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Addictions

“Unscientific and bizarre”: Yet another Toronto addiction physician criticizes Canada’s “safer supply” experiment

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8 minute read

By Liam Hunt

“It seems to be motivated by a very small, vocal, and well-connected group of advocates” says Dr. Michael Lester

Dr. Michael Lester, a Toronto-based addiction physician with 30 years of experience, says Canada’s “safer supply” programs are “inherently dangerous” and causing “dystopian” community harms due to widespread fraud.

These programs claim to reduce overdoses and deaths by distributing free addictive drugs—typically 8-milligram tablets of hydromorphone, an opioid as potent as heroin—to dissuade addicts from consuming riskier street substances. Yet experts across Canada say recipients regularly divert (sell or trade) their safer supply on the black market to acquire stronger illicit drugs, which then fuels addiction and organized crime.

“I have a couple dozen patients in my practice who were drug-free prior to the advent of safe supply, and they’ve gone back to using opioids in a destructive way because of the availability of diverted hydromorphone,” said Lester. “Every single day that I go to work, people tell me they’re struggling with the temptation not to take diverted safe supply. They don’t want to take it, but they take it anyway just because it’s cheap and available.”

After safer supply programs became widely accessible across Canada in 2020, Lester’s patients reported an influx of 8-milligram hydromorphone tablets on the black market, coinciding with a crash in the drug’s street price from $15–$20 per pill to just $2. He now estimates that 80 percent of his patients struggling with opioid addiction have relapsed due to diverted safer supply, leading some to abandon treatment entirely.

“Even if it’s sold at the rock-bottom price of $2 or $3 a pill, a person would make tens of thousands of dollars a year, which would have a tremendous impact on their ability to buy other drugs,” he explained. “Selling hydromorphone is too tempting not to do it, which keeps them entrenched in the whole world of dealing with opioid users and having opioids in their premises.”

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Lester said safer supply is evidently “fueling organized crime” because drug seizures in Ontario now commonly include hydromorphone, “which wasn’t happening before.” He added that some individuals who try these diverted drugs later transition to stronger opioids, such as fentanyl.

In July, for example, the London Police Service announced that seizures of hydromorphone had increased by more than 3,000 percent in the city since 2020. According to London Police Chief Thai Truong, “Diverted safer supply is being resold into our community. There’s organized drug trafficking at the highest levels of organized crime, and there’s drug trafficking at the street level. We’re seeing all of it.”

While Lester acknowledges that safer supply can be useful as a “treatment of last resort, after traditional treatments have been tried and failed,” he said it is now being offered immediately to a wide variety of patients, which has “decimated” uptake of traditional addiction therapies, such as methadone and Suboxone.

As a result, conventional addiction clinics are now at risk of shutting down, meaning some communities could lose access to gold-standard treatments (i.e., methadone and Suboxone) while highly profitable, but unscientific, safer supply programs take over instead.

Lester said the evidence supporting safer supply is biased and “misleading” because, generally speaking, these studies simply interview enrolled patients and ask them to self-report whether they benefit from the programs. He noted that many safer supply researchers are public health academics, not doctors, meaning they lack clinical experience with the communities they study.

“It seems to be motivated by a very small, vocal, and well-connected group of advocates that has completely changed the landscape in addiction medicine treatment in a very short time,” he said.

Lester argues that some safer supply researchers seem to purposefully design their study methodologies to favor the programs and disregard systemic harms. He said this flawed science is then propagated by credulous journalists who fail to adequately scrutinize agenda-driven research.

While he personally knows “a couple dozen” colleagues in addiction medicine who regularly express skepticism about safer supply, many have been reluctant to speak out, fearing backlash from activist groups that “terrorize” critics.

“The stories are common of people being harassed and insulted on social media. We’ve heard of doctors being threatened [and] dropped from committees because they spoke out.”

