Dr. Lori Regenstreif warns: No other country would hand bottles of opioids to addicts ‘with the assumption that this will solve their risk of overdose death’

A scathing new study by a Canadian addictions physician concludes that ideologically driven “social justice” governments have worsened the country’s fentanyl crisis by aggressively funding and promoting so-called “safer supply” programs—despite a lack of evidence they save lives. Instead, as mounting proof showed that thousands of government-distributed opioid tablets—as potent as heroin—were being diverted into the black market by organized crime, Health Canada, public health officials, and sympathetic media outlets continued to defend the controversial programs and attack critics.

Even as violent incidents emerged—including a shooting outside a Toronto safer supply clinic—the study notes that some advocates called for medical professionals to be removed from program oversight entirely.

In a paper published by the Macdonald-Laurier Institute, Dr. Lori Regenstreif, a veteran addictions physician, argues that Canada’s “safe supply” programs—widely expanded after 2019—have not only failed to reduce overdose deaths, but have coincided with a steep rise in fatalities. The number of opioid-related deaths in Canada surged from 3,023 in 2016 to more than 7,300 by 2021, despite increased distribution of government-supplied hydromorphone tablets. Regenstreif warns that the policy, intended as harm reduction, has morphed into a dangerous social justice experiment, sidelining evidence-based treatments like methadone and buprenorphine in favour of unproven, unsupervised opioid dispensing.

What Canada has chosen to do to address opioid overdose is unique, Regenstreif states of her findings, released today.

Instead of curbing fatalities, safe supply programs have unleashed a wave of diversion—with powerful 8mg hydromorphone tablets, known on the street as “Dillies,” leaking into illicit markets and being trafficked across the country. She cites a growing body of evidence, also covered in reports from The Bureau, that these pills are not only widely sold and traded by program participants, but also used as currency by organized crime groups.

Cited in the study, like-minded addiction experts Dr. Sharon Koivu and Dr. Jenny Melamed report that the street price of Dilaudid 8mg tablets collapsed from $15–$20 in 2020 to as low as $0.50 by late 2021. “Things changed within weeks of the hydromorphone hitting the streets,” Melamed said. This sudden flood of pharmaceutical-grade opioids reshaped local drug economies—allowing criminal networks to exploit the government-funded supply chain and expand access to hard opioids far beyond clinical settings.

Regenstreif also highlights systemic flaws in the program’s implementation. Staff at supervised injection sites often appeared well-meaning, but lacked clinical experience and a clear understanding of untreated addiction behaviour.

One notable case cited in the report occurred in 2023, when a peer support worker at the Parkdale Community Health Centre in Toronto was implicated in a shooting incident.

“A peer support worker, perhaps with naïve but good intentions, ended up on the wrong side of the law in attempting to protect a safe consumption site client involved in a shooting,” Regenstreif writes.

Yet despite such outcomes, advocates continued to push for a “non-medicalized” model of opioid distribution, in which trained addiction specialists were sidelined.

Regenstreif traces how media coverage of the safer supply programs has shifted in tone amid growing investigative scrutiny and backlash from program advocates and public health officials.

Health Canada is described as having dismissed or re-framed concerns over diversion. One federally funded guidance document, titled Re-Framing Diversion for Health Care Providers, argued that diversion should not be stigmatized. “The current medical and criminal-legal framing of diversion perpetuates stigmatizing and patronizing views of people who use drugs,” the document reads.

The Globe and Mail’s Andrea Woo wrote in 2024 citing British Columbia’s Coroners Service and noting no definitive link between prescribed safe supply and overdose deaths. However, Regenstreif points out that coroners cannot determine how a victim first encountered opioids—only which drug was in their system at death. “A coroner cannot determine if the opioid came from a diverted prescription,” she writes.

National Post contributor Adam Zivo—who has reported on diversion for The Bureau—was among the first to investigate pill diversion in 2023, interviewing clinicians who used pseudonyms due to fear of backlash. The study cites his reporting in describing a pattern: as police across the country seized tens of thousands of prescription opioid pills, and more physicians documented evidence of diversion, the research field remained notably shallow. Meanwhile, advocates of safe supply programs politicized the issue, accusing critics of inciting a “moral panic” and aligning with entrenched institutional interests.

Regenstreif contends that it is frontline addiction physicians—those treating users of fentanyl and working within the safer supply framework—who are best placed to assess its consequences. She recounts one patient under 18 describing a visit to a Burlington, Ontario clinic, where they saw a doctor only on video and were handed a bottle of Dilaudid. Others reported buying diverted Dilaudid bottles openly on the streets of Peterborough, Thunder Bay, and Windsor in Ontario, or Victoria and Nanaimo in British Columbia.

Not all supporters of the program are acting in bad faith, Regenstreif notes, but many fail to see the bigger picture. Addiction specialists, public health officials, and researchers have each addressed isolated elements of the crisis based on their particular lens—yet none have managed to bring these perspectives together into an effective, unified response.

Corroborating Canadian reports, the U.S. Drug Enforcement Administration identifies hydromorphone—marketed as Dilaudid—as a drug of interest to traffickers, producing effects similar to heroin and fentanyl. The DEA lists common street names such as “D,” “Dillies,” “Dust,” “Footballs,” “Juice,” and “Smack,” and warns that diversion occurs through forged prescriptions, doctor-shopping, and pharmacy theft—risks compounded by unmonitored safe supply systems.

In her conclusion, Regenstreif warns that comparing opioids to alcohol, as some safe supply advocates do, is a false analogy. Alcohol’s harms accumulate gradually; opioids, by contrast, are acutely toxic and deadly. Canada must chart a better path forward, she argues—one that prioritizes evidence-based care, not ideological narratives. That path includes a return to opioid agonist therapy and wraparound services; genuine adherence to medical science; balancing individual and community well-being; and reuniting the four pillars of Canada’s drug strategy: prevention, treatment, harm reduction, and enforcement.