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Addictions

“Safer supply” reminiscent of the OxyContin crisis, warns addiction physician

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Dr. Lori Regenstreif, MD, MSc, CCFP (AM), FCFP, MScCH (AMH), CISAM, has been working as an addiction medicine physician in inner city Hamilton, Ontario, since 2004. She co-founded the Shelter Health Network in 2005 and the Hamilton Clinic’s opioid treatment clinic in 2010, and helped found the St. Joseph’s Hospital Rapid Access Addiction Medicine (RAAM) clinic.

[This article is part of Break The Needle’s “Experts Speak Up” series, which documents healthcare professionals’ experiences with Canada’s “safer supply” programs] By: Liam Hunt

Dr. Lori Regenstreif, an addiction physician with decades of experience on the frontlines of Canada’s opioid crisis, is sounding the alarm about the country’s rapidly expanding “safer supply” programs.

While proponents of safe supply contend that providing drug users with free tablets of hydromorphone – a pharmaceutical opioid roughly as potent as heroin – can mitigate harms, Dr. Regenstreif expresses grave concern that these programs may inadvertently perpetuate new addictions and entrench existing opioid use.

She sees ominous similarities between safer supply and the OxyContin crisis of the late 1990s, when the widespread overprescribing of opioids flooded North American communities with narcotics, sparking an addiction crisis that continues to this day. Having witnessed the devastating consequences of OxyContin in the late 1990s, she believes that low-quality and misleading research is once again encouraging dangerous overprescribing practices.

Flashbacks to the OxyContin Crisis

Soon after Dr. Regenstreif received her medical license in Canada, harm reduction became the primary framework guiding her practice in inner-city Vancouver. This period coincided with Health Canada’s 1996 regulatory approval of oxycodone (brand name: OxyContin) based on trials, sponsored by Purdue Pharma, that failed to assess the serious risks of misuse or addiction.

Dr. Regenstreif subsequently witnessed highly addictive prescription opioids flood North American streets while Purdue and its distributors reaped record profits at the expense of vulnerable communities. “That was really peaking in the late 90s as I was coming into practice,” she recounted during an extended interview with Break The Needle. “I was being pressured to prescribe it as well.”

Oxycodone addiction led to the deaths of tens of thousands of individuals in the United States and Canada. As a result, Purdue Pharma faced criminal penalties, fines, and civil settlements amounting to 8.5 billion USD, ultimately leading to the company’s bankruptcy in 2019.

During the OxyContin crisis, patients would regularly procure large amounts of pharmaceutical opioids for resale on the black market – a process known as “diversion.” Dr. Regenstreif has seen alarming indications that safer supply hydromorphone is being diverted at similarly high levels, and estimated that, out of her patient pool, “15 to 20 out of maybe 40 people who have to go to a pharmacy frequently” have reported witnessing diversion.

Between one to two thirds of her new patients have told her that they are accessing diverted hydromorphone tablets – in many cases, the tablets almost certainly originate from safer supply.

Injecting crushed hydromorphone tablets pose severe health risks, including endocarditis and spinal abscesses. “I’ve seen people become quadriplegic and paraplegic because the infection invaded their spinal cord and damaged their nervous system,” said Dr. Regenstreif. While infections can be mitigated by reducing the number of times drug users inject drugs into their bodies, she says that safer supply programs do not discourage or reduce injections.

She further noted, “I’ve seen a teenager in [the] hospital getting their second heart valve replacement because they continue to inject after the first one.” The pill that nearly stopped the patient’s heart was one of the tens of thousands of hydromorphone tablets handed out daily via Canadian safe supply programs.

Her experiences are consistent with preliminary data from a scientific paper published by JAMA Internal Medicine in January, which found that safe supply distribution in British Columbia is associated with a “substantial” increase in opioid-related hospitalizations, rising by 63% over the first two years of program implementation — all without reducing deaths by a statistically significant margin.

While Dr. Regenstreif has worked in a variety of settings, from Ontario’s youth correctional system to Indigenous healing facilities in the Northwest Territories, her experiences in Australia, where she worked during a sabbatical year from 2013 to 2014, were particularly educational.

