Six years after then-provincial health officer Dr. Perry Kendall declared a public health emergency, about six or seven people a day are dying of drug overdose in B.C. Calls for a bold response from government are escalating. The loudest voices belong to activists demanding safe supply — now more often called a “safer” supply — that go beyond prescribed opioid substitutes to include illicit drugs, such as heroin, methamphetamines, cocaine, and fentanyl.
Few Canadians favour legalization of all drugs. A majority support safe supply. But it turns out, “safe” or “safer” supply means different things to different people.
Some harm reduction advocates, like most Canadians, favour safer supply when prescribed by medical professionals. Others would prefer access through non-medical models such as compassion clubs and dispensaries. Still others are calling for wholesale legalization of all currently illicit drugs, including a brave new world where the government provides all addictive drugs to anybody who wants them for free.
Then there are those who think safe supply is a dangerous idea that will lead more people to experiment with potentially deadly substances.
“Don’t do it”
Eldon Telford began using heroin as a teenager. “The only regret I have in my life was trying drugs for the first time,” said Telford on a rainy November day as he walked along a Victoria street near the Vancouver Island Drug Checking Project. “I don’t regret anything in my life except for that. Because if I didn’t try it, then I would never do it.”
Were Telford to encounter someone introducing hard drugs to a non-user today, “I’d smack them,” he said.
Now 48, Telford said he was also an alcoholic who was able to quit drinking at age 29 but he hasn’t been able to beat the opioid habit. Despite being prescribed the opioid substitute methadone, Telford also smokes fentanyl regularly. Even though he’d prefer heroin, he uses fentanyl because it now dominates the opiate street supply. It’s also the drug that, initially at least, has been present in about 90 per cent of all fatal drug overdoses.
“There’s no point in trying it. Don’t do it,” Telford said of opioids. “Anybody that’s on it knows damn well that they wish they’ve never done it and it’s stupid. Because once you’re dope sick, you’re screwed. So I catch people giving it to somebody for the first time, I give them a slap.”
Safer, not safe supply
Fred Cameron, program manager for drug-user advocacy group SOLID Outreach who also works helping people in their recovery, said it’s considered shameful among the street community to give someone their first hit.
“That’s not looked upon very kindly when people on the street are giving a young person their first taste of it,” Cameron said. “That said, people are going to use drugs, whether you want them to or not. It is not a policing issue. Policing has failed miserably and caused a ridiculous amount of irreversible trauma out in the community, generations of this.”
Cameron added that using the expression “safe supply” has also fallen out of favour. “Because, just like alcohol, drugs are not necessarily going to be safe, but safer,” he said.
The basic premise is that drugs on the street can be toxic and safer supply enables access to uncontaminated, government-regulated products at known concentrations, without dangerous fillers or unexpected additional drugs like benzodiazepines mixed in.
“Dead people can’t recover”
Between March 2020 and June 2022, 6,120 clinicians have prescribed safer supply in B.C., according to the Ministry of Mental Health and Addictions.
“We’re just trying to keep people alive. I’m sure you’ve probably heard that dead people can’t recover,” said Jack LeMaistre, program manager for the Victoria SAFER Initiative, a program that provides prescription safer supply drugs, including fentanyl, to about 100 residents of the B.C. capital region.
“There are thousands of people in this province that have a substance use disorder that need to be met where they’re at so they can get the treatment and recovery or their needs met in terms of health care,” Sharma said in an interview. “And we heard some remarkable stories in terms of where safer supplies stepped in to do that, where people that are in chaos in their life are trying to fight withdrawal symptoms.”
The all-party committee released a 74-page report in November on responding to the toxic drug crisis. It included 37 recommendations, three of them relating directly to safer supply. Among those is a call for safer supply to be available in all areas of the province. The report also proposes safer supply for teens with substance use disorders.
As well, the report supports decriminalization, which the province has already committed to doing in January 2023. An agreement with the federal government will allow possession for personal use of up to 2.5 grams of combined illicit substances, including meth, cocaine and fentanyl. That’s less than the 4.5 grams that harm-reduction advocates were calling for.
