Safer Drug Supply – Made Simple
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| A Primer on a Regulated Drug Supply |
Written by and for people with Lived Experience - Port Alberni Community Action Team - Families Helping Families
Introduction
There’s not much fence-sitting when it comes to the idea of a regulated supply (notice we didn't call it a safe or safer supply) of drugs we currently consider illegal. Both sides of the coin tend to be pretty extreme in their points of view. But, what if there was a middle ground?
Let’s pull this apart in a way that will make sense for most of us.
We’ll start by taking a look at supply and demand. Yeap, part of our problems with the unregulated drug supply come from the fundamental Laws of Supply and Demand. I’m paraphrasing here, - The higher the demand, the higher the price. In addition, the harder something is to acquire, the more unscrupulous suppliers will enter the market. Nonregulation leaves the entire market to dodgy suppliers who don’t care about quality control or even what they’re claiming to sell. All they care about is making it as cheap as possible and their profit.
We have to add another fundamental law to this mess. It’s called the Iron Law of Prohibition. In short, this law was a term coined by Richard Cowan in 1986 which states that as the prohibition of something becomes more intense, correspondently, the toxicity of prohibited substances will also increase. Yes, you read that right! The more we criminalize something, the more we’ll drive the black market to create a product that takes up less space, is harder to intercept by police, and is easier to smuggle. The road by black-market suppliers in creating drugs that meet these conditions includes creating and adding the most potent substances they can find. The higher the potency, the smaller the size of their shipments, and the less likely they will be discovered.
Now in Canada, we’re not the most extreme country that applies efforts to interrupt and suppress the illicit drug supply. Not by a long shot. The USA has been waging the War on Drugs for decades, Not only in their own country but around the world. The USA uses draconian laws and leverages its criminal system to incarcerate not just drug dealers and suppliers, but people who use drugs, even in the smallest amounts. In Canada, We certainly prosecute dealers and drug suppliers when we find them. Yes, we agree that drug suppliers need to be prosecuted to the fullest extent of the law. Despite this, substance use, addiction, crime, toxicity, and most disturbingly, overdose deaths continue to climb to new heights every year.
In most places in Canada, we also prosecute many people found with small amounts of drugs they possess for personal use. For the most part in Canada, people using drugs for personal use thankfully don’t end up in jail for decades like in the US. However, they still end up with a criminal record and that’s likely to impact their future in many serious ways.
Our biggest challenge in Canada right now is that we don’t have a regulated supply, (5)(6)(7) people who use substances mostly only get those drugs from black market sources. That means they have no idea what’s in the drug or how strong it is. This is the root cause of the Toxic Drug Crisis in our country and the reason so many people have died. Since 2016 over 30,000 Canadians have died from an overdose. To put that in perspective, we lost 42,000 Canadians in WW2. Ask yourself, if we had lost 30,000 citizens to any other cause, what would we expect from our Federal and Provincial Governments?
Some Historical Perspective
Now, mix the Law of Supply and Demand, the Iron Law of Prohibition (1)(2)(3)(4) with human nature. When we humans want something, illegal or not, we WILL get it. Let's take a look at some other things we’ve tried to outlaw over the centuries.
Alcohol would be first on the list. Prohibition was a dismal failure and resulted in one of the most vigorous black markets ever created. Suppliers often cooked up batches of alcohol which could result in blindness and some cases, death. Especially if you weren’t knowledgeable about running a still. No matter, there were lots of customers. A few less customers didn’t matter because the demand was so high. Any product that resembled alcohol was snapped up in a heartbeat. Did you know that during probation, some clergy sold their communion wine? Religious ceremonies were one of the few exceptions for acquiring legal alcohol. Some unscrupulous clergy took full advantage. During prohibition, the orders for religious wines went through the roof.
Now I’m not trying to pick on the clergy. There are many fine, honourable and ethical people in all religious clergy groups. I point out this story because it demonstrates human desires and the lengths people will go to when they want what is forbidden. Laws, prosecutions and threats of long jail sentences do not deter us when we want something bad enough. Frankly, for many people, increasing the risk of doing or getting something increases the motivation to acquire that very thing, especially youth. Wanting something so bad you’ll do anything to get it is one of the cornerstones of addiction.
Here are some other activities humans have tried to control over the centuries – books – oh we’ve tried to ban all kinds of books (14), including the Bible, people who believed the earth is round, people who believed the earth revolved around the sun, drugs of all kinds and types, including tobacco and marijuana, gambling and humanity’s most favourite activity – anything to do with sex, especially prostitution. We’ve even banned marriage between different races or within the same sex. The damage over the centuries to individuals is incalculable.
Anyway, the point is we have a lot of history of banning things. Many of which in today’s world seem ludicrous and even stupid. Here’s a question to consider – what if banning drugs is just as illogical? Cocaine used to be in soft drinks and morphine was readily available in cough syrups and elixirs in the late 19th century. Coca-Cola was originally marketed as a remedy to stop drinking alcohol.
Regulated Drug Supply – What Is It. What it Isn’t.