Australia has far fewer opioid-related deaths than Canada – in 2021, opioid mortality rates were 3.8 per 100,000 in Australia and 21 per 100,000 in Canada (a difference of over 500%). Dr. Regenstreif credited this difference to Australia’s comparatively controlled opioid landscape, where access to pharmaceutical narcotics is tightly regulated.

“Heroin had been a long-standing street opioid. It was really the only opioid you tended to see, because the only other ones people could get a prescription for were over-the-counter, low-potency codeine tablets,” she said. To this day, opioid prescriptions in Australia require special approval for repeat supplies, preventing stockpiling and street diversion.

No real evidence supports “safer supply”

Critics and whistleblowers have argued that Canadian safe supply programs, which have received over $100 million in federal funding through Health Canada’s Substance Use and Addictions Program (SUAP), were initiated without adhering to the rigorous evidentiary standards typically required to classify medication as “safe.”

Dr. Regenstreif shares these concerns and says that no credible studies show that safer supply saves lives, and that little effort is invested into exploring its possible risks and unintended consequences – such as increased addiction, hospitalization, overdose and illicit diversion to youth and vulnerable individuals.

Most studies which support the experiment simply interview recipients of safer supply and then present their answers as objective evidence of success. Dr. Regenstreif criticized these qualitative studies as methodologically flawed “customer satisfaction surveys,” as they are “very selective” and rely on small, bias-prone samples.

“If you have 400 people in a program, and you get feedback from 12, and 90% of those 12 said X, that’s not [adequate] data,” said Dr. Regenstreif, criticizing the lack of follow-up often shown safer supply researchers. “Nobody seems to track down the […] people who were not included. Did they get kicked out of the program? [Did they engage in] diversion? Did they die? We’re not hearing about that. It doesn’t make any sense in an empirical scientific universe.”

Safe supply advocates typically argue that opioids themselves are not problematic, but rather their unregulated and illicit supply, as this allows for contaminants and unpredictable dosing. However, studies have found that opioid-related deaths rise when narcotics, legal or not, are more widely available.

Dr. Regensteif is calling upon harm reduction researchers to build a more robust evidence base before calling for the expansion of safer supply. That includes more methodologically rigorous and transparent quantitative research to evaluate the full impact of Canada’s harm reduction strategies. Forgoing this evidence or adequate risk-prevention measures could lead to consequences as catastrophic as those resulting from Purdue’s deceptive marketing of OxyContin, she said.

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Critics propose solutions despite bullying

Dr. Regenstreif has faced pressure and exclusion for speaking out against safe supply. She estimates that while only a quarter of her local colleagues shared her doubts a few years ago, “now I would say more than half” harbor the same concerns. However, many are reluctant to voice their reservations publicly, fearing professional or social repercussions. “People who don’t want to speak out don’t want to be labeled as right-wing […] they don’t want to be labeled as conservative.”

While she acknowledges that safe supply may play a limited role for a small subset of patients, she believes it has been oversold as a panacea without adequate safeguards or due evaluation. “It doesn’t seem as if policymakers are listening to the people on the ground who have experience in doing this,” she said.

She contends that the solution to Canada’s addiction crisis lies in a more holistic, recovery-oriented approach that includes all four pillars of addiction: harm reduction, prevention, treatment, and enforcement. Her vision includes a national network of publicly-funded, rapid-access addiction medicine clinics with integrated counseling and wraparound services.

Additionally, Dr. Regenstreif stresses the importance of building upon established opioid agonist treatments (OAT), like methadone and buprenorphine, rather than solely relying on novel approaches whose social and medical risks are not yet fully understood.

At the core of Dr. Regenstreif’s advocacy lies a profound dedication to her patients and to the science of addiction medicine. “I like to think I kind of am fear-mongering with my patients, [by] trying to make them afraid of not getting better,” she explains. “I don’t want them to end up in the hospital and not come back out. I don’t want them to end up dead.”


[This article has been co-published with The Bureau, a Canadian media outlet that tackles corruption and foreign influence campaigns through investigative journalism. Subscribe to their work to get the latest updates on how organized crime influences the Canadian drug trade.]

