Juno News - Addiction specialist blames “safe supply” for spike in fentanyl use

00:00:00.000 you're tuned in to the andrew lawton show

00:00:05.920 but this is not exclusively a british columbia problem many of you may know i live in london

00:00:14.220 ontario and my city uh very quickly i i saw about a decade ago maybe eight years ago or so

00:00:20.660 started to become just as notable on the drug issue as many other communities and you had

00:00:28.540 these weird pockets where you'd look at you know vancouver and london and i never quite understood

00:00:33.140 why that was why london had become this hotbed for it and there are political reasons for this

00:00:39.540 as well in terms of how london has chosen to deal with this issue over time and some of these have

00:00:45.380 come to a bit of a flashpoint in recent months as we've seen the debate uh wage on and one of the

00:00:51.880 former advocates for what's called safe supply has become one of its most prominent critics right now

00:00:57.500 she was on the show in the past on a panel we did exploring a lot of these issues and i wanted to

00:01:02.360 bring her back on now as she had a fantastic piece in the national post this week looking at london as

00:01:08.380 a case study here dr sharon koivu is an addiction medicine physician and joins me now dr koivu good

00:01:15.460 to talk to you again thanks for coming on today thank you very much for having me so just to start

00:01:21.720 with london here for a moment because this is my own community it's my own city and i i've spoken to

00:01:26.640 so many people who have uh just refused to go down they've refused to go to parts of it they've

00:01:32.200 talked about feeling unsafe so so we have this issue here in the city and i know that for for you

00:01:39.100 you've seen this very closely over the course of your career but but why has london become so unique in

00:01:45.540 some ways i think that's a very good question and it's a somewhat complicated answer but i'm going

00:01:52.980 to try to give a quick answer london was a place that had a significant problem with opioid use

00:02:00.260 during what i would refer to as the purdue um the purdue driven opioid crisis when we had a lot of use

00:02:08.240 with oxycontin um we had a lot of prescribing of opioids that switched to a drug called hydromorph

00:02:15.760 cotton when oxycontin was taken off the market when that happened we had a problem with people

00:02:21.760 injecting hydromorph cotton which led to um problems with a heart valve infection and hib becoming a

00:02:30.160 problem in london and we tried to fix that problem by putting more drugs at it by by giving out dilaudid

00:02:37.840 which is the same drug as hydromorph cotton and to people who were high risk who were sex workers

00:02:44.080 particularly um we fixed the or we we really helped the problem we were aiming for which was to reduce

00:02:53.520 the heart valve infection and hiv but we've kind of been playing whack-a-mole and we've been trying to

00:02:58.720 fix things with more opioids and with doing this we've created more problems um so we now have a

00:03:07.440 program in london that gives out large quantities of opioids that aren't witnessed um refer to it as

00:03:13.920 safe and i think it's really important to remember prescription opioids got us into the problem we're in

00:03:20.720 opioids aren't safe they are toxic um illicit fentanyl is toxic hydromorphone

00:03:28.080 is toxic and now we've we've increased the availability of opioids on the streets of london

00:03:35.840 and we did it in a way that most people weren't even aware um i was very involved in the the town

00:03:41.440 hall meetings on the supervised consumption sites um so people knew that we were going to be having

00:03:48.640 supervised consumption sites people weren't aware of um the sort of giving the safe supply program where

00:03:58.480 we were giving out large amounts of opioids to people and and really weren't able to understand

00:04:04.640 some of the side effects that they were seeing from that i think some of them they blamed the

00:04:09.360 supervised injection site on um but but by doing that we've really increased we've increased the amount

00:04:16.800 of opioids on the street we've decreased the price of opioids on the street and um we've essentially

00:04:24.720 flooded london with opioids which has also led to an increase as people become addicted to to one thing

00:04:32.560 they seek something stronger it's kind of driven um people to sell their drugs in exchange for fentanyl

00:04:40.880 it's helped drive the fentanyl crisis so we particularly have driven that in london and we can see that

00:04:50.160 london is different so we have a program that's different and london's was similar to ontario for

00:04:59.360 our overdose deaths our emerge visits for example and since the program has started we've actually gone

