Safe supply policies provide drugs for users in Canada

Bella Smid often helps youth struggling with substance addictions in her work as a program manager at Sanctuary Youth Centre, a Christian nonprofit in Victoria, British Columbia. But the organization declined to participate in a program to help individuals with addictions because the program’s safe supply policy clashes with its values.

“We believe that one day, all youth can be living healthy and fulfilling lives,” Smid said. “We want to support [them] as much as we can, but we don’t want to be in a place where we are enabling them.”

Drug overdoses claimed over 1,000 lives in the first five months of this year in British Columbia. Toxic, illicit drugs are now the leading cause of death for people age 10 to 59. Some advocates wonder if the province’s harm reduction policies really work and what’s stopping participants from selling legally acquired drugs on the street.

In March 2020, British Columbia became the first province in Canada to introduce pilot programs utilizing safe supply, a harm reduction strategy that involves prescribing opioids to individuals who engage in high-risk drug use. The goal is to replace or supplement the use of illicit and potentially toxic drugs, like fentanyl, with less deadly alternatives. British Columbia’s safe supply program primarily prescribes hydromorphone, diacetylmorphine (pharmaceutical-grade heroin), and slow-release oral morphine.

In Canada, the federal government funds universal healthcare through taxes, while provinces and territories are responsible for managing and organizing the delivery of healthcare services.The British Columbian government expanded its safe supply programs in 2021 and vowed to provide up to about $17 million over the next three years to support the planning and implementation of the services. In April 2023, about 4,916 individuals received prescriptions for safe supply.

Ontario authorities have also instituted safe supply policies, while Alberta forces some addicts to undergo drug addiction treatment.

Since the crisis was declared a public health emergency in 2016, British Columbia has employed various harm reduction strategies, including supervised consumption sites, needle exchange programs, and the distribution of naloxone kits, which can reverse the effects of opioid overdose. In January, British Columbia obtained approval from the federal government to grant adults immunity from criminal charges for personal possession of small amounts of specific illegal drugs. Over the next three years, individuals age 18 and older may possess up to a combined 2.5 grams of opioids, cocaine, methamphetamine, and MDMA, also known as ecstasy.

The political opposition has criticized these policies at the federal and provincial levels. Last month, Conservative Party leader Pierre Poilievre attempted to pass a motion against harm reduction policies. He specifically targeted safe supply and stated he would invest in more recovery and treatment centers. In British Columbia’s budgetary negotiations this year, a motion failed that would have expanded treatment and recovery services.

“While the prime minister has sent inflation for gas, heat, and grocery soaring, there is one product that’s actually come down in price: powerful opioids,” Poilievre said during a question period in the House of Commons on May 16.

Leslie McBain is the co-founder of Moms Stop the Harm, an advocacy group that lobbies for harm reduction. She founded the group after her son died of a drug overdose in 2014.

“We must have a safe regulated implementation of a safe supply of drugs so people don’t die—those people who die will never get to those treatment facilities,” she said. “The primary goal is to keep people alive.”

While safe supply is intended to preserve the lives of drug addicts with the hope of eventual recovery, the approach may exacerbate existing problems. Earlier this month, Global News reported that within about 30 minutes, journalist Paul Johnson was able to purchase a bag of hydromorphone for less than $1 per pill on Vancouver’s East Hastings Street. Johnson said that some of the pills were still in the safe supply prescription packaging.

Dr. Alan Brookstone is an addiction physician in Surrey, British Columbia, who has worked with drug addicts for over 13 years. Since the introduction of safe supply, Brookstone has treated numerous patients who developed their addictions due to wide access to hydromorphone.

“I’ve seen three patients who have initiated or started their addiction because of the availability of hydromorphone on the street,” said Brookstone. “They are individuals who have purchased tablets from somebody who is selling these tablets and are obtaining them through the safe supply channels.”

During a June 5 news conference, the chief of the British Columbia Coroners Service, Lisa Lapointe, said that fentanyl is now a prevailing factor in over 80 percent of drug-poisoning deaths in the province, marking a significant rise from 67 percent in 2016. She made clear that the drugs used in safe supply programs have shown no significant overdose numbers.

While deaths linked to drugs like hydromorphone have not substantially increased, Brookstone asserts that the expansion of the market is pushing more people toward addiction.

“The hydromorphone tablets are becoming a gateway drug, not that they’re actually causing the death of individuals, but they’re becoming a gateway,” he said. “New people … are becoming addicted through the easy availability of hydromorphone.”

According to Brookstone, the effects of hydromorphone diminish over time with prolonged use. This compels individuals struggling with addiction to seek alternative sources, often resorting to obtaining fentanyl from illicit street markets.

At Sanctuary Youth Centre, Smid has found that the most crucial aspect of the recovery journey for drug-addicted youth is a trusting relationship.

“When they can have at least one super healthy person in their life that they trust, I would say that’s probably the most important thing,” she said. “We really believe that relationships are the best way to, one, get to know the person but also to be able to show them that there is a different way to live.”