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Addiction experts demand witnessed dosing guidelines after pharmacy scam exposed

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Addictions

Addiction experts demand witnessed dosing guidelines after pharmacy scam exposed

Todayville

Published

3 months ago

11 minute read

By Alexandra Keeler 

The move follows explosive revelations that more than 60 B.C. pharmacies were allegedly participating in a scheme to overbill the government under its safer supply program. The scheme involved pharmacies incentivizing clients to fill prescriptions they did not require by offering them cash or rewards. Some of those clients then sold the drugs on the black market.

An addiction medicine advocacy group is urging B.C. to promptly issue new guidelines for witnessed dosing of drugs dispensed under the province’s controversial safer supply program.

In a March 24 letter to B.C.’s health minister, Addiction Medicine Canada criticized the BC Centre on Substance Use for dragging its feet on delivering the guidelines and downplaying the harms of prescription opioids.

The centre, a government-funded research hub, was tasked by the B.C. government with developing the guidelines after B.C. pledged in February to return to witnessed dosing. The government’s promise followed revelations that many B.C. pharmacies were exploiting rules permitting patients to take safer supply opioids home with them, leading to abuse of the program.

“I think this is just a delay,” said Dr. Jenny Melamed, a Surrey-based family physician and addiction specialist who signed the Addiction Medicine Canada letter. But she urged the centre to act promptly to release new guidelines.

“We’re doing harm and we cannot just leave people where they are.”

Addiction Medicine Canada’s letter also includes recommendations for moving clients off addictive opioids altogether.

“We should go back to evidence-based medicine, where we have medications that work for people in addiction,” said Melamed.

‘Best for patients’

On Feb. 19, the B.C. government said it would return to a witnessed dosing model. This model — which had been in place prior to the pandemic — will require safer supply participants to take prescribed opioids under the supervision of health-care professionals.

The move follows explosive revelations that more than 60 B.C. pharmacies were allegedly participating in a scheme to overbill the government under its safer supply program. The scheme involved pharmacies incentivizing clients to fill prescriptions they did not require by offering them cash or rewards. Some of those clients then sold the drugs on the black market.

In its Feb. 19 announcement, the province said new participants in the safer supply program would immediately be subject to the witnessed dosing requirement. For existing clients of the program, new guidelines would be forthcoming.

“The Ministry will work with the BC Centre on Substance Use to rapidly develop clinical guidelines to support prescribers that also takes into account what’s best for patients and their safety,” Kendra Wong, a spokesperson for B.C.’s health ministry, told Canadian Affairs in an emailed statement on Feb. 27.

More than a month later, addiction specialists are still waiting.

 

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According to Addiction Medicine Canada’s letter, the BC Centre on Substance Use posed “fundamental questions” to the B.C. government, potentially causing the delay.

“We’re stuck in a place where the government publicly has said it’s told BCCSU to make guidance, and BCCSU has said it’s waiting for government to tell them what to do,” Melamed told Canadian Affairs.

This lag has frustrated addiction specialists, who argue the lack of clear guidance is impeding the transition to witnessed dosing and jeopardizing patient care. They warn that permitting take-home drugs leads to more diversion onto the streets, putting individuals at greater risk.

“Diversion of prescribed alternatives expands the number of people using opioids, and dying from hydromorphone and fentanyl use,” reads the letter, which was also co-signed by Dr. Robert Cooper and Dr. Michael Lester. The doctors are founding board members of Addiction Medicine Canada, a nonprofit that advises on addiction medicine and advocates for research-based treatment options.

“We have had people come in [to our clinic] and say they’ve accessed hydromorphone on the street and now they would like us to continue [prescribing] it,” Melamed told Canadian Affairs.

A spokesperson for the BC Centre on Substance Use declined to comment, referring Canadian Affairs to the Ministry of Health. The ministry was unable to provide comment by the publication deadline.

Big challenges

Under the witnessed dosing model, doctors, nurses and pharmacists will oversee consumption of opioids such as hydromorphone, methadone and morphine in clinics or pharmacies.

The shift back to witnessed dosing will place significant demands on pharmacists and patients. In April 2024, an estimated 4,400 people participated in B.C.’s safer supply program.

