down,” so that behaviours which were once unacceptable become acceptable.  Over time, this newly- acceptable behaviour can even become society’s norm.

Of course, the converse must also be true — society looks down on those who label social behaviours “wrong,” deeming them moralistic, judgemental or simply out of touch with the realities of modern life.

Thirty years later, this philosophy is entrenched in British Columbia politics and policies. The province has become a society that cannot say “no” to harmful or wrong behaviours related to drug use. It doesn’t matter if you view drug use as a medical issue, a law-and-order issue, or both – we have lost the ability to simply say “no” to harmful or wrong behaviour.

That much has become abundantly clear over the past two weeks as evidence mounts that BC’s experiment with decriminalization and safe supply of hard drugs is only making things worse.

recently-leaked memo from BC’s Northern Health Authority shows the deleterious impact these measures have had on BC’s hospitals.

The memo instructs staff at the region’s hospitals to tolerate and not intervene with illegal drug use by patients.  Apparently, staff should not be taking away any drugs or personal items like a knife or other weapons under four inches long.  Staff cannot restrict visitors even if they are openly bringing illicit drugs into the hospital and conducting their drug transactions in the hallways.

The public was quite rightly outraged at the news and BC’s Health Minister Adrian Dix quickly attempted to contain the mess by saying that the memo was outdated and poorly worded.

But his facile excuses were quickly exposed by publication of the very clearly worded memo and by nurses from across the province who came forward to tell their stories of what is really happening in our hospitals.

The President of the BC Nurses Union, Adriane Gear, said the issue was “widespread” and “of significant magnitude.” She commented that the problems in hospitals spiked once the province decriminalized drugs. In a telling quote, she said, “Before there would be behaviours that just wouldn’t be tolerated, whereas now, because of decriminalization, it is being tolerated.”

Other nurses said the problem wasn’t limited to the Northern Health Authority. They came forward (both anonymously and openly) to say that drug use and violence have become common place in hospitals. Drug-addicted patients openly smoke meth and fentanyl, and inject heroin. Dealers traffic illicit drugs.  Nurses are harassed, forced to work amidst the toxic fumes from drugs and can’t confiscate weapons. In short, according to one nurse, “We’ve absolutely lost control.”

People think that drug policies have no impact on those outside of drug circles – but what about those who have to share a room with a drug-smoking patient?

No wonder healthcare workers are demoralized and leaving in droves. Maybe it isn’t just related to the chaos of Covid.

The shibboleth of decriminalization faced further damage when Fiona Wilson, the deputy chief of Vancouver’s Police Department, testified before a federal Parliamentary committee to say that the policy has been a failure. There have been more negative impacts than positive, and no decreases in overdose deaths or the overdose rate. (If such data emerged from any other healthcare experiment, it would immediately be shut down).

Wison also confirmed that safe supply drugs are being re-directed to illegal markets and now account for 50% of safe supply drugs that are seized. Her words echoed those of BC’s nurses when she told the committee that the police, “have absolutely no authority to address the problem of drug use.”

Once Premier David Eby and Health Minister Adrian Dix stopped denying that drug use was occurring in hospitals, they continued their laissez-faire approach to illegal drugs with a plan to create “safe consumption sites” at hospitals. When that lacked public appeal, Mr. Dix said the province would establish a task force to study the issue.

What exactly needs to be studied?

The NDP government appears to be uninformed, at best, and dishonest, at worst. It has backed itself into a corner and is now taking frantic and even ludicrous steps to legitimize its experimental policy of decriminalization. The realities that show it is not working and is creating harm towards others and toward institutions that should be a haven for healing.

How quickly we have become a society that lacks the moral will – and the moral credibility – to just to say “no.”

Susan Martinuk is a Senior Fellow with the Frontier Centre for Public Policy and author of Patients at Risk: Exposing Canada’s Health-care Crisis.

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Addictions

British Columbia should allow addicts to possess even more drugs, federal report suggests

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From LifeSiteNews

By Clare Marie Merkowsky

Despite the drug crisis only getting worse in British Columbia after decriminalization, a federal report by the Canadian Institutes of Health Research advocates for further relaxing its policy so addicts can possess even more drugs.

Despite the drug crisis only worsening since decriminalization, federal researchers are now advocating for British Columbia to allow the possession of even larger quantities of cocaine, claiming that current possession limits don’t allow addicts to buy enough.

According to a federal report published April 23 by Blacklock’s Reporter, the current decriminalization program in British Columbia approved by Prime Minister Justin Trudeau’s government has set cocaine possession limits “too low.”

“People who use drugs are less concerned about being arrested and feel more comfortable carrying substances they need,” said the report by the Canadian Institutes of Health Research. “The threshold of 2.5 grams is too low and is unreflective of users’ substance use and purchasing patterns.” 

Under the policy, which launched in early 2023, the federal government began allowing people within the province to possess up to 2.5 grams of hard drugs – including cocaine, opioids, ecstasy and methamphetamine – without criminal penalty, but selling drugs remained a crime.   

The policy has been widely criticized, especially after it was found that the province broke three different drug-related overdose records in the first month the new law was in effect.   

However, now researchers are claiming that the new policy is insufficient for drug users.   

“People who use drugs indicated the 2.5 gram threshold is too low and unreflective of their substance use patterns,” the report stated. “Although some people indicated the policy wouldn’t impact their purchasing patterns because they are unable to purchase large amounts at a time, others suggested it may force them to seek out substances more frequently which could increase their risk of harms.”  

“Buying in bulk may be more economical particularly for people who use drugs,” it continued, adding that it was “common practice to purchase in bulk and split or share among peers.”  

The recommendation comes as deaths from drug overdoses in Canada have gone through the roof in recent years, particularly in British Columbia.  

Gunn says he documents the “general societal chaos and explosion of drug use in every major Canadian city.”   

“Overdose deaths are up 1,000 percent in the last 10 years,” he said in his film, adding that “[e]very day in Vancouver four people are randomly attacked.”   

Similarly, even Liberals have begun to condemn Trudeau’s “safe supply” program, linking them to “chaos” in cities.  

Safe supply“ is the term used to refer to government-prescribed drugs that are given to addicts under the assumption that a more controlled batch of narcotics reduces the risk of overdose – critics of the policy argue that giving addicts drugs only enables their behavior, puts the public at risk, disincentivizes recovery from addiction and has not reduced, and sometimes even increased, overdose deaths where implemented.    

Last week, Liberal MP Dr. Marcus Powlowski revealed that violence from drug users has become a problem in Ottawa, especially in areas near so-called “safe supply” drug sites which operate within blocks of Parliament Hill.    

“A few months ago I was downtown in a bar here in Ottawa, not that I do that very often, but a couple of colleagues I met up with, one was assaulted as he was going to the bar, another one was threatened,” said Powlowski.   

“Within a month of that I was returning down Wellington Street from downtown, the Rideau Centre, and my son who is 15 was coming after me,” he continued. “It was nighttime and there was someone out in the middle of the street, yelling and screaming, accosting cars.”  

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