Juno News - ＂Safe supply＂ isn't safe

00:00:00.000 Welcome to Canada's Most Irreverent Talk Show. This is the Andrew Lawton Show, brought to you by True North.

00:00:10.700 Hello and welcome to another edition of the Andrew Lawton Show here on True North.

00:00:15.920 It is Friday, August 18th, and as you know by now on the Friday show, we like to rip up the usual format and do a deep dive into a big picture issue.

00:00:25.580 Now, this is a big picture issue, but it's also one that on the ground has very significant implications for community safety, for public health, and as a result, it's been very heavily politicized.

00:00:38.180 We've seen in the course of the drug crisis in Canada, massive increases in just one metric alone, the number of opioid deaths per year.

00:00:47.780 Now, I live in Ontario, and I can say that for years, we all used to look at the drug problem as being a British Columbia thing.

00:00:54.860 You'd look out and say, oh, well, yeah, all those things they're doing in Vancouver are not affecting our city.

00:00:59.880 And very quickly, my own city of London, Ontario, became one of the hotbeds of this drug and addiction crisis.

00:01:07.000 And now we're seeing there really isn't a community in Canada that is immune to this.

00:01:12.780 And there have been all sorts of proposals that have been pushed forward under the auspices of harm reduction,

00:01:18.280 the most contentious of which I'd say is so-called safe supply, which is predicated on this belief that the dangers in the drug supply are among the most pressing threats to drug users.

00:01:31.280 So if we can eliminate that variable, we can make drug use somewhat safer.

00:01:36.420 Now, is this working?

00:01:37.740 Well, there have been a lot of very conflicting perspectives on this and perspectives that have shifted.

00:01:42.540 Just this week, for example, there was – now, this is not a safe supply issue –

00:01:47.840 but there was a story about a clinic in Toronto, in Leslieville, that had to apologize after they were giving out free chocolate in exchange for needles,

00:01:56.780 which obviously the parents of children in that area weren't exactly too keen on.

00:02:01.280 So there are a lot of different threads to pull on this issue.

00:02:05.020 So we may go in some different directions here, but I have a tremendous panel of guests that have all done a great deal of work on this,

00:02:12.620 either in the clinical setting, the research setting, or in the media setting, and in some cases in all three forums.

00:02:20.020 So we'll bring into this show Adam Zivo, who is a columnist with the National Post and wrote a tremendous piece back in May

00:02:27.260 that really delved into this issue from a lot of different angles.

00:02:30.300 Dr. Julian Summers, who is a clinical psychologist and addiction specialist and a health sciences professor at Simon Fraser University.

00:02:39.320 And Dr. Sharon Koivu, who is an addiction medicine consultant, actually in my neck of the woods, in London, Ontario, with London Health Sciences Centre.

00:02:47.820 All three of you, it's wonderful to talk to you. Thank you for joining me today.

00:02:52.040 Let me start with you, Dr. Koivu, because I know you've actually evolved yourself on this issue quite a bit,

00:02:58.160 and you've not come at this because of any political reason.

00:03:01.200 You've just done what I think researchers are supposed to do, which is followed the science

00:03:05.280 and have found that safe supply isn't really what you once thought it was.

00:03:10.060 Yes. Thank you.

00:03:12.660 Certainly, my involvement in this is working with inpatients at a hospital in London and in St. Thomas.

00:03:20.840 And I guess originally, when I started working, the drug of choice in London was hydromorph content.

00:03:28.380 And through working with patients, I was able to identify that hydromorph content was leading to an outbreak or an epidemic in our area,

00:03:38.840 essentially, of heart valve infections, particularly the first valve in the heart called the tricuspid valve.

00:03:45.560 We also, because of this particular drug, hydromorph content, had an outbreak of HIV.

00:03:53.300 So when safe supply first started in our area, it was actually not in a response to fentanyl.

00:04:00.640 We did have some fentanyl problems.

00:04:03.480 When we had a fentanyl overdose in London, it was most likely related to using diverted patches or using the fentanyl patches.