Chris Chiew, vice president of pharmacy and health-care innovation at the pharmacy chain London Drugs, told Canadian Affairs that the chain’s pharmacists will supervise consumption in semi-private booths.

Nathan Wong, a B.C.-based pharmacist who left the profession in 2024, fears witnessed dosing will overwhelm already overburdened pharmacists, creating new barriers to care.

“One of the biggest challenges of the retail pharmacy model is that there is a tension between making commercial profit, and being able to spend the necessary time with the patient to do a good and thorough job,” he said.

“Pharmacists often feel rushed to check prescriptions, and may not have the time to perform detailed patient counselling.”

Others say the return to witnessed dosing could create serious challenges for individuals who do not live close to health-care providers.

Shelley Singer, a resident of Cowichan Bay, B.C., on Vancouver Island, says it was difficult to make multiple, daily visits to a pharmacy each day when her daughter was placed on witnessed dosing years ago.

“It was ridiculous,” said Singer, whose local pharmacy is a 15-minute drive from her home. As a retiree, she was able to drive her daughter to the pharmacy twice a day for her doses. But she worries about patients who do not have that kind of support.

“I don’t believe witnessed supply is the way to go,” said Singer, who credits safer supply with saving her daughter’s life.

Melamed notes that not all safer supply medications require witnessed dosing.

“Methadone is under witness dosing because you start low and go slow, and then it’s based on a contingency management program,” she said. “When the urine shows evidence of no other drug, when the person is stable, [they can] take it at home.”

She also noted that Suboxone, a daily medication that prevents opioid highs, reduces cravings and alleviates withdrawal, does not require strict supervision.

Kendra Wong, of the B.C. health ministry, told Canadian Affairs that long-acting medications such as methadone and buprenorphine could be reintroduced to help reduce the strain on health-care professionals and patients.

“There are medications available through the [safer supply] program that have to be taken less often than others — some as far apart as every two to three days,” said Wong.

“Clinicians may choose to transition patients to those medications so that they have to come in less regularly.”

Such an approach would align with Addiction Medicine Canada’s recommendations to the ministry.

The group says it supports supervised dosing of hydromorphone as a short-term solution to prevent diversion. But Melamed said the long-term goal of any addiction treatment program should be to reduce users’ reliance on opioids.

The group recommends combining safer supply hydromorphone with opioid agonist therapies. These therapies use controlled medications to reduce withdrawal symptoms, cravings and some of the risks associated with addiction.

They also recommend limiting unsupervised hydromorphone to a maximum of five 8 mg tablets a day — down from the 30 tablets currently permitted with take-home supplies. And they recommend that doses be tapered over time.

“This protocol is being used with success by clinicians in B.C. and elsewhere,” the letter says.

“Please ensure that the administrative delay of the implementation of your new policy is not used to continue to harm the public.”


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.


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Launched a year ago Break The Needle provides news and analysis on addiction and crime in Canada.

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Related Topics:#66TrillionDollarWeaponUsedToControlCorporateAmerica#BreakTheNeedleAddictionMedicineCanadaAlexandraKeelerBCCentreOnSubstanceAbuseBCOpioidsBCWitnessedDosing
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Addictions

More young men want to restrict pornography: survey

Published on July 11, 2025

By

Todayville

From LifeSiteNews

By Andreas Wailzer

Nearly 64% of American men now believe online pornography should be more difficult to access, with even higher numbers of women saying the same thing.

A new survey has shown that an increasing number of young men want more restrictions on online pornography.

According to a survey by the American Enterprise Institute’s Survey Center on American Life, nearly 7 in 10 (69 percent) of Americans support the idea of making online pornography less accessible. In 2013, 65 percent expressed support for policies restricting internet pornography.

The most substantial increase in the support for restrictive measures on pornography could be observed in young men (age 18-24). In 2013, about half of young men favored restrictions, while 40 percent actively opposed such policies. In 2025, 64 percent of men believe accessing online pornography should be made more difficult.

The largest support for restriction on internet pornography overall could be measured among older men (65+), where 73 percent favored restrictions. An even larger percentage of women in each age group supported making online pornography less accessible. Seventy-two percent of young women (age 18-24) favored restriction, while 87 percent of women 55 years or older expressed support for less accessibility of internet pornography.

