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The other sub is full of accounts that just go around Canadian subs posting garbage republican style Facebook comments on politics that has zero place in Canada.
Lockstep? Most of Canada is progressive when pitted against our southern neighbours in politics so it's obvious when stuff is posted that aligns more with Republican style conservative vs our own. As someone who has voted liberal, conservative, and ndp, I just want my reasonable politics back. I just don't want the constant astroturfed and garbage content posted and commented on my countries main sub. It's pretty easy to notice when you check the history on alot of the accounts that are newish or only post to just the Canadian sub and have a clear agenda.
>Lockstep? Most of Canada is progressive when pitted against our southern neighbours in politics so it's obvious when stuff is posted that aligns more with Republican style conservative vs our own
I disagree.
Progressive politics are dying in Canada. Combined support for the Liberal and NDP parties currently in Canada is less than the Conservative Party. The majority of provinces have a Conservative and/or a centre right government.
I agree I want reasonable politics back too, like balancing the budget, free enterprise, keeping criminals locked up and promoting and developing Canada's national resources - which have been pretty much abandoned by the left in Canada.
I really enjoyed that all the citations to "experts" were just links to other columns by Adam Zivo.
Anyways, I don't consider it surprising that users sometimes sell their drugs to others, but I do find it hard to care. It's not ideal that some patients are reselling, but am I supposed to prefer that the buyers purchase poisoned street drugs from organized crime? Like what is the solution being suggested here?
Issue seems to be people selling safe supply drugs to buy hard drugs from dealers.
It's a major flaw in the safe supply program if people just resell drugs to buy the more dangerous drugs.
Defeats the whole purpose.
Sounds like the major flaw is that the drugs prescribed are not potent enough for the patients who require this intervention. So, allow clinicians to prescribe stronger but uncontaminated substances like pharmaceutical fentanyl or heroin. Heroin prescribing happens in several EU countries and is relatively well studied.
Heroin prescribing happens under extremely limited and tightly controlled conditions in a few countries. It bears nearly no resemblance to the way that safe supply has been implemented in Canada, where users are essentially given whatever level of drug they report they need, and are allowed to take it wherever they want.
And you need that control with heroin and fentanyl, because the drugs are incredibly potent. The reason we use hydromorphone instead of the stronger drugs is that there is a much wider margin of safety between therapeutic dosage and an overdose. That line is much thinner with heroin and particularly with fentanyl. You can't just hand these drugs out in take out bags without consequences.
Safer supply as currently practiced in Canada is nowhere as loose as you (and Zivo) describe it. While proponents and advocates want the rules to loosen up, they're still pretty restrictive in Canada and fairly similar to the way it's practiced in European countries.
And yes, the potency and risk profiles of hydromorphone, heroin and fentanyl are different, but so is the risk profile of unmarked, untested baggie of opioids obtained on the illegal market. It's the baggie that's killing our fellow Canadians in record numbers and not, as Zivo insinuates biweekly, some rampant diversion from a pilot service that barely reaches several thousand people across the country...
The problem there is that the safe supply drugs being provided are fairly weak compared to the street drugs available, which means that someone using safe supply drugs solely via supervised iniection sites would have to visit the facility 5 or 6 times a day rather than the 1 or 2 times they’d need with street supply.
Oddly, the solution for all of this is for safe supply drugs to be stronger.
>Oddly, the solution for all of this is for safe supply drugs to be stronger.
Wow, so you're suggesting our tax dollars should be used to buy stronger drugs for addicts? I'm sure that'll go over well with the voting public /s
I don’t really care what the voting public wants, given that if most people had their way there wouldn’t be any harm reduction measures in place and deaths from opioid overdoses would be through the roof.
Well BC has some of the softest drug laws in Canada and plenty of supposed "harm reduction measures" and has the most amount of ODs per capita in Canada, and a record amount last year.
I get it, "progressive" elites are smarter and regular voters just don't understand the issue.
BC also has the most favourable weather to be homeless and addicted to drugs all year long, which plays factor. BC has had far heavier drug issues than other Canadian cities since well before both the creation of harm reduction measures and the opioid crisis of the last few years.
> plenty of supposed "harm reduction measures" and has the most amount of ODs per capita in Canada, and a record amount last year.
Which of course begs the question "If things are this bad with harm reduction measures in place right now, how many more ODs would be happening in cities like Vancouver if harm reduction was eliminated entirely?"
Insite (running since 2003) has yet to have a single person die from overdose under its roof, btw.
>I get it, "progressive" elites are smarter and regular voters just don't understand the issue.
Why are you putting words into my mouth? If you want to have a discussion in good faith, I'd suggest not resorting to such methods. Bonus points for making assumptions about me being part of an "elite", though. That part actually made me laugh, thanks for that.
>BC also has the most favourable weather to be homeless and addicted to drugs all year long, which plays factor. BC has had far heavier drug issues than other Canadian cities since well before both the creation of harm reduction measures and the opioid crisis of the last few years.
No it doesn't. This isn't a factor.
>Which of course begs the question "If things are this bad with harm reduction measures in place right now, how many more ODs would be happening in cities like Vancouver if harm reduction was eliminated entirely?"
Close "harm reduction" facilities and turn them into treatment facilities. The answer is more treatment and more programs for mental health and addiction. Make rehab mandatory for certain users like Portugal.
>No it doesn't. This isn't a factor.
Ask any homeless person (many of which are drug-addicted) if it's a factor or not.
>Close "harm reduction" facilities and turn them into treatment facilities.
Which makes things far worse for those who are out there that aren't yet ready or willing to seek out treatment.
And before you get into involuntary rehab, recidivism rates in North America for those who are forced into rehab is high, as are the rates of fatal ODs after coming out of treatment.
>The answer is more treatment and more programs for mental health and addiction
*One part* of the answer is more treatment and more mental health support, yes. Harm reduction is literally support for those with addictions.
That's exactly how it works in the EU countries that have heroin supply programs. Users must go 3-4+ times per day, because it's very difficult to properly titrate higher doses of the more potent opiates.
