Juno News - May 14, 2024


The truth about ＂safe supply＂ - Interview with Dr. Sharon Koivu

Topics
diversion dangers diversion and infections impacts neighborhood fentanyl crisis
Mentioned
Sharon Koivu Fentanyl
Are anti-Israel encampments a free speech issue？ Trudeau still thinks he's not going anywhere

Episode Stats


Length

15 minutes

Words per minute

157.71

Word count

2,449

Sentence count

152

Harmful content

Misogyny

1

sentences flagged


Summary

Summaries generated with gmurro/bart-large-finetuned-filtered-spotify-podcast-summ .

As one of this country s loudest critics against so-called "safe supply" programs, and as someone who is on the front lines of battling the addictions crisis in southern Ontario, there is perhaps no one better to speak to about safe supply than Dr. Sharon Koivu.

Transcript

Transcript generated with Whisper (turbo).
Misogyny classifications generated with MilaNLProc/bert-base-uncased-ear-misogyny .
Topics generated with Qwen2.5-3B-Instruct.
Hosts, guests, and mentioned names generated with spaCy (en_core_web_sm), reconciled against Wikidata.
00:00:00.000 The following is an interview with London-based addictions doctor Sharon Koivu.
00:00:10.440 As one of this country's loudest critics against so-called safe supply,
00:00:14.980 and as someone who is on the front lines of battling the addictions crisis in southern Ontario,
00:00:20.140 there is perhaps no one better to speak to about safe supply than Dr. Koivu.
00:00:25.040 The interview was filmed in London, Ontario last week when True North was in town
00:00:30.000 to film a mini-documentary on the harms of the safe supply experiment.
00:00:35.260 If you're watching this video on YouTube, you can watch the full episode of Ratioed
00:00:39.280 by clicking the link on the screen right now.
00:00:41.800 And if you're watching this video on any other platform,
00:00:44.700 be sure to follow the link to the Ratioed episode in the description of this video.
00:00:49.260 Without further ado, here is Dr. Sharon Koivu on the dangers of safe supply.
00:00:55.860 Sharon, first of all, you've been a loud critic of safe supply programs in London and in general.
00:01:03.340 Why do you feel so strongly about this issue?
00:01:06.320 I think that I've really had the opportunity to see the harms from a physician level.
00:01:13.300 I also lived within a kilometre of the intercommunity health where most of the prescriptions in this area
00:01:20.440 have been given from, where the main program is, and I've seen what happened to our community.
00:01:27.320 I also have family who have lived experience with addiction
00:01:31.220 and really feel that if it had been available when they were younger,
00:01:35.980 I might not have all the family members that I have now.
00:01:39.340 So I'm coming at it from many perspectives and from years of experience.
00:01:44.860 On the case of, on the situation with diversion, right,
00:01:48.780 we've seen reports that the federal government has funded a report
00:01:52.620 that tries to downplay the concerns of diversion.
00:01:55.880 Whenever this issue is brought up, it seems the true believers in safe supply
00:02:00.120 always try to shoot down concerns about diversion.
00:02:03.240 What is, what should Canadians know about diversion, in your opinion?
00:02:07.060 I think there are many things we need to know.
00:02:09.800 One is that most diversion is not about compassionate sharing.
00:02:14.800 I think that's a myth.
00:02:17.460 Most diversion really involves either selling,
00:02:20.020 or what I'm seeing a lot more of is actually forced diversion.
00:02:24.380 When people walk into the drugstore with their prescription and then walk out,
00:02:29.360 people know who they are.
00:02:30.480 So a lot of people are more intimidated and don't have the opportunity
00:02:35.520 to necessarily financially benefit, but are kind of forced to be giving up
00:02:41.240 some of their prescription.
00:02:44.140 So it's not necessarily even good for the people that are diverting.
00:02:47.500 So it's really changed.
00:02:49.720 I think when it first started, people were financially benefiting from diverting.
00:02:55.140 And it's understandable.
00:02:57.540 These can be people that are very marginalized and are in poverty,
00:03:02.980 and they have issues around housing insecurity and food insecurity.
00:03:07.700 But the problem is that then we now have a lot of pills on the street.
00:03:13.380 And what I've seen since diversion happened, I guess a few things.
00:03:17.500 One is I first started seeing people developing infections from injecting the tablets.
00:03:22.980 They're meant to be swallowed.