00:05:06.320 up and up and up we are much higher um in our overdose deaths than the general population of ontario

00:05:13.360 and is significantly higher in our emergency department visits and certainly in what i see in

00:05:18.560 the hospital with infections related to injection drug use particularly dilaudid use so we've we've created

00:05:25.600 a problem that is worse in london because of the what we were trying to fix in the first place

00:05:32.080 so you you raise an important point there dr koivu in that there's a knee-jerk reaction and

00:05:38.160 i think a moral argument that often gets made about drugs but if we want to restrict this just to the

00:05:42.480 science and to the data we now have eight years of data on this and we've seen as you know more

00:05:47.680 infections more patient deaths we certainly see diversion and i think there some people try to

00:05:52.640 downplay that but we know it exists so how do the advocates of safe supply account for that because

00:05:59.040 they convince they they are convinced or at least they claim to be convinced that the data are on

00:06:03.680 their side i i think that um i don't have complete control of how they use their data um you hear the

00:06:12.640 arguments oh i hear the arguments and i i guess what i'd say is something working doesn't mean that

00:06:19.040 it's side effects aren't bad and one of the things i'd like to compare this to is actually if you

00:06:24.080 if you're just looking at if something works so if you're looking at nausea of pregnancy for example

00:06:30.080 and being nauseated in pregnancy can be quite serious it can cause problems to the mother

00:06:34.640 problems to the fetus so a good treatment is important one of if you're just looking at benefits

00:06:41.600 thalidomide is probably one of the best drugs to take to help get rid of nausea of of pregnancy

00:06:49.200 but it has significant side effects to the fetus if it's taken in the first trimester and can cause a

00:06:55.120 decrease in the limbs so seeing a benefit doesn't mean that the side effects don't outweigh the benefits

00:07:03.600 so when people are saying they see a benefit they may be but i also would say we don't know for sure

00:07:11.920 what the benefits are from so when we started this program we've also got people into primary care

00:07:20.480 we know primary care is important wound care hiv care wraparound services housing first programs

00:07:28.720 just engaging in a program increases um people's ability to stabilize and we didn't really look at

00:07:39.280 what part of the program was actually effective we so i'm sure that people are seeing for some

00:07:47.680 individuals in the program they feel that they're benefiting but some of that benefit would have been

00:07:54.560 from the other parts of the program and they didn't compare it to other programs that are so much safer

00:08:01.040 like opioid agonist therapy programs and getting people into a um on something like people

00:08:09.280 are getting very frightened we'll work to get her back on the line in just a moment here it's quite

00:08:20.640 fascinating to me and you know again i understand the emotionally charged arguments on this i do i

00:08:25.920 understand why people are getting very frightened because again there's an inherent absurdity to let's

00:08:32.240 give people suffering with drug addiction drugs and you know think that that's going to work and

00:08:37.760 but but but even if you overcome that and you don't care about that argument and you move beyond

00:08:42.560 that it's not doing what it's supposed to do it's not actually turning this thing which is inherently

00:08:48.880 unsafe into something that is safe and this was an issue that was raised back when needle dispensaries

00:08:54.800 and crack pipe dispensaries were becoming a thing and i remember this uh in london probably what eight

00:09:00.160 years ago or so and it's happened elsewhere and you'd look at this and say you know drugs are not

00:09:05.360 unsafe just because of the delivery mechanism they're not just unsafe because people might

00:09:10.240 reuse a needle they are unsafe because drugs are unsafe and drugs uh certainly of these uh these

00:09:16.800 varieties are incredibly incredibly dangerous to people so i i'm i'm looking at this and i'm seeing

00:09:24.640 this big divide between the so-called expert class and where a lot of ordinary canadians are and i was

00:09:30.240 actually at a a social event uh believe it or not i get invited to those like once every three or four

00:09:34.800 years i was at a a social event not that long ago and i was talking to someone very very anti-conservative

00:09:40.880 did not like polyev didn't like danielle smith didn't like the right uh probably doesn't like me

00:09:46.000 but anyway and and this person had said well you know the one thing i'll say about danielle smith

00:09:52.160 i love what she's doing on drugs i love that she's you know going to force people into treatment 1.00