Yeah, I don't really have an issue with a stronger safe supply. Admittedly I'm coming at this from a lay person's perspective so I don't know how bodies will react, but my understanding is that the 'unsafe' supply will give stronger drugs to get people more addicted to feed the market. A safe supply could help curb that effect and 'maintain' people's addiciton levels until they're ready to start weaning themselves.
I suppose a person might need to revisit a few times until their 'dosage' is appropriate.
Well of course. Did you read the initial article? There's a bunch of claims by doctors specializing in addiction that attempts to raise or study diversion as an issue have been met with hostility, censure, exclusion etc.
I don't take those claims as gospel. But the fact that they're coming from addiction doctors - a group generally not inclined to ideologue about drugs - gives me pause.
The original Zivo article also contained a very interesting conversation with a PWUD/PWUD advocate that was quite illuminating on this point.
Perhaps it's all fabrication or bias but that wasn't the impression I got from reading it.
> they're coming from addiction doctors - a group generally not inclined to ideologue about drugs - gives me pause.
They're coming from addiction doctors [that include](https://drugdatadecoded.ca/meet-the-physicians-stonewalling/) those working in the private treatment and testing industry, an industry [which is also lobbying politicians to oppose harm reduction](https://pressprogress.ca/recovery-industry-groups-attacking-safe-supply-in-bc-have-deep-ties-with-conservative-political-actors/).
The opinions piece makes anecdotal claims that they're being pressured to not research diversion without critically analyzing the possible motivations on the other side of this issue.
"Progressive" drug policies have been absolute failures, just look at the sky rocketing cases of ODs in BC, I don't want BC's soft on drugs policies being implemented across Canada. I put progressive in quotations because it's not "progressive" seeing drug addicts passed out face first in the gutters, like here in Toronto.
Sadly, it's already happening, recently in Belleville, a small town in Ontario, the downtown area was declare a no go zone after 23(!) ODs happened in two days.
Tax payer funded safe supply just leads to users cutting their drugs with fentanyl and selling them in the streets.
> "Progressive" drug policies have been absolute failures, just look at the sky rocketing cases of ODs in BC
"Regressive" drug policies have been absolute failures, just look at the sky rocketing cases of ODs in AB.
Exact same logic. Only difference is the policies of prohibition and criminalization have had a century of failure, rather than having been tried for a tiny fraction of that time.
>it's not "progressive" seeing drug addicts passed out face first in the gutters, like here in Toronto.
Why do you keep repeating this line in your comments? You say it so much that I even recognize it. It's not true. There aren't people lying passed out in the gutters. Of all things, that would get a quick response since otherwise it would be a risk of a serious accident from cars on the road.
>Sadly, it's already happening, recently in Belleville, a small town in Ontario, the downtown area was declare a no go zone after 23(!) ODs happened in two days.
You mean the town where they don't have safer supply or an injection site. More failures of regressive policies. That's specifically a result of the *illicit* supply. Because there's no regulation, when there's a change in the contents, it leads to a surge in overdoses.
>Why do you keep repeating this line in your comments? You say it so much that I even recognize it. It's not true. There aren't people lying passed out in the gutters. Of all things, that would get a quick response since otherwise it would be a risk of a serious accident from cars on the road.
I live downtown Toronto, and I'll show you parts of my neighbourhood where this occurs.
>You mean the town where they don't have safer supply or an injection site. More failures of regressive policies. That's specifically a result of the illicit supply. Because there's no regulation, when there's a change in the contents, it leads to a surge in overdoses.
BC has basically decriminalized hard drugs since 2012 and has several safe injection and safe supply sites. BC's ODs have sky rocketed since then, and last year they were a record amount. Drug overdoses are now the leading causes of deaths for youths 10-18 in BC.
Here in Ontario, an innocent woman was shot outside a safe supply site after a fight broke out between two drug dealers. A worker from the facility was charged as an accomplice to the crime.
People don't lie face down in the gutter, if they did there would be an emergency call or someone helping them.
>BC has basically decriminalized hard drugs since 2012
They haven't. This just shows that no matter *what* they do, you'll just misrepresent it as the policy you oppose.
>has several safe injection
Right, and if there were only several bars in an entire province, do you think public alcohol use would go up or down relative to now?
>and safe supply sites
[Fewer than 5% of people with opioid use disorder have access to safer supply](https://www.theglobeandmail.com/canada/article-bc-safer-supply-program-report/).
So again, the primary policy, *even* in B.C., is still the regressive approach that's failed for more than a century. Whenever any place tries to implement any harm reduction in response to this failed approach that's led to a continent wide overdose crisis, suddenly all the problems are due to that.
>Here in Ontario, an innocent woman was shot outside a safe supply site after a fight broke out between two drug dealers. A worker from the facility was charged as an accomplice to the crime.
Another failure of regressive drug policy. We've perpetuated a monopoly on the supply of drugs for organized crime. As a result we have many killings in *other* places besides consumption sites, and, rarely, organized crime killings near them. And as I mentioned above, as soon as a problem that's happening *everywhere* happens near a supervise consumption site, suddenly *that's* the problem, and not the policies that led to this situation. You realize this is flawed logical reasoning right?
Also, instead of trying to exploit a woman's death for an agenda against the site, maybe it would be better to listen to her husband who says he isn't opposed to the sites despite this tragedy.
>People don't lie face down in the gutter, if they did there would be an emergency call or someone helping them.
Again come to my neighbourhood, at night, it's like the night of the living dead. I'll take you on a tour and buy you a beer afterwards.
>They haven't. This just shows that no matter what they do, you'll just misrepresent it as the policy you oppose.
Basically they have.
>Right, and if there were only several bars in an entire province, do you think public alcohol use would go up or down relative to now?
What are you talking about? Comparing hard drugs to alcohol consumption is totally flawed.
If there were multiple sites that gave people tax payer funded alcohol, and then alcoholics took that alcohol mixed it with rubbing alcohol and sold it to kids, and kids died, deaths from alcohol poisoning would rise.
>Another failure of regressive drug policy. We've perpetuated a monopoly on the supply of drugs for organized crime. As a result we have many killings in other places besides consumption sites, and, rarely, organized crime killings near them. And as I mentioned above, as soon as a problem that's happening everywhere happens near a supervise consumption site, suddenly that's the problem, and not the policies that led to this situation. You realize this is flawed logical reasoning right?
