Eby government stance on medical ‘safer supply’ at odds with reality

Written By Fran Yanor

Deflecting criticism for funding a drug user group with known involvement in the illegal narcotics trade, the BC NDP government firmed its position on hard drugs this month, pledging to only allow medically prescribed ‘safer supply.’ But the new tough stance is at odds with what’s really been going on in public health’s chaotic scramble to get ahead of the opioid overdose crisis.

Not only have public dollars gone to other similar drug-buying ‘compassion clubs,’ health agency researchers and bureaucrats have systematically been building up a range of non-medical models in a desperate drive to make pharmaceuticals and tested street drugs – including cocaine, methamphetamine, and heroin – widely available, by whatever means possible.

While the B.C. government’s front-facing public policy on addictions treatment espouses certain harm reduction measures, several taxpayer-funded projects over the past few years bypass convention and precedent, suggesting a diametrically different de facto public health policy at play, this one aimed squarely at legalization. 

Legalization, a long-held dream for some public health officials

Legalization of all drugs is a fervent dream for some public health bureaucrats, no matter if elected government officials won’t breathe a word about it. 

“In the long term, would [legalization] be a way to counter the toxic street drugs and to take that business away from organized crime? Absolutely,” said B.C. Provincial Health Officer Dr. Bonnie Henry at a press conference in June.

Senior public health officials, including Henry’s predecessor and her peers, have advocated for years for various versions of non-medical safe supply as an intermediate step towards regulation and legalization. 

Both Henry’s former colleague Dr. Mark Tyndall, who served as Deputy Provincial Health Officer at the same time Henry did, along with her mentor and former Provincial Health Officer boss, Dr. Perry Kendall, now own heroin manufacturing or distribution companies in the private sector. 

Tyndall owns MySafe, a non-profit company that administers prescribed safer supply through biometric-reading vending machines. According to a 2022 presentation by Tyndall – an infectious disease doctor, UBC professor and former executive director of the BC Centre for Disease Control – health teams find patients for MySafe, then he prescribes them the hydromorphone his company is paid to distribute.

“I have a nurse and a community worker who identify people who are interested in it. We put a little advertisement up in the hotel: ‘Hydromorphone is going to be available.’ They do a quick screening on people, and then I’m the prescriber,” Tyndall told B.C. legislators in June 2022.

As of this summer, MySafe had been awarded $4.5 million in federal funding over several years to operate vending machines in Vancouver’s Downtown Eastside and Victoria.

Kendall, who served as B.C.’s highly respected Provincial Health Officer prior to Henry, was a guiding light for safer supply, legalization, and heroin substitution. When he retired as PHO he started Fair Price Pharma, a non-profit heroin manufacturing and distributing company, with his colleague, fellow University of BC professor and Order of BC recipient, Dr. Martin Schechter.

The two formed the company to provide an affordable alternative to the very expensive pharmaceutical supply, Kendall said last year. “Fair Price Pharma was trying to do it as a philanthropic initiative.” 

The former chief scientific officer of B.C.’s Michael Smith Foundation for Health Research, Schechter is still a director and a registered lobbyist of the B.C. government.

Up until a few months ago, Kendall was also acting interim co-director at the BC Centre on Substance Use, according to his Linked In profile. Which means both he and Schechter were pressuring the government to buy their heroin products while simultaneously holding influential positions in health research agencies that inform B.C.’s safe supply policies.

Kendall declared the opioid crisis a health emergency in 2016. when he was Provincial Health Officer. Since then, an estimated 40,000 people have died of drug toxicity in Canada, more than 13,100 of those in British Columbia.

Both Kendall and Schechter are among an elite crowd of former senior public health officials who blazed through the HIV/ intravenous drug crisis 20-plus years ago, helped create some of B.C.’s original safe supply policies like Insite, constructed the province’s early harm reduction industry, and now run companies supplying B.C.’s harm reduction industry. 

Compassion clubs have deep roots in BC

The compassion club framework has deep roots in B.C.’s health sector. Modelled after groups in the 1980s and 90s which purchased cannabis and HIV/AIDS treatment outside of the public health system, it’s still being championed by the BC Centre for Disease Control and the BC Centre on Substance Use.

In 2019, BCCSU researchers teamed up with drug users to develop a heroin compassion club model. Since then, the government’s own health research agencies have directed a significant portion of their efforts at making that concept a reality for opioids and stimulants. 