00:09:57.760 because this was an issue that transcended the left right divide it transcended that

00:10:02.560 and this was someone who actually found that this was a a policy because again they're looking in

00:10:07.680 their community and they're seeing they're seeing what so many others in this country are seeing

00:10:13.840 and they're wondering why no one's doing anything about it so when you hear and i would encourage you

00:10:19.520 to go back and look at my panel discussion that i had on this show with uh sharon koivu and uh julian

00:10:26.480 summers dr julian summers who's a psychologist and adam zeebo the uh journalist with the national

00:10:31.920 post and we talked about this we talked about it from a number of different angles and what's notable

00:10:36.320 about doctors koivu and summers is that they were advocates for this they were not just ideologues they

00:10:42.560 were advocates for this who saw the data who saw the research and then from there realized that okay this

00:10:50.400 isn't actually working this is not doing what we thought it was going to do at best and at worst

00:10:55.920 it's making things far worse so uh we are uh we have to move on in a couple of moments but we do

00:11:01.680 have dr koivu back on now so i i want to just at least get uh one or two more questions here before

00:11:06.960 we we talk about lng which is a far less controversial issue uh dr koivu thank you for for reconnecting here

00:11:13.200 let me just ask you as we kind of look at the way forward on this there are people that

00:11:18.400 like i said are against harm reduction in general the people that would not like supervised injection

00:11:23.600 sites that wouldn't like needle dispensaries and all of that where do you think is the optimal point

00:11:29.360 at you know the harm reduction that works versus the harm reduction that doesn't

00:11:34.800 i think speaking specifically about harm reduction harm reduction um by definition can't harm others if it's

00:11:42.320 reducing harm it's really important that it doesn't harm the community and certainly not other people

00:11:47.840 so i think we really have to be aware of harm reduction but i also think when i started in

00:11:52.640 addiction work we talked about the four pillars prevention treatment harm reduction and enforcement

00:11:59.040 and like anything where you have a structure if you only have one pillar things fall down and putting

00:12:04.800 all of your emphasis on harm reduction at the expense of prevention um and treatment and even enforcement

00:12:13.680 we we lose the ability to really get a complete um comprehensive approach for people we need

00:12:21.040 prevention but we also know prevention includes about accessibility when things are very accessible

00:12:29.920 cheap um easy to access you have an increase of people using them we need to decrease access to opioids we

00:12:38.560 knew that during the opioid crisis we also need to look at social determinants of health

00:12:44.160 and trauma and really be working to have mental health care um and services to help prevent people from

00:12:51.360 getting into a problem with addiction we need to have treatment and that treatment needs to include

00:12:56.960 things that are proven such as opiate agonist treatment as well as other options for people

00:13:03.680 in harm reduction i think we have to go back and look at supervised injection sites i do think they have

00:13:08.880 merit but they're they were meant to help engage people get them into care connect them with resources

00:13:17.760 and help people do motivational interrupt interviewing to get into a recovery program but extremely important

00:13:25.680 that a supervised injection site engages with the community that they're in and works to ensure

00:13:32.000 that they're a safe place to be for that community and do not add harm to the community i think that's

00:13:39.360 extremely important and enforcement sometimes i i do not feel people should be criminalized for their addiction

00:13:47.760 which is a mental health issue but i think the importance of enforcement in um helping to work with

00:13:54.640 communities even helping to engage people into recovery um is something that we are now really

00:14:01.760 overlooking so we need to be balancing all of those pillars and make sure we provide appropriate

00:14:08.880 medical treatment for medical illness engage the community and make sure that while we're doing

00:14:15.040 this we aren't making things worse for individuals and for society dr sharon koivu's op-ed in the national

00:14:23.040 post uh quote-unquote safe supply has only worsened the addiction crisis in london and i i note uh that

00:14:30.240 safe supply is always in quotation marks throughout your piece which i think is a a very important bit

00:14:34.720 of punctuation there for for the discussion at hand uh dr koivu thank you very much for your time

00:14:40.080 thank you thanks for listening to the andrew lawton show support the program by donating to true north

00:14:45.600 at www.tnc.news

Juno News - June 16, 2024

Addiction specialist blames “safe supply” for spike in fentanyl use

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