HUNT: A new world of people with addiction... it’s criminal

When addiction physician Dr. Jenny Melamed heard that British Columbia was going to expand its “safer supply” experiment in 2020, she knew it was going to be a disaster. It was obvious to her that freely distributing large amounts of hydromorphone, an opioid as potent as heroin, would not save lives or pry drug users away from the riskier street supply. It would only flood communities with powerful and addictive drugs.Four years later, her concerns appear to have been vindicated — but the government is closing its eyes and plugging its ears..Drawing from conversations with patients and her daily observations on the streets of Surrey B.C., Dr. Melamed contends that a significant number of individuals enrolled in safe supply programs are illegally selling or trading their prescribed hydromorphone on the black market, a practice known as “diversion,” in order to acquire more potent drugs, including fentanyl.This has “flooded the market” with diverted hydromorphone, dramatically lowering the drug’s street price and lowering barriers to entry for opioid use. While 8-mg hydromorphone tablets used to sell for $20 each, patients now tell Dr. Melamed that their street price averages $1-2, although some patients have been “ripped off” by dealers who sell the pills for $5.While there are only approximately 4,600 safer supply patients in British Columbia, most of them receive 14 8-mg hydromorphone tablets every day. For reference, just three or four of these tablets is enough to induce an overdose in an opioid-naive user. While the B.C. government does not publicly disclose how much safer supply hydromorphone it distributes, experts estimate up to 50,000 pills are being given out each day.In her clinical practice, new patients have been telling Dr. Melamed that they are accessing diverted hydromorphone due to its low cost. She now worries that diverted safer supply may be enticing economically disadvantaged Canadians into addiction and opening a new pathway of escalation to fentanyl — a drug found in 82% of opioid-related deaths in Canada.While leading officials in the B.C. government claimed last year that widespread safer supply diversion is an urban myth, Dr. Melamed’s observations have been corroborated by Fiona Wilson, President of the B.C. Association of Chiefs of Police, who told a parliamentary committee earlier this year that roughly half of all hydromorphone seized in the province can be traced back to safer supply.This raises ethical and practical questions about prescription drug oversight within vulnerable communities. “If you want to give this drug to somebody, and if you ethically feel that you should,” said Dr. Melamed, during an extended interview with Break The Needle, “[then] it should only be done while being witnessed in a pharmacy.” Her voice resonated with solemn, unequivocal conviction. “I have no other line for this,” she emphasized. “That’s my line in the sand.”Dr. Melamed is concerned by the lack of rigorous scientific evidence supporting the safety and efficacy of safe supply initiatives. "There is no evidence to support safe supply," she asserted, pointing out that Health Canada implemented these programs without subjecting them to the stringent evaluative processes typically required for novel pharmaceutical interventions."It's a trial using humans as guinea pigs," she added, characterizing the supporting research as solely anecdotal, qualitative, and methodologically flawed. “The government has never said there was evidence [supporting safe supply]. They just said we needed to do something because nothing else was working.”Dr. Melamed’s concerns are well-founded. Opioid-related poisonings and hospitalizations have only increased since the implementation of Canada’s publicly-funded safe supply program in 2020, and other prominent physicians have spoken out about the alarmingly lax evidentiary standards applied to studies supporting safe supply.Although top officials in the B.C. and federal governments publicly claim that safer supply is an evidence-based strategy, the provincial protocols for safer supply fentanyl, which were published in August 2023, explicitly state, “To date, there is no evidence available supporting this intervention, safety data, or established best practices for when and how to provide it.”Since publicly voicing her concerns, Dr. Melamed has had her criticisms largely dismissed by pro-safe supply organizations, who have dismissed reports of diversion as “anecdotal.” She rebutted that these organizations selectively accept anecdotal evidence only when it suits them, as most safer supply studies similarly rely on anecdotes (i.e. interviews with drug users enrolled in these programs).For safer supply advocates, it seems that the testimony of current drug users is “evidence,” while the testimony of individuals in recovery, along with parents and youth, should be ignored.Dr. Melamed is far from alone in her skepticism. "Every colleague that I've spoken to" shares her misgivings about safe supply, she said. However, many are reluctant to voice their concerns in a public setting, fearing professional or social backlash in a field where questioning the status quo can lead to ostracization and even harassment.In January, Moms Stop The Harm, an activist group which works closely with the federal government and receives substantial funding from Health Canada, mailed a series of disparaging letters to Dr. Melamed’s office, which she interpreted as an attempt to intimidate her into silence.Yet Dr. Melamed remains firm in her determination to speak out.“You cannot treat addiction with more drugs," she stressed. "You have to treat addiction with treatment and recovery." She believes that safe supply programs, as currently designed, are perpetuating harmful patterns of drug use under the guise of compassion. "We're not treating, we're just enabling," she added. “That is not compassion.”She acknowledged that safer supply may have a limited role for helping a small subset of patients, but only if these patients are integrated within a continuum of care that moves them towards recovery — something which is currently not happening. “You need to put people into long-term living facilities where they learn a trade,” she said. “Where they learn to live, where they have no access to drugs.”Instead of expanding access to safer supply, Dr. Melamed advocates for a greater focus on evidence-based treatments like opioid agonist therapy (OAT) coupled with comprehensive psychosocial supports.She warns that the presence of an easily accessible, no-cost opioid alternative has already led, by her estimation, to a 15 per cent decline in enrollment in OAT programs. "We have legitimized drug use. It’s heartbreaking. We’re creating a new world of people with addiction. In some ways, it’s criminal.”Liam Hunt is a Canadian writer with significant recent international experience in eastern Europe and central Asia. He wrote this article for 'Break the Needle,' to provide news and analysis on addiction and crime in Canada.

HUNT: A new world of people with addiction... it’s criminal

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