In 2020, Kendall and Schechter’s Fair Price Pharma required 200 participants to jump start its operations, and was actively looking for customers among drug user groups.

A Fair Price Pharma promo video posted on social media in late 2020 says the company can have pre-filled syringes of heroin ready for 200 people within three months. [Image Fair Price Pharma]

“All that’s needed to initiate the first order of pre-filled heroin syringes, is a contract with a health authority and 200 guaranteed daily customers, a Fair Price Pharma company video explains.

Yet another non-medical project

In 2022, the BCCSU proposed setting up just such project – a non-prescriber compassion club pilot project for 200 drug users in the Vancouver Coastal and Fraser health authorities. 

By last April, the BC Centre for Substance Use and the two health authorities had drafted an initial proposal for the Ministry of Mental Health and Addictions, according to the Minister, Jennifer Whiteside. Once a final proposal was complete, it was to be submitted to Health Canada for funding and an exemption under the Controlled Drugs and Substances Act, according to a BCCSU briefing note for Whiteside.

But, as of last week, the pilot was stalled.

“Their project is not moving forward,” a Ministry of Addictions and Mental Health spokeswoman wrote in response to questions from Northern Beat about the pilot’s status.

Asked when and why the proposal had stopped progressing, the ministry deferred further inquiries to the BCCSU, whose spokesman said “resources are focused on the implementation of prescribed safer supply” and other government harm reduction and treatment programs. Neither office would say when the pilot was halted.

The abrupt change in plans may track back to the current controversy involving the B.C. government and the Drug Users Liberation Front in Vancouver. On Oct. 26, the Premier said he asked Whiteside to inform all health authority-funded organizations “that government has a zero-tolerance policy in relation to breaking the law.”

Illegal activities of drug user group well known

For several weeks, Eby and his ministers have come under political fire after an international media report and the BC United Opposition revealed the provincial Ministry of Health was funding the Drug Users Liberation Front (DULF) – a compassion club well and widely known to have repeatedly bought, tested, and sold illicit drugs as its own unsanctioned version of safer supply. 

Health Minister Adrian Dix referred all questions about DULF and his ministry’s funding of them to Addictions Minister Whiteside.

DULF and its ally organization Vancouver Area Network of Drug Users (VANDU) have received around $1.5 million in funding from the province over the past couple years, during which they were involved in aspects of buying, testing and selling or giving away illicit drugs bought on the black market.

The Premier and his ministers have insisted they only learned of the DULF’s illegal activities last month, even though Attorney General Niki Sharma was briefed on the group’s illegal drug operations more than a year ago. And despite DULF’s representatives having freely shared details of their illicit drug trade activities across 20 well-publicized giveaway events and in repeated interviews with media outlets from B.C., Canada, and the world, beginning in 2020. 

For their second illegal drug giveaway event in April 2021, DULF and VANDU gave away free packages of cocaine, heroin, methamphetamine in front of a police station, with a live band playing on the back of a flatbed truck, amid a neighbourhood block barbeque.

“I find it really, really unbelievable with the level public [exposure], media interviews, publicity that this organization has done that the government would say that they were unaware,” said BC United addictions critic, Elenore Sturko.

Following disclosure the two groups had received public funds, Sturko wrote a letter to Sharma asking for a full investigation into their government funding and perceived criminal activities. Three weeks later, the B.C. government terminated DULF’s contract and police arrested (then released) its top representatives. The Opposition have called for an independent public prosecutor to be appointed to the case.

Shortly after the police raid on DULF, the Eby government slammed the door on any expansion of non-medical safer supply. 

“Non-prescription models for the delivery of pharmaceutical alternatives are not under consideration,” Addictions Minister Jennifer Whiteside wrote in response to a recommendation by the chief coroner’s death review panel to allow access to opioids and stimulants without a medical prescription.

“Non-prescription models for the delivery of pharmaceutical alternatives are not under consideration.”

Jennifer Whiteside

“These are very serious drugs with very serious consequences and it’s hard to imagine how we shift to a system that doesn’t have medical oversight of access to those drugs,” Whiteside reportedly told CityNews.

The hurry to legalize

Yet, until this month, that’s exactly what the public health system appeared to be doing under the NDP government.