Viewing pornography is highly addictive and can lead to serious health problems. Studies have shown that children often have their first encounter with pornography at around 12 years old, with boys having a lower average age of about 10-11, and some encountering online pornography as young as 8. Studies have also shown that viewing pornography regularly rewires humans brains and that children, adolescents, and younger men are especially at risk for becoming addicted to online pornography.

According to Gary Wilson’s landmark book on the matter, “Your Brain on Porn,” pornography addiction frequently leads to problems like destruction of genuine intimate relationships, difficulty forming and maintaining real bonds in relationship, depression, social anxiety, as well as reduction of gray matter, leading to desensitization and diminished pleasure from everyday activities among many others.

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Addictions

Can addiction be predicted—and prevented?

Published on July 11, 2025

By

Todayville

By Alexandra Keeler

These four personality traits are predictive of addiction. A new program is using this knowledge to prevent addiction from ever developing

In classrooms across Canada, addiction prevention is getting personal.

Instead of warning students about the dangers of drugs, a program called PreVenture teaches students about themselves — and it’s working.

Developed by Canadian clinical psychologist Patricia Conrod, PreVenture helps young people recognize how traits like risk-taking or negative thinking shape their reactions to stress.

“When you intervene around these traits and help people learn new cognitive behavioural strategies to manage these traits, you are able to reduce their substance use,” said Conrod, who is also a professor at the Université de Montréal.

By tailoring addiction prevention strategies to individual personality profiles, the program is changing how we think about addiction — from something we react to, to something we might stop before it starts.

And now, scientists say the potential for early intervention is going even deeper — down to our genes.

Personality and addiction

PreVenture is a personality-targeted prevention program that helps young people understand and manage traits linked to a higher propensity for future substance use.

The program focuses on four core traits — anxiety sensitivity, sensation seeking, impulsivity and hopelessness — that shape how individuals experience the world and respond to stress, social situations and emotional challenges.

“They don’t only predict who’s at risk,” said Conrod in an interview with Canadian Affairs. “They predict what you’re at risk for with quite a lot of specificity.”

Anxiety sensitivity shows up in people who feel overwhelmed by physical symptoms like a racing heart or dizziness. People with this trait may ultimately turn to alcohol, benzodiazepines such as Xanax, or opioids to calm their bodies.

Sensation seeking is characterized by a desire for excitement and novel experiences. This trait is associated with a higher likelihood of being drawn to substances like cannabis, MDMA, psilocybin or other hallucinogens.

“[Cannabis] alters their perceptual experiences, and so makes things feel more novel,” said Conrod.

Sensation seeking is also associated with binge drinking or use of stimulants such as cocaine.

The trait of impulsivity involves difficulty controlling urges and delaying gratification. This trait is associated with a higher likelihood of engaging in risky behaviours and an increased risk of addiction to a broad range of substances.

“Young people with attentional problems and a core difficulty with response inhibition have a hard time putting a stop on a behaviour once they’ve initiated it,” said Conrod.

Finally, the trait of hopelessness is tied to a pessimistic, self-critical mindset. People with this trait often expect rejection or assume others are hostile, so they may use alcohol or opioids to dull emotional pain.

“We call it negative attributional style,” said Conrod. “They have come to believe that the world is against them, and they need to protect themselves.”

These traits also cluster into two broader categories — internalizing and externalizing.

Anxiety sensitivity and hopelessness direct distress inward, while sensation seeking and impulsivity are characterized by outward disinhibition.

“These traits change your perception,” said Conrod. “You see the world differently through these traits.”

Conrod also notes that these traits appear across cultures, making targeted addiction prevention broadly applicable.

Personality-based prevention

Unlike most one-size-fits-all drug prevention programs, PreVenture tailors its prevention strategies for each individual trait category to reduce substance use risk.

The program uses a brief personality assessment tool to identify students’ dominant traits. It then delivers cognitive-behavioural strategies to help users manage stress, emotions and risky behaviours associated with them.

Recreation of the personality assessment tool based on the substance use risk profile scale — a scale measuring traits linked to reinforcement-specific substance use profiles. | Alexandra Keeler

Students learn to recognize how their dominant trait influences their thoughts and reactions — and how to shift those patterns in healthier directions.