Stakeholders on both ends of the safer-supply spectrum were critical of the legislative report recommendations. Those skeptical of safer supply argue it’s a fraught path that will increase drug use and has not yet been scientifically proven effective. And those in favour of safer supply say the committee’s recommendations don’t go far enough.
People want help
“The research on what people with addictions want is international and clear: they want help getting off of drugs, they want help reducing the harms of their addictions,” said Dr. Julian Somers, a clinical psychologist specializing in addiction.
The director of the Centre for Applied Research in Mental Health & Addiction at Simon Fraser University in Vancouver, Somers added, “People overwhelmingly are looking to increase the overall wellness in their lives. They know that being poly-substance addicted is not only life threatening, but sucks.”
In the early 2000s, Vancouver introduced a four-pillars drug strategy — harm reduction, prevention, treatment, and enforcement. Harm reduction now dominates the other three.
“The four pillars is completely outdated with the [toxic drug] crisis that we’re dealing with now,” said Sarah Blyth, executive director of Vancouver’s Overdose Prevention Society, adding that the strategy “was invented at a time that there wasn’t fentanyl, benzodiazepines, and a contamination crisis.”
Simon Fraser University professor Dr. Donald MacPherson, author of Vancouver’s original four pillars strategy, didn’t respond to an interview request. MacPherson is the current director of the SFU-based Canadian Drug Policy Coalition, which makes a case for reform on its website: “If we acknowledge that the root of the current overdose crisis is a poisoned drug supply, then we are compelled to create a system that provides alternatives to the unregulated and extremely toxic illegal drug market through legal regulation of all drugs,” the post states, summing up the position of safer supply advocates.
Somers questions the characterization of the spike in opiate deaths as a “toxic“ drug crisis. He says it’s actually a poly-drug crisis and points to toxicology reports that show most of the deaths are among people mixing multiple drugs at the same time.
Surveys of 1,017 drug users conducted in 2018 and 2019 by researchers with the BC Centre for Disease Control lend weight to the poly-drug-use thesis. The surveys found that 46.7 per cent of participants reported “polysubstance use involving opioids, stimulants, and/or benzodiazepines.”
To argue for safer supply as a solution treats the matter as a supply problem, comparing it with the War on Drugs, Somers said. Instead, he regards it as a demand problem driven by poverty, mental illness, colonization, wealth inequality and the like — all things that safer supply proponents also identify as drivers of addiction.
“Public supply of addictive drugs”
This spring, when Somers and fellow addiction researchers at SFU prepared a “rapid review” of safer supply — what the authors call a “public supply of addictive drugs,” or PSAD — for Alberta’s Ministry of Health, it found no evidence demonstrating the safety and effectiveness of safe supply. The review suggested “at present, safe supply represents a loosely defined slogan to increase the distribution of publicly-funded addictive drugs to people whose life circumstances perpetuate profound addictions.”
Somers said that giving a supply of a drug to a person addicted to that drug goes against what addiction clinicians have learned actually works to address addiction. “Drug policy should always aspire, through the social means that are available, to reduce or to keep at a minimum, the total volume of drugs made available in society,” Somers said.
“If you’re a doctor, you’d definitely get drug treatment. If you’re an airline pilot, a lawyer, a nurse, a B.C. public servant, a wealthy person, you get treatment. And that treatment is all of the psychosocial stuff that used to be provided to poor people,” Somers said. “And in most treatments, you’re not allowed to take any drugs, including methadone,” he added.
Review draws stern rebuke
The rapid review drew a stern rebuke from what Somers calls “the harm reduction establishment.”
About 50 safer supply research scientists and clinicians wrote a submission to the legislative health committee urging it to ignore the review.
“The report’s portrayal of the state of ongoing safer supply evaluations in Canada is inaccurate and arguably misleading,” the authors stated, calling the report flawed, of critically low quality and “potentially dangerous,” among other things.
