Canada’s harmful “safe supply” agenda (feat. Adam Zivo)
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Summary
In this episode, I speak with National Post columnist Adam Zeevo, who has written several pieces about Safe Supplies and its harms. In addition to his journalism on safe supply, Adam is also known for his coverage of the War in Ukraine and his reporting on LGBTQ issues.
Transcript
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Canada is currently facing an opioid crisis, one that has killed over 30,000 people since 2016
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and is continuing to kill people today. The epicenter of this crisis is British Columbia,
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which saw over 1,000 drug-related deaths in the first five months of this year alone.
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Illegal drugs are killing so many people in BC that drug toxicity is now the leading cause of
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death between people aged 10 and 59. More than homicides, suicides, car accidents and natural
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diseases combined, the BC NDP and federal liberals have responded to this crisis with a harm reduction
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and safe supply agenda. The latter consists of the decriminalization of hard drugs in the province,
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giving addicts a safer supply of drugs, and having injection sites where people can safely
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consume drugs. While this so-called harm reduction agenda is supported by politicians and activists,
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the opinions of several experts, as well as the lived experience of people who dealt with safe
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supply are painting a different picture, one that shows that Canada's safe supply agenda has been a
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disaster. One of the people bringing light to this issue is National Post columnist Adam Zeevo,
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who has written several pieces about safe supplies and its harms. He joins me today to discuss this
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issue. In addition to his journalism on safe supply, Zeevo is known for his coverage of the war in
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Ukraine. He even spent some time in Ukraine during the war, as well as his coverage of various LGBTQ
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issues. Adam, thank you so much for joining me. Thank you for having me. So we often hear in the media
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the terms harm reduction and safe supply, but I'm not sure if Canadians or a good part of Canadians
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actually know what these terms entail. So how about we start with maybe you explaining what do we mean by
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harm reduction and safe supply in a Canadian context?
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So harm reduction refers to a broad umbrella of interventions, which are meant to reduce the harms that
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drug users experience while they're using. So some examples of harm reduction include needle exchanges,
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safer injection sites, and safer supply. So harm reduction is considered to be one of the main key
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pillars of addressing any drug crisis. Now, within this umbrella, you have, you know, safer supply,
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and safer supply is this idea that we can reduce overdoses and deaths by providing drug users with
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pharmaceutical alternatives to potentially tainted illicit substances. So in Canada, that means giving
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people hydromorphone, which is a drug that is as potent as heroin, to try to dissuade people from
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using illegal opioids, predominantly fentanyl. I do want to flag that there are multiple models
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of safer supply that exists in the world. The one that exists in Canada is unique and is uniquely
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Well, if you look at safer supply in Switzerland, which has done fairly well, there's a high barrier
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to access, meaning that it's not as if anyone can come off the street and get on the program.
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And on top of that, consumption of the drug is typically supervised. In contrast, in Canada,
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there are, we really emphasize low barriers to access. So anyone can walk in and say,
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I want to be on safer supply. And as long as they find some trace of an opioid in your blood,
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you know, they will give you it. As long as you say that you are worried about overdosing on fentanyl,
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there's no verification of the truth of what you say, aside from that simple blood test.
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And more importantly, consumption is not supervised. So we hand out large amounts of hydromorphone,
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which I do want to stress again, is as powerful as heroin. And we don't really confirm whether
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people consume their doses so they can take it home. Now, why this is a problem? Well,
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hydromorphone, as powerful as it is, is only one-tenth as strong as fentanyl. You know,
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it's strange compared to fentanyl as like holding a candle against the sun.
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And people who are on fentanyl do not get high on hydromorphone. So they don't actually like the
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drug. It doesn't give them what they're looking for. So they sell the hydromorphone on the streets
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to purchase harder drugs, predominantly illicit fentanyl.
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Right. And when they sell hydromorphone on the street, it ends up in the community and
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it goes into schools, for example. What impacts has this drug that is marketed as a safer supply
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drug had on the broader community and particularly teenagers?