For example, after Lester and his colleagues published two open letters criticizing safer supply in late 2023, they were targeted by a series of articles by Drug Data Decoded, a popular Canadian harm reduction Substack, which compared the doctors to Nazis and eugenicists. The articles were then widely shared on social media by safer supply activists.

Lester recalled an incident in which harm reduction activists targeted a doctor’s daughter at her high school in retaliation for her parent’s public criticism of safer supply.

“It’s just something that seems so unscientific and so bizarre in medicine,” he said. “Physicians just aren’t used to a powerful political lobby changing a treatment protocol.”

After Lester and more than a dozen of his colleagues wrote several public letters calling for reform and requested a meeting with Ya’ara Saks, the federal Minister of Mental Health and Addictions, they found themselves “sidelined and ignored.”

After months of delays, they were able to present their clinical observations to Saks, only to have her disregard them and incorrectly claim, weeks later, that criticism of safer supply is rooted in “fear and stigma.”

“The insults aren’t a big enough consequence to keep me from speaking my mind,” he declared.

After a short reflection, he then added, “If anyone doesn’t have a stigma against this population, it’s me. I’ve dedicated my life to helping them.”


Liam Hunt is a Canadian writer and journalist with an interest in humanism, international affairs, and crime and justice. This story is produced by the Centre For Responsible Drug Policy’s “Experts Speak Up” series in partnership with the Macdonald-Laurier Institute.

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Addictions

Canada must make public order a priority again

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A Toronto park

Public disorder has cities crying out for help. The solution cannot simply be to expand our public institutions’ crisis services

[This editorial was originally published by Canadian Affairs and has been republished with permission]

This week, Canada’s largest public transit system, the Toronto Transit Commission, announced it would be stationing crisis worker teams directly on subway platforms to improve public safety.

Last week, Canada’s largest library, the Toronto Public Library, announced it would be increasing the number of branches that offer crisis and social support services. This builds on a 2023 pilot project between the library and Toronto’s Gerstein Crisis Centre to service people experiencing mental health, substance abuse and other issues.

The move “only made sense,” Amanda French, the manager of social development at Toronto Public Library, told CBC.

Does it, though?

Over the past decade, public institutions — our libraries, parks, transit systems, hospitals and city centres — have steadily increased the resources they devote to servicing the homeless, mentally ill and drug addicted. In many cases, this has come at the expense of serving the groups these spaces were intended to serve.

For some communities, it is all becoming too much.

Recently, some cities have taken the extraordinary step of calling states of emergency over the public disorder in their communities. This September, both Barrie, Ont. and Smithers, B.C. did so, citing the public disorder caused by open drug use, encampments, theft and violence.

In June, Williams Lake, B.C., did the same. It was planning to “bring in an 11 p.m. curfew and was exploring involuntary detention when the province directed an expert task force to enter the city,” The Globe and Mail reported last week.

These cries for help — which Canadian Affairs has also reported on in TorontoOttawa and Nanaimo — must be taken seriously. The solution cannot simply be more of the same — to further expand public institutions’ crisis services while neglecting their core purposes and clientele.

Canada must make public order a priority again.

Without public order, Canadians will increasingly cease to patronize the public institutions that make communities welcoming and vibrant. Businesses will increasingly close up shop in city centres. This will accelerate community decline, creating a vicious downward spiral.

We do not pretend to have the answers for how best to restore public order while also addressing the very real needs of individuals struggling with homelessness, mental illness and addiction.

But we can offer a few observations.

First, Canadians must be willing to critically examine our policies.

Harm-reduction policies — which correlate with the rise of public disorder — should be at the top of the list.

The aim of these policies is to reduce the harms associated with drug use, such as overdose or infection. They were intended to be introduced alongside investments in other social supports, such as recovery.

But unlike Portugal, which prioritized treatment alongside harm reduction, Canada failed to make these investments. For this and other reasons, many experts now say our harm-reduction policies are not working.