00:04:11.480 But safe supply started to help street-level workers, street-level sex workers, get off of hydromorph content

00:04:21.540 and onto something that we believed would be safer, which was immediate release hydromorphone, referred to as dilaudid.

00:04:29.620 So it's the same drug.

00:04:31.300 This wasn't a treatment for fentanyl.

00:04:34.140 This was specifically to get people off of hydromorph content.

00:04:37.460 And I was one of the people that thought it sounded like a good idea.

00:04:41.820 It sounded like a good idea on paper because of the problems we were having in London at the time.

00:04:48.600 But once it was in place, I started seeing other problems.

00:04:53.500 So yes, HIV, we no longer have the outbreak of HIV.

00:04:58.600 We were able to get on top of that for many reasons with a community effort.

00:05:02.740 And our endocarditis rates have improved.

00:05:05.120 But what I started seeing clinically was an increase in other infections.

00:05:12.720 So since this started in London, we have had an increase in essentially all other infections that are related to injection drug use.

00:05:22.400 The ones that particularly alarmed me was I started seeing an increase in spine infections.

00:05:30.320 So an increase in what we call epidural abscesses, which for some people can cause horrific pain, horrific suffering, and often leads to paraplegia or quadriplegia.

00:05:43.700 And currently, I have a patient, I've been working with a patient who's quadriplegic and a patient who's paraplegic and one that we're hoping will be able to walk, but related to injecting.

00:05:54.220 And just like when I was seeing people with the heart valve infections, I spent a lot of time asking patients what they were taking.

00:06:04.180 And really, the common thread for almost all patients that I was seeing with this increase in infection was using Dilaudid, often either from the Safe Supply Program or diverted from it.

00:06:19.780 And I think it's, you know, now people often will say, well, it's from the fentanyl.

00:06:24.200 At the time when I started seeing these infections, we still did not have a problem with fentanyl in London.

00:06:30.860 We do now, and we can talk about how I think it's related to the increase in opioids in London.

00:06:36.440 But at the time, it wasn't.

00:06:38.680 The two main drugs were crystal methamphetamine and Dilaudid.

00:06:42.780 And really, the common thread I found was the Dilaudid.

00:06:48.540 And it led to other problems, too, that we can, you know, with diversion, making it cheaper, making it more accessible.

00:06:56.800 But I think we can, those were the first things that really got me to start being aware and critical.

00:07:03.640 And I took that information back to the community and was kind of surprised that it wasn't kind of welcomed as a place we needed to start doing research.

00:07:15.440 Well, and this was obviously a story that is somewhat familiar to you, Dr. Summers.

00:07:20.380 I know you did something very similar.

00:07:22.520 You followed the science.

00:07:23.700 You looked at the effects of this.

00:07:25.540 And you had quite a bit of pushback for conclusions you drew as well that were very similar and that Safe Supply was not, in fact, safer.

00:07:34.140 Yeah, thanks, Andrew.

00:07:35.440 That's true.

00:08:05.440 Sex workers at very high risk in a variety of ways and then seeing the unintended consequences of the implementation of that service in other patient groups or other segments of society.

00:08:18.300 And these risks are not only the acute risks that Dr. Koivu and other clinicians see in their practices, but also longer-term risks that they might also see, but that become more apparent when we group people together and look at the entire population.

00:08:34.300 So it's well known that long-term administration, self-administration of opioids results in chronic risks as well as acute level risks.

00:08:44.840 And so there are a variety of ways in which this approach poses risks.

00:08:51.300 It also, I think more fundamentally, mischaracterizes how we would best address harms associated with substance use, including addiction in the population.

00:09:03.380 It has nothing to do with a focus on supply.

00:09:06.140 That's the approach of the war on drugs, is to focus on supply.

00:09:10.200 And we've learned in these last 60 years that that doesn't result in much measurable improvement in our local populations.

00:09:17.360 It's important, but it doesn't result in much measurable improvement, where all of the research has backed opportunities for progress is on demand reduction.