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Well, so as you mentioned, it does flood into communities. And when you have a flood of
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supply, that causes prices to go down. I've spoken with addiction physicians in about five or six
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different cities, and they've independently told me, you know, no correspondence between them,
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that in their communities, since safer supply was launched, that the price of hydromorphone,
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from the street price has gone down by between 70 and 95%. And crucially, these price drops seem
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to be correlated to proximity to safer supply dispensaries. So for example, in downtown Vancouver
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in the downtown east side, where there is a whole bunch of these, you know, pharmacies that dispense
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safer supply, you can buy a 8 milligram tablet of hydromorphone for between one to $2. Whereas if you go
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slightly outside of Vancouver and you go into the suburbs, tablets begin to cost around $5 to $10.
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Now, what happens is that people often buy these drugs in these hotspots and then sell them in
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markets where they're more valuable. And they tend to sell these drugs to opioid naive users for whom
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the drug produces a high, right? You're not going to sell hydromorphone to fentanyl users because they
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don't want it. And if you're selling to opioid naive users, that means you disproportionately sell
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to younger people and to people who are in recovery. Now, younger people are attracted to
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the drug for a variety of reasons. First of all, it's cheap, right? And for someone who is young,
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that matters a lot, especially if you're from a lower socioeconomic bracket. And secondly,
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they don't understand the risks of hydromorphone. It's not stigmatized in the same way that heroin is.
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And additionally, it is marketed as safe and is technically prescribed from a doctor. It comes
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from a pharmacy. So they're much more willing to experiment with it versus other drugs, even
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though hydromorphone is extremely dangerous for them. So essentially what you're saying is that
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the safer supply agenda has kind of created a new drug deal and a new kind of generation of drug addicts.
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It has. The problem though is that the government seems woefully uninterested in measuring this impact
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and they seem to be doing their best to try to minimize this effect. So there's not a lot of data
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that has been collected on this. And what happens is that, for example, the BC government has often
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misrepresented data to say that this problem doesn't exist. Now, one thing I want to note is
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that kids who go on hydromorphone to become addicted, they often then graduate to using fentanyl
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because you develop a tolerance over time. So you need harder substances in larger amounts to get the
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same high. And it's not the hydromorphone that tends to kill people. It's the fentanyl that they use
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after developing the hydromorphone addiction. I'm currently writing the story that, you know,
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spotlights one such youth in the Vancouver area who had that exact problem. Now, the BC government,
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in response to my reporting, has really emphasized the fact that they have not seen a rise in a
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hydromorphone-related deaths in the province. And they say that, okay, based on that, we can see that
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there is no problem with safer supply. But that's misleading because, of course, you're not going to see
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that rise in deaths if the hypothesis is that fentanyl kills. Now, I'll just finish my monologue
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with one last thing. Sorry for talking so much. No, go ahead. So the BC government released a
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report last month that included for the first time data on youth drug deaths. And what they tried to
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bury in the report, but what myself and other physicians, what myself and physicians were able
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to discover is that, okay, the data was from 2017 to 2022. From 2017 to 2019, 0% of youth drug deaths
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had any hydromorphone involved. Then safer supply has expanded in 2020, and that number increases to
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5%. Then 2021, I believe it's 8% or 9%. And then last year in 2022, hydromorphone was found in 22%
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of youth drug deaths. So that's a sudden and significant spike, which seems to indicate that
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there's a problem. Drug injection sites have been a kind of a staple of the harm reduction model. And
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the first one in North America opened in Vancouver. Since the election of Justin Trudeau, there have been
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many more to have opened across the country, including where I live in Ottawa, where you live in Toronto.
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What are your thoughts on these sites? Because the people who support them say they offer a safe and
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clean place for users to inject themselves. There are critics that say that they enable drug use.
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Should these drug injection sites continue to operate or should they be shut down?