Northern Beat reached out to several of the authors, including Dr. Thomas Kerr, director of research at the BC Centre on Substance Use at the University of B.C., and researchers at the Canadian Institute for Substance Use Research at the University of Victoria. They either were unavailable to talk or didn’t respond.
The letter signatories stated key studies were excluded and “the large body of evidence about heroin assisted trials” was overlooked. Further, the report failed to provide evidence about harms or inefficacy of safer supply, and “does not accurately portray the preferences of people who use drugs.”
The letter also acknowledged that research into safer supply is in its infancy “and there remains much to be learned. It is too early to make firm conclusions such as those offered by authors of this report.”
Somers, though, says that doing more research into safer supply is a dangerous path to tread — particularly when the government has put hardly any effort into the interventions he says have been proven to work, such as better housing and more access to treatment.
“Do not pass Go with safe supply,” Somers said.
More supply creates more users
In February 2022, the Stanford-Lancet Commission reached a similar conclusion in a report on the opioid crisis. “The faith of some advocates that opioids are safe as long they are not derived from illicit markets is impossible to reconcile with the hundreds of thousands of overdose deaths from legal, pharmaceutical grade opioids that preceded the introduction of fentanyl into US and Canadian heroin markets,” the report stated.
“This is a really good topic because I think different people have different perspectives,” said Dr. Tim Naimi, director of the Canadian Institute for Substance Use Research.
Naimi, who didn’t sign the letter critiquing the SFU rapid review and wasn’t asked to sign it, said the more supply there is of any potentially addictive substance, the more people will start using it. A big part of the oversupply of opioids began with doctors, at the recommendations of drug makers, overprescribing opioids for pain management. That led to a per capita quadrupling of opioid use, he said.
“We kicked off this problem. And one of the ways we kicked it off was through oversupply,” Naimi said, noting that the dominant source is no longer diverted pharmaceuticals but drugs produced in the illicit market.
“You dump in 10 people, and one or two of them will end up with a problem, and then some fraction of them will have a serious problem,” Naimi said. “In the case of the opioid epidemic, it’s a little bit of a special problem, because of the issue of the tainted drug supply.”
Safer supply may have saved her son
Victoria area resident Rachel Staples now favours prescribed safer supply, which she believes would have saved the life of her eldest son, Elliot Eurchuk, had it been available to him.
“I think it’s pretty much going to be the only thing that that makes a difference,” Staples said. Her rationale is that for most people with substance use disorders, the drugs have so badly messed up the pain receptors in their brains “that I don’t think they could function normally, without something to replace it, whether that’s a safe supply or access to something like methadone.”
That applies more so to teenage brains, which are still developing, Staples said, citing a report by addictions specialist Dr. Tom Warshawski.
Staples isn’t up for legalization — “not at this point” — but she says other options should be explored, including vending machines and mobile dispensaries where people can connect with addictions counsellors and other specialists.
“I honestly think that with the level of toxicity of the drugs out there, heroin is not going to cut it anymore,” Staples said. “They’re going to have to supply fentanyl in a safe way.”
As a dentist, Staples knows “all about opioids.” Elliot also knew his mom was prescribed them during her treatment for breast cancer. She says opioids continue to be over-prescribed — one reason she shunned them after a serious cycling accident in 2021.
Staples also blames overprescribing for putting Elliot on the path that led to his death on April 20, 2018 shortly before his 17th birthday. He was prescribed opiates for a rotator cuff injury, a common sports injury that can be very painful.
“Elliott turned his back on me,” Staples said. “He died saying he hated me. And he hated me because he knew I knew. They become very manipulative to get what they want. So they play one parent against the other and it becomes a very, very toxic household situation when you have somebody who is desperately ill and one parent believing they need help and the other person not quite getting it.”
Safer supply, a temporary intervention
Naimi sees safer supply as a temporary intervention to keep people from dying.
“It’s not just open to anyone. You have to have a severe opioid use disorder and not be willing to get treatment,” Naimi said. “So I don’t think even the people who are proponents of safer supply are saying like, ‘Oh, we should just be giving everyone pharmaceutical grade (opioids).’”