Even as the Premier has repeatedly touted the merits of government-sanctioned prescribed safe supply as getting a physician between drug users and “the predatory drug dealer,” public health documents, online recordings and parliamentary health committee transcripts describe a public health sector advancing toward making an addictive drug supply accessible with no medical oversight, similar to the cannabis retail model.  

B.C. needs to expand access to “safer drug supply in both medicalized and non-medicalized models,” BCCSU executive director, Cheyenne Johnson, told the province’s legislative health committee in 2022. 

“[The] scale-up of prescribed safer supply through a prescriber-based medical model has shown to have very poor reach. And the medications used are currently ineffective at separating people from the toxic supply,” she said explaining why non-medicalized drug supply was needed.

Pushing for non-medical access before prescribed safe supply proven

This shift to make non-medical, unproven initiatives a staple of public health is unknown to most of the general public, but well understood by B.C.’s senior public health officials. 

As of May 2022, Vancouver Coastal Health and Providence Health Care already had a “range of non-prescriber models that are being either developed, or are in place and evaluated right now,” said Réka Gustafson, then the Deputy Provincial Health Officer with responsibility for the BCCDC, one of B.C.’s top health research agencies.  Gustafson was since appointed chief medical officer for the Vancouver Island Health Authority.

“One of the most important things that we can do right now is to support the rapid implementation and evaluation of non-medical models of safer supply,” Gustafson told legislators last year. 

Among the highest paid public health officials in the province at the time, Gustafson described the existing government-sanctioned prescribed safe supply program as “life-saving for some, but it, by itself, will not be effective.” 

“In the context of an emergency or an evolving situation, we don’t have the luxury of lengthy, randomized controlled trials.”

Réka Gustafson

The safe supply program allows medical prescribers to dispense highly addictive, fast-acting (producing a euphoric ‘high’) pharmaceuticals, namely opioids like heroin, to people diagnosed with substance use disorder to be consumed unsupervised.

The program has not been as successful as hoped. Addictions physicians have been leery about prescribing it and many people around the province don’t have access. Doctors have criticized it, saying after three years there is still no proof it works. it has not delivered on its original goals to reduce reliance on street drugs and stop overdoses. Also, people are selling their prescribed hydromorphone ‘dillies’ (similar to heroin, brand name Dilaudid) to buy the street fentanyl it’s supposed to replace, causing new addictions in people previously not dependent on opioids.

Public health advocates are not swayed. They say people are fatally overdosing due to the unregulated potencies and cross contamination in street drugs, so greater access to prescribed safer supply is needed. 

Before the program has been proven to work or not. No matter if it’s creating new addictions in the process.

“In the context of an emergency or an evolving situation, we don’t have the luxury of lengthy, randomized controlled trials,” said Gustafson, comparing the need for blind speed in the overdose crisis to the urgency of the HIV/intravenous drug crisis and the early days of the COVID pandemic, when action was taken before the science was settled.

‘Incremental step toward non-medical safe supply’

Another unproven model deployed by the province more than a year ago is “enhanced access” safe supply, which allows free access to addictive pharmaceuticals to people not diagnosed with a substance use disorder, Gustafson said. 

Practiced at the Portland Hotel Society, the enhanced access model begins with an initial physician assessment, a prescription and supervised consumption, then evolves so no healthcare prescriber is required, drugs are available for purchase, and off-site, unsupervised consumption is allowed.

“It’s an incremental step toward that non-medical safer supply,” said Gustafson. “It is a commitment to a regulated drug supply” and a step “closer to the public health vision of a tightly regulated market.”

Government funding builds capacity of compassion clubs

For some in the public sector, compassion clubs are an essential progression on the journey to legalization. And the province has been pouring resources into drug user groups to support their growth.

All drug user groups are not compassion clubs and most provide much more than just access to tested illicit drugs. But at least 10 drug user groups that received money from the B.C. government were also mailed illicit drugs by the Drug Users Liberation Front, according to DULF’s own website and BC United’s Sturko in a Nov. 1 letter to Solicitor General Mike Farnworth.

The Community Action Initiatives (CAI), a society funded by the Ministry of Addictions and Mental Health and the Overdose Emergency Response Centre, had as part of its mandate the goal of building capacity in drug user groups across the province. According to its own literature, “the CAI has a long track record in … leveraging provincial investments to support strategic shifts in the types of [mental health and substance use] services offered and innovation in how these services are delivered in community.”

