Western Standard - July 16, 2024


＂The Escalating Craze of Safe Supply Advocacy＂


Episode Stats

Length

14 minutes

Words per Minute

192.46677

Word Count

2,761

Sentence Count

176


Summary

In this episode, Dr. Adam Boyarski joins me to discuss the dangers of the so-called "safer supply" advocacy, and why it's a cult-like advocacy. We discuss the lack of evidence behind Safe Streets, and how activists are blinded by a lack of understanding of the problems they re trying to solve.


Transcript

00:00:00.000 Thank you very much for joining us again today, Adam. I'm certain we'll be able to hear each
00:00:03.500 other this time, right? Yeah, I can hear you just well. Thanks for having me back on the show.
00:00:07.840 So, I mean, I've been watching with interest on social media. Boy, you cover a lot of things,
00:00:12.300 and it's fantastic out there. But the one I do want to discuss has been the safer supply,
00:00:19.260 almost, I say it is a cult-like advocacy. I mean, the people who are pushing for this,
00:00:24.180 just the advocates are getting so extreme, I mean, to the point of looking to sabotage conferences,
00:00:31.660 coming after you, and just a refusal to look at the consequences of these policies. What's going
00:00:37.960 on out there, Adam? Well, I mean, it's a long story. But what I have to say is that addiction
00:00:42.440 policymaking in Canada is dominated by a clique of activists and activist-minded researchers who,
00:00:48.860 for 20 years, have been championing this radical harm reduction ideology that has helped, well,
00:00:56.620 I mean, facilitated countless deaths, because we're really not solving this addiction crisis.
00:01:01.720 They claim to be evidence-based. They're often not. Their definition of evidence is quite questionable.
00:01:06.880 For example, many of the studies that they have, which support safer supply,
00:01:10.600 amount to just interviews with drug users who are on this program. And then the answers given to
00:01:17.520 those interviews are framed as objective proof that it's working. So imagine, for example,
00:01:21.940 you go up to a drug user who is receiving free opioids, and we say, oh, you know, do you like
00:01:26.140 this program? Is it benefiting you? Are you selling the drugs? And the guy says, oh, yeah,
00:01:30.080 it's great. It's wonderful. Of course, I would never sell the drugs. And if I do, it's only out of
00:01:33.540 compassion. There's no downsides. And the researchers say, oh, yeah, you know what? We're going to
00:01:37.440 believe him. And we need to expand safer supply, because this is evidence that this is true. And this is
00:01:42.720 evidence-based policymaking. And it's just absurd. I mean, if it worked, if we could see results,
00:01:47.280 if we could see people's lives really being saved, if we could see a decline in overdoses,
00:01:52.060 a reduction in addiction, I'd support it too. But we're just not seeing it.
00:01:56.960 We're really not. And here's the thing, is that the largest study ever conducted on safer supply
00:02:02.140 was published in January. And it was published in the British Medical Journal. And it claimed
00:02:07.880 that safer supply led to a 55% to 91% reduction in overdose deaths. But I reviewed the evidence and
00:02:15.120 the underlying data with a team of six physicians, all who have a background in addiction medicine,
00:02:19.760 all of whom are distinguished. And we realized that the researchers actually fudged their
00:02:25.700 interpretation of this data. And that when you actually did, when you actually fully filtered
00:02:30.240 out confounding effects and measured long-term outcomes, safer supply had no statistically significant
00:02:36.460 impact on death. So essentially, these researchers found this robust data that showed that safer supply
00:02:44.000 didn't work. And then they misrepresented the data to imply that it did. And I think that that's deeply
00:02:49.440 unethical. Absolutely. But what I don't understand, as I said, is the almost religious, like,
00:02:55.520 hang-up advocates have with it to the point of, again, I was just shocked when you wrote that piece
00:03:01.360 what they were looking to even dye the water in a fountain red, or do things like, where are these
00:03:07.520 people coming from? Why are they so fixated on this? I mean, I understand compassion and concern,
00:03:13.180 then why aren't they looking at evidence-based instead of this strange obsession with this?