00:09:26.620 Focus on the conditions that put people at high risk where resorting to addictions, addictions that put them and others at great risk, is a preferred approach to coping.

00:09:37.360 There are ways of helping people, but it involves focusing on those very demand drivers.

00:09:43.240 And we've been lied to, I think, by leaders, some deliberately, some innocently.

00:09:49.960 And we've opened floodgates for profit interests to enter into the field.

00:09:55.160 And that takes it well away from a focus on particular patient groups, high-risk sex workers and others, and seeks where's the biggest bottom line return.

00:10:04.580 And we see companies now formally seeking investors in order to back an expected expansion of so-called safer supply in Canada initially and then internationally.

00:10:17.600 I'm simply summarizing from their promotional materials to investors.

00:10:21.120 And Adam knows more about this than me.

00:10:23.060 Some of what I've learned has been through his reporting.

00:10:25.820 But the backlash was severe, unlike anything I've encountered previously in my career.

00:10:32.000 Adam's also covered that.

00:10:33.140 Thanks, Adam.

00:10:34.580 That, you know, bringing to light that the backlash is really a big part of the story here.

00:10:41.080 Under what circumstances do scientists who have no evidence to support what they're advocating for jump aggressively on someone who's raising, in our case, myself and my co-authors, reasonable grounds for concern?

00:10:56.760 How much is this program going to cost per year?

00:10:58.980 And importantly, there are several concerns, but what's the exit strategy?

00:11:03.640 If we succeed in engaging disaffected, disenfranchised people, remember, safe supply is not a treatment program.

00:11:10.720 It's framed as a way of engaging people who are alienated from care.

00:11:14.200 Great.

00:11:14.460 Once we engage them in care, what are our next steps?

00:11:17.800 And there are none.

00:11:18.840 And there's a flat refusal to talk about it.

00:11:21.140 And it sounds perhaps cynical to say this, but I believe there's a deliberate refusal because the entire profit motive hinges on perpetuating people's suffering so they remain good customers.

00:11:31.940 You've touched on, I think, an important aspect of this, which is the motivation.

00:11:37.400 And I wanted to bring you in on this, Adam, because I do feel there's been a fair bit of mission creep on harm reduction itself.

00:11:45.060 I remember originally when we were talking about insight in BC many years ago, and there were obviously some concerns about that.

00:11:52.860 A lot of the argument for just supervised injection sites, not providing supply, which at the time I think would have been seen as insane.

00:12:00.940 But the arguments in favor of it were that, OK, we bring people into a space where we can then give them the resources to get clean and get off drugs.

00:12:09.620 There was always that, whether it was honest or not, there always seemed to be this idea that if we bring people into the system, so to speak, we can work with them and help them get off drugs.

00:12:18.940 With safe supply, I don't hear those arguments anymore.

00:12:21.940 And maybe I've missed something, but it actually, to me, strikes me as though they're giving up on that idea of trying to fight addiction.

00:12:30.120 And I don't know if that's an accurate read on my part, Adam.

00:12:32.700 Like, what is the stated purpose of this program?

00:12:35.940 Well, I mean, we have to keep in mind that there are different stakeholders who have different motivations.

00:12:40.980 So there's one part of this camp which is ideologically motivated by this idea that drug use is a right, that you can use drugs safely, that harms associated with drug use come from the criminalization of these drugs, not from the drugs themselves.

00:12:56.340 And for these people, they don't think it's a problem if someone is chronically using opioids.

00:13:00.400 They think that's perfectly fine.

00:13:01.820 And so for them, you know, they're not profit-motivated.

00:13:06.540 They're just very ideological.

00:13:08.560 And they espouse this kind of strange strain of libertarianism that prioritizes the individual liberty of the drug user above all else, including community good, right?

00:13:20.060 And so we see that now where we aren't allowed to criticize people for being addicted to, you know, various drugs and harming others because that's imposing on their right to use drugs euphorically.

00:13:34.100 Now, there's another group of stakeholders who seem to be more profit-oriented.

