After police in two separate B.C. cities seized thousands of suspected safe supply pills, Alberta’s addiction minister threw down the gauntlet to the BC NDP government, challenging them to prove their publicly-supplied drugs aren’t being diverted to other jurisdictions.
“We believe that safe supply is coming to Alberta,” Alberta Addictions and Mental Health Minister, Dan Williams, told Northern Beat this week. “If they refuse to defund [safer supply], they should at least know the data on whether or not diversion is happening and the harm that could potentially be coming from it.”
Safe, or safer, supply was introduced four years ago in B.C. and eight years ago in Ontario, with the goal of replacing people’s reliance on illicit drugs and reducing overdoses. Since then, there is no scientific evidence it has achieved either and increasing reports some of the drugs are being diverted to people not prescribed the drugs, creating new opioid users.
Williams challenged the B.C. government to join Alberta in petitioning the federal government to make changes to help track where safe supply drugs, like hydromorphone, a powerful opioid, are ending up.
On Feb. 6, Williams wrote to federal Minister of Mental Health and Addictions Ya’ara Saks, asking her government to add a unique chemical identifier to the drugs used in the federally approved safer supply program. The chemical could then be detected in autopsies and following police seizures to distinguish the drugs from those prescribed for other purposes.
“Canadians deserve to know the truth of these programs and the damage they are causing to our country,” Williams told Saks.
“The most radical policy globally on addiction is safe supply found in British Columbia [and B.C.] is allowing that policy to spill over its borders and cause carnage” … [ending] with cadaverous streets in Edmonton, and Ontario,” Williams said in an interview.
If the B.C. government doesn’t believe diversion is happening, “British Columbia, with every other province, should be first in line calling on the federal government to say, let’s prove it. Let’s prove whether or not there is diversion,” he said.
B.C. politicians and senior public health officials have downplayed issues related to diversion of safe supply and how it might be impacting wider community safety. B.C.’s Provincial Health Officer Dr. Bonnie Henry said in a press conference last month that diversion was happening but called it “neither good nor bad,” even while conceding little is known about where the diverted drugs are going and to whom.
And both B.C. Addictions Minister Jennifer Whiteside and Health Minister Adrian Dix have sidestepped questions about implementing monitoring or oversight to better understand where drugs are being diverted and whether youth, in particular, are being harmed or are at risk.
Over the past year, two B.C. police detachments have seized about 18,000 suspected diverted safe supply pharmaceutical tablets, more than half of which were believed to be hydromorphone/Dilaudid.
When asked how much safe supply hydromorphone has been seized in total by police forces in B.C., Solicitor General Mike Farnworth said he didn’t know but promised to have his office gather and share the information. After more than a week, no data on diverted safe supply has been provided.
“Canadians deserve to know the truth of these programs and the damage they are causing.”
Dan Williams
Prescribed to people with severe addictions and a substance use disorder diagnosis, the pharmaceuticals offered in safe supply programs in B.C. have expanded from mainly hydromorphone, to include an array of stimulants, opioids, benzodiazepines, including oxycodone, fentanyl, and methamphetamine and cocaine replacements.
More and more, frontline addictions physicians, pharmacists and the media are reporting diversion of safe supply drugs, namely hydromorphone, the euphoria-inducing, opioid at the centre of the program.
Federal addictions minister rejects call for chemical marker
A group of doctors from across Canada have written Federal Mental Health and Addictions Minister Ya’ara Saks several times warning her that free hydromorphone was harming communities, increasing the illicit market with drug diversion, and causing new addictions and overdoses. They called for an end of safer supply funding or tight controls on supervised consumption.
“The idea of unsupervised safer supply being helpful is contrary to decades of addiction research,” said Dr. Robert Cooper, a family physician with clinical practices in downtown Toronto and Orillia, ON., who likened it to giving unlimited alcohol to treat alcoholism.
“Part of the mistake is thinking that hydromorphone itself is safe. Hydromorphone was always restricted, in low supply, given out very small quantities to people because of its high addiction potential,” he said, adding he hasn’t seen anyone using safer supply stop using fentanyl.
The former chair of the Ontario Medical Association’s addictions section, Cooper also has a law degree and is a lead signatory on the letters to Saks.