00:03:18.580 Well, I mean, there's different groups here, right? So I feel the most compassionate for the
00:03:22.500 grassroots organizers who are dealing with addiction every single day and who are watching
00:03:27.280 their friends and associates die. That's really traumatizing. We've seen such a rise in death
00:03:34.380 over the past 10 years that it's understandable that these activists are desperate in a way,
00:03:40.080 and they are searching for anything which could potentially save their friends' lives.
00:03:45.200 But when you're in that kind of mind space, sometimes you're willing to make compromises,
00:03:50.200 and you are willing to believe, to really delude yourself into thinking that something like
00:03:57.940 Safer Supply is an effective intervention, when in reality it's not. I think also there's a lack
00:04:05.660 of understanding of the weakness of the evidence-based in Safer Supply. Many Safer Supply advocates
00:04:11.580 think that these studies are legitimate, but once again, when you break them down, you find that
00:04:17.240 oftentimes they have really weak methodologies or really strange interpretations of data.
00:04:23.280 Yeah, and some of the stuff we can see is anecdotal, but people getting out and being on the streets,
00:04:28.980 paradoxically, one of the commenters saying, and yeah, in Calgary's Beltline, I mean, it's just
00:04:31.920 horrific. It's dystopian. And we know that Vancouver, of course, has really been the epicenter of it,
00:04:37.440 but the failure, unfortunately, of current policies. And I don't think anybody's really found a solution
00:04:42.300 yet, but we just know there's a tragic, horrific problem of addiction going on out there.
00:04:47.240 But some of it's been exposed. I mean, there was a recent piece, I'm forgetting which one it was
00:04:51.180 now. It was, I think, from the UK, but I mean, it was some photojournalism and some fantastic work
00:04:55.480 just to bring it home for people who perhaps don't get out of the suburbs or don't get out of rural
00:04:59.240 areas just to see how awful and terrible this addiction epidemic is. I mean, how it's eating
00:05:05.000 people alive out there. Well, I mean, that's the thing is that we have to all recognize the fact that
00:05:09.060 this is a real crisis that is taking thousands of lives every single year. Overdose is now,
00:05:15.240 over drug-related deaths, like the leading cause of death for youth in BC. And our governments are
00:05:23.060 saying that they're taking this seriously, but they're not. We don't have significant investment
00:05:28.860 into treatment capacity. In BC, for example, it takes a very long time to get into detox. It takes
00:05:33.820 a very long time to get into a rehab center. Same thing in Ontario. In Alberta, it's much better
00:05:39.200 because Daniel Smith has been investing heavily into treatment services, but it's still not where
00:05:44.960 it needs to be. So we constantly talk about this illicit drug crisis and all of these overdoses,
00:05:51.040 but it's really rhetoric. There's no real action here. And even these big interventions like safe
00:05:57.720 supply, people say it's the compassionate thing. Unfortunately, it is actually just the lazy
00:06:03.140 solution. It is the cheap solution because getting people better, giving them the comprehensive
00:06:09.560 supports, the housing supports, the employment supports, the counseling needed for them to reclaim
00:06:15.020 their lives is expensive and complicated. It's much easier and much cheaper just to give people a bottle
00:06:22.120 of pills every day so they can go kill themselves slowly. Yeah. And then not only is it not effective
00:06:27.840 in getting people, you know, off of their addictions that are slowly killing them. When we get diversion
00:06:33.580 of these, the risk now, and there's evidence starting to show that it's actually causing harm. It's
00:06:39.160 creating new addicts, which is even more devastating. I mean, it's bad enough to have a policy that's
00:06:43.640 ineffective, but this policy could very well be making things worse. Oh yeah, no, though. The safer
00:06:48.800 supply policy is obviously exacerbating the addiction crisis in Canada. And so for viewers who haven't been
00:06:54.800 following the safer supplies, this idea that we give out pharmaceutical alternatives to elicit street
00:06:59.100 drugs, let's say Cory gets addicted to fentanyl because he's really stressed, you know, running
00:07:04.080 this show. You need something to take the edge off. So Cory, you're addicted to fentanyl. You buy your
