Canada's mental health and addictions minister believes fear and stigma are driving criticism of the government's decision to support prescribing pharmaceuticals to drug users to combat the country's overdose crisis.
Ya'ara Saks attributes growing pushback to most harm reduction strategies — including federal funding for what are referred to as safer supply programs and the operation of supervised consumption sites — to the discomfort, she says, many feel toward a reality they can no longer ignore.
"The debate is hard because people have looked away and they can't look away anymore," she told The Canadian Press in a recent interview.
That reality would be the country's skyrocketing number of overdose deaths. The Public Health Agency of Canada said drug overdoses killed an average of 23 people each day last year. More than 40,000 people have died from opioid-related deaths since 2016, which is when the federal agency began collecting such data.
Data shows a majority of overdose deaths between January and June 2023 involved fentanyl, an opioid experts warn has become increasingly tainted with even more toxic substances.
In just the last two months alone, police and health officials in Saskatchewan, Thunder Bay and Belleville, Ont., have warned about opioids, mostly fentanyl, laced with an animal tranquillizer known as xylazine. Dealers often lace fentanyl with other substances because it's cheaper than providing pure opioids.
The overdose crisis worsened during the COVID-19 pandemic, with border closures leading to a more contaminated drug supply and health restrictions resulting in a lack of access to addictions services and an uptick in people using alone, as well as in heavier doses.
That led the federal government to allow users deemed to be at high risk of overdosing to instead be prescribed pharmaceutical alternatives as opposed to taking toxic street drugs — an approach known as providing safer supply.
British Columbia became the first jurisdiction to test out such an approach, with Ottawa also providing funds for pilots in New Brunswick and Ontario. Health Canada reported tablets of the opioid hydromorphone as the most commonly prescribed replacement.
A federally-commissioned review of those pilots found a decreased risk of overdoses and that drug users were able to obtain drugs more safely than through street dealers or sex work.
At the same time, however, it reported that some fentanyl users had too high a tolerance for the amount of hydromorphone they were prescribed. As a result they turned around and sold their prescribed drugs on the street, in what has become known as "diversion."
The issue was flagged by British Columbia's Provincial Health Officer Dr. Bonnie Henry as a "common occurrence" in her recent review of her province's safer supply program. Henry said it wasn't clear how big the problem was.
Critics of the approach have seized on the problem, perhaps none more so than federal Conservative Leader Pierre Poilievre, who has expressed concerns about diverted narcotics ending up in the hands of minors.
Henry noted in her review that reports suggesting this are "anecdotal," but underlined that diverting these drugs to people who aren't already users poses great harm.
Poilievre, who speaks often about "crime, chaos and disorder" in cities, slams safer supply programs as Prime Minister Justin Trudeau's "failed hard-drug supply project" and vowed to cut federal funding for them if he is elected. He said a Conservative government would put that money into recovery programs.
Saks says she has listened to the concerns around diversion, including from a group of doctors who wrote to her directly. She added that last fall she asked officials to examine the program "from top to bottom" and make adjustments where needed.
"We stand clear on public health and public safety — diversion is illegal," she said.
Despite the political pushback and worries around diversion, Saks defended the continued funding of 'safer supply' programs as necessary to save lives, but said it is only one approach to tackle the crisis.
"Why are we giving in to stigma and fear and not leading the discussion with compassion and trust?"
She added: "A lot of what's driving the prescriber alternative debate is anchored, unfortunately by the opposition, in stigma and fear."
But she acknowledged the federal government could also do more to inform people about how such programs work.
"Do we need to help communities get more comfortable with the realities of what is a toxic drug supply poisoning their communities? One-hundred per cent."
Last week Saks visited Belleville, after the eastern Ontario city of 50,000 people declared a state of emergency on Feb. 8 because of overdoses. First responders tended to 17 overdoses in just 24-hours. Ontario Premier Doug Ford's office promised more money for the city but said he was not considering offering a 'safer supply' of drugs.
Saks says her message to those taking issue with harm reduction programs such as those protesting a proposed drug consumption site in Richmond, B.C., is to sit down and talk.
"Let's sit down and have the conversation, so that we can see those who are most vulnerable in our communities, and understand how they got there."
"If it means that we have to have hard conversations in communities, so that they don't look away, that they become a community that wants to help."
This report by The Canadian Press was first published Feb. 20, 2024.
-With files from Christopher Reynolds in Montreal and Liam Casey in Toronto.
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