Addictions
Leading addiction doctor warns of Canada’s ‘safer supply’ disaster
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.”
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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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From LifeSiteNews
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.
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.
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.
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