00:07:09.360 fentanyl off the street. It could be contaminated with xylazine, with other forms of fentanyl, like
00:07:15.060 carfentanil, which is much stronger. The dosage is unpredictable. So there's easily, you could easily
00:07:20.820 die from buying drugs off the street. So the idea here is that we give you, uh, drugs of a known
00:07:26.360 potency and of a known purity. Uh, so pharmaceutical drugs to keep you alive until you're ready to seek
00:07:31.800 treatment. Sure. That sounds great in theory. In practice though, uh, the drug we give hydromorphone,
00:07:38.780 it's as power as a potent as heroin, but fentanyl is 50 times stronger. So Corey, if you get a bottle
00:07:46.240 of hydromorphone and you take it, it's not going to do anything for you, it's too weak. And so you do
00:07:51.240 the rational thing that any person would do in the situation. You sell your hydromorphone at rock
00:07:56.840 bottom prices because you got it for free and you use that money to buy your drug of choice, which is
00:08:01.440 fentanyl. So not only is this program not mitigating the illicit fentanyl market, it's subsidizing it.
00:08:08.880 And it would actually make more sense for us just to give you cash, right? But to buy your fentanyl,
00:08:16.040 but at this point, because you're selling this, you are flooding communities with hydromorphone.
00:08:21.180 So essentially government heroin, and then because experienced drug users don't want it, it goes to
00:08:26.920 people who are opioid naive. It goes to kids. It goes to people in recovery. The kids will take it
00:08:32.500 because they don't know what it is. You know, it's a pill at a party. They're told it's a prescription
00:08:36.640 pain medication. It's safe. It's from the government. Then they get hooked. Then they
00:08:40.800 graduate on fentanyl and it kills them. This is an absolute disaster.
00:08:45.120 And something else, Jordan, one of my commenters pointed out, which is another thing, you know,
00:08:48.480 we're getting hints of, there might be some people with a vested interest in business interests in
00:08:53.660 being part of the dispersal of the safer supply. I mean, that's kind of a different rabbit hole to go
00:08:58.640 down, but unfortunately some people are finding themselves with a financial interest in the status
00:09:02.680 quo, which is morbid, but another thing to look into.
00:09:06.460 Well, I mean, the problem here is that like clinics can make a lot of money by prescribing
00:09:10.680 safer supply. You have people coming in, you have your patients coming in all the time to get their
00:09:14.860 safer supply prescriptions versus if you put them on sublocate, for example, which is a once a month
00:09:19.820 shot. The pharmacies are making an absolute killing because they dispense the safer supply every
00:09:25.220 single day. So you're paying, you're charging a dispensing fee every single day for every single
00:09:29.680 patients. One doctor I spoke with estimated that a single pharmacy can make $1 million a year off of
00:09:36.100 100 patients. So yeah, Shoppers Drug Mart, for example, gave about $2 million to the BC Center for
00:09:42.760 Substance Use to encourage them to create like training programs for safer supply. And I think
00:09:48.380 that's a huge conflict of interest. Purdue Pharma, which was the, you know, really awful company that
00:09:55.100 was behind the OxyContin crisis and started this whole opiate addiction in the first place,
00:09:59.480 this crisis. They produce Dilaudid, which is the brand version of hydromorphone. So they are making
00:10:06.660 a lot of money off of this as well. And I'm aware of the fact that they are currently lobbying some
00:10:11.580 governments about safer supply. I still need to fully investigate that. So yeah, there's a lot of
00:10:17.560 pharma money involved here, which I think is really concerning.
00:10:19.840 And I guess something that has to be, you know, you put it out as well. I mean, full treatment,
00:10:24.600 the counseling, the housing, the time, it's very expensive. You need facilities, you need trained
00:10:30.200 staff, you need resources. Alberta's working along that course. But I actually have a family member
00:10:36.220 who's been in and out of rehab once now, and it didn't work. It could take multiple visits. And
00:10:42.820 they say, yes, you certainly are addicted, you qualify, come back in 30 days, and we'll probably
00:10:48.440 have a bed for you. But unfortunately, living on the streets for 30 days, you know, your chances