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Well, I really want to emphasize that safer injection sites are a totally different intervention
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from safe supply. So while I can speak quite knowledgeably about safe supply, I know much
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less about safer injection sites, and there are much less or much less confidence about, you know,
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my opinions there. What I will say is that there is this belief that safer injection sites do reduce harm,
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but the evidence in support of that seems to be a little bit questionable. And then here's where I'm
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going into some background information that I haven't publicly reported yet.
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So Insight, that's the name of the first safe for injection site, which was launched in Vancouver
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in the early 2000s. Two doctors, Dr. Julio Montaner and Dr. Thomas Kerr, advocated for the creation of
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that project. And then it was approved. And then the federal government, federal liberals at the time,
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gave a $1.5 million, I believe, dollar evaluation contract to the BC Center for HIV Excellence.
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And, you know, at that center, that happens to be where Dr. Kerr and, you know, Dr. Montaner worked.
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So these two doctors were essentially tasked with evaluating their own project, which was a giant
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conflict of interest that everyone just ignored.
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So in subsequent few years, they produced over 30 evaluations of Insight, all of which were co-authored
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by Dr. Kerr, and all of which, you know, gave glowing reviews to the project and said that it
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was wonderful and, you know, it was reducing crime and so on and so forth. Well, there was something
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suspicious there. So the RCMP ended up commissioning an independent researcher to evaluate these
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evaluations. The guy's name was Colin Mangum. And he did this, I think, in around 2007.
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And what he found was that these evaluations routinely misrepresented the impact of Insight,
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overstating positive outcomes and minimizing harms. And I'm going to give you two specific examples of
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that. So the evaluations claimed that Insight reduced crime. However, when Mangum spoke with
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police stakeholders, he found that the opposite was true, that crime seemed to significantly increase,
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resulting in a need for a significant increase in policing in the area. So I believe three police
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officers approximately were posted 24-7 around Insight, and dozens more were brought into the area,
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and that reduced crime. But the evaluations claimed that Insight itself reduced crime and, you know,
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ignored any notes of increased policing. Similarly, Insight claimed to create thousands of referrals
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to treatment services. When Mangum investigated that, he found out that their definition of referral
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was just handing someone a leaflet. And when he contacted nearby treatment facilities, he found that
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none of them said that they had received any referral from Insight. So, you know, we're looking at gross
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misrepresentation of data, or at least these allegations. Now, this is what Colin Mangum says.
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So it's an allegation that hasn't been fully proved yet. I don't want to be sued by these guys by
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claiming that it's an objective fact. But, you know, it's a pretty serious allegation. So when people
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say that, you know, safer injection sites work, and that we just keep on investing in them, we have to be
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mindful of the fact that the evidence base for these interventions is quite questionable.
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Right, for sure. Another thing that liberal drug policy supporters claim works is decriminalization,
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and they'll point to Portugal that decriminalized drugs, and they went from having high overdose rates,
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high use of heroin, to having some of the lowest in the European Union. When BC decriminalized drugs,
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that didn't stop it from having the highest cause of death be illegal drug use. So what are the
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Portuguese doing differently from Canada and British Columbia, in particular?
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Sure, I think we might bleep it out, but go ahead.
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Okay. So you know what, the Portuguese model has historically done quite well. And what Canada's done
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is implemented the shitiest possible version of that model. So what Portugal did is that it
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decriminalized possession and purchase of small personal amounts of drugs. Everything else
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remained criminalized. So if you sell the drug, it's still criminalized. If you have larger amounts of
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drugs, it's still criminalized. It's just that, you know, if you get caught with a small amount of
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cocaine or a small amount of pot, you're not going to be sent to the criminal justice system.
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Now, what happens instead is that they have something known as dissuasion commissions.
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And dissuasion commissions are composed of a lawyer, a social worker, and a psychiatrist.
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And together, they evaluate someone who has been caught with drugs and figure out what to do.
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And they have punitive powers, such as being able to temporarily block access to welfare,
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or levy fines, or ban someone from going to certain people or places.