Addictions

Claims about ‘safer supply’ diversion aren’t disinformation

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News release from Break The Needle

This month, police in London, Ont., admitted to what critics have said all along: safer supply diversion is happening at alarming levels

Last spring, Canada’s minister of mental health and addictions claimed critics’ concerns about “safer supply” diversion — the illegal selling and trading of taxpayer-funded addictive drugs — were based on lies.

“For Pierre Poilievre to state untrue information about safer supply, and try to create barriers to accessing harm reduction services that are saving lives amid this ongoing crisis, is incredibly irresponsible and dehumanizing to people who use drugs,” read a statement by then-minister Carolyn Bennett’s office.

Fast forward a year, and it’s clear which side was telling the truth.

This month, police in London, Ont., admitted to what critics said all along: diversion of pharmaceutically supplied opioids to the streets is happening at alarming levels. London is home to Canada’s longest-running safer supply program, which dates back to 2016 and was significantly expanded in 2020.

The London Police Service released data that shows a staggering 3,000 per cent increase in the seizure of hydromorphone tablets — the opioid predominantly given out by safer supply programs — over the last five years. In 2019, London police seized just under 1,000 tablets. By 2020, that number had tripled. In 2023, they seized 30,000 hydromorphone tablets.

For context, hydromorphone is as potent as heroin and just two or three of these pills, if snorted, can cause an overdose in an inexperienced opioid user.

Earlier this month, the city’s deputy police chief, Paul Bastien, told CBC’s London Morning, “We recognize the value that safe supply plays as part of that harm reduction piece, but diversion is an important issue that is affecting community safety. I won’t say that everyone’s doing it, but some of the tablets from safe supply are being diverted for that purpose.”

“Criminal groups are fairly adept at exploiting policy changes that are well intended. But unforeseen consequences sometimes arise and this appears to be, at least in part, one of them,” he continued.

A reasonable person may assume that, given this alarming new evidence, proponents of safer supply would change their tune about widespread diversion being “fake news.” Unfortunately, they haven’t.

Some activists are now claiming on social media that London’s spike in hydromorphone seizures was not caused by safer supply, but rather by a high-profile theft of 245,000 hydromorphone tablets from an Ontario pharmacy. Yet the spike in seizures began years before this theft and, according to multiple addiction physicians, the street price of hydromorphone collapsed in the city well before 2023, suggesting an earlier influx of diverted supply.

However, these mental contortions aren’t surprising. As more and more evidence of widespread diversion emerged over the past year, accusations of disinformation and misinformation haven’t stopped –– they have simply evolved. The narrative changed from “Diversion doesn’t exist” to “Fine, it exists, but only on a small scale” to, now, “Fine, diversion exists at scale, but imagine the alternative?”

This is the angle already emerging in British Columbia, where the province’s top doctor, Bonnie Henry, authored a damning report that acknowledges the regularity and harms of safer supply diversion, yet still concludes safer supply is “ethically defensible” and advocates for its expansion.

Like many safer supply activists, Henry often argues diversion isn’t a significant concern because most opioid deaths are caused by fentanyl.

While it’s true that most opioid deaths are attributable to fentanyl, hydromorphone is still incredibly dangerous. When diverted into the black market, it creates new addictions, often among young people, which culminate in fentanyl use.

Moreover, data indicate hydromorphone is implicated in an increasing share of drug-related deaths in young people in B.C. In 2019, there were no reported deaths involving hydromorphone. By 2022, that number jumped to 22 per cent. Similarly, a recent report by the Centre for Addiction and Mental Health in Ontario found the number of youth in the province who self-reported using prescription opioids for “non-medical” reasons jumped 71 per cent between 2021 and 2023.

Still, safer supply activists continue to insist, despite overwhelming evidence to the contrary, that widespread diversion isn’t happening.

In 2017, Collins Dictionary declared “fake news” the word of the year. Since then, the term –– along with sister terms “misinformation” and “disinformation” –– have taken on a disturbing new life.

While fake news, misinformation and disinformation are very real democratic threats, some politicians and activists realized they could delegitimize opponents’ arguments and unflattering media stories by simply proclaiming them fake. Now, we’re in the dizzyingly ironic position of real news, and real facts, being dismissed as misinfo and disinfo by self-declared guardians of the truth.