Even the institute’s substance use researchers have a variety of opinions about safer supply, himself included, and are free to express them, Naimi said, voicing doubts anyone associated with the organization would advocate for making hard drugs available free of charge to anyone.
Naimi pointed out that current safer supply programs, such as the Victoria SAFER Initiative – which is affiliated with the Canadian Institute for Substance Use Research –only do prescribed safe supply. (LeMaistre confirmed that, but said prohibition restricts prescribed safer supply from going far enough to address the toxic drug crisis.)
“The idea is a good one. It’s being evaluated,” Naimi said of prescriber safer supply. “It’s hoped that there will be good benefits for the people who are using it. The question is that the longer the program goes on, and the more people that applies to, the incremental benefits may get less. And at some point, you’re going to enter a situation where the concern is there’s more harm than good. So I think everyone’s trying to figure out where that is.”
Opiates should be legalized
Piotr Burek, a research assistant with the UVic-sponsored Vancouver Island Drug Checking Project, said opiates should be legalized and “absolutely” made available to anyone who wants them, free of charge. A downside of the marijuana legalization is that “it’s highly regulated, it’s not entirely accessible to people (and) it can be quite expensive,” Burek said.
An endeavour of the substance use institute at UVic, along with the school’s departments of social work, chemistry and computer science, the drug-checking project uses a mass spectrometre to analyze drug samples as part of “the continuum of safer supply interventions,” Burek said.
Drug-checking would still be required even in a regulated environment because it’s unlikely that the government would be able to regulate all of the wide array of drugs now on the street, Burek said. “It might be unlikely that even the main ones will be regulated.”
SOLID’s Cameron also favours legalization of all drugs. “As a drug users group, we would want to see something that’s much more organic that’s designed by the participants, and carried out by the participants as well,” he said.
He envisions substance users from the street designing and operating what would resemble cannabis compassion clubs.
“Everything is so sterile and clinical right now, which is a major problem in terms of getting people to engage,” said Cameron, who formerly had addictions to cocaine and alcohol but hasn’t used either substance for years. “In the short term, though, I think that’s the only option. What we’re seeing is services that are going to mimic what we see in a pharmacy or a similar setting.”
In addition to legalizing the drugs, Cameron also envisions the compassion club model doing its own drug-checking weeks in advance “and you would have it ready to go with the paperwork.” (His office is in the same building as the Vancouver Island Drug Checking Project.)
Cameron would also love to see the Fair Price Pharma Inc. model rolled out. It aims to provide medical-grade heroin to users. But that project — which SFU’s Somers calls a heroin company started by former provincial health officer Perry Kendall — has run into regulatory hurdles, according to a recent news report.
Northern Beat reached out by email to Kendall and his partner, Dr. Martin Schechter, for comment but they didn’t respond.
Multiple drugs in overdose deaths
According to the BC Coroners Office, fentanyl was detected in almost 90 per cent of fatal illicit drug overdoses. Often, multiple drugs were present, with cocaine and methamphetamines detected more than 40 per cent of the time. Drug overdose has been the leading cause of unnatural death in B.C. since 2015.
Depending on how the data is interpreted, the deaths are caused by drug poisoning or, as the addictions psychologist Somers sees it, by mixing multiple drugs.
Sell hard drugs over the counter
Somers agrees with his mentor, retired SFU psychology professor Bruce Alexander, that poverty, lack of housing, and inequality are among the major factors underlying addiction. Where they differ is whether or not it’s a good idea to treat addicts by giving them more of the drugs to which they have become addicted, or making those drugs more widely available.
Alexander says that all hard drugs, including fentanyl, should be made available for sale, over the counter, in drug stores.
In a Zoom call from his home on Pender Island, Alexander noted that children receive fentanyl lollipops for cancer treatment. He wondered why such lollipops couldn’t be sold to anybody who wants to get a buzz from them.
“Nobody is going to stick 1,000 lollipops in their mouth so that they get blasted on fentanyl,” Alexander said.