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And they use these powers to heavily pressure, but not necessarily force someone to go into
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treatments. And treatment facilities are, you know, widely available and very well funded in
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Portugal. So what happens essentially is that, you know, you have what you would normally have in
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society. There's accountability for drug use of all types. It's just that at the lowest level,
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they have an alternative system that keeps people out of the criminal justice system,
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doesn't burden them with criminal records that ruin their lives, and tries to divert people to
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the healthcare, to the healthcare system, rather than throwing them in jail. And that all makes
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sense. Now, what BC has done is they basically said, okay, let's just decriminalize small amounts
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of drugs, but put in almost no effort into diverting people into healthcare and treatments.
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So, you know, Portugal has these dissuasion commissions, where there's actually, you know,
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punitive powers that force people into treatment. Whereas in BC, if you're caught with a small
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number of drugs, small amount of drugs, you are just given a pamphlet that, you know, tells you about
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treatment options, as if you, as a drug user, were not already aware of this. So it's a joke,
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right? Like, it's completely, there is no real attempt to push people towards treatment. We're
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just letting people do what they want with impunity. And we're seeing the negative impacts of that
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already. So do you think that, I mean, some of the activists in BC call for destigmatization? And,
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you know, there's other aspects of society that we've moved to maybe destigmatize, and the one I'm
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thinking the most of is mental health. We've talked about a good way to have people come out and
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explain their mental health issues is to have it destigmatized. But they also want to destigmatize
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drug use. Do you think that it's important for drugs to kind of stay stigmatized? How do we find
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a balance where people are not ashamed to be open about their addictions while also maintaining a
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notion in society that, no, you should not be using these drugs?
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Well, I want to flag that this is an element of the conversation that I haven't done a substantial
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amount of research in. So what I'm about to say is based on my personal impressions and it's not
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scientifically backed. So, you know, take it with a grain of salt. But I think that, you know,
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obviously some level of destigmatization is important for helping people be more open about
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their drug use and pushing them towards treatment, right? When someone hides their drug use,
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it's painful for them and it pushes them into risky behavior versus when they're able to open up to
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people around them about the fact that they're doing drugs. It helps them, you know, seek out
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help and support from their close social contacts. So that's important. There's a certain level of
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destigmatization which is needed. However, we can't destigmatize too much because, you know,
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when you have higher barriers to using drugs, people use drugs less. If something costs more,
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you know, you're going to use it less. And stigma is a social, it's a sort of psychological and social
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cost, right? Like if you're afraid of the stigma of using a drug, you're not going to use it as
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easily. And, you know, to illustrate that, let's go back to the comparison between hydromorphone and
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heroin. Heroin is highly stigmatized amongst youth. Hydromorphone is not. Youth are more likely to
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use hydromorphone because that stigma is not there. So similarly, you know, we don't want people to
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think that using hard drugs is fine. It's obviously not. It's going to destroy your life. So we need
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to find that middle ground where we say, if you're using drugs, you know what, you're not a terrible
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person. We're here to help you, you know, talk about your problems, but also drugs are bad and please
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don't do them. Right, for sure. I think there's often a need for balance in most days. And unfortunately,
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because things kind of become politicized, there becomes too extremes and no room for nuance.
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I mean, you've criticized a lot, safe supply. What would you see as a maybe an alternative? Because
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I mean, there's, if you look at Vancouver East Side, even Toronto, Ottawa, there are so many drug
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addicts on the streets that are, you know, it's almost like they're lost souls. These poor people
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are completely high and not even, you know, maybe conscious that they're living. How do we save these
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people? How do we get them off the streets, off these drugs and back in society where they belong?
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Well, I want to, first of all, clarify something. So at the very beginning of our conversation,
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I had mentioned that there are different models of safer supply. And I'm very much against the model
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that is in Canada right now, because I think that it's grossly irresponsible. However, the addiction
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physicians who I've spoken with have identified a model where safer supply could be responsible. And
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that's something that I broadly agree with. So a model of safer supply that I think could work
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is one where paradoxically stronger drugs are provided. So hydroborofone doesn't, you know,
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help fentanyl users. So let's provide people with safe fentanyl. But let's ensure that consumption
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is supervised. So we're not just going to give you fentanyl and like, you know, send you on your way.