00:13:37.860 And as Julian mentioned, there are definitely companies that are looking to make quite a bit of money off of this.

00:13:45.080 So one thing that I became aware of earlier in the year was the existence of a new company known as the Safer Supply Streaming Corporation, which is currently seeking investors so that it can capture the entire value chain of Safer Supply.

00:14:00.100 Basically, the people who are leading this program are people who have had a history of monetizing on psychedelics and cannabis.

00:14:09.840 So they're looking at this in a sort of recreational lens, not like an addiction treatment lens.

00:14:16.520 And I think that's really concerning.

00:14:17.460 I think it's concerning that for-profit actors are coming into this space with no real background in addiction medicine and seem to be conceptualizing opioids and cocaine as like one big party.

00:14:31.720 Now, you have these two poles, and you also have people who are a little bit in the middle. 0.76

00:14:36.420 And one example here would be, let's say, Perry Kendall, who was the former public health officer in BC.

00:14:41.840 So in his capacity as a public health officer, he declared the opioid epidemic to be a public health crisis, which then allowed for changes in the policy environment in BC to allow for the approval of therapeutic use of heroin and the importation of heroin without getting, you know, seeking approval from the federal government.

00:15:02.300 After he advocated for all of these changes, he then went on to create a for-profit company known as Fair Price Pharma, which, you know, coincidentally specialized in importing and producing heroin.

00:15:16.440 And then he received a contract with the federal government to do just that, which is very questionable.

00:15:21.600 I mean, there seems to be a very strong conflict of interest here.

00:15:23.740 Now, from my conversations with other people who are involved in this space, it seems like he is genuinely concerned about the well-being of people who are in addiction.

00:15:34.100 But at the same time, one has to wonder how pure can his motives be if he's starting a full-profit company?

00:15:40.360 As another example, you have Dr. Evan Wood, who founded the BCCSU, the British Columbia Central on Substance Use, which is very influential in the addiction policy space.

00:15:49.120 And when he was running that organization, they accepted dollars, they accepted funding from cannabis companies, and then produced low-quality research, which suggested that cannabis would be an adequate response.

00:16:01.660 Cannabis consumption would be an adequate response to opioid addiction, research that completely contradicted higher-quality studies being produced elsewhere in Canada.

00:16:10.180 And then afterwards, he left the BCCSU and then accepted a high-paid position at a cannabis company, which I think should raise a lot of eyebrows here.

00:16:20.580 So you see this habit of harm-reduction leaders having very few scruples about accepting for-profit positions where they monetize off the consumption of drugs.

00:16:32.660 And I think that any Canadian should be concerned about that.

00:16:35.100 Well, I know money is a very powerful force, and even in academia, money is tied to research grants, and sometimes there's no money in researching one thing, but there is in researching something else.

00:16:46.920 But just to go back to the story you told about your own shift on this, Dr. Koivu, you were not one of these evil, maniacal profit-seekers when you thought this was in the best interest of patients.

00:16:57.480 And looking around at your colleagues in medicine now that still very much believe in safe supply, which of those camps, to use the categories that Adam set out, do you think most of them fall in?

00:17:09.120 Are they ideologues?

00:17:10.340 Are they profit-seekers?

00:17:12.440 Or are they people that, you know, maybe they're not ideologues, but they genuinely believe that's where the science is leading?

00:17:17.300 I think that it's a tough question, Andrew, because just to really know someone's motive can be a bit tricky.

00:17:26.220 I think that what I'm seeing, my perspective would be that a lot of the people in this area, for example, are ideologues, and that they really, it's become something they believe in.

00:17:39.700 And at the, without sort of like believing in it so much that they're not seeing the downsides, sort of like seeing your child and not seeing the harm that they could do, that they don't want to see the harm.

00:17:55.300 But having said that, the programs are receiving millions of dollars in funding.

00:18:03.460 So even if that's not something that people take home with them, there can be lots of reasons to want to keep that kind of funding for your organization that isn't directly profit-seeking.

