There’s disagreement, however, on how much is being diverted and whether it has become a gateway drug for youth to fall into opioid addiction. This contentious point is a wedge in Canada’s political and social divide on the “safer supply” approach to the overdose crisis.
The Epoch Times took a look at much of the available data, along with other evidence for and against a teen “dilly” problem. Dilly is the street name of Dilaudid, a brand name for the safer supply opioid hydromorphone. Other drugs in the opioid class include fentanyl, morphine, oxycodone, heroin, and codeine.
“Opioids were not a high school recreational drug prior to safe supply. Hydromorphone is now,” Dr. Koivu told The Epoch Times via email. “Safe supply has magnified our opioid use.”
She has been vocal on the issue for some time now, but says her complaints have fallen on deaf ears within the safer supply program. Safe supply proponents say hydromorphone is needed to give people an alternative to fentanyl or fentanyl-laced drugs sold on the street, to prevent overdoses.
Mark Mallet, a hospitalist in Victoria, British Columbia, also recently raised the alarm on hydromorphone diversion and discussed why some are reticent to address the issue.
As a physician whose primary focus is the general medical care of hospitalized patients, Dr. Mallet said evidence is dismissed as “anecdotal” because not enough hard data has been collected.
The Data
The Epoch Times asked Health Canada for data related to youth hydromorphone use, and to what extent the ministry is aware of safer supply drugs being diverted to youth.
The Epoch Times followed up with Health Canada to see if any more recent data is available, but didn’t receive a reply by press time. The 2019 CADS did not have data for “problematic use of opioids” for youth aged 15 to 19.
It seems the currently available youth drug-use data lacks the precision to say how much safer supply hydromorphone young Canadians are using.
It said that in the meantime clinicians may take action to prevent diversion, including prescribing less and monitoring use, such as by taking urine samples to see if the patient is taking the hydromorphone or requiring witnessed consumption.
“Data from the BC Centre for Disease Control (BCCDC) does not indicate there has been an increase in opioid use disorder diagnoses among youth. However, we remain committed to listening to families and are working hard to address their concerns,” the ministry said via email.
“Results are descriptive. Additional work is needed to examine the association between rates of new OUD [opioid-use disorder] diagnosis and prescribed safer supply availability across age groups in BC,” the BCCDC report says. It adds that “Many factors impact how likely people are to receive a diagnosis for OUD.”
Police Reports
It’s worth noting how safe supply hydromorphone sales are said to happen. It seems safer supply hydromorphone is often sold not far from the pharmacy where it was obtained, and it is legal. It is thus less likely than illicit drugs to be seized in a drug bust.
Dr. Koivu said she lives near a pharmacy that distributes safer supply drugs and has seen the area deteriorate as addicts moved closer to the pharmacy, “where much of the diversion takes place.”
Many of the people who receive hydromorphone prescriptions are vulnerable, she said, and often forced by others to give up their pills.
The service’s Opioid Enforcement and Education Unit replied briefly via email that not enough data is available to say whether hydromorphone trafficking is on the rise. “At this time we cannot suggest or deny that vulnerable populations such as our youth are the recipients of said drugs.”
The RCMP told The Epoch Times that hydromorphone has been trafficked for the past 10-plus years in Canada but has waned in popularity with the rise of fentanyl. Before safer supply, hydromorphone was prescribed as a painkiller and some of it was diverted to the streets then.
Dr. Koivu disputes claims that safer supply hasn’t significantly changed the amount of hydromorphone on the street.
“The amount of prescription opioids on the street was far less and much more expensive prior to safe supply,” she said. “People tell me they buy safe supply. People tell me they sell safe supply. Opioids prescribed for pain have decreased. From everything I see, safe supply is the main source of street hydromorphone in London.”
Going only by the name John Doe, the dealer answered multiple questions about the impacts he saw of the safer supply program.
“He believes that the hydromorphone prescribed in safe supply is not largely used by those who use fentanyl. When asked what he thinks happens to the hydromorphone prescribed in safe supply, he replied, ‘A lot of people sell it to get fentanyl,’” the article states.
He said that the hydromorphone is sold to people who “only use hydromorphone. They don’t use fentanyl.”
Most of the data DAS referred The Epoch Times to is from 2020 to 2023. It shows a relatively higher prevalence of opioids in Ontario and B.C.
In 2012, identification of hydromorphone was far below that of oxycodone. Identification of hydromorphone rose fairly steadily until about 2017, and during the same period, identification of oxycodone dropped fairly steadily. From 2017 to 2020, both dipped. In 2020, they both rose, but hydromorphone climbed more quickly and reached almost the same level oxycodone was at in 2012.
Identification of fentanyl was much higher—over six times higher than hydromorphone in 2022.
Dr. Koivu argues that a rise in safer supply opioids has driven the rise in fentanyl. Hydromorphone creates and feeds opioid addiction, she said, leading people to eventually seek fentanyl, a stronger opioid.
It’s akin to the proverbial chicken-and-egg argument.
“As more people were using [safe supply] opioids, it brought illicit fentanyl to our community,” Dr. Koivu said. “I think it is extremely important to know the program promoted the fentanyl crisis—it was not a response to it. The ’safe supply' advocates are now using the fentanyl crisis to justify the program’s existence.”
Dr. Koivu says she saw the benefits of the program at first. She gave the example of a woman she called Linda, who was a 38-year-old sex worker struggling with addiction. Receiving safer supply helped Linda access other supports, such as HIV treatment, and helped her financially, so she decreased her street work. But, eventually, Dr. Koivu saw the downside of the program.
Anecdotes
Media reports have brought to light some stories of young people affected by safer supply, and Dr. Mallet told of some young people he knows.“All of a sudden people were doing them, and like my friends would just be like, ‘Oh, I’m on a dilly,’” she said. She said drug dealers market them as safe.
“They tell you that there’s nothing bad in them, that they’re clean drugs that won’t kill you or harm you in any way, that they’re 100 percent dilly,” she said.
The RCMP told The Epoch Times that criminals also create pills that look like pharmaceutical hydromorphone, creating the illusion of safety—though they say it’s not a widespread phenomenon.
“They don’t want to face the truth: A decision they made is causing more harm. They want to think that they’re saving people,” he said.
Dr. Mallet says the 18-year-old daughter of one of his friends was offered a dilly at a party in Victoria. She took it, and subsequent use of the drug led her to full-blown opioid addiction. He says she was offered a prescription for more hydromorphone when she went to seek help for her addiction.
He also told the story of a 35-year-old patient of his who got hooked on dillies and is now addicted to fentanyl.
“We have not publicly come forward on the issue and, at this point, we are still in conversations internally,” she said.
The Epoch Times reached out to many youth addiction clinics across Canada and received a reply from only one. A clinic in Thunder Bay, Ontario—where a federally funded safe supply program is in place—declined to comment.
Policy-Making
Policy-makers continue to wrangle over safer supply as they wait for more information, anecdotal and empirical, to come in.
The federal Conservatives introduced a motion in May to put a stop to the safer supply program, but it failed.
During question period on May 10, Prime Minister Justin Trudeau accused Conservative Leader Pierre Poilievre of “ideological fear mongering” on the issue. He said there is evidence safe supply has prevented overdoses and saved lives.
Mr. Poilievre blamed safer supply drugs for an increase in opioid addictions and overdoses. He referred to Mr. Zivo’s article, informed by interviews with dozens of health-care and addiction experts. Mr. Poilievre said the Liberal government is “subsidizing” the opioids “and flooding them into our streets, including through dispensaries.”
