Canada is experiencing a drug poisoning crisis. Health Canada reports over 29,000 apparent opioid-related deaths between January 2016 and December 2021, alongside 30,806 hospitalizations from drug overdoses. The pandemic exacerbated the issue, driving up deaths by nearly 100 percent in its first year. In the US context, researcher Brenda Saloner notes social isolation, economic stress, and solo drug usage alongside an increasingly unsafe supply drove up overdose numbers. The same can be said of Canada.
Recognizing that prohibition and an unregulated supply of drugs is harming and killing people, Vancouver, British Columbia, is making a serious effort to reduce harm and save lives by providing a safe supply. It’s a model that ought to be applied throughout the country — and with a little sense from politicians in other provinces, will someday soon be implemented far and wide.
Making Criminals of Our Friends and Neighbors
“Government drugs” may strike the reader as an unusual way to address a drug crisis. But pushing beyond an initial, visceral, and uninformed response reveals the logic — and wisdom —of the approach. The goal of safe supply is to reduce harm, save lives, and give people who use drugs control of their lives. We cannot address the drug poisoning crisis without accepting the particularly powerful nature of opioids and the fact that keeping people from accessing a safe, regulated supply is killing them.
People who wish to use drugs will use drugs. Millions upon millions of people enjoy regular access to safe substances such as coffee, alcohol, and tobacco – drugs that are legal. Many millions of these legal drug users are dependent on their morning joe, pints after work, or a smoke break several times a day. This isn’t to say caffeine or alcohol or opioids are the same sort of substance, producing the same sorts of outcomes. They aren’t. Again, opioids are particularly powerful. But to mention common, legal recreational substances alongside them is to say that we are all bound up in substance use in one way or another. And understanding how to address drug supplies begins from understanding how people actually live and why they make the choices they make.
Folks who use different kinds of drugs deserve to consume safely and stay alive just as much as anyone else, especially if the social, political, and economic context in which they use that drug produces external outcomes we’d all prefer to live without, including crime and illness. Their safety and well-being ought to be treated as the public health matters they are.
Drug use and addiction may rise during economic downturns — including recessions and attendant unemployment — and is conditioned by industry pushers and the highly addictive quality of certain substances. To see an egregious instance of how these factors can work in tandem to produce health crises, we need only look to the case of Purdue Pharma. There are no longer any serviceable rationales for arguing against the state ensuring safe supply.
Heretofore, the state has been complicit in drug poisonings and deaths through economic and service neglect. Decades of war against drugs — which is to say, war against the people who use drugs — has produced nothing of value. Instead, it has produced extraordinary harm, including illness, death, and a surge in incarceration rates. Meanwhile, the “war on drugs” does nothing to serve those who are addicted to one substance or another. Combined with an economic system that undervalues, underpays, overworks, and structurally exploits individuals, the state is fighting a war against the consequences of its own decisions. It’s absurd and cruel.
By criminalizing drugs, the state forces drug users into risky circumstances to obtain their substance of choice. The illicit market is more dangerous than a controlled alternative, and people who use drugs are often forced to consume them alone in unsafe spaces. Unlike the many who can get their drug of choice at the pub or coffee shop or cannabis dispensary, illegal drug users are unable to access their drug of choice and then consume on-site. Safe supply and safe spaces work to undermine black markets and prevent death from overdose.
The Vancouver fentanyl dispensary is a pilot program that will no doubt yield results consistent with what experts already know from prior research and experience in other contexts: providing people with safe drugs reduces harms, saves lives, and helps drug users decide for themselves how they wish to live. If users prefer to reduce consumption, the provision of safe drugs can actually help. By removing the criminal aspect of drug acquisition and consumption, safe spaces can provide an opening for users to access social, health, and housing services.
As Stephanie Nolen writes in the New York Times,
A clinical trial in Vancouver found that providing injectable heroin to patients who had not responded to other forms of treatment helped them reduce their use, stay tied to health care and improve their quality of life, compared with users who were given methadone. Another found a similar benefit from prescribed hydromorphone. Research on the fentanyl program has just begun but will track whether it shows a similar benefit, which could justify expanding it.
A March 2022 paper in the American Journal of Public Health on safe supply in BC during the pandemic echoes this conclusion. Researchers found that “reliable access to prescription alternatives addressed overdose vulnerability by reducing engagement with the illicit drug market while allowing greater agency over drug use.” Their conclusion is what you’d expect to find: “Providing prescription alternatives to illicit drugs is a critical harm reduction approach that reduces exposure to an increasingly toxic drug supply, yet further optimizations are needed.” The data is clear. There is no reason — that isn’t tethered to prejudice, hatred of people who use illicit drugs, or thoughtless ideological precommitment — not to embrace safe supply.
Saving lives and reducing harms is a moral imperative. That’s as true of users of criminalized drugs as it is of those who use substances that have become a normalized, routine part of the daily lives of people all over the world. Safe supply is one way to realize that imperative. It’s also a commonsense approach that redounds to the benefit of users and the broader community alike. In the absence of regulated, government supply, the only game in town is organized crime.
The community benefits from safe-supply programs — especially when safe supply is a component part of a strategy that includes decriminalization, stigma reduction, and safe consumption sites. Those benefits include a reduction in illicit activities incidental to drug procurement and use, reduced policing and criminal justice costs, and a drop in the health care resources required to address poisonings. Just as important, safe supply helps to preserve and improve the communities of drug users who deserve to have their social connections protected and who do not deserve to see any more of the people they care about suffer and die because of harmful, punitive, and ineffective state prohibition.
The models of safe supply piloted in BC ought to become national, even international, common practice. With a little sense, and even a bit of political courage, they will be. The sooner that happens, the better for everyone.