00:18:15.160 But with that million dollars, I think it's really important, you know, there, I think it was $6 million for the program in London.

00:18:21.980 None of that covers the cost of the drugs.

00:18:25.300 So I'm not exactly sure what cost it covers, but it doesn't cover the cost of the drugs.

00:18:31.700 That's covered by OHIP.

00:18:32.800 That's covered by everybody else's, you know, tax dollars.

00:18:36.780 It's not.

00:18:37.780 So profit, so any amount of funding from the federal government doesn't really cover the cost of the program.

00:18:45.980 But that funding for an organization like a community health center is really important funding.

00:18:52.420 So I don't know how much is motivated by a sort of desire to keep that kind of funding, even if that's in the context of a belief that that funding will help people and help the organization.

00:19:06.080 So I think it's very complicated, but I also think it's really interesting how hard it's been to express any concerns about the program.

00:19:20.680 I've never felt, I was a very quick adapter of being critical of Purdue.

00:19:26.680 I gave talks before it was the thing to do.

00:19:31.420 And every time I gave a talk, I would start by criticizing Purdue.

00:19:35.960 And I remember being asked if I was worried about Purdue.

00:19:39.340 And I wasn't.

00:19:40.560 They never bullied me.

00:19:41.960 I never felt unsafe to talk about it.

00:19:44.500 But I have found that the environment has been very challenging to be able to say, this is what I'm seeing.

00:19:51.880 I don't have a motive to say I'm seeing somebody who's quadriplegic and the suffering is horrific.

00:19:59.100 The only motive I have is to end that suffering.

00:20:03.300 So I don't have a personal gain from it.

00:20:06.500 I have the horror of the trauma of witnessing suffering.

00:20:13.280 And when I express that suffering, I've almost literally been told that those patients don't exist.

00:20:18.920 And I feel like tell that to those patients that I'm seeing suffering.

00:20:23.880 I mean, I've been told that doesn't happen.

00:20:26.520 They don't exist.

00:20:27.300 I think the other thing that I want to make sure gets out there is that increasing more opioids has done nothing to decrease fentanyl, which is illicit fentanyl, toxic fentanyl.

00:20:45.320 So and the goal that is now claimed is that it's to be a safer alternative to toxic fentanyl.

00:20:53.160 That hasn't happened.

00:20:54.480 It's increased fentanyl in London and increased overdose deaths in London.

00:20:58.460 It's increased hospitalizations and ED visits in London.

00:21:02.560 And looking at diversion hasn't been part of what the programs have done.

00:21:08.880 But looking at specifically just looking at the kind of goal of decreasing toxic fentanyl, once people become addicted to an opioid, to get the same effect, they either have to take more of it or something stronger.

00:21:23.660 And what I'm seeing over and over again are people that have started with safe supply or started with diverted opioids that then progress to using fentanyl.

00:21:35.760 So if anything, I'm finding that it is absolutely worsened the fentanyl crisis in our area.

00:21:41.860 Well, that's the yeah, let's go ahead, Adam.

00:21:45.560 Yeah, I just want to make a point of clarification for listeners who aren't aware of why safe supply doesn't dissuade people from using fentanyl.

00:21:53.620 So safe supply programs in Canada predominantly distribute hydromorphone, which is an opioid which is roughly as potent as heroin, if not more potent.

00:22:01.060 And that's dangerous for someone who's opioid naive.

00:22:04.620 However, fentanyl is at least 10 times stronger than that, which means that for a fentanyl user that because of their high tolerance, hydrolofen doesn't actually do anything for them.

00:22:14.260 At most, it manages their withdrawals, but it doesn't give them the euphoric high that they crave.

00:22:18.740 So the actual premise of safer supply, that these drugs are an actual substitute for fentanyl, doesn't check out at all.

00:22:28.260 And it's important to note.

00:22:29.960 So I've interviewed at least 25 addiction experts across Canada at this point, most of whom said the exact same thing.

00:22:37.180 You know, that it's crazy to imagine that hydromorphone could substitute for fentanyl.

