The rationale behind safer supply is not actually unreasonable. Overdoses, infections and deaths often occur because addicts consume street drugs that have unpredictable doses and contaminants—so why not provide safer substances that are less likely to kill users until they are ready to seek treatment?
Yet Canada’s model of safer supply takes the opposite approach and is profoundly reckless.
Clients receive free drugs indefinitely and are generally not shepherded toward recovery. As there is a strong focus on “lowering barriers,” accessing safer supply is often, but not always, fairly easy. This has led addiction physicians to complain that patients are abandoning treatment in favour of using taxpayer-funded drugs.
Canada’s model of safer supply simply enables addiction and amounts to little more than palliative care. It gives up on addicts and only keeps them comfortable until they die by their own destructive habits, and then frames this as “compassion.”
Worse yet, the drugs being distributed are not fit to purpose, which is causing significant harm to both drug users and surrounding communities.
Canadian safer supply programs typically distribute 8mg tablets of hydromorphone, an opioid as potent as heroin. A single tablet is four times the dose typically used to manage post-surgery pain in a hospital setting, and just two or three are enough to induce an overdose in an opioid-naive user, especially if mixed with alcohol.
Yet most opioid addicts abuse fentanyl, which is 30–50 times stronger than heroin and hydromorphone. To overcome this difference, safer supply programs give huge amounts of tablets to clients—generally between 10–30 per day, although there have been reports of clients receiving as many as 40 or 50 tablets daily.
Yet dozens of respected addiction physicians have told me over the past year that even these large doses of hydromorphone do not satisfy fentanyl addicts, as such users have a formidable opioid tolerance. The federal government is aware of this issue and acknowledged in a 2022 report that maximal doses of hydromorphone produce little effect for fentanyl addicts beyond reducing withdrawal symptoms.
As fentanyl users do not enjoy hydromorphone tablets, they regularly sell (“divert”) their safer supply on the street to purchase their substance of choice—which means that safer supply is actually subsidizing, not mitigating, the illicit fentanyl market.
These tablets then flood into surrounding communities, crashing the street price of hydromorphone.
I have interviewed dozens of youth who have told me that “dillies” (the street slang for hydromorphone) suddenly became popular two years ago which, coincidentally, is when safer supply expanded. Many of these youths explicitly said that they and their friends had purchased dillies originating from safer supply.
Many of these youth tried dillies because they did not understand that hydromorphone is equivalent to heroin. All they knew was that it was for “pain relief” and that it was “safe” and pharmacy-prescribed–and then they became hopelessly addicted. Some even graduated to fentanyl.
Let this be a warning to other countries. When ideology trumps evidence, people die.