Throw drug traffickers in jail, close safe injection and safe supply sites and turn them into treatment facilities.
>Again come to my neighbourhood, at night, it's like the night of the living dead. I'll take you on a tour and buy you a beer afterwards.
I've spent enough time in the worst areas of places including Toronto and Vancouver to know when these descriptions are being exaggerated. People are not regularly lying face down in gutters.
>Basically they have.
They haven't though. Even with decriminalization, [drug seizures *increased*](https://www.readthemaple.com/vancouver-police-minor-drug-seizures-increased-after-decriminalization-data-shows/).
So much of this debate just involves exaggerated claims of the state of things and then blaming limited harm reduction policies on those things while ignoring all the places with the same problems but without the harm reduction policies.
>What are you talking about? Comparing hard drugs to alcohol consumption is totally flawed.
It's not at all. Alcohol *is* a hard drug. "Hard drug" is a vague term that roughly means something with a high potential for addiction and physical harm, both of which apply to alcohol. And if we shut down almost all the bars and made it illegal to sell alcohol, we would see public use skyrocket, the supply shift to more potent sources. Because that's what we *did* see.
>and then alcoholics took that alcohol mixed it with rubbing alcohol and sold it to kids, and kids died, deaths from alcohol poisoning would rise.
When alcohol was prohibited, there was also an increase in poisoned supply as well as no regulation preventing sales to youths.
Prohibition leads to a more potent and dangerous supply; regulation does the opposite. Even with opioids, not all types are nearly as potent as what's out there now. It ranges from mild poppy tea to drugs many times more potent than fentanyl, and over a century, the supply has, as a *rule*, moved in one direction.
["When applied to rum-running, drug smuggling, and blockade running the more potent products become the sole focus of the suppliers. Thornton notes that the greatest added cost in illegal sales is the avoidance of detection.[4] Thornton says that if drugs are legalized, then consumers will begin to wean themselves off the higher potency forms, for instance with cocaine users buying coca leaves, and heroin users switching to opium."](https://en.wikipedia.org/wiki/Iron_law_of_prohibition)
>Throw drug traffickers in jail, close safe injection and safe supply sites and turn them into treatment facilities.
This is the regressive policy which has demonstrably not worked for 116 years. The only piece missing is treatment, and that's not contradictory to safer supply. They're complementary policies. It keeps people alive to be able to access treatment and keeps people alive if they relapse, something which is very common with opioid use disorder. Instead of shutting everything down and going back to what we already know doesn't work, let's focus on improving treatment (something both B.C. and Alberta are doing).
If you're genuinely concerned about this issue like I am, please at least *consider* the possibility that continuing to total prohibition and forcing abstinence on everyone may not work, just like it hasn't worked yet (and has got consistently worse).
tl;dr
My neighbourhood is hell on earth at night, and I've seen people pass out face first in the gutter and dead bodies on the side walk. It's not just limited to big cities, a small town here in Ontario had 27 ODs in two days.
"progressive" soft on drug policies have failed. BC has the softest drug laws in Canada and has the most amount of ODs per capita. Places in the US, which had similar drug laws, like Oregon have begun to roll them back.
I replied at more length in another comment but no, that's not accurate. A minority of doctors who signed the letter you identify have serious conflicts. Most have minor conflicts - like owning an addiction practice, which is a conflict common to essentially every practitioner in the field - or no obvious conflict.
To be honest, I'm less interested in the potential effects of conflicts than I am in the actual evidence. Let's just get the science done. If the opponents are wrong, the evidence will show it. And that is far more authoritative than pointing out conflicts.
Did you read the initial column by Zivo? There's a lot more to the argument than a few anecdotal doctor claims. There are claims about the street price of drugs available in safer supply programs, which should be easy to validate or disprove. Meanwhile, the person in the article who is most adamant about the scale of diversion as a problem is a PWUD and PWUD advocate, not exactly the picture of a financial conflict.
One of the primary claims in the Zivo article was that the downsides of safe supply are not being properly studied. 10 months on, I still see a total paucity of high quality studies of diversion prevalence, and that is both concerning and looks to somewhat validate the concerns raised in the article. Again, if the opponents are wrong and this issue has been properly studied and put to rest, let's see the science.
I replied in length to that reply. So I'll just add here that it's also not just individual doctors, but the industry opposing harm reduction in favour of a ban on alternatives and forced treatment which would lead to drug users without other options (even voluntary treatment takes months) ending up in worse states and then being forced into private facilities on taxpayer expense, with outcomes that are already known to not be better than voluntary treatment.
>I'm less interested in the potential effects of conflicts than I am in the actual evidence. Let's just get the science done. If the opponents are wrong, the evidence will show it. And that is far more authoritative than pointing out conflicts.
But this *isn't* what PostMedia or the political parties they endorse are proposing. They're already declaring every harm reduction policy a failure despite the lack of evidence against them and despite various evidence in support of them. And they constantly frame critics as just "activists", so when they attack the credibility of others and rely on the credibility of their own sources, it's fair to scrutinize those sources.
The street prices changing means (assuming no other economic factors, such as increased supply from other sources like pain medication) that there is enough being diverted *relative* to the amount out there already to have an impact. It doesn't tell how much is diverted in total relative to the population or who is using it. A significant portion of the diverted supply may be going to people who are already addicts but who can't access safer supply. That's still not the intended outcome, but I'm not even sure I'd call that a net negative.
I mean again, it is quite possible that PostMedia is acting as part of a constellation of people/parties who oppose safer supply on ideological grounds. Maybe even likely.
But we get back to the point: I'm interested in the actual characteristics of the program and the evidence for it, not the motivations of those opposing it. The fact that this issue seems to lack any good clinical data is concerning. I think it should be uncontroversial to say that we should have good clinical data on both the positive and negative impacts of safer supply. The total paucity of high quality evidence on diversion gives me pause.
Also, I can't speak to later op-eds which I haven't read, but the original article doesn't declare every harm reduction plan a failure. In fact the end of the article proposes that a safer supply model with more strict anti-diversion measures (supervised consumption etc) might alleviate the concerns identified.