00:22:41.360 The ones who haven't said that, they've only haven't said that because we haven't talked about that topic.

00:22:45.440 Um, but some might say, well, you know, these are a few addiction physicians.

00:22:49.920 What, what do they know?

00:22:51.240 Well, it's important for us to remember that Health Canada itself is aware of this issue.

00:22:56.340 In March of 2022, they published a preliminary report evaluating their pilot safer supply projects all across Canada.

00:23:03.440 And one of their central findings was that even maximum doses of hydromorphone didn't generate a high in fentanyl users,

00:23:10.040 leaving people to go and sell it on the street to purchase more fentanyl.

00:23:13.360 So Health Canada is aware that the central concept of their safer supply programs.

00:23:21.040 Let me ask you about that, Dr. Summers, because if there is such, you know,

00:23:25.280 unanimity among certain pockets of this addictions specialist community, as Adam said,

00:23:31.020 why are people like you and Dr. Koivu seen as the dissidents here?

00:23:35.780 I mean, where's the breakdown happening?

00:23:37.760 Um, well, it plays out over decades, unfortunately, Andrew.

00:23:43.640 So there's, there's a big, uh, there's a big gap in education.

00:23:46.400 I've, I've, I've, I've taught clinicians in, uh, medical schools and, um, departments of, of clinical psychology, nurses.

00:23:55.480 Um, and the amount of time allocated to education on addiction is scant.

00:24:00.700 Um, so people finish and there, and there's a lot to learn more and more as, as clinicians.

00:24:06.900 So, um, we wind up with a big gap.

00:24:10.380 Um, and we have, you know, like it's, it's a bit of an embarrassment that we're producing clinicians who reflexively draw a comparison between, um, untreated addiction and diabetes.

00:24:21.260 There's, there's no one in the clinical literature who has decided through a force of frustration and will to quit diabetes, right?

00:24:29.560 No, no one, no one.

00:24:31.180 But people do that all the time with addiction.

00:24:33.460 And it's, and it's, and we need to learn from that in order to mobilize the factors that contribute to their, not only their motivation.

00:24:40.540 It's not, it's not limited to that.

00:24:42.780 It's about the conditions in which their motivation can be increased and actually expressed.

00:24:48.020 That's what can give people the opportunity for wellness.

00:24:50.140 Most people overcome addictions.

00:24:52.160 There are more ex-smokers, at least in higher income countries, there are more ex-smokers alive than current smokers.

00:24:57.600 And the same has been known for heroin, cocaine, alcohol for decades.

00:25:02.520 We don't teach the skills that mobilize clinicians' capacity and relationships to advance that.

00:25:10.600 And so we wind up with this kind of, you know, well, what do you, what do you do?

00:25:13.800 What do you do?

00:25:14.500 And nothing, because nothing has changed in neighborhoods like the downtown east side of where I live and in others,

00:25:20.140 clinicians have gone there and seen, well, this is like nothing changes here.

00:25:24.560 That's not because the people are incapable of change.

00:25:27.240 And that's one of my biggest frustrations is we've had the opportunity in Canada.

00:25:31.500 At Home Chaisois was a multi-site randomized control, several randomized control trials that, that aimed to investigate if people deemed the hardest to house in, in different regions of the country could in fact experience wellness.

00:25:47.660 The answer is a resounding yes, with crime reduction, with reductions in medical emergencies, improvements in quality of life, and social reintegration.

00:25:56.000 We started that work in 2008.

00:25:58.860 Portugal had already shown the possibility at the population level because their whole plan revolves around social reintegration.

00:26:06.660 That's a core construct in their national strategy, the 2000 national strategy, social reintegration.

00:26:13.420 Now, having committed to that goal and realizing all of the improvements that they did over the next decade, it's important to note they did it without a single drug consumption site.

00:26:24.460 The harm that's addressed by consumption sites includes not having safe places to live, being on the street and exposed to predation and violence.

00:26:34.380 If one is committed to addressing those harms by providing people with safe places to live, you don't need consumption sites.