“A better name for it would have been reckless supply. Because the opiates are being distributed in a reckless way,” he said. “There’s no desire to ensure that the people prescribed them, take them. If they did that, then we would only be talking about the risk to the people who are on the program.”
“A better name for it would have been reckless supply. Because the opiates are being distributed in a reckless way.”
Robert Cooper
Dozens of clinicians and scientist safer supply advocates have pushed back against criticisms of diversion with everything from denial it’s happening, to embracing it as a positive thing, because, they say, anyone using safe supply is, theoretically, not using the illicit drug supply.
Saks falls into the latter camp and rejected the doctors’ request to pause the program as well as Alberta’s request to add a chemical identifier to safer supply drugs, saying there are practical obstacles to marking drugs that are manufactured for a range of applications beyond just the safe supply program. For instance, hydromorphone is also prescribed for severe pain like cancer treatment.
Purdue Pharma, the main manufacturer of hydromorphone – brand name, Dilaudid – may be in no rush to find out where their pills are going either. Particularly as an increasing chorus of doctors are reporting the drug is ending up in the hands of youths, creating new addictions.
Available in injectable and tablet-form known as a ‘dilly,’ the highly addictive hydromorphone carries the respectability of the “safer supply” brand, while delivering a euphoric high three times more potent than oxycodone. Purdue also manufactured oxycodone, brand name OxyContin, which fueled an unprecdented level of opioid addictions in North America over two decades, eventually seeding the current crippling market for fentanyl.
In fact, in 2022, the B.C. government, along with Canada, the provinces and territories won a $150 million settlement from Purdue (as did several U.S. states, in a separate lawsuit) after alleging deceptive marketing practices causing opioid addictions and overdoses.
At the same time, B.C. has continued paying Purdue to manufacture hydromorphone and other drugs to treat the addictions begun by the company’s previous drug, oxycodone.
Hydromorphone begins turning up in drug seizures
Fourteen months after the safe supply program began in March 2020 in B.C., 8,400 British Columbians had been dispensed safe supply pharmaceuticals 257,000 times. Within two years, 14,000 people had been prescribed PSAD/safe supply in the province.
Based on those numbers and conservative estimates of 8 to 20 x 8-mg pills per day per person, approximately two to five million hydromorphone pills were dispensed in the first 14 months of the program in B.C.
Now, four years after the program’s inception, B.C. police are finding increasingly quantities of hydromorphone and other suspected safe supply pharmaceuticals turning up in their high-level, organized crime-type drug seizures.
“We’re getting multi-kilo seizures of illicit cocaine, fentanyl, methamphetamine. And the safe supply has been present pretty much now in every investigation we’ve done,” said Cpl. Scott Cundy, senior investigator with the Prince George RCMP street crew unit.
“Safe supply has been present pretty much now in every investigation we’ve done.”
Scott Cundy
Since October, Campbell River RCMP have seized more than 4,200 suspected hydromorphone/Dilaudid pills, along with many kgs of fentanyl, methamphetamine and cocaine.
Drug seizures in Kelowna have yielded suspected safer supply pharmaceuticals. Hydromorphone and other safer supply opioids have repeatedly turned up in drug seizure operations in New Brunswick, where the federal government has funded a safer supply program since 2020.
Over the last 12 months in Prince George alone, the RCMP have confiscated more than 14,000 pharmaceutical pills potentially prescribed under safe supply program, including 3,000 stimulants, 6,000 hydromorphone and more than 5,000 other opioids, such as morphine and oxycodone.
“Our investigative theory is that these drugs are being all bulk-collected and then actually shipped out-of-province because there’s no reason for these pills to be hoarded in that quantity,” said Cundy, whose unit focuses on gang activity and mid-level organized drug trade.
“These organized crime groups are highly mobile in between [cities and] provinces. We’ve been able to track a lot of targets … and they’re moving between British Columbia, Alberta, Saskatchewan.”
Crime organization operations can be incredibly fluid. They can quickly set up shop in a town and soon be pulling in thousands of dollars a day selling drugs. One recent drug operation Cundy’s crew interrupted was a fairly simple ‘dial-a-dope’ operation that was making an estimated $3,000 a day in revenue. At $90,000 a month, competition is fierce and the risk is worth it.
