Safe supply is no answer

Jerry Storie rightfully points out in his op-ed, A conversation on drug policy is overdue (Think Tank, Jan. 22), the benefits of decriminalization in diverting resources from policing, enforcement and incarceration of drug addiction. This would allow us to spend resources on more beneficial and evidence-based public health interventions.

According to Mr. Storie, this would include “clean, free drugs” which should, in addition to safe injection sites, ostensibly derail the illicit drug supply and give drug users what they “need.” He mistakenly invokes Portugal as an example of classic harm reduction.

In Portugal, harm reduction has not, in fact, been central to their drug strategy but rather the diversion of drug users from punishment towards treatment.

This is not at all what we have seen evolving in Canadian drug policy.

What many folks miss is the fact that the so-called “free, clean drugs” that B.C. (and Ontario) have been supplying to drug users are not what they “need.”

People who use fentanyl will quickly tell you that “safe supply” hydromorphone (Dilaudid) eight-milligram tablets are not strong enough to resolve the intense opioid withdrawal that happens within hours of stopping fentanyl. They are also not a solution for people addicted to stimulants such as crack cocaine and crystal methamphetamines.

As a result, these tablets, prescribed and dispensed daily and abundantly as “safe supply,” are quickly sold or traded for the more addictive, more potent and “dirtier” drug of choice. None of these options has a “safe and clean” equivalent.

Rather than providing people with “clean” drugs, what we are doing is setting them up to worsen, as they develop increasing tolerance to the short-acting opioids in their system.

Addiction medicine experts and opioid treatment patients all know that only a long-acting opioid replacement like methadone or buprenorphine will provide the relief that people are seeking from the relentless cycles of use, withdrawal, cravings and relapse.

We do a great disservice to people with substance-use disorder to romanticize their life-threatening mental illness as a simple “lifestyle choice” to use drugs.

Most, if not all, the patients we see seeking treatment are desperate to get off the roller coaster, not to have someone stand by and encourage them to continue.

What is the actual outcome of the apparently progressive “safe supply” drug policies? In the last six months, I have seen more than 20 youth under the age of 18 with hydromorphone addiction from the cheap and available “safe supply.” Dilaudid 8mg tablets or, “D8s” are five percocets (oxycodone) in one tablet.

For young people, prescription opioid tablets are now cheap, accessible and perceived as safe. This is exactly where we found ourselves in Canada 20 years ago with the liberal prescribing of oxycodone — engaging new devotees to opioids every day by exposing a large portion of the population to opioids.

Sure, alcohol and cannabis are regulated. But they are still problematic and they are certainly not free.

Why would we need to introduce yet more dangerous, high potency drugs to young brains?

No, safe supply is not good drug policy and no, Manitoba does not need more “clean, free drugs.”

Lori Regenstreif is a family physician, working in inner-city Hamilton, Ont., with a focused practice in addiction medicine for the past 15 years.