In the CAI 2020-21 fiscal year, the society leveraged almost $14 million to community groups, according to the society’s annual report. Several funding streams were geared to people who use drugs and drug user groups. The provincial peer network grants went solely to drug user groups, with $1 million allotted to the umbrella group, the BC Yukon Association of Drug War Survivors, which then dispersed unspecified amounts to four other drug user groups, including two on DULF’s mail out.

Screen capture of the page that used to list the groups funded by the Community Action Initiative’s peer network grant stream. [Image CAI]

The pages previously listing peer network grant recipients, along with the grantees from several other streams, have disappeared from the society’s website. Northern Beat retained a record of the now missing content.

Some of the other groups mailed illicit drugs from DULF are funded by the federal government’s Substance Use and Addictions Program (SUAP). For instance, SOLID Outreach received drugs from DULF and funds from the provincial CAI society, while its partner, the Victoria SAFER program, is funded by SUAP.

“[DULF and KISS] are trying to do this differently.”

Lindsey Richardson

Before the DULF controversy, compassion clubs were fast gaining ground and credibility within the public health sector.

“There are some really interesting community-based models that are moving forward. You know, there’s the Drug Users Liberation Front in Vancouver, the Kootenay Insurrection for Safe Supply in the interior of BC, and they are trying to do this differently,” said Dr. Lindsey Richardson, a UBC and BCCSU sociologist, said in an interview in May. 

‘We purchase drugs online, get them tested … and distribute to our members’

The Nelson-based Kootenay Insurrection for Safe Supply (KISS) group was formed in 2022 with the singular purpose “to establish a non-medicalized, drug user-led safe supply compassion club,” according to group founder Dylan Griffith. 

Organized as a reaction to “the lack of movements around safe supply and any real response to the drug poisoning crisis,” KISS was inspired by the work of DULF and VANDU, and modelled on their compassion club and fulfillment centre, Griffith told other rural drug user advocates, an Interior Health safe supply prescriber, and a BCCSU official in a February meeting posted online. 

“We use the same basic logistical framework that DULF uses,” said Griffith. “Which is we purchase drugs online, get them tested at Substance – which is at the University of Victoria – then we package and distribute to our members at cost.

“Our hope is [to] … eventually become a sanctioned drug user-run compassion club that’s accessing substances through legal channels.”

Dylan Griffith

“We’re starting off unsanctioned, but our hope is that we will be in it for the long haul and eventually become a sanctioned drug user-run compassion club that’s accessing substances through legal channels.”

‘Compassion clubs have a huge potential’

Like DULF and VANDU, KISS was funded by the B.C. government as of the spring of 2023.  Following the DULF/VANDU lead, KISS formed a second organization so it could qualify for government funding and partner with other entities.

“All the research and advocacy activities we do will be a registered non-profit society called the Kootenay independent Safe Supply society,” Griffith said. “And that will allow us to partner with agencies and organizations that otherwise wouldn’t be able to partner with us because of our association with the non-sanctioned compassion club.”

Forming the society “allows us to strengthen our legitimate arm, and … become a more durable and sustainable entity,” he said. 

BCCSU researchers are conducting the group’s initial evaluative study, which Griffith said copies “totally off the DULF/VANDU framework,” and will follow 20 participants over the first 12 months of unsanctioned operation. 

“Hopefully, ideally, we don’t get shut down.” 

“Compassion clubs have a huge potential to really up the scale of safe supply provision until we can actually get to regulation.”

Thomas Kerr

People who use drugs are often one step ahead of bureaucracy and can lead the way and develop innovative new pathways, public health scientist, Dr. Thomas Kerr, said on the same webinar with Griffith earlier this year.

[Note: Online access to the online video was restricted following the B.C. government’s announcement it would only support medical models of safer supply. Northern Beat retained a copy which can be viewed here.

Director of research at the BC Centre on Substance Use (BCCSU), Kerr is the KISS “study advisor” and the BCCSU itself the “technical advisor,” according to Griffith.

“I’m really honored to be helping support the DULF initiative in their evaluation as well as the KISS initiative,” Kerr said. 

“Compassion clubs have a huge potential to really up the scale of safe supply provision until we can actually get to regulation,” he said. 

“Which in my view, is the ultimate goal.” 

Whether it’s also the Eby government’s objective is hard to say.

If it is, British Columbians deserve to be told. Before the next election.