00:03:25.240 And I started seeing very severe infections from injecting pills,
00:03:29.560 primarily diverted, but even from people that were in the program.
00:03:33.620 And the infections that I've spoken out the most about are infections of the spine.
00:03:38.720 And they are, I've been doing palliative care and addiction work for years,
00:03:44.440 but infections of the spine are probably the worst suffering I see
00:03:49.000 because they're so painful.
00:03:50.620 If you think about a spine getting infected, that's your nerve center is being infected.
00:03:56.420 They're extremely painful.
00:03:58.140 But I've also seen people develop permanent paraplegia, so they can't walk,
00:04:02.940 and even quadriplegia, so they're affected from the neck down.
00:04:06.180 It really depends on where their infection is.
00:04:09.140 And when I first started seeing this,
00:04:12.260 people could really tell me that the only pill that they were injecting was Dilaudid.
00:04:17.320 So the risk of an infection has been something that I've taken very, very seriously.
00:04:23.120 The other thing that I've seen living in this neighborhood,
00:04:27.040 living within a kilometer of intercommunity health where the main program started,
00:04:31.920 when I first moved in in 2015,
00:04:34.600 I moved in knowing this might be an area where there was a supervised injection site.
00:04:40.280 I support harm reduction,
00:04:42.620 and I have supported the concept of supervised injection sites.
00:04:46.900 But what I saw after the safe supply program started
00:04:51.740 was I literally had patients tell me they were leaving their houses,
00:04:56.600 leaving apartments that they had to live in tents behind the pharmacy
00:05:01.680 where a lot of the diversion was taking place.
00:05:05.860 And living here, I saw that happen.
00:05:08.160 When I moved in, there were no encampments in that parking lot area behind that pharmacy.
00:05:13.500 And they really spread between sort of Adelaide Street and English.
00:05:19.820 So even behind the Palace Theatre and all of that area,
00:05:23.740 they developed encampments that weren't there before.
00:05:27.020 And they were because when people were buying diverted drugs,
00:05:31.400 they were more abundant and cheaper, closer to the source.
00:05:35.820 So people moved there.
00:05:37.400 Now, there's a lot of homelessness,
00:05:39.480 and there's a lot of issues around homelessness
00:05:42.000 that are extremely important, and I don't want to downplay them.
00:05:45.560 But the attraction to having encampments in this area
00:05:49.640 was largely about getting diverted, dilauded, from the safer supply program.
00:05:55.100 And encampments have with them so many harms,
00:05:57.560 not just for the neighbourhood,
00:05:58.960 but certainly for the people that were living there.
00:06:01.220 There's no ability for cleanliness or ability to use washrooms.
00:06:08.540 So it became a very unsafe place
00:06:10.780 that probably even contributed more to the infections that I was seeing.
00:06:14.280 So how it's impacted the neighbourhood as well.
00:06:18.560 Living here, I watched that change.
00:06:21.300 I watched more crime taking place.
00:06:24.060 I don't think I know anyone who hasn't had a bicycle stolen
00:06:27.460 that lived in this neighbourhood.
00:06:29.300 And it really, it changed gradually.
00:06:32.220 And I think one of the concerns I have too,
00:06:35.640 when we were talking about supervised injection sites,
00:06:38.840 we had many town hall meetings.
00:06:42.460 We engaged the community.
00:06:43.880 We let them know about it.
00:06:45.500 And we brought them in to talk about it.
00:06:47.840 When this happened, most people didn't know what was happening.
00:06:51.120 Most people weren't aware that there was a program
00:06:53.880 where people were getting large amounts of drugs
00:06:56.620 and walking out with them without them being witnessed.
00:06:59.620 So the other thing that I see with Diversion is we have patients come into the hospital
00:07:06.900 and the amount they are prescribed is often in the neighbourhood of 40 pills of Dilaudid a day.
00:07:13.960 Sometimes in addition to that, they're also on a medication called Cadian,
00:07:18.360 which is a long-acting morphine.
00:07:20.180 So 100 milligram tablets, sometimes nine of those a day as well.
00:07:25.760 And then when we actually see what their body can tolerate, 0.79
00:07:29.160 it's somewhere like, you know, nine or ten.
00:07:32.140 So the amount that they actually could take without being harmful,
00:07:36.920 without being toxic to them,
00:07:38.920 is a third, a quarter of what they're being prescribed.
00:07:44.100 So when we look at that, that becomes a lot of pills on the street.
