Daphne Bramham: Will a ‘safe’ drug supply ease Vancouver’s overdose epidemic?

Opinion: As a harm reduction measure, Vancouver Coastal Health and others want Ottawa to allow drug clubs to give free, tested drugs to members.

Article content

Harm reduction’s truism is hard to argue with: You can’t help drug users if they’re dead.


Article content

In fact, it’s usually a conversation stopper. But it is also a convenient cudgel when someone suggests that in the midst of the long-running overdose crisis that governments have leaned-in rather too hard on reducing harm and not hard enough on addressing the root causes fuelling the drug-use epidemic.

So it is with a proposal that Vancouver city council endorsed that urges Health Canada to allow drug clubs or co-ops to buy heroin, cocaine and methamphetamines, test them, repackage them, and give them away to members.

This is harm reduction pure and simple, untethered from health-care providers and any pretense that it is part of a treatment plan. These would be pharmacies without pharmacists, providing users with the drugs they crave in the quantities they want.


Article content

With an average of six British Columbians a day dying from illicit drugs with increasingly high concentrations of fentanyl, carfentanil and benzodiazepines, there is no disputing that Vancouver and most other B.C. cities have a deadly problem.

Desperate times, they say, require desperate measures.

But if Health Canada accedes to the request from the city and Vancouver Coastal Health to exempt the Drug Users Liberation Front (DULF) from the Controlled Drugs and Substances Act, would drug clubs work?

Nobody knows because it’s never been done before.

“It wouldn’t make drug use safe. But it would make it safer than what (users) are currently doing,” Mark Lyshyshyn, the deputy medical health officer, said in an interview.


Article content

“We don’t know if it would be a successful program, but I felt it had the potential to reduce the risk of overdose. … The whole point is for them to get safer drugs.”

He sees DULF’s proposal as an extension of Vancouver Coastal Health’s drug-checking services and supervised injection sites.

The whole idea of a “safe supply” or even a “safer supply” is a relatively new one first used by groups like the Vancouver Area Network of Drugs Users (VANDU) more than a decade ago before the illicit supply was rife with synthetic opioids like fentanyl and before a public health emergency was declared in 2016.

Critics of “safe supply” say that there is no such thing, pointing out that the genesis of the emergency was the false and aggressive marketing of OxyContin as non-addictive followed by its over-prescription.


Article content

Even before that, Vancouver’s drug problem was bad enough that in 2001 the city approved a “four pillars” approach — prevention, treatment, enforcement, and harm reduction. Over the years, the policy debate has devolved into harm reduction versus treatment.

“It comes down to a matter of philosophy of what the right balance is,” Lyshyshyn said. “And right now people are dying, so the most important pillar is harm reduction, to stop people from dying.”

He said governments spend “100 times as much on addiction treatment” as on harm reduction, as well as more on enforcement even after a decade of de facto decriminalization in Vancouver.

Police are going after drug traffickers and illegal drug producers, Lyshyshyn said. And that only “incentivizes people to create more potent drugs.”


Article content

Still, he hopes that with a safer drug supply, more users would seek treatment. Unfortunately, that doesn’t quite line up with users’ letters appended to Vancouver council’s motion. For them, the treatment isn’t working.

Greg Fresz gets diacetylmorphine (heroin) twice daily from Crosstown Clinic, which is licensed by Health Canada to provide it. But he wants a take-home supply (aka “carries”) and has been denied that.

“You can’t use crack if you’re going to get carries. … For me, that’s not feasible because sometimes I can’t get anything else, so I’ll buy pills, dilaudids, benzos, something to help me sleep because I’m in pain.”

Martin Steward quit Crosstown Clinic because it was “too tedious.”

“I had to wait for my turn, wait for my medication, after the medication, I had to sit for 20 minutes before I could leave.”


Article content

A man identified as Steel, who described himself as a “social user”, tried and quit the B.C. government’s “safer supply program” that allows doctors and nurses to prescribe opioids (including fentanyl patches), alcohol, stimulants and benzodiazepines.

“The government supply is weak. It doesn’t satisfy. Yes, it might be free, but it doesn’t do what the drugs are meant to do for many of us.”

Steel also complained about the drugs that DULF has handed out freely on three occasions in the Downtown Eastside: “I found that I needed more.”

Samona Marsh, an “ethical use substance navigator” with VANDU, wrote: “I don’t go to the doctor at the best of times. Why would I go to the doctor to get high? Existing safe supply programs give you pills. I want to get high on drugs, not on their pills.”


Article content

Lorna Bird complained about being in an opioid replacement program that requires daily witnessed ingestion of drugs such as methadone and suboxone at a pharmacy: “It was a real hassle and interfered with my life a lot.”

Before that, she quit an injectable heroin program. She didn’t like being watched as she used.

VANDU “peer navigator” Laura Shaver spends about $100 a day on “a range of street and safe supply drugs” that includes heroin, hydromorphone, Dexedrine, metadol-D, Seroquel and gabapentin.

She has asked for prescription benzodiazepines, but her doctor refused because there were traces of fentanyl in her urine.

“The feeling (on benzos) can be euphoric — and reminds me of the type of high I would have before I was on methadone.”

For more than two decades, the Canadian consensus has been that addiction is a health issue, not a moral failing, and ought to be treated like every other chronic, recurring disease.

But the challenge set before Carolyn Bennett, Canada’s new mental health and addictions minister, is deciding whether harm reduction includes the right to get high.


Twitter: @bramham_daphne



Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. Comments may take up to an hour for moderation before appearing on the site. We ask you to keep your comments relevant and respectful. We have enabled email notifications—you will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. Visit our Community Guidelines for more information and details on how to adjust your email settings.

This website uses cookies and asks your personal data to enhance your browsing experience.