“Many of my addiction medicine colleagues have stopped prescribing ‘safe supply’ hydromorphone to their patients because of the high rates of diversion … and lack of efficacy in stabilizing the substance use disorder (sometimes worsening it),” Dr. Launette Rieb, a clinical associate professor at the University of British Columbia and addiction medicine specialist recently told Canadian Affairs.

Yet, despite such damning claims, some Canadians remain closed to the possibility that these policies may need to change. Worse, some foster a climate that penalizes dissent.

“Many doctors who initially supported ‘safe supply’ no longer provide it but do not wish to talk about it publicly for fear of reprisals,” Rieb said.

Second, Canadians must look abroad — well beyond the United States — for policy alternatives.

As The Globe and Mail reported in August, Canada and the U.S. have been far harder hit by the drug crisis than European countries.

The article points to a host of potential factors, spanning everything from doctors’ prescribing practices to drug trade flows to drug laws and enforcement.

For example, unlike Canada, most of Europe has not legalized cannabis, the article says. European countries also enforce their drug laws more rigorously.

“According to the UN, Europe arrests, prosecutes and convicts people for drug-related offences at a much higher rate than that of the Americas,” it says.

Addiction treatment rates also vary.

“According to the latest data from the UN, 28 per cent of people with drug use disorders in Europe received treatment. In contrast, only 9 per cent of those with drug use disorders in the Americas received treatment.”

And then there is harm reduction. No other country went “whole hog” on harm reduction the way Canada did, one professor told The Globe.

If we want public order, we should look to the countries that are orderly and identify what makes them different — in a good way.

There is no shame in copying good policies. There should be shame in sticking with failed ones due to ideology.

 

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Addictions

No, Addicts Shouldn’t Make Drug Policy

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By Adam Zivo

Canada’s policy of deferring to the “leadership” of drug users has proved predictably disastrous. The United States should take heed.

[This article was originally published in City Journal, a public policy magazine and website published by the Manhattan Institute for Policy Research]

Progressive “harm reduction” advocates have insisted for decades that active users should take a central role in crafting drug policy. While this belief is profoundly reckless—akin to letting drunk drivers set traffic laws—it is now entrenched in many left-leaning jurisdictions. The harms and absurdities of the position cannot be understated.

While the harm-reduction movement is best known for championing public-health interventions that supposedly minimize the negative effects of drug use, it also has a “social justice” component. In this context, harm reduction tries to redefine addicts as a persecuted minority and illicit drug use as a human right.

This campaign traces its roots to the 1980s and early 1990s, when “queer” activists, desperate to reduce the spread of HIV, began operating underground needle exchanges to curb infections among drug users. These exchanges and similar efforts allowed some more extreme LGBTQ groups to form close bonds with addicts and drug-reform advocates. Together, they normalized the concept of harm reduction, such that, within a few years, needle exchanges would become officially sanctioned public-health interventions.

The alliance between these more radical gay rights advocates and harm-reduction proponents proved enduring. Drug addiction remained linked to HIV, and both groups shared a deep hostility to the police, capitalism, and society’s “moralizing” forces.

In the 1990s, harm-reduction proponents imitated the LGBTQ community’s advocacy tactics. They realized that addicts would have greater political capital if they were considered a persecuted minority group, which could legitimize their demands for extensive accommodations and legal protections under human rights laws. Harm reductionists thus argued that addiction was a kind of disability, and that, like the disabled, active users were victims of social exclusion who should be given a leading role in crafting drug policy.

These arguments were not entirely specious. Addiction can reasonably be considered a mental and physical disability because illicit drugs hijack users’ brains and bodies. But being disabled doesn’t necessarily mean that one is part of a persecuted group, much less that one should be given control over public policy.

More fundamentally, advocates were wrong to argue that the stigma associated with drug addiction was senseless persecution. In fact, it was a reasonable response to anti-social behavior. Drug addiction severely impairs a person’s judgement, often making him a threat to himself and others. Someone who is constantly high and must rob others to fuel his habit is a self-evident danger to society.