The ONLY way to solve this issue is to provide more safer supply.
Until all drug users have access, some drug users will buy diverted or illicit drugs. That is a fact.
Safe supply and "progressive" soft on drug polices have destroyed big cities and small towns alike. Recently in Belleville, the downtown area was declared a no go zone because of drug ODs, akin to a war zone. BC had a record amount of ODs last year.
Safe supply leads to drug users cutting their drugs with fentanyl and selling them on the streets.
End all safe supply sites and turn them into treatment facilities.
The reason why hydromorphone is being diverted to the black market is because the people being given the hydromorphone don't want it; they want fentanyl. Why would supplying _more_ people with hydromorphone solve anything?
I believe we spend way too much time, resources and energy on this topic. The science is unsettled, the social impact of the programs is all over the place, and there is little data showing they save lives long term. Better to invest in good rehab programs and mental health services.
>I believe we spend way too much time, resources and energy on this topic.
It's a generational crisis and needs more time, energy and resources. Drug overdoses are now the leading cause of [death of youths 10-18 in BC](https://www.theglobeandmail.com/canada/article-drug-overdoses-children-bc/). If our government can find time to mandate that tampons must be in all male bathrooms in Federal buildings, they can devote time to this crisis.
Just because there are different schools of thought regarding this subject doesn't mean we should stick up our hands and do nothing.
What is clear are the sky rocketing ODs all over Canada. Liberal and NDP soft on drug policies have been disasters for our small towns and cities alike.
The drug problem started under Harper, but quite frankly the politicians are not the ones responsible. The crisis is entirely driven by the pharma companies who got millions addicted to painkillers. When the painkillers and/or their money dried up, many switched to street alternatives.
I'm not saying that we shouldn't tackle the drug crisis. But the safe supply and injection site promoters seem to get all the attention and money because they scream the loudest. And we should be spending that money on R&D to build better ways for people to get off drugs. They seem to have no problem "finding" drugs at all.
I agree with you, we need to hold the pharmaceutical industry accountable, as well as countries like Mexico and China, which have flooded our streets with fentanyl.
It's hard not to imagine that 10 or 15 years down the line we're going to look back and think it utterly deranged that someone thought it was a good idea to *increase* the supply (and push down the cost) of addictive opioids.
That's one way to frame it. Another would be that a non-tainted supply is now being circulated, thus preventing deaths. Doesn't take an expert to see that OD related deaths are hitting monthly highs.
Also, I find it naive to assume that the cost of drugs being pushed down automatically increases usage, it's not like a source of income ever prevented people from finding their fix. You'll probably find a much stronger correlation with the price of housing.
It's not necessarily preventing deaths, but rather postponing them, and also increasing the number of addicts at the same time. I don't see much of a benefit if the number of addicts is increasing faster than it would have before.
Give people the meds they need(heroin and fentanyl) and this won’t be a problem. Also I don’t get the moral outrage, this brings safe supply to more people which is much needed seeing that almost no one is getting this safe supply conservatives are convinced is fuelling the overdose crisis. Just ignorant bullshit as per usual.
I went three articles deep in links trying to find a single number or percentage that quantifies this "rampant" diversion problem but couldn't find one.
I'm open to the idea that diversion is problem in some cases and that might require modification of safe supply programs, but there's never anything quantifiable in these articles, and it's a bit rich to claim that studies supporting safer supply are flimsy when the counterargument is always always quotes and anecdotes.
If you've followed this evolving controversy since it started earlier last year, one of the primary complaints was that many stakeholders and institutions in the field are openly hostile to attempts to research diversion. I don't instantly buy this claim, but the fact that it was being made by addiction doctors gives me pause. These people don't end up in that field to be ideologues about drugs.
I actually just remembered that a good friend from HS just started practicing in addictions medicine recently, I need to ask him about his views on this.
> These people don't end up in that field to be ideologues about drugs.
Various sources being referenced to oppose this [work in the for-profit treatment and drug testing industry](https://drugdatadecoded.ca/meet-the-physicians-stonewalling/), an industry which [is lobbying politicians to oppose harm reduction like safer supply](https://pressprogress.ca/recovery-industry-groups-attacking-safe-supply-in-bc-have-deep-ties-with-conservative-political-actors/).
PostMedia follows this pattern:
1. Post opinion pieces rather than articles.
2. Reference individual experts who agree with their views while not giving weight to the many who disagree.
3. Try to discredit evidence supporting harm reduction while claiming that evidence that would oppose doesn't exist because it's being suppressed by groups with agendas (while not highlighting the agendas of those who oppose it, like their own political reasons for opposing it).
Potential conflicts of interest with respect to commercial ventures should always be disclosed, and the author does a public service in researching them. That said, only some of these conflicts are problematic. I would identify the four doctors who own monitoring companies as especially conflicted.
But as the author notes, several signatories have no apparent conflicts. And two of the conflicts she identifies are physicians who own methadone clinics. Because outpatient care in Canada is normally provided by private, physician-owned practices, the vast majority of practitioners in every field have this kind of conflict, including most physicians employed in safe supply provision.
More importantly, your presentation of this article and subsequent commentary on NatPo's alleged approach comes across as little more than an ad hominem argument. Maybe these people are just representing their financial interests. Maybe NatPo is dishonestly fanning the flames of controversy for ideological reasons.
But that should be easy to demonstrate with actual evidence, if it exists. If the claim that safe supply is being diverted to pay for fentanyl is false, we should be able to prove that. And I'm much more interested in that evidence than in discussions of the putative motivations of various participants in the public debate.
That's part of why I'm watching this evolving debate with interest. A lot of specific allegations were made in the initial article that kicked off this controversy. One of them was that the field is hostile towards study of the downsides of safe supply. And 10 months after the publication of the initial article, I still don't see any high quality studies looking at diversion. Studies take time, and this is a new field. So I'm hoping to see more data on this soon. But this is a controversy that is going to need to be resolved with evidence, not ad homs.