00:26:42.040 So it's not a matter of, are you for harm reduction or against harm reduction?

00:26:45.800 It's about how should we best reduce the harms that are associated with drug use in our population?

00:26:51.800 Portugal remains, I think, a real important test or learning opportunity for us, a natural experiment.

00:26:59.660 They built on the experiences in Switzerland and England before in previous decades.

00:27:04.040 So there's there is a volume of evidence that hangs together, both from other countries and experimentally in Canada that we're turning our backs on.

00:27:13.920 And the result is people who have who are not aware of that literature making decisions.

00:27:22.280 And as Adam said, you know, often with the with good intentions, we also have this weird dynamic where, look, addictions are are diagnosed as mental disorders.

00:27:34.040 At their core, they involve an agonizing frustration around loss of control.

00:27:41.260 It's the loss of one's own control to influence behavior that is resulting in harms to oneself and often to others as well.

00:27:49.820 And that's that's a core dynamic in what we refer to as harmful addictions and why and why they are so why they create such strong mental suffering.

00:28:02.320 And so we have this weird dynamic where we're asking people who are likely experiencing addictions, a loss of control over behavior that causes harm to them if they would like publicly funded drugs to be provided.

00:28:20.780 Well, they have not had much reason to think that effective treatment is available or that there are ways in which they can gain greater control.

00:28:33.320 And so, of course, they say, yes, of course, that would be beneficial.

00:28:37.460 That would be an improvement over what they're currently doing.

00:28:39.760 But it's the wrong question.

00:28:41.080 We should be asking them, would you like access to the same resources that restore control that have been available to physicians who experience addictions for decades or airline pilots or in B.C., public servants?

00:28:57.360 Yes, because all of those groups and wealthy people, because all of those groups have access to forms of addiction treatment that focus on the psychological and the social and that preclude use of drugs, at least in the short term, and they are highly effective.

00:29:12.820 If, on the other hand, you are poor in Canada, there is no way for you to get access to psychological and social supports addressing addiction and all we provide are drugs.

00:29:24.080 And this is the practice of stigma.

00:29:27.980 Any leader who says safe supply is about stigma reduction doesn't know the meaning of the word stigma because it is the definition of responding differently to two groups in the population based on how they look.

00:29:43.620 If you look like a doctor, if you look like a public servant, an airline pilot, a safety sensitive employee, we want to take care of you.

00:29:51.260 We want you to have control of your life back.

00:29:54.080 And we will help you get there.

00:29:55.680 If you're poor, here you go.

00:29:58.400 And we need to eliminate that discrepancy.

00:30:01.580 Stigma reduction is the right cause. 1.00

00:30:03.840 It's the wrong execution.

00:30:06.260 Now, that's a fascinating and quite upsetting analysis there.

00:30:10.860 And when you talk about housing, one tweet that I wanted to bring up at some point in the show is that it illustrates that when you have one problem, it starts to skew your way of dealing with other problems.

00:30:24.240 And this is a tweet from a Toronto community worker that I think is involved with some of these organizations that are in the harm reduction space.

00:30:31.580 And she writes, meth is a smart way to stay awake and avoid assault or theft on the street or in a shelter.

00:30:38.000 This is someone who is looking at meth, which has destroyed people's lives and done so much damage and saying, well, this is actually a thing that will help you avoid being raped or assaulted or killed if you live in a shelter because you don't have a home.

00:30:54.900 So it strikes me that the problem here is actually the maybe we should make sure that either shelters are safer or that people have a safe place to be and not use meth as a harm reduction tool.

00:31:07.820 And again, I'm extrapolating a fair bit from one tweet here, but it's that these problems are, as you say, Dr. Summers, very interconnected here.

00:31:15.380 And I just want to make a point that we've been talking about this and nowhere in this discussion has there been anything unsympathetic to people with addiction.

00:31:23.840 It's not looking at them. No one's saying we need to lock them up.

00:31:26.700 And I think often in a political context, that's what people try to reduce this thing to, which is, you know, you're either anti-addicts or you're pro-harm reduction, which is not at all the case here.