00:07:48.020 It's very, very dangerous for the street.
00:07:50.980 And I'll talk about that more.
00:07:52.120 But even for that person,
00:07:53.600 because now they have to guess what is a safe dose for them.
00:07:57.200 If they get sick, which is when I see them,
00:08:00.000 they're actually tolerating less.
00:08:02.460 And they're not really being educated
00:08:05.840 in that you can get an overdose on the same dose
00:08:09.680 if you develop a pneumonia or you develop a problem with your heart
00:08:14.200 or anything that affects your cardiorespiratory system.
00:08:18.920 And I guess the other point about diversion
00:08:21.780 is that it means we're creating a huge problem
00:08:25.900 with more people becoming addicted.
00:08:28.740 It used to be $20 for a pill.
00:08:31.560 The last time I talked to somebody
00:08:33.280 who could tell me with fairly good authority,
00:08:35.560 you could get them for as cheap as $1.
00:08:37.820 And that makes them very accessible.
00:08:42.040 We know that if things are cheap and readily accessible,
00:08:45.460 we understand this from tobacco,
00:08:46.980 we understand this from our work with alcohol,
00:08:49.940 that makes it more likely that new people
00:08:52.000 are going to start using drugs
00:08:54.020 and that people are going to use them recreationally
00:08:57.460 and then develop an addiction.
00:08:59.760 And that is exactly what I've seen.
00:09:01.720 When I started my addiction work in 2012,
00:09:05.080 almost everyone I saw had chronic pain
00:09:08.960 and had been prescribed opioids from a physician
00:09:13.340 for their chronic pain.
00:09:14.660 And that had been what had introduced them
00:09:17.180 to getting addicted.
00:09:18.680 At that time, most of the people I saw
00:09:21.040 also had severe trauma or intergenerational trauma.
00:09:25.860 Now, most of the people I see
00:09:28.220 that have started using opioids since 2016,
00:09:31.860 started recreationally
00:09:33.320 and often didn't know that it was dangerous.
00:09:36.280 It's called safe supply.
00:09:37.980 So people literally are thinking it's safe to take
00:09:40.460 and that they won't get addicted
00:09:41.620 and safe to inject because it's called safe supply.
00:09:45.560 So my experience has been
00:09:47.180 that I'm seeing a lot more people,
00:09:50.240 young adults that have addiction.
00:09:52.500 And when we look at overdose deaths in London,
00:09:57.320 in 2016, we were equal to Ontario.
00:10:01.400 The rates of overdose deaths from toxicity of opioids
00:10:04.300 was equal to the rest of Ontario.
00:10:07.380 Now in 2012, looking at the 2022 data,
00:10:10.360 that's the latest I have,
00:10:12.320 our overdose deaths are substantially higher
00:10:15.320 than the provincial average.
00:10:17.980 The other thing about our overdose deaths
00:10:21.220 is we have a much higher rate of overdose deaths
00:10:25.320 in people that are 15 to 24 and 24 to 45.
00:10:29.200 So before 2016,
00:10:31.140 we were lower than the provincial average.
00:10:33.660 Now we're higher than the provincial average
00:10:36.580 in those young age groups.
00:10:39.860 And I think people are saying that,
00:10:41.860 you know, it's not affecting young people.
00:10:43.540 I'm seeing it affecting young people.
00:10:45.540 And the data supports that it is affecting young people.
00:10:50.640 And that is about having a lot of opioid on the street.
00:10:54.940 Why is it that so many doctors
00:10:57.440 are not willing to speak out against this?
00:11:00.000 If they know that there is something wrong with it,
00:11:02.500 it seems that there aren't many
00:11:03.500 that are willing to speak out against it.
00:11:04.740 Why do you think that is?
00:11:05.380 I think that to a degree,
00:11:09.840 some people don't understand what's happening.
00:11:12.520 Having concerns about its risk
00:11:14.560 doesn't mean that there aren't any benefits
00:11:16.640 for some of the people that are involved.
00:11:19.120 And I think that when people haven't really seen,
00:11:22.120 when people haven't been to the hospital
00:11:23.720 and seen people with a spine infection,
00:11:26.160 they don't really understand
00:11:27.980 how severe the consequences are.
00:11:30.700 The other thing is having lived here,
00:11:33.740 it's completely different to live in a community,
00:11:37.940 you know, a rural community or a gated community
00:11:40.640 or even the other end of town.
00:11:44.460 I have family that live in a fairly similar
00:11:47.060 socioeconomic neighborhood to this
00:11:49.200 and have no experiences like what it's like to live here.
00:11:52.740 So they don't really understand
