[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.

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.]

From the Brownstone Institute

By Jeffrey A. Tucker

Deborah Birx is at it again, urging mass testing for the detection of bird flu. She wants cows and dairy workers examined to ferret out asymptomatic infections and exposures in animals and people. We have the technology so why not use it, she demands to know. We are making the same mistake we made with Covid early on, she argues.

The role of testing is relatively uncontroversial but it probably should be. Early on in the Covid crisis, though completely against the lockdowns, I was an enthusiast for testing simply because I thought doing so would overcome the epistemic void that was driving public panic.

If you are scared of a disease and have no means to discover whether or not you have it, what is your choice but to hop around in a frenzy and comply with every edict? That was my thinking in any case. We live and learn.

What’s left out of the testing issue is the great question of why. Is it track, trace, and isolate? That has been proven impossible – and long known to be impossible – in the case of a fast-spreading and fast-mutating respiratory virus with a zoonotic reservoir. They tried it anyway with many states quickly hiring tens of thousands of contact tracers.

The iTunes and Google app stores had contact tracing programs you could download. That way if you came close to someone who had tested positive, you would be alerted. It worked like a digital leper’s bell. In fact, even now, the airlines are still doing Covid contact tracing for flying in and out of the country.

Another possible rationale is likely the one in the mind of Birx. She was formed in the AIDS era where the goal was zero infections. Early on, she was a proponent of zero Covid and made that very clear. She is a virus exterminationist: every policy is structured to drive infections, cases, and even exposure to zero, despite the utter impossibility of this goal.

Another possible rationale would be to discern early intervention therapies for people who need them. But realizing that goal is contingent on two other conditions: having therapeutics available and knowing with some sense of confidence that an asymptomatic infection is certainly going to get worse.

Think of the movie Contagion (2011) in this way. It was a killer virus that you get and get worse and then die, all rather quickly. In the movie, the job of the health authorities was always to find the infected and notify everyone with whom they had contact. By the way, this didn’t even work in the film but we are presented with some impressive disease forensics that ended up isolating patient zero.

Again, the question beckons: why are we doing all this? The goals of stopping the spread, driving exposure to zero, and actually treating the sick (if they are sick versus just exposed) are certainly in tension with each other. If you are going to embark on an elaborate and invasive scheme to find and isolate every instance of the pathogen, it’s a good idea to know what precisely you are trying to achieve with the effort. No interviewer has been smart enough to ask this fundamental question of Birx.

And keep in mind that Birx does not want to limit testing to people. She wants cows and chickens tested too, and there’s no particular reason to limit it to that. It could include every member of the animal kingdom, every four-legged creature, and every fish and foul. The expense would be enormous and truly unthinkable, driving the cost of meat production sky-high, especially given the inevitable slaughters that would be mandated.

This is made worse, as we learned last time, by PCR tests that can be set at any cycle rate to discover the mere presence of a virus in just about anything. The last time, this led to unwarranted assumptions of contagiousness, up to 90 percent in 2020, as reported by the New York Times. Because there was and is so much confusion about this piece, let’s quote it directly.

The PCR test amplifies genetic matter from the virus in cycles; the fewer cycles required, the greater the amount of virus, or viral load, in the sample. The greater the viral load, the more likely the patient is to be contagious.

This number of amplification cycles needed to find the virus, called the cycle threshold, is never included in the results sent to doctors and coronavirus patients, although it could tell them how infectious the patients are.

In three sets of testing data that include cycle thresholds, compiled by officials in Massachusetts, New York and Nevada, up to 90 percent of people testing positive carried barely any virus, a review by The Times found.

On Thursday, the United States recorded 45,604 new coronavirus cases, according to a database maintained by The Times. If the rates of contagiousness in Massachusetts and New York were to apply nationwide, then perhaps only 4,500 of those people may actually need to isolate and submit to contact tracing.

While it’s not quite precise to say that the PCR tests generate 90% false positives, it is correct to say that in those tests looked at by the NYT at the height of the pandemic, 90 percent of positive results did not warrant concern at all. They should have been thrown out entirely.

That’s a serious problem for the test, track, trace, and isolate regime that Birx is proposing. Is it any wonder that people today are highly suspicious of this entire idea? Rightly so. Nothing is to be gained by throwing the whole of society into a mysophobic panic when the tests themselves are so poor at discerning the difference between a mild exposure and a medically significant case.

For more on this, see my interview with Jay Bhattacharya, who was onto this problem very early on.

Indeed it was precisely the PCR tests that created this wild confusion between an exposure, an infection, and an actual case. The word case in the past had been reserved for someone actually sick and needing some medical intervention. For reasons never explained, that entire language was blown up, such that OurWorldinData suddenly started listing every documented PCR exposure as a case, creating the feeling of disaster when actually life was functioning entirely normally. The better the authorities got at testing, and the more universal the testing mandates, the sicker the population seemed to be getting.

This all depends on the conflation of exposure, infection, and cases.

Once the disease panic is created, what’s left to do about it remains entirely within the realm of public health authorities. Already last week, the authorities ordered 4 million chickens to be slaughtered. Already more than 90 million birds have been killed since 2022.

As Joe Salatin points out: “The policy of mass extermination without regard to immunity, without even researching why some birds flourish while all around are dying, is insane. The most fundamental principles of animal husbandry and breeding demand that farmers select for healthy immune systems. We farmers have been doing that for millennia. We pick the most robust specimens as genetic material to propagate, whether it’s plants, animals, or microbes.”

This is precisely where this obsession with testing gets us. Whether it is animals or humans, the power of government to compel disease tests and act on the results has led to destructive policies in every instance. You might think we would have learned. Instead, reporters just let Birx ramble on without asking fundamental questions about severity, purpose, viability, or consequences.

There has probably in the history of government never been a more presumptuous aspiration than for bureaucrats to seek to manage the whole of the microbial kingdom. But that is where we are. There’s never been a better time for every citizen of a would-be free nation to proclaim: my biology is none of the government’s business.