00:31:37.880 We are out of time, but I just want to give the last word to you on this, Dr. Koivu, because when we are talking about, you know, the stigma issue here and the idea of treatment,

00:31:48.920 is there a viable model that you've seen to get us where we need to go?

00:31:54.260 Are we still looking for that?

00:31:56.300 I think that there are definitely there are viable models.

00:31:59.300 And I think we need to look at an integrated approach that looks at all the aspects of care.

00:32:05.940 We know wraparound services, primary care, health care are essential.

00:32:10.920 Housing is an essential part of being able to get ahead and away from an addiction.

00:32:20.660 And I totally agree.

00:32:21.660 It needs to be a safe place, not just a safe way of making an unsafe place less dangerous in a very short term.

00:32:30.080 It promotes so much danger and so much risk that sort of like double downing on, you know, doing more bad, bad on to bad,

00:32:39.980 because adding meth on to crystal meth, which causes all sorts of other diseases on to another thing that's that's dangerous.

00:32:47.940 And then looking at other strategies, opioid agonist therapy, methadone and suboxone, sublocade are absolutely,

00:32:57.420 I'm seeing huge amounts of improvement, life-changing improvement.

00:33:01.360 When people really get on an opioid agonist therapy program, often now because of the income associated with selling safe supply,

00:33:12.500 diverting safe supply, that's less accessible.

00:33:16.760 Because to give up safe supply, you're giving up primary care, wraparound services and an income.

00:33:22.980 We have to change that.

00:33:24.600 That can't be where you get those services.

00:33:27.660 We need to have an integrated approach.

00:33:29.840 We need to have an accessible, rapid access, good integration.

00:33:33.980 We need to look at what really happened in Portugal, not how people are translating the decriminalization to justify things that weren't Portugal's experience.

00:33:45.860 We need to look at what Alberta is doing. 0.91

00:33:48.160 We need to look at what really has been done in Switzerland and recognize the harm that we're doing

00:33:58.500 and not be afraid to recognize the harm, both to the individual involved, that we're keeping, we're locking into an addiction.

00:34:06.820 And the community, and really look at why are there so many more encampments in London?

00:34:13.920 And why are just, you know, adding hubs, I mean, might be a short solution.

00:34:19.560 But as long as we're creating an environment in which people want to be in the core, want to be near the diverted drugs,

00:34:25.380 whether they were housed from another community and are coming into London to get the diverted drugs,

00:34:31.400 we have to be looking at the source of the problems we're creating and stop the flood of that problem as we're creating an integrated approach.

00:34:41.700 Very well said.

00:34:43.300 That was Dr. Sharon Koivu, also Dr. Julian Summers and Adam Zivo, columnist with The National Post.

00:34:50.760 And by the way, we talked about it on the show when it came out.

00:34:53.440 I mentioned it at the beginning. The piece came out on May 9th.

00:34:57.140 Drug fail. The Liberal government's safer supply is fueling a new opioid crisis.

00:35:02.780 It was probably one of the most evocative and in-depth looks at this issue that I've seen.

00:35:08.040 It features Drs. Summers and Koivu and a number of other experts.

00:35:11.840 And you did a tremendous job on that, Adam.

00:35:13.620 So thanks for writing that and for coming on today.

00:35:16.260 And everyone, thank you so much. It was a pleasure.

00:35:18.120 Thank you so much.

00:35:18.860 That does it for us.

00:35:21.020 My thanks again to Drs. Summers and Koivu and also to Adam Zivo for coming on the show.

00:35:26.860 We will see you next week with more of The Andrew Lawton Show here on True North.

00:35:30.740 Thank you, God bless, and good day to you all.

00:35:32.840 Thanks for listening to The Andrew Lawton Show.

00:35:35.180 Support the program by donating to True North at www.tnc.news.

00:35:40.640 True North at www.tnc.news.com

Juno News - August 18, 2023

＂Safe supply＂ isn't safe

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