It’s difficult to understate Alexander’s influence on how scientists and policy makers understand addiction. His famous “Rat Park” experiments informed Dr. Gabor Maté’s book, In the Realm of Hungry Ghosts: Close Encounters with Addiction, and inspired writer Johann Hari to give a Ted Talk on addictions that has drawn more than 20 million views.
Alexander argues that at different in points in history different drugs have been demonized — he calls it the Myth of the Demon Drug — from “demon rum” in the 19th century, to crystal meth more recently, and heroin for about the last century. He and others say that, compared with alcohol, heroin is a safe drug that won’t wreck one’s liver.
“If you’re going to go on the nod, you’re way better to go on the nod with heroin than alcohol,” Alexander said.
Somers and the Mayo Clinic beg to differ, pointing out that opioid use has deleterious physiological effects. Among those effects, are a 50 per cent lifetime risk of developing a co-occurring mental disorder, and a heightened sensitivity to pain resulting in “more disability from pain as well as more prolonged recovery from injuries,” Somers noted in his rapid review.
A Mayo Clinic post on opioid addiction notes, “When you take opioids repeatedly over time, your body slows its production of endorphins.”
For Alexander’s guidance on safer supply, his greatest influence is Moms Stop the Harm. “All these ladies are saying is just we don’t want our children to die. And I think they’re entitled to that.”
Moms want hard drugs regulated
By safe supply, Moms Stop the Harm mean “a legally sourced, tested and regulated form of heroin, fentanyl, methamphetamines, and cocaine,” said director Traci Letts, who is based in Langley. She and the group would like to see them made available in “a low barrier, non-stigmatizing widespread way.” That would include sale and distribution through medical clinics, pharmacies, compassion clubs and dispensaries.
“I see so many different pathways, and it depends on how people identify,” Letts said.
Other safer supply initiatives in the works or proposed include opiate vending machines, unsanctioned overdose prevention sites, a scheme to license prospective opiate users, efforts by drug-user groups to obtain drugs off the dark web and test them for resale, and a plan by an entrepreneur to open a retail supermarket for opiates, cocaine, meth and other hard drugs.
The province has committed $22.6 million to safer supply initiatives out of $500 million it is budgeting over three years “to expand mental health and substance use services in order to end the toxic drug crisis,” according to the Ministry of Health and Addictions.
Safer supply would’ve spared his niece
“A legacy for her would be that I have to keep fighting so that her memory lives on,” Thorne said.
As a father, a grandfather, and a volunteer who picks up needles in the vicinity of the community’s safe-injection site, Thorne doesn’t see safer supply as a long-term solution to problems he encounters daily in the Cowichan Valley.
“I don’t know that safe places to go take drugs is the answer,” Thorne said. “I think government has to change its laws. Everybody’s got rights. I agree with that. But my kids are seeing people commit suicide every day. And we’re watching and in effect we’re encouraging it with a place to go and inject (drugs).”
Thorne, who is also a Cowichan Valley School District trustee, said he sees children as young as 13 living on the streets of Duncan.
“Why doesn’t the government take the money they’ve got and start creating facilities to house, care, treat, train, and create a life for these people instead of watching them panhandle, watching them steal.”
Canadian opinion divided
In an online survey in October, only about 10 per cent of Canadians support legalizing heroin, ecstasy, fentanyl and crystal meth – a five per cent drop from a similar survey two years earlier.
“There is little appetite for a blanket legalization of all substances that are currently controlled or prohibited,” Research Co. president Mario Canseco wrote at the time.
Meanwhile, support for prescribed safer supply has increased from 70 per cent in 2020 to 74 per cent in 2022.
“Now we see more people saying harm reduction is working; we should continue to do this. What this really tells me when I look at our data is people want a holistic approach,” Canseco said. “And I think what we have right now is two solitudes screaming at each other.”
Support for safer supply questioned
Dr. Vincent Lam, a Toronto addictions specialist who co-authored a guidebook on treating opioid use disorder, said the poll showing nearly three-fourths support for prescribed safer supply indicates that people are compassionate.
Lam suspects that the high support for prescribed safer supply comes from it being “a compelling term because it implies that it’s actually been demonstrated in some way that it’s safer.” Lam has serious doubts about that.