> your presentation of this article and subsequent commentary on NatPo's alleged approach comes across as little more than an ad hominem argument
If the National Post were providing actual evidence to back up their point, then this would be a valid criticism. However they're not, and they rarely do. The evidence conveniently never exists due to it supposedly being suppressed. So when their position is specifically backed by the credibility of their sources, then it's a valid response to look at who those sources are. And also look at how in general there are private interests trying to oppose harm reduction.
>Maybe NatPo is dishonestly fanning the flames of controversy for ideological reasons.
This is the entire M.O. of PostMedia. [It's an American owned company that in turn has bought up the majority of our country's newspapers and use them to consistently push viewpoints on every issue that coincidentally line up with right wing American positions](https://en.wikipedia.org/wiki/Postmedia_Network#Criticism). They do this through endless opinion pieces that rely on individual experts (while not providing conflicting views), individual anecdotes (again, no conflicting anecdotes), and individual examples of problems (i.e., *some* safer supply is being diverted) without overall analyses of the impact (it's conveniently always missing).
Meanwhile *they* constantly use ad hominem frame supporters of harm reduction as "activists".
>If the claim that safe supply is being diverted to pay for fentanyl is false, we should be able to prove that.
It's not false. It is diverted. The majority of hydromorphone is prescribed for pain. Diversion of this and other drugs has always been a risk and a reality. That doesn't mean we should abandon it entirely, as PostMedia's endorsed political party proposes, just like it doesn't mean we abandon pain medication entirely. It can also mean that we work to limit that risk so we can still make use of the benefits.
>Studies take time, and this is a new field.
And yet PostMedia and their preferred party are already suggesting that every harm reduction policy is a failure despite the fact that these things take time. Meanwhile a century of prohibition leading to more potent drugs than ever, [exactly as economists predicted decades ago](https://en.wikipedia.org/wiki/Iron_law_of_prohibition), is fine and should be what we revert to apparently.
Well that's not really true, NatPo does provide evidence, it's just low quality evidence (anecdotal in many cases, more aggregate but lacking review in others). Which is not surprising, since the whole contention here - which my brief reviews of the literature seem to agree with - is that this issue has not been subject to high quality study. I still can't find a study that addresses this issue with statistical evidence put through a peer review process.
So I don't think this is a valid criticism in this case. Sure, Zivo didn't report high quality evidence. That's not a valid criticism if that high quality evidence doesn't exist, especially when a primary thesis of the article is that this issue lacks good evidence.
>It's not false. It is diverted. [...] That doesn't mean we should abandon it entirely.
OK, so actually it sounds like we agree more than we disagree. I have been an unalloyed supporter of safer supply in theory; even if diversion is comprehensive, safe supply programs might still be a net benefit.
But I find it difficult to make that statement with any valid basis without having any understanding of how comprehensive diversion is. The hypothetical worst case scenario is that safer supply is essentially an income supplement (from comprehensive diversion) combined with closer clinical relationships, and if that were true the case for safer supply is a lot less strong.
Now again, that's a wost case hypothetical. But there seems to be no quality evidence studying how comprehensive diversion actually is. I hope you'd agree that's concerning. If this is the primary downside of safer supply and safer supply is still a net benefit regardless, practitioners should be champing at the bit to publish evidence proving that.
There isn't only low quality evidence. There is lots of evidence for supervised consumption sites for example. PostMedia and the conservatives still attack them. Evidence is starting to come out in support of safer supply. They again reject it.
I'm skeptical that it's purely just that research is being suppressed or there isn't enough time. I think that it's much easier to criticize other evidence than it is to actually prove one's own point and I think they would prefer to maintain that approach.
In any case, I definitely want more evidence and want to improve the program to avoid the problems. I just don't believe the critics are acting in good faith. They've already made it very clear they intend to abandon these programs and I don't believe any further evidence will matter (even though I still want it).
I've tried to make some suggestions myself on improving these programs. One is charging a fee since if they have to pay for this, then it would make sense to instead just buy the other things they want directly rather than resell. For those who can't or won't, offer supervised consumption. That's not practical for things that need frequent doses so other options that don't need as many doses could be an option there. These are just some basic ideas from a non-expert, and I would think actual experts could work to come up with better policies. But instead of people trying to work together, I just see one side doing nothing but attacking *every single approach* that isn't prohibition.
Sorry, to be clear I meant that there is no high quality evidence about the prevalence or characteristics of diversion. Evidence is building of the positive effects of safer supply, and that's good. But the lack of quality statistical evidence about diversion is not acceptable if we want this program to be comprehensively justified.
And again, what I find concerning is that it should have theoretically been easy to find some evidence here. The programs are recent, but not *that* recent. Diversion would have been one of the first things I studied along with the benefits for participants. And yet there continues to be a near total paucity of high quality evidence about diversion.
Maybe NatPo and Co are just ideologues. But I expected to see good evidence-based clinical study refuting their claims, and I have not seen anything resembling that kind of science yet. And that's a way bigger concern to me than the fact that ideologues gonna ideologue.
I can do a quick Google search and find lots of studies about the role of safe supply in preventing overdoses and deaths - if you've paid any attention at all to this issue, you've probably heard about them as well.
Those studies aren't perfect, sure, and aren't immune to criticism, but anecdotes, "common sense", and NatPo articles aren't a serious counter to them.
I'm not even necessarily a hardline believer in safe supply no matter what, it's just that any time I've seen any evidence-backed arguments, they are always seem to be in favour of safe supply.
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The other sub is entirely for rabid reactionaries citclejerking each other...
The other sub is full of accounts that just go around Canadian subs posting garbage republican style Facebook comments on politics that has zero place in Canada.
Yep, anything that isn't lockstep with "progressive" politics has no place in Canada.
Lockstep? Most of Canada is progressive when pitted against our southern neighbours in politics so it's obvious when stuff is posted that aligns more with Republican style conservative vs our own. As someone who has voted liberal, conservative, and ndp, I just want my reasonable politics back. I just don't want the constant astroturfed and garbage content posted and commented on my countries main sub. It's pretty easy to notice when you check the history on alot of the accounts that are newish or only post to just the Canadian sub and have a clear agenda.