Despite these obvious pitfalls, portraying drug addicts as a persecuted minority group became increasingly popular in the 2000s, thanks to several North American AIDS organizations that pivoted to addiction work after the HIV epidemic subsided.

In 2005, the Canadian HIV/AIDS Legal Network published a report titled “Nothing about us without us.” (The nonprofit joined other groups in publishing an international version in 2008.) The 2005 report included a “manifesto” written by Canadian drug users, who complained that they were “among the most vilified and demonized groups in society” and demanded that policymakers respect their “expertise and professionalism in addressing drug use.”

The international report argued that addiction qualified as a disability under international human rights treaties, and called on governments to “enact anti-discrimination or protective laws to reduce human rights violations based on dependence to drugs.” It further advised that drug users be heavily involved in addiction-related policy and decision-making bodies; that addict-led organizations be established and amply funded; and that “community-based organizations . . . increase involvement of people who use drugs at all levels of the organization.”

While the international report suggested that addicts could serve as effective policymakers, it also presented them as incapable of basic professionalism. In a list of “do’s and don’ts,” the authors counseled potential employers to pay addicts in cash and not to pass judgment if the money were spent on drugs. They also encouraged policymakers to hold meetings “in a low-key setting or in a setting where users already hang out,” and to avoid scheduling meetings at “9 a.m., or on welfare cheque issue day.” In cases where addicts must travel for policy-related work, the report recommended policymakers provide “access to sterile injecting equipment” and “advice from a local person who uses drugs.”

The international report further asserted that if an organization’s employees—even those who are former drug users—were bothered by the presence of addicts, then management should refer those employees to counselling at the organization’s expense. “Under no circumstances should [drug addicts] be reprimanded, singled out or made to feel responsible in any way for the triggering responses of others,” stressed the authors.

Reflecting the document’s general hostility to recovery, the international report emphasized that former drug addicts “can never replace involvement of active users” in public policy work, because people in recovery “may be somewhat disconnected from the community they seek to represent, may have other priorities than active users, may sometimes even have different and conflicting agenda, and may find it difficult to be around people who currently use drugs.”

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The messaging in these reports proved highly influential throughout the 2000s and 2010s. In Canada, federal and provincial human rights legislation expanded to protect active addicts on the basis of disability. Reformers in the United States mirrored Canadian activists’ appeals to addicts’ “lived experience,” albeit with less success. For now, American anti-discrimination protections only extend to people who have a history of addiction but who are not actively using drugs.

The harm reduction movement reached its zenith in the early 2020s, after the Covid-19 pandemic swept the world and instigated a global spike in addiction. During this period, North American drug-reform activists again promoted the importance of treating addicts like public-health experts.

Canada was at the forefront of this push. For example, the Canadian Association of People Who Use Drugs released its “Hear Us, See Us, Respect Us” report in 2021, which recommended that organizations “deliberately choose to normalize the culture of drug use” and pay addicts $25-50 per hour. The authors stressed that employers should pay addicts “under the table” in cash to avoid jeopardizing access to government benefits.

These ideas had a profound impact on Canadian drug policy. Throughout the country, public health officials pushed for radical pro-drug experiments, including giving away free heroin-strength opioids without supervision, simply because addicts told researchers that doing so would be helpful. In 2024, British Columbia’s top doctor even called for the legalization of all illicit drugs (“non-medical safer supply”) primarily on the basis of addict testimonials, with almost no other supporting evidence.

For Canadian policymakers, deferring to the “lived experiences” and “leadership” of drug users meant giving addicts almost everything they asked for. The results were predictably disastrous: crime, public disorder, overdoses, and program fraud skyrocketed. Things have been less dire in the United States, where the harm reduction movement is much weaker. But Americans should be vigilant and ensure that this ideology does not flower in their own backyard.

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