When we talk about a medically regulated supply, it means a pharmaceutical-grade regulated source controlled by Government Health Policies and distributed by health professionals via consultation and prescriptions or through other approved networks. Exactly like existing drugs supplied through PharmaCare for illnesses like diabetes, heart conditions etc, etc. One point to clear up. A regulated supply is NOT a medicinal addiction treatment of agonists such as methadone and suboxone.
Many opponents of regulated "safer" supply voice concern because they perceive the government would be giving drugs to “addicts” for free. All drugs covered under PharmaCare are made available to patients based on their ability to pay. A regulated supply would follow that model. Now a case could be made that until we get control of the toxic drug crisis, we may make drugs available to all regardless of ability, just like we make COVID Vaccines available free of charge. That should be left up to Provincial Chief Health Officers. There is one very important caveat here. Our experience with the COVID Vaccine rollout has shown that marginalized demographics do not have the same access to programs that the rest of us do. That means whatever regulated supply program we introduce will have to meet marginalized people where they are, by increasing the roles of current programs that already do this effectively.
A regulated supply also doesn’t mean that comprehensive treatment and prevention programs go away. Quite the contrary. Other countries further down the road to a safer supply than Canada have significantly increased funding and resources allocated to treatment and prevention, harm reduction, and other policies and programs supporting social health determinants such as housing and employment. That makes sense – if you save money in the justice system, you can use some of those funds to increase treatment and prevention, harm reduction, and all the other much-needed social programs that are crucial in addressing the addiction and overdose crises.
Let's Look At the Pros and Cons of a Regulated Supply
Cons First
Some people point to potential downsides to regulated supply initiatives. One of the most commonly cited concerns relates to the potential for increased drug use and addiction due to a perceived "normalization" of drug use.
You hear many opponents of regulated supply objecting because they fundamentally don’t believe in providing “free” drugs for people with addictions. Of course, that assertion is not objective nor is it accurate. For one thing, our PharmaCare system is based on an individual's ability to pay. Secondarily, the premise of not believing in regulated supply is in direct contradiction to evidence-based harm reduction strategies.
Additionally, there are concerns surrounding the safety and efficacy of certain drugs that may be distributed through a safer supply program. Furthermore, people against regulated supply point out that there could be unintended consequences associated with these programs, such as an increase in criminal activity or a decrease in prices that could lead to cheaper, more accessible drugs on the black market.
In countries that practise a hybrid of decriminalization and access to opioid substitute drug programs, most of these concerns have not materialized. (Note: Drug substitute programs are not safe supply – Portugal does not provide safe supply) For example, let's take a look at Portugal, since decriminalizing personal possession in July 2001, the country has experienced significant decreases in almost all statistics related to substance disorders. Portugal’s radical plan was to abolish all drug-related criminal penalties for possession of up to a ten-day personal supply. (this next sentence defines the success of the Portugal model) Along with it, there would be a strong emphasis on dissuasion of the use of drugs, harm prevention, treatment, rehabilitation, and social programs assisting with education, housing, and job training.
After the first ten years, the country's overdose fatalities had decreased to just 30 per year, and the number of people using substances had been cut in half. In the last few years, OD deaths have increased in Portugal due to toxic supply and the pandemic. Portugal’s numbers still remain the lowest in Europe and around the world but unsafe supply and lack of access to services have also taken a toll there as it has worldwide.
Also, to state this again, to be clear and concise, the Portugal model does not provide a safe supply. They provide medicinal addiction treatment that includes opiate agonists such as methadone and suboxone.
Another European country that does dispense opioids (regulated supply) is Switzerland. Switzerland's progressive and controversial drug policies include the dispensing of heroin(9)(10). They went through similar problems as Portugal and implemented similar solutions including augmenting agonist treatments such as methadone and suboxone with a safer supply of opioids.
In contrast, BC, Canada, has a population of 5 million compared to Portugal's 10 million people. In 2021, Portugal experienced 74 overdose deaths compared to 2306 in British Columbia. We could have saved the lives of approximately 2200 people in BC in that year alone if we were followed a program similar to the Portugal model.
Europe’s drug-monitoring agency says Portugal’s mortality rate from drugs is now more than four times lower than the European average. Portugal poured the money they were using in policing into the health care system. Costs related to drugs in the criminal system have been reduced significantly. (13)
Here in BC, we already have some very small regulated supply initiatives. For example, located in Vancouver’s Down Town East Side, (11) (12) in 2020 an agency called MYSAFE opened opiate vending machines where people who use substances can access a prescribed regulated supply of hydromorphone. In 2022, PHS Vancouver community services launched a prescribed take-home fentanyl program to improve much-needed access to a regulated supply. Other programs are being considered as well like the concept of compassion clubs. The Drug User Liberation Front has been able to obtain, test, and provide a regulated supply to many who live in the DTES and are unable to obtain prescriptions for many reasons. Those reasons may include not having a doctor and/or not having a doctor willing to prescribe a regulated supply; more reasons include the more marginalized and disenfranchised members of our community who do not have medical cards, ID, addresses, phones and so on. The strict medical approach with regulated supply serves a few but misses many.