00:11:54.560 the intensity of the problem.
00:11:56.980 But I also think for physicians,
00:11:58.820 there certainly are a lot more
00:12:00.280 that are speaking up about their concerns.
00:12:02.740 It has been a battle to speak out.
00:12:05.120 I was shocked.
00:12:06.200 When I first started talking about my concerns
00:12:08.960 about seeing people with spine infections,
00:12:11.720 I was told, you know,
00:12:14.660 I was accused of saying that that wasn't true.
00:12:17.600 And what's kept me going
00:12:18.960 is that I know that it is true.
00:12:20.860 I know that I am trying to put a voice
00:12:23.180 for those people that I have seen suffer.
00:12:25.520 And it's quite shocking to be criticized
00:12:29.020 and called a fear monger
00:12:31.140 when you're really just trying to express
00:12:33.900 the suffering that you're seeing.
00:12:36.940 That has stopped a lot of physicians.
00:12:38.960 Also, I know personally,
00:12:40.720 physicians that are worried about their relationship,
00:12:44.040 they work with intercommunity health.
00:12:45.280 It's a great health center for many things.
00:12:47.500 They don't want to be involved
00:12:49.280 in saying things that seem like
00:12:50.680 it's against the entire health center
00:12:52.380 when really it's just about being concerned
00:12:54.860 about a program.
00:12:56.100 So there are many things
00:12:57.120 that are keeping people silent,
00:12:58.480 but more people are speaking out.
00:13:00.120 The last question I have for you, doctor,
00:13:01.480 is what your message would be
00:13:02.520 to cities who are looking
00:13:03.820 at adopting similar policies
00:13:05.540 of safe supply policies.
00:13:07.620 What would be your message to those cities?
00:13:09.480 I think the first thing is
00:13:11.700 make sure that you have
00:13:14.040 really good treatment facilities available.
00:13:16.440 In London, for example,
00:13:17.940 where we have a robust safe supply program,
00:13:20.860 we do not have a robust rapid access
00:13:23.560 addiction medical treatment center
00:13:25.320 open seven days a week.
00:13:27.080 Put enhancement in the things we know that works.
00:13:30.380 We know that suboxone and supplicate save lives.
00:13:33.560 There's lots of evidence to show that.
00:13:36.060 We really, and those two drugs
00:13:38.220 weren't available when this program started here.
00:13:41.800 The other thing is this program started here
00:13:43.940 before we had a problem with fentanyl.
00:13:46.360 Fentanyl came after.
00:13:47.720 This was not a response to the fentanyl crisis.
00:13:50.420 The fentanyl crisis has perhaps been fueled by this,
00:13:55.500 or at least certainly hasn't been in any way prevented
00:13:58.360 by what we are doing in London.
00:14:00.340 It is not a response to the fentanyl crisis.
00:14:03.580 So what I'd be saying to other communities
00:14:05.360 is look at the four pillars.
00:14:07.600 Make sure you have adapted good programs in everything.
00:14:12.020 The first pillar is prevention.
00:14:13.780 We really need to be working on prevention.
00:14:16.260 And that includes mental health counseling,
00:14:18.420 trauma care, intergenerational trauma care.
00:14:21.260 And also we know that the best way to prevent things
00:14:24.240 is to decrease accessibility and availability.
00:14:27.320 When you add something that's gonna increase that,
00:14:29.480 you are going to have an increase
00:14:30.900 in the people who are suffering.
00:14:32.540 The next pillar is treatment.
00:14:34.840 I really think we need to be enhancing
00:14:37.440 all of the treatment options
00:14:38.980 that we have available to people,
00:14:40.480 particularly a fast, rapid response
00:14:43.520 when people know that they're ready
00:14:45.580 to be going into treatment.
00:14:47.360 The next pillar is harm reduction.
00:14:49.840 And I think that it's important
00:14:51.360 to have access to safe paraphernalia.
00:14:55.720 Supervised consumption sites
00:14:57.140 can be an important part of that,
00:15:00.060 particularly if they are a sort of gateway
00:15:03.460 into treatment and work well
00:15:06.360 and are engaged with the community.
00:15:09.140 The last is enforcement.
00:15:11.120 It's one we don't talk about much anymore.
00:15:13.520 But to be able to deal with the fentanyl crisis,
00:15:17.140 we have to deal with fentanyl.
00:15:18.820 And to deal with fentanyl,
00:15:19.980 we have to be looking at ways
00:15:21.280 to stop the flow of fentanyl
00:15:22.780 into communities,
00:15:23.740 not just try to pretend it's not there
00:15:26.500 by throwing more drugs at the problem.
00:15:29.620 Thank you so much, doctor.
00:15:30.900 I really appreciate it.