“Then when there’s heat on them, they get busted, there’s enforcement, they leave. They go work somewhere else and organized crime sends their next worker up here that we don’t know about,” he said. It’s so lucrative, a new operation is often up and running again a few days after the previous one was broken up.
Hydromorphone trade route
Hydromorphone is a hotly traded commodity. Hundreds of prescription bottles, many with pharmacist’s labels still legible, were recovered in the drug seizures.
“Multiple different sources of information we rely on… are admitting that they are turning over basically a full prescription, which could be maybe three-day’s supply, or four day’s supply of hydromorphone, for one point of fentanyl. So it’s basically a $20 value is what these users are able to get for a prescription fill,” Cundy said.
Just yesterday, uniformed officers in Prince George watched as 10 people exited a pharmacy and, one-by-one, handed their medication to people waiting outside, Cundy said.
Often as soon as people get their fentanyl, they use it right there on the street. “So it’s pretty obvious.”
“They are turning over basically a full prescription … for one point of fentanyl.”
Scott Cundy
Individuals sell their prescription pills for about $1 each. Since the local market is flooded with easy access to safer supply, the drugs are moved further afield where a single pill can garner $4 or $5 each.
Most street-level dealers are trapped in their own addictions and make little-to-no profit, Cundy said. “The people that are really benefiting from it are going to be organized crime. They see the money if they can ship it out-of-province into Alberta, and then in Saskatchewan.
In Prince George, where Cundy and his police colleagues track the movements of interprovincial organized crime groups, there’s no doubt safe supply medication has been incorporated into the organized crime business model.
“Prescription pills – call them safe supply or whatever you want – are funding organized crime, there’s no doubt about it,” said Cundy. “It’s 100 per cent that a portion of organized crime is getting funded by prescription drugs.
Chemical marking technology is available
When asked if they would consider adding a tracing chemical to hydromorphone, the province’s Health Minister Adrian Dix skirted the question entirely, while B.C.’s Addictions Minister Jennifer Whiteside implied it wasn’t technologically possible.
“I’m not aware of technology that is at the point where we can actually meet those objectives of distinguishing medication that has been produced in different ways,” Whiteside said in a press conference this week.
But Williams said the technology has been available for some time. “Since 2011, the [Federal Drug Administration] has had guidance, which means to say it’s a common practice for exactly this kind of technology.” The pharmaceutical industry in the U.S. uses unique chemical identifiers in trademarked products to protect their for-profit research and design, he said.
“If it’s possible to do in the United States with a guidance document from the FDA to protect profits, why would anybody be asking whether or not we should do it to protect the lives of our children, and the safety of our communities in Canada?”
‘We need to think about what kind of society we are creating’
Dr. Dr. Alex Nataros, a primary care and emergency room physician with 1,500 people in his Port Hardy practice said, there needs to be a pause and an examination of what’s happening right now with programs like the managed alcohol program and the safe supply policy.
“Diverted safe supply hydromorphone, this is Dilaudid, this is a hard drug … is getting onto the streets and it’s getting into kids’ hands. And we’re paying for this as taxpayers,” Nataros said in a public plea posted on his social media X account.
“Diverted safe supply hydromorphone [is] … getting into kids’ hands.”
Alex Nataros
The physician is advocating to keep the Port Hardy hospital open 24/7 after the local Gwa’sala-‘Nakwaxda’xw Nations lost 11 people to drug and alcohol overdose in the past two months. And he’s pledged $100,000 of his own money towards building a new community centre for children to gather, which he called genuine harm reduction for youth.
“Alcohol, hard drugs, no matter how safe a supply, that’s not harm reduction for kids,” he said. “We need to think hard about what society we’re creating.”
Williams said the federal and B.C. governments must understand the human harm that the safe supply policy is causing.
“This policy is responsible for propelling more of those lives towards the natural end of addiction without intervention of treatment, and that’s death.”
The Alberta strategy
Alberta does not provide safe supply. “We believe in Alberta that handing dangerous drugs out to drug addicts is not going to help with the addiction crisis.”
Instead, the province has fashioned much of its drug strategy after Portugal and chosen to focus the bulk of its resources on treatment and recovery.