This is the exact problem journalists and concerned medical professionals continue to face when raising the alarm on so-called “safer supply.” Despite the abundance of solid reporting, emerging data, whistleblower warnings and first-hand accounts of widespread diversion, harm reduction activists and their allies in government don’t just recklessly dismiss the problem, they weaponize the language of fake news to discredit a reality they don’t like.

Communities across Canada, and addicts themselves, deserve better.

A guest post by
Sabrina Maddeaux
Bold opinions and analysis of the political and economic issues that matter.
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Addictions

‘Drug dens’: Poilievre calls out Trudeau’s misleadingly named ‘safe’ injection sites

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From LifeSiteNews

By Clare Marie Merkowsky

Pierre Poilievre haș again sounded off on the Trudeau government’s ‘safe’ injection sites and other drug measures, policies which have been followed by an uptick in drug overdoses wherever implemented.

Conservative Party leader Pierre Poilievre has condemned Prime Minister Justin Trudeau’s Liberal government and the mainstream media for concealing the failure of federally-subsidized “safe” injection sites for hard drug use.

During a July 12 press conference in Montreal, Quebec, Poilievre slammed politicians and mainstream media alike for masking the failure of the Trudeau government-led “supervised injection sites,” pointing out the misleading nature of the term “safe” often used when discussing these facilities, which allow addicts to abuse themselves by injecting deadly narcotics such as heroin.

“I know wacko politicians in the Liberals and the NDP [New Democratic Party] and their supporters in the media want to make it sound like there’s a constitutional obligation that we allow these drug dens anywhere they want to go up,” said Poilievre. “That is not true. That is the opposite of true.” 

Poilievre’s remarks were delivered in a kindergarten playground near Montreal’s first federally-subsidized injection site that opened on April 15.  

Poilievre promised that “there will not be a single taxpayer dollar from a Poilievre government going to drug dens.”  

“Every single penny will go to treatment and recovery services to bring our loved ones home drug-free,” he added. 

Poilievre further called out mainstream media reporters for repeating Trudeau’s claim that the drug sites are “safe” or “supervised.” 

“What will you do around safe injection sites across the country?” Globe & Mail reporter Eric Andrew-Gee questioned. 

“You guys repeat the same language you get from the radical Liberal-NDP activists and bureaucracy,” said Poilievre. “You call them safe. How can they be safe? Do you think it’s safe when a bullet comes flying out of one these sites to kill a mother in Toronto? Do you think that’s safe? Do you think it’s safe to have people using crack and heroin and cocaine next to a playground like this? Do you think that is safe? It’s not safe.”  

Poilievre’s mention of the Toronto mother is a reference to the 2023 shooting death of Karolina Huebner-Makurat, a 44-year-old mother of two. Police allege Huebner-Makurat was killed by a stray bullet fired by a man in a drug-related dispute with another man outside of an injection site in the city’s Leslieville neighborhood.

In addition to injection sites, the Trudeau government has also been involved in the distribution of drugs to addicts. In fact, Health Canada recently noted that the Trudeau government has budgeted over $27 million in funding for “safe supply” drug programs that have been linked to increased violence and overdose deaths across Canada. 

Safe supply” is the term used to refer to government-prescribed drugs 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 when implemented. 

The best example of the Trudeau government’s drug policy failures come from the province of British Columbia. Starting in 2023, the Trudeau government decriminalized the possession of up to 2.5 grams of hard drugs without criminal penalty.

Shortly thereafter, record numbers of overdose deaths and similar incidents occurred, leading to the province itself requesting that the Trudeau government recriminalize drugs in public spaces.

Nearly two weeks later, the Trudeau government announced it would “immediately” end the allowance of hard drug use in public, which critics see as tacit admission the policy was a disaster.

The effects of decriminalizing hard drugs have been the source of contention throughout the country, as evidenced in Aaron Gunn’s documentary, Canada is Dying, and in U.K. Telegraph journalist Steven Edginton’s mini-documentary,  Canada’s Woke Nightmare: A Warning to the West. 

Gunn, who has since become a Conservative Party candidate, previously noted that his film shows clearly the “general societal chaos and explosion of drug use in every major Canadian city” since lax policies were implemented.

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

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