SFU’s Somers wondered if Canadians would show such support for safer supply, or PSAD (public supply of addictive drugs) as he calls it, were pollsters to ask if they preferred it “over proven approaches that transform people’s wellbeing while dramatically reducing crime, medical illness, and community distress” and if they knew what it might cost and how long it would remain in place.
In a Globe and Mail op/ed a year ago, Lam wrote, “Doctors who have been chastised for a decade for causing the opioid crisis through their prescriptions, are hearing from advocates of ‘safe supply’ and from Health Canada that the best way to save lives is now to liberally prescribe opioids. Many are unconvinced.” Providing less risky safer supply substances to people with increasing tolerance who will always seek a euphoric high “looks more like an infinite escalator than a destination,” wrote Lam.
In an interview, Lam said he has many patients who are in recovery from substance use disorders and no longer use illicit opioids. Those voices “are relatively quiet.” Part of that quiet he attributed to persistent stigmas surrounding substance use. “Although they might think that [public supply of addictive drugs] is, in fact, a really dangerous idea, they’re not very public about that because they’re not really in a place where they’re talking openly about their past history with substances,” Lam said.
“I certainly absolutely believe that people who use drugs, and people who have decided to stop using drugs, have really, really important knowledge, and absolutely should be listened to, and absolutely must be listened to,” he said.
“It doesn’t mean that one particular thing which is said by a particular group of people who use drugs is necessarily the only perspective,” Lam added.
Drug users should drive policy
Many drug-user advocates argue that the policies on drug use should centre around those with lived experience using drugs.
“I think the reality is the general population is pushing their opinions on a population of people that they don’t have the right to be making decisions for and hence the ‘Nothing about us without us,’” said Charlene Burmeister, whose titles include founder and executive director of the Coalition of Substance Users of the North.
Burmeister supports legalization of all drugs — “including heroin, fentanyl, meth, and stimulants like powder cocaine and crack cocaine.” She also calls for medicalized and non-medicalized models.
The prescription model leaves out all those users too stigmatized to seek medical help, said Burmeister, who is based in Quesnel, or as she prefers to call it, the unceded territories of the Lhtako Dene Nation. And at present, the current prescriber model isn’t even meeting the needs of their chemical dependencies, she added. For example, stimulant users like her — her substance of choice is crack cocaine — “are being left in the lurch when it comes to that safer supply programming that’s currently rolling out.”
While she endorses free substances through a medical model for people with problematic substance use, she doesn’t recommend free drugs for all and anyone. “I think that would be like saying we should provide alcohol free to everybody in the country,” said Burmeister, who is also a PWLLE (person with lived and living experience) stakeholder for the BC Centre for Disease Control and Provincial Health Services Authority.
And she also agreed that caution is necessary even though the current approach isn’t working.
“The death rate is increasing all of the time,” Burmeister said. “And the reality is, we need to do something. We also need to recognize as drug users that nobody’s coming to save us. They’re leaving us here to die.”
“Most people don’t want to stop”
Meanwhile, Eldon Telford, who spoke openly about his drug use, doesn’t bother checking his drugs because he trusts his dealer. He still has concerns though. He initially thought he’d be safer because he smokes his drugs. But then he read about people who smoke drugs are at an even greater risk of a toxic drug death.
“I shouldn’t be smoking fentanyl period because of how strong it is but if you’re hard-wired, you’re hard-wired and there’s nothing you can do,” Telford said on that rainy November day.
He too has tried treatment but found it useless because he wasn’t ready.
“You don’t even need treatment,” said Telford, who worked in construction for 20 years, building retaining walls and pavers, which took a toll on his body. “You just need to be on methadone so you don’t get sick and then just stop. But most people don’t want to stop or aren’t ready to stop.”
He’s still not ready in part because he has difficulty sleeping.
“I quit everything, all the other drugs. I quit alcohol. Really, it’s just this and it helps me sleep,” Telford said. “For some reason, it’s gonna be a monkey on my back for probably a few more years yet.”