Unlike B.C.’s Ministry of Mental Health and Addictions, which has a current annual budget of about $40 million (up $14 million from last fiscal year) that doesn’t cover much more than salaries and policy development, leaving delivery of services to the Ministry of Health, Alberta’s addictions ministry has a whopping $1.55 billion budget. Which means, the minister responsible for Alberta’s addictions and mental health is actually the minister who delivers those services.
And since 2019, it has delivered a lot.
Alberta has provided more than 10,000 treatment beds free of charge, with all beds currently full, Williams said. It has committed to building 11 new, high-quality, long-term-stay recovery communities of up to 100 beds each. Four will be located in Indigenous communities and are expected to be completed within a year-and-a-half.
They will be owned and operated, by and with, the Indigenous on reserve. As well, two therapeutic addiction treatment living units have already been built in correctional centres in Red Deer and Lethbridge, with another four or five potentially completed within the next year or so.
“I fully intend on continuing to build capacity in our treatment facilities until everyone who wants to get treatment for addiction is able to access it,” he said.
Diversion is in the eye of the beholder
Meanwhile, though, he wants to know how much diverted safer supply is coursing through Albertan veins. And the quickest, easiest path to understanding the scope and reach of hydromorphone is by putting a chemical marker in the drug.
“The group that should be loudest in demanding this to prove their case, if they have nothing to hide, should be the British Columbia government – in partnership with every other province – requiring the federal government Health Canada to put this in,” said Williams.
“This will alleviate all their concerns, they will be able to shout from the rooftops, if they are right, that there is no diversion.”
B.C.’s provincial health officer, Dr. Bonnie Henry, said last month “Diversion is not, in itself, good or bad, or right or wrong,” and it occurs essentially because safer supply drugs aren’t meeting people’s needs.
Despite the lack of diversion data and the absence of evidence for the benefits of safer supply, Henry recommended expanding access, potency levels and the types of drugs offered under safer supply, with the stated eventual long-term goal of legalizing all drugs, similar to cannabis.
“So let me get this straight,” said Williams. “The chief medical officer of health has admitted that diversion is commonplace, does not know the extent to which diversion has happened, does not know who is consuming the end product, does not know if this is creating new addictions or even overdoses, doesn’t know the geographic extent to which her diversion has reached outside or within her boundaries of British Columbia, but thinks that it might be good and could be helping us deal with the addiction crisis.
“If she had the data of a unique chemical identifier, and she could [say] that none of that was happening, and that it’s a net benefit in some way, we’ll be willing to listen. But she has none of that information.”
B.C.’s ministers of health and addiction on the other hand, are cagey about even acknowledging diversion exists.
“I’m delighted that the Campbell River police are taking drugs off the street. We’ve got to take every step we can to treat people as human beings to keep them alive and get them into treatment,” said Health Minister Dix responding to whether he was concerned about the vast quantities of diverted hydromorphone seized by police.
When Whiteside was asked about diverted hydromorphone, she high-jumped over the idea it was real safe supply. “One of the situations that really is complicating our ability, and the ability of law enforcement, to deal with the illicit drug supply is the fact that there is a very robust, illicit supply of fake Dilaudid,” she said, adding, most hydromorphone out there is “for seniors who are suffering from pain, maybe due to arthritis, or for cancer patients.”
Counterfeit or genuine, all the pharmaceuticals that end up in the street trade are a public safety concern for police, Cundy said.
A young man wanting an escape, might shy away from street drugs but be willing to try a prescription pill, he said, and whether it’s real hydromorphone or a fake Oxy laced with fentanyl, it’s unsafe.
The tragedy of B.C.’s drug strategy is that it’s gone from harm reduction to “harm production,” Williams said. “Their policies are the source of the harm. They are producing it in-house in British Columbia.”
What’s at stake, he said, is the safety of communities and the lives of the citizens that politicians are constitutionally and morally sworn to protect and serve.
“The concern I have is that they’re hiding from this, that they’re denying the reality, and that they’re effectively allowing their policies to harm thousands upon thousands of Canadians, not just British Columbians.”
Note: The amount of suspected safe supply pharmaceutical pills seized in RCMP drug operations was updated on Mar. 9.