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

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.

Juno News - May 14, 2024

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

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