00:10:53.780 aren't looking very good at all. But I guess people have to realize that the investment in these
00:10:58.460 facilities too, as expensive as they sound, we're still paying because the person I'm speaking of
00:11:02.300 was in and out of conventional hospitals, chronically in and out of shelters. Often people are in and out of
00:11:07.920 jail, we're paying anyway. So we can spend those dollars better if we're trying at least, even if
00:11:13.440 there's a limited success rate in rehab. But hopefully we're starting to realize that. I mean,
00:11:19.040 in BC, they've gotten rid of the, you know, the reality seems to be sinking in with that government.
00:11:23.660 Yeah. Well, that's the thing, as you said, our capacity here is quite limited, right? So if
00:11:29.340 someone has to wait 30 days to get into rehab, then that's going to be, that's going to make it very
00:11:33.320 hard for them to get better. Because you make that decision, you want to get better. But then you have
00:11:37.020 to wait 30 days, well, you're going to start using during that period. And then in 30 days, you may
00:11:41.380 not want to go to rehab. It costs a lot to do all of this. As you said, we're already paying a lot.
00:11:49.180 You know, our healthcare system is strained to the max. And part of it is because we have a small
00:11:55.180 number of severely addicted people who are visiting hospitals again and again and again and again.
00:12:01.020 So it would be fiscally responsible for us to put them in a treatment center instead,
00:12:07.420 and could also improve healthcare access for everyone else. It just makes sense.
00:12:13.780 Yeah. Well, it's a large and complicated problem. I mean, part of it too, is at least letting people
00:12:18.680 know so they can let their representatives know, I mean, how acute it is and encourage them. I mean,
00:12:25.080 I think most compassionate people when they realize just how bad it's getting would support
00:12:29.160 the investment in rehab and a results-based policy. But I mean, it takes exposure. It takes
00:12:34.840 letting people know, as I said, if they live in the suburbs and don't get downtown, they might not
00:12:38.220 realize how bad it is until it costs them directly. So I mean, just kind of, you know, to wrap things up,
00:12:43.860 you've been fantastic in covering this and exposing it. Where can people find your work and keep track of
00:12:49.660 what you've been writing on?
00:12:50.540 Well, I mean, I'm a columnist of the National Post, so I think you should subscribe to the paper. It's
00:12:54.200 great. There are also many other great writers there. And then on top of that, I run a non-profit
00:12:59.680 called the Center for Responsible Drug Policy. And we have a little sub-stack called Breaking
00:13:05.000 Needles. So you can go find us at www.breakingneedles.com or responsibledrugpolicies.com. Either
00:13:11.620 will give you access to all sorts of great material on addiction that challenges some of these,
00:13:16.720 you know, narratives of radical harm reduction that have ruined our country.
00:13:21.480 Well, that's it. I mean, you know, just applying some common sense or looking for results. I had a
00:13:26.440 Dr. Monty Ghosh on. He specializes in addiction treatment. And you talked about, you know, we don't
00:13:31.920 have time to go into the whole thing of consumption centers. There was this horrific case of a Vancouver
00:13:35.960 one. I saw it look like an opium den of old with what it turned into. But the effectiveness of safe
00:13:42.120 consumption is typically only good for about 500 yards, he said, from where the addict is. Otherwise,
00:13:47.620 they're not going to travel that far. And we just don't have the resources to set one up every 500
00:13:51.780 yards in every major city. So we've got to think a little harder on it.
00:13:55.080 Yeah. If we're going to spend the money, like rather than spend the money on putting a safe
00:13:58.380 consumption site everywhere, we should be spending money on building up treatment capacity. You know,
00:14:04.220 it's a better investment to get people better than to enable their addictions and let them
00:14:08.460 slowly kill themselves. Absolutely. Well, thank you very much for joining us today, Adam,
00:14:12.500 and for the work you've been doing and exposing this. I really appreciate it. And I hope we can
00:14:17.320 have you on again sometime soon to talk again. Likewise. Thanks for having me on the show.