“We’re trying to raise awareness to young people about how these traits are influencing their automatic thinking,” said Conrod. “You’re having them be a little more critical of their thoughts.”

Hopelessness is addressed by teaching strategies to challenge depressive thoughts; those high in sensation seeking explore safer ways to satisfy their need for stimulation; anxiety sensitivity is managed through calming techniques; and impulsivity is reduced by practicing pausing before acting.

Crucially, the program emphasizes the strengths of each trait as well.

“We try to present [traits] in a more positive way, not just a negative way,” said Sherry Stewart, a clinical psychologist at Dalhousie University who collaborates with Conrod.

“Your personality gets you into trouble — certainly, we discuss that — but also, what are the strengths of your personality?”

While a main goal of the program is preventing substance use disorders, the program barely discusses substances.

“You don’t really have to talk about substances very much,” said Conrod. “You talk more about how you’re managing the trait, and it has this direct impact on someone’s motivation to use, as well as how severely they experience mental health symptoms.”

The workshops make it clear, however, that while substances may offer temporary relief, they often worsen the very symptoms participants are trying to manage.

Subscribe for free to get BTN’s latest news and analysis – or donate to our investigative journalism fund.

Break The Needle provides news and analysis on addiction and crime in Canada.

Subscribe to Break The Needle

The genetic angle

Catherine Brownstein, a Harvard Medical School professor and geneticist at Boston Children’s Hospital, says genetic factors also help explain why some people are more vulnerable to addiction.

“A lot of personality is genetic,” she said in an interview with Canadian Affairs.

Her research has identified 47 locations in human DNA that affect brain development and shape personality traits.

While substance use risk cannot yet be detected genetically, certain gene variants — like SHANK3, NRXN1 and CRY1 — are linked to psychiatric disorders that often co-occur with substance use, including ADHD and schizophrenia.

Brownstein also says genetic variations influence pain perception.

Some variants increase pain sensitivity, while others eliminate it altogether. One such gene, SCN9A, may make individuals more likely to seek opioids for relief.

“If you’re in pain all the time, you want it to stop, and opioids are effective,” said Brownstein.

While we cannot yet predict addiction risk from genetics alone, Brownstein says she thinks genetic screening combined with psychological profiling could one day personalize prevention even further.

Expansion and challenges

Conrod’s personality-targeted intervention program, PreVenture, has proven highly effective.

A five-year study published in January found that students who participated in PreVenture workshops were 23 to 80 per cent less likely to develop substance use disorders by Grade 11.

Stewart says that the concept of PreVenture began with adults with substance use disorders, but research suggests earlier intervention can alter life trajectories. That insight has driven PreVenture’s expansion to younger age groups.

Conrod’s team delivers PreVenture to middle and high school students, UniVenture to university students and OpiVenture to adults in treatment for opioid dependence.

PreVenture has been implemented in schools across the U.S. and Canada, including in B.C., Ontario, Quebec, Nova Scotia and Newfoundland and Labrador. Five Canadian universities are participating in the UniVenture study.

However, currently, Canada’s flagship youth prevention strategy is based on the Icelandic Prevention Model — a 1990s framework that aims to reduce youth substance use by focusing on environmental factors such as family, school and peer influence.

While the Icelandic Prevention Model has shown success in Iceland, it has serious limitations. It lacks a mental health component, does not specifically address opioid use and has demonstrated mixed results by gender.

Despite strong evidence for personality-targeted prevention, programs like PreVenture remain underused.

Conrod says education systems often default to less effective, generic methods like one-off guest speakers. She also cites staffing shortages and burnout in schools, along with insufficient mental health services, as major barriers to implementing a new program.

Still, momentum is building.

B.C. has aligned their prevention services with the PreVenture model. And organizations such as the youth wellness networks Foundry B.C. and Youth Wellness Hubs Ontario are offering the program and expanding its reach.

Conrod believes the power of the program lies in helping young people feel seen and understood.

“It’s really important that a young person is provided with the space and focus to recognize what’s unique about [their] particular trait,” she said.

“Recognize that there are other people in the world that also think this way [and tell them] you’re not going crazy.”


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.


Launched a year ago
Break The Needle provides news and analysis on addiction and crime in Canada.

Subscribe to Break The Needle

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