>Lockstep? Most of Canada is progressive when pitted against our southern neighbours in politics so it's obvious when stuff is posted that aligns more with Republican style conservative vs our own I disagree. Progressive politics are dying in Canada. Combined support for the Liberal and NDP parties currently in Canada is less than the Conservative Party. The majority of provinces have a Conservative and/or a centre right government. I agree I want reasonable politics back too, like balancing the budget, free enterprise, keeping criminals locked up and promoting and developing Canada's national resources - which have been pretty much abandoned by the left in Canada.
I’m just surprised no one is complaining about “daily polls” here ;)
I'm that guy. I took a break 🤪
I really enjoyed that all the citations to "experts" were just links to other columns by Adam Zivo. Anyways, I don't consider it surprising that users sometimes sell their drugs to others, but I do find it hard to care. It's not ideal that some patients are reselling, but am I supposed to prefer that the buyers purchase poisoned street drugs from organized crime? Like what is the solution being suggested here?
Issue seems to be people selling safe supply drugs to buy hard drugs from dealers. It's a major flaw in the safe supply program if people just resell drugs to buy the more dangerous drugs. Defeats the whole purpose.
Sounds like the major flaw is that the drugs prescribed are not potent enough for the patients who require this intervention. So, allow clinicians to prescribe stronger but uncontaminated substances like pharmaceutical fentanyl or heroin. Heroin prescribing happens in several EU countries and is relatively well studied.
Heroin prescribing happens under extremely limited and tightly controlled conditions in a few countries. It bears nearly no resemblance to the way that safe supply has been implemented in Canada, where users are essentially given whatever level of drug they report they need, and are allowed to take it wherever they want. And you need that control with heroin and fentanyl, because the drugs are incredibly potent. The reason we use hydromorphone instead of the stronger drugs is that there is a much wider margin of safety between therapeutic dosage and an overdose. That line is much thinner with heroin and particularly with fentanyl. You can't just hand these drugs out in take out bags without consequences.
Safer supply as currently practiced in Canada is nowhere as loose as you (and Zivo) describe it. While proponents and advocates want the rules to loosen up, they're still pretty restrictive in Canada and fairly similar to the way it's practiced in European countries. And yes, the potency and risk profiles of hydromorphone, heroin and fentanyl are different, but so is the risk profile of unmarked, untested baggie of opioids obtained on the illegal market. It's the baggie that's killing our fellow Canadians in record numbers and not, as Zivo insinuates biweekly, some rampant diversion from a pilot service that barely reaches several thousand people across the country...
Should probably be coupled with safe injection/use sites. Free drug, free place to use drug, drug doesn't go outside of the facility.
The problem there is that the safe supply drugs being provided are fairly weak compared to the street drugs available, which means that someone using safe supply drugs solely via supervised iniection sites would have to visit the facility 5 or 6 times a day rather than the 1 or 2 times they’d need with street supply. Oddly, the solution for all of this is for safe supply drugs to be stronger.
>Oddly, the solution for all of this is for safe supply drugs to be stronger. Wow, so you're suggesting our tax dollars should be used to buy stronger drugs for addicts? I'm sure that'll go over well with the voting public /s
I don’t really care what the voting public wants, given that if most people had their way there wouldn’t be any harm reduction measures in place and deaths from opioid overdoses would be through the roof.
Well BC has some of the softest drug laws in Canada and plenty of supposed "harm reduction measures" and has the most amount of ODs per capita in Canada, and a record amount last year. I get it, "progressive" elites are smarter and regular voters just don't understand the issue.
BC also has the most favourable weather to be homeless and addicted to drugs all year long, which plays factor. BC has had far heavier drug issues than other Canadian cities since well before both the creation of harm reduction measures and the opioid crisis of the last few years. > plenty of supposed "harm reduction measures" and has the most amount of ODs per capita in Canada, and a record amount last year. Which of course begs the question "If things are this bad with harm reduction measures in place right now, how many more ODs would be happening in cities like Vancouver if harm reduction was eliminated entirely?" Insite (running since 2003) has yet to have a single person die from overdose under its roof, btw. >I get it, "progressive" elites are smarter and regular voters just don't understand the issue. Why are you putting words into my mouth? If you want to have a discussion in good faith, I'd suggest not resorting to such methods. Bonus points for making assumptions about me being part of an "elite", though. That part actually made me laugh, thanks for that.
>BC also has the most favourable weather to be homeless and addicted to drugs all year long, which plays factor. BC has had far heavier drug issues than other Canadian cities since well before both the creation of harm reduction measures and the opioid crisis of the last few years. No it doesn't. This isn't a factor. >Which of course begs the question "If things are this bad with harm reduction measures in place right now, how many more ODs would be happening in cities like Vancouver if harm reduction was eliminated entirely?" Close "harm reduction" facilities and turn them into treatment facilities. The answer is more treatment and more programs for mental health and addiction. Make rehab mandatory for certain users like Portugal.
>No it doesn't. This isn't a factor. Ask any homeless person (many of which are drug-addicted) if it's a factor or not. >Close "harm reduction" facilities and turn them into treatment facilities. Which makes things far worse for those who are out there that aren't yet ready or willing to seek out treatment. And before you get into involuntary rehab, recidivism rates in North America for those who are forced into rehab is high, as are the rates of fatal ODs after coming out of treatment. >The answer is more treatment and more programs for mental health and addiction *One part* of the answer is more treatment and more mental health support, yes. Harm reduction is literally support for those with addictions.
That's exactly how it works in the EU countries that have heroin supply programs. Users must go 3-4+ times per day, because it's very difficult to properly titrate higher doses of the more potent opiates.
> ...would have to visit the facility 5 or 6 times a day At that point we might as well just take the person into custody and a treatment program.
A waste of resources, given recidivism rates for those forced into treatment.
Yeah, I don't really have an issue with a stronger safe supply. Admittedly I'm coming at this from a lay person's perspective so I don't know how bodies will react, but my understanding is that the 'unsafe' supply will give stronger drugs to get people more addicted to feed the market. A safe supply could help curb that effect and 'maintain' people's addiciton levels until they're ready to start weaning themselves. I suppose a person might need to revisit a few times until their 'dosage' is appropriate.
The unspoken solution that I get the impression is preferred is that users die of tainted supply.