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You have to, we'll give you safe fentanyl. You have to consume it while supervised and you stay
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under supervision. Right. And that prevents you from dying. Um, and rather than using as an
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indefinite intervention where we just give you drugs until whenever, uh, we instead think of it
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as a temporary solution with a very specific deadline that is used to help transition people
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into more traditional forms of care. So let's say you're about to start using suboxone or sublocate
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and you need some time to transition. I think it would make sense, you know, to provide that
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patient with a temporary supervised version of safer supply. Uh, that model is being somewhat
00:21:27.320
implemented in Alberta. So Alberta is planning to roll out something known as, uh, I forget the exact
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term, heroin assistant treatment, something like that. It's like essentially providing drug users with
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stronger opioids as a temporary measure to transition them to care. So, you know, we're seeing that in
00:21:47.660
Alberta, but once again, like that model of safer supply is so different from what we're doing in BC right
00:21:54.980
now that it's kind of like the same thing in name only. Um, do you think eventually the people in BC are
00:22:04.560
going to realize that maybe they're not doing it right? Or do you think they'll just kind of double
00:22:11.600
down the same way public health leaders have, you know, double down on, on the lockdowns during the
00:22:16.540
pandemics and the masks, even when they have signs to otherwise, or double down on the pediatric, uh,
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trans healthcare, despite all these de-transitioners coming out? Do you think we're seeing a trend here
00:22:26.920
where they're going to keep on doubling down until there's maybe a change in government?
00:22:30.160
Uh, I think so because the issue has become so political. I think that the federal government
00:22:37.240
will find it almost impossible to let go of this program and admit that something is wrong.
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Uh, and partially that's because the minister for mental health slash associate health minister,
00:22:48.480
Carolyn Bennett is a bit of an ideologue. You know, I've seen her speeches, I've engaged with her.
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Uh, she doesn't seem to be able to critically evaluate study design and she doesn't always seem
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like the most astute of thinkers to put it euphemistically. Um, so I don't think that,
00:23:06.720
you know, she'll be reevaluating her beliefs anytime soon. Uh, however, I think that there are some level
00:23:13.560
of changes, um, in BC. So after my report came out, BC seemed to shift course. So initially they denied
00:23:23.440
that anything was a problem. Now CTV and global are also reporting, you know, the same stuff that
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I'm reporting and we're seeing a shift. So the BC government recently announced they're going to
00:23:33.960
get more funding to opioid agonist treatments. So methadone and suboxone, uh, which is a recovery
00:23:39.840
oriented treatment, which is, you know, an alternative to safer supply and has decades of
00:23:44.220
research behind it. So we're seeing a shift towards recovery oriented care in BC. Um, and from my
00:23:50.820
understanding, you know, I'm aware that some people might be trying to put together lawsuits against
00:23:54.460
the federal governments, people who have been harmed by safer supply. And I think that if these
00:24:00.100
lawsuits do come to the public and, you know, they do percolates and multiply, then that might force
00:24:06.100
the federal government to abandon safer supply unwillingly because the legal and political
00:24:11.840
exposure would be too high. But once again, we need people to file these lawsuits first.
00:24:18.220
Right. For sure. And hopefully, uh, something can be done because I mean, we're, we're talking about
00:24:23.660
people's lives here and it's, it's so sad how people's lives are getting destroyed by, by these
00:24:30.620
drugs and these, you know, supplies, drugs and whatnot. Uh, Adam, thank you so much for, uh, coming
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to speak with me. I really appreciate your insights on this and the work you do to expose the problem
00:24:42.380
with what's going on right now. And, uh, I'm sure we'll talk again soon.
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I hope that you enjoyed this interview. If you did, please consider making a donation to True
00:24:54.420
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00:25:02.100
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