Pros – The Case For Regulated Supply
First of all, regulated supply programs do not happen in a vacuum by themselves. Those countries that have successfully reduced overdose deaths have done so with combinations of programs that include, harm reduction, treatment, decriminalization, law enforcement for trafficking, and moving substance disorders into health programs and social programs.
Illegal drugs cost all of us worldwide billions of dollars every year in increased health care costs, property crimes, and loss of life. At the same time, the illegal narcotics trade has proven to be very lucrative for certain groups in society. Failed drug policies across the world contribute significantly to the mess, making the need for a regulated drug supply greater than it has ever been.
A regulated drug supply ensures drug quality and safety: A regulated drug supply ensures that drugs are manufactured, labeled, and distributed in a way that meets quality and safety standards set by regulatory authorities. This helps to reduce the risk of harmful or ineffective drugs reaching the market.
A regulated drug supply can help to reduce drug-related harm by ensuring that drugs are dosed correctly and labeled with clear instructions for use. This can help to prevent accidental overdoses, drug interactions, and other adverse effects.
In programs like DULF in DTES, they have created their own packaging with information on it similar to prescription labeling. This is possible due to the testing of the product long before it is given or sold during advocacy events. People know exactly what they are getting, similar to the vending machines and the take-home program.
A regulated drug supply can help to combat drug-related crime by reducing the black market for drugs. When drugs are available through legal channels, there is less incentive for criminals to engage in drug trafficking and other illicit activities. (no profit margin in the illegal drug market)
A regulated supply can improve public health by ensuring that people have access to safe and effective drugs. This can help to prevent and treat diseases, reduce the spread of infectious diseases, and improve overall health outcomes. Overall, a regulated drug supply can help to protect public health, reduce drug-related harm, and improve the quality of life for individuals and communities.
Perhaps the single greatest reason to implement regulated supply – dead people do not get a chance to seek help.
Author: Ron Merk – Ron is a person with lived experience and advocates for people and family with concurrent disorders.
Note: We may use words or phrases in our articles that are not first person, or the latest best-in-practice language. Sometimes we will use older, non-informed jargon. to clarify and inform people who are learning the new non-stigmatizing language. (linking old language usage to new terms) You can tell when you run into these old or non-inclusive words or phrases. They will be in quotation marks - eg old word “addiction” – When we introduce new inclusive language, words or phrases, they will be in Parenthesis - eg (people with substance disorders).
Families Helping Families is an initiative of the Port Alberni Community Action Team. We regularly send out "Learning Moment" articles to help folks understand substance illness. Knowledge is vital in understanding the disorder of our family members. You may copy, distribute or share our articles as long as you retain the attribution. Add yourself to our distribution list by dropping us a note at - albernihelp@gmail.com
Resources:
1. Drug Policy and the War on Illegal Drugs – Social Problems (https://open.lib.umn.edu/socialproblems/chapter/7-5-drug-policy-and-the-war-on-illegal-drugs/)
2. Explaining Drug Use – Social Problems - University of Minnesota (https://open.lib.umn.edu/socialproblems/chapter/7-4-explaining-drug-use/)
3. The Iron Law Of Prohibition – Wikipedia
The iron law of prohibition is a term coined by Richard Cowan in 1986 which posits that as law enforcement becomes more intense, the potency of prohibited substances increases. Cowan put it this way: "the harder the enforcement, the harder the drugs."
4. Today's fentanyl crisis: Prohibition's Iron Law, revisited
Under the Iron Law of Prohibition, efforts to interrupt and suppress the illicit drug supply produce economic and logistical pressures favouring ever-more ...
5. A safer drug supply: a pragmatic and ethical response to the overdose crisis
Tyndall M. A safer drug supply: a pragmatic and ethical response to the overdose crisis. CMAJ. 2020 Aug 24;192(34):E986–7. doi: 10.1503/cmaj.201618. PMCID: PMC7840515.
6. Safer Supply – The Government of Canada
7. The Ontario HIV Treatment Network – Possible Advantages to Safer Supply
8. Vancouver’s Drug Dispensing Machines – How they Work
9. Switzerland – In addition to Social Initiatives, a Real Safe Supply Trial https://www.northcarolinahealthnews.org/2019/01/28/switzerland-fights-heroin-with-heroin/
10. Decriminalizing Drugs in Switzerland - https://www.swissinfo.ch/eng/focus-page-drugs-policy_how-far-is-switzerland-willing-to-go-when-it-comes-to-decriminalising-drugs-/45810320
11. Vending Machines Dispense Safe Drugs In Canada https://mysafe.org/2021/04/vice-a-vending-machine-in-canada-is-dispensing-a-drug-twice-as-strong-as-heroin/
12. Safe Supply Begins Perscribing Take Home Fentanyl In Vancouver https://www.bccsu.ca/blog/news/vancouver-safe-supply-program-begins-prescribing-take-home-fentanyl/
13. Portugal Decriminalizes https://www.cbc.ca/news2/interactives/portugal-heroin-decriminalization/
14. Banned Books in History - https://www.freedomtoread.ca/resources/bannings-and-burnings-in-history/
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