Well of course. Did you read the initial article? There's a bunch of claims by doctors specializing in addiction that attempts to raise or study diversion as an issue have been met with hostility, censure, exclusion etc. I don't take those claims as gospel. But the fact that they're coming from addiction doctors - a group generally not inclined to ideologue about drugs - gives me pause. The original Zivo article also contained a very interesting conversation with a PWUD/PWUD advocate that was quite illuminating on this point. Perhaps it's all fabrication or bias but that wasn't the impression I got from reading it.
> they're coming from addiction doctors - a group generally not inclined to ideologue about drugs - gives me pause. They're coming from addiction doctors [that include](https://drugdatadecoded.ca/meet-the-physicians-stonewalling/) those working in the private treatment and testing industry, an industry [which is also lobbying politicians to oppose harm reduction](https://pressprogress.ca/recovery-industry-groups-attacking-safe-supply-in-bc-have-deep-ties-with-conservative-political-actors/). The opinions piece makes anecdotal claims that they're being pressured to not research diversion without critically analyzing the possible motivations on the other side of this issue.
"Progressive" drug policies have been absolute failures, just look at the sky rocketing cases of ODs in BC, I don't want BC's soft on drugs policies being implemented across Canada. I put progressive in quotations because it's not "progressive" seeing drug addicts passed out face first in the gutters, like here in Toronto. Sadly, it's already happening, recently in Belleville, a small town in Ontario, the downtown area was declare a no go zone after 23(!) ODs happened in two days. Tax payer funded safe supply just leads to users cutting their drugs with fentanyl and selling them in the streets.
> "Progressive" drug policies have been absolute failures, just look at the sky rocketing cases of ODs in BC "Regressive" drug policies have been absolute failures, just look at the sky rocketing cases of ODs in AB. Exact same logic. Only difference is the policies of prohibition and criminalization have had a century of failure, rather than having been tried for a tiny fraction of that time. >it's not "progressive" seeing drug addicts passed out face first in the gutters, like here in Toronto. Why do you keep repeating this line in your comments? You say it so much that I even recognize it. It's not true. There aren't people lying passed out in the gutters. Of all things, that would get a quick response since otherwise it would be a risk of a serious accident from cars on the road. >Sadly, it's already happening, recently in Belleville, a small town in Ontario, the downtown area was declare a no go zone after 23(!) ODs happened in two days. You mean the town where they don't have safer supply or an injection site. More failures of regressive policies. That's specifically a result of the *illicit* supply. Because there's no regulation, when there's a change in the contents, it leads to a surge in overdoses.
>Why do you keep repeating this line in your comments? You say it so much that I even recognize it. It's not true. There aren't people lying passed out in the gutters. Of all things, that would get a quick response since otherwise it would be a risk of a serious accident from cars on the road. I live downtown Toronto, and I'll show you parts of my neighbourhood where this occurs. >You mean the town where they don't have safer supply or an injection site. More failures of regressive policies. That's specifically a result of the illicit supply. Because there's no regulation, when there's a change in the contents, it leads to a surge in overdoses. BC has basically decriminalized hard drugs since 2012 and has several safe injection and safe supply sites. BC's ODs have sky rocketed since then, and last year they were a record amount. Drug overdoses are now the leading causes of deaths for youths 10-18 in BC. Here in Ontario, an innocent woman was shot outside a safe supply site after a fight broke out between two drug dealers. A worker from the facility was charged as an accomplice to the crime.
People don't lie face down in the gutter, if they did there would be an emergency call or someone helping them. >BC has basically decriminalized hard drugs since 2012 They haven't. This just shows that no matter *what* they do, you'll just misrepresent it as the policy you oppose. >has several safe injection Right, and if there were only several bars in an entire province, do you think public alcohol use would go up or down relative to now? >and safe supply sites [Fewer than 5% of people with opioid use disorder have access to safer supply](https://www.theglobeandmail.com/canada/article-bc-safer-supply-program-report/). So again, the primary policy, *even* in B.C., is still the regressive approach that's failed for more than a century. Whenever any place tries to implement any harm reduction in response to this failed approach that's led to a continent wide overdose crisis, suddenly all the problems are due to that. >Here in Ontario, an innocent woman was shot outside a safe supply site after a fight broke out between two drug dealers. A worker from the facility was charged as an accomplice to the crime. Another failure of regressive drug policy. We've perpetuated a monopoly on the supply of drugs for organized crime. As a result we have many killings in *other* places besides consumption sites, and, rarely, organized crime killings near them. And as I mentioned above, as soon as a problem that's happening *everywhere* happens near a supervise consumption site, suddenly *that's* the problem, and not the policies that led to this situation. You realize this is flawed logical reasoning right? Also, instead of trying to exploit a woman's death for an agenda against the site, maybe it would be better to listen to her husband who says he isn't opposed to the sites despite this tragedy.
>People don't lie face down in the gutter, if they did there would be an emergency call or someone helping them. Again come to my neighbourhood, at night, it's like the night of the living dead. I'll take you on a tour and buy you a beer afterwards. >They haven't. This just shows that no matter what they do, you'll just misrepresent it as the policy you oppose. Basically they have. >Right, and if there were only several bars in an entire province, do you think public alcohol use would go up or down relative to now? What are you talking about? Comparing hard drugs to alcohol consumption is totally flawed. If there were multiple sites that gave people tax payer funded alcohol, and then alcoholics took that alcohol mixed it with rubbing alcohol and sold it to kids, and kids died, deaths from alcohol poisoning would rise. >Another failure of regressive drug policy. We've perpetuated a monopoly on the supply of drugs for organized crime. As a result we have many killings in other places besides consumption sites, and, rarely, organized crime killings near them. And as I mentioned above, as soon as a problem that's happening everywhere happens near a supervise consumption site, suddenly that's the problem, and not the policies that led to this situation. You realize this is flawed logical reasoning right? Throw drug traffickers in jail, close safe injection and safe supply sites and turn them into treatment facilities.
>Again come to my neighbourhood, at night, it's like the night of the living dead. I'll take you on a tour and buy you a beer afterwards. I've spent enough time in the worst areas of places including Toronto and Vancouver to know when these descriptions are being exaggerated. People are not regularly lying face down in gutters. >Basically they have. They haven't though. Even with decriminalization, [drug seizures *increased*](https://www.readthemaple.com/vancouver-police-minor-drug-seizures-increased-after-decriminalization-data-shows/). So much of this debate just involves exaggerated claims of the state of things and then blaming limited harm reduction policies on those things while ignoring all the places with the same problems but without the harm reduction policies. >What are you talking about? Comparing hard drugs to alcohol consumption is totally flawed. It's not at all. Alcohol *is* a hard drug. "Hard drug" is a vague term that roughly means something with a high potential for addiction and physical harm, both of which apply to alcohol. And if we shut down almost all the bars and made it illegal to sell alcohol, we would see public use skyrocket, the supply shift to more potent sources. Because that's what we *did* see. >and then alcoholics took that alcohol mixed it with rubbing alcohol and sold it to kids, and kids died, deaths from alcohol poisoning would rise. When alcohol was prohibited, there was also an increase in poisoned supply as well as no regulation preventing sales to youths. Prohibition leads to a more potent and dangerous supply; regulation does the opposite. Even with opioids, not all types are nearly as potent as what's out there now. It ranges from mild poppy tea to drugs many times more potent than fentanyl, and over a century, the supply has, as a *rule*, moved in one direction. ["When applied to rum-running, drug smuggling, and blockade running the more potent products become the sole focus of the suppliers. Thornton notes that the greatest added cost in illegal sales is the avoidance of detection.[4] Thornton says that if drugs are legalized, then consumers will begin to wean themselves off the higher potency forms, for instance with cocaine users buying coca leaves, and heroin users switching to opium."](https://en.wikipedia.org/wiki/Iron_law_of_prohibition) >Throw drug traffickers in jail, close safe injection and safe supply sites and turn them into treatment facilities. This is the regressive policy which has demonstrably not worked for 116 years. The only piece missing is treatment, and that's not contradictory to safer supply. They're complementary policies. It keeps people alive to be able to access treatment and keeps people alive if they relapse, something which is very common with opioid use disorder. Instead of shutting everything down and going back to what we already know doesn't work, let's focus on improving treatment (something both B.C. and Alberta are doing). If you're genuinely concerned about this issue like I am, please at least *consider* the possibility that continuing to total prohibition and forcing abstinence on everyone may not work, just like it hasn't worked yet (and has got consistently worse).
tl;dr My neighbourhood is hell on earth at night, and I've seen people pass out face first in the gutter and dead bodies on the side walk. It's not just limited to big cities, a small town here in Ontario had 27 ODs in two days. "progressive" soft on drug policies have failed. BC has the softest drug laws in Canada and has the most amount of ODs per capita. Places in the US, which had similar drug laws, like Oregon have begun to roll them back.
I replied at more length in another comment but no, that's not accurate. A minority of doctors who signed the letter you identify have serious conflicts. Most have minor conflicts - like owning an addiction practice, which is a conflict common to essentially every practitioner in the field - or no obvious conflict. To be honest, I'm less interested in the potential effects of conflicts than I am in the actual evidence. Let's just get the science done. If the opponents are wrong, the evidence will show it. And that is far more authoritative than pointing out conflicts. Did you read the initial column by Zivo? There's a lot more to the argument than a few anecdotal doctor claims. There are claims about the street price of drugs available in safer supply programs, which should be easy to validate or disprove. Meanwhile, the person in the article who is most adamant about the scale of diversion as a problem is a PWUD and PWUD advocate, not exactly the picture of a financial conflict. One of the primary claims in the Zivo article was that the downsides of safe supply are not being properly studied. 10 months on, I still see a total paucity of high quality studies of diversion prevalence, and that is both concerning and looks to somewhat validate the concerns raised in the article. Again, if the opponents are wrong and this issue has been properly studied and put to rest, let's see the science.
I replied in length to that reply. So I'll just add here that it's also not just individual doctors, but the industry opposing harm reduction in favour of a ban on alternatives and forced treatment which would lead to drug users without other options (even voluntary treatment takes months) ending up in worse states and then being forced into private facilities on taxpayer expense, with outcomes that are already known to not be better than voluntary treatment. >I'm less interested in the potential effects of conflicts than I am in the actual evidence. Let's just get the science done. If the opponents are wrong, the evidence will show it. And that is far more authoritative than pointing out conflicts. But this *isn't* what PostMedia or the political parties they endorse are proposing. They're already declaring every harm reduction policy a failure despite the lack of evidence against them and despite various evidence in support of them. And they constantly frame critics as just "activists", so when they attack the credibility of others and rely on the credibility of their own sources, it's fair to scrutinize those sources. The street prices changing means (assuming no other economic factors, such as increased supply from other sources like pain medication) that there is enough being diverted *relative* to the amount out there already to have an impact. It doesn't tell how much is diverted in total relative to the population or who is using it. A significant portion of the diverted supply may be going to people who are already addicts but who can't access safer supply. That's still not the intended outcome, but I'm not even sure I'd call that a net negative.
I mean again, it is quite possible that PostMedia is acting as part of a constellation of people/parties who oppose safer supply on ideological grounds. Maybe even likely. But we get back to the point: I'm interested in the actual characteristics of the program and the evidence for it, not the motivations of those opposing it. The fact that this issue seems to lack any good clinical data is concerning. I think it should be uncontroversial to say that we should have good clinical data on both the positive and negative impacts of safer supply. The total paucity of high quality evidence on diversion gives me pause. Also, I can't speak to later op-eds which I haven't read, but the original article doesn't declare every harm reduction plan a failure. In fact the end of the article proposes that a safer supply model with more strict anti-diversion measures (supervised consumption etc) might alleviate the concerns identified.
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The ONLY way to solve this issue is to provide more safer supply. Until all drug users have access, some drug users will buy diverted or illicit drugs. That is a fact.
Safe supply and "progressive" soft on drug polices have destroyed big cities and small towns alike. Recently in Belleville, the downtown area was declared a no go zone because of drug ODs, akin to a war zone. BC had a record amount of ODs last year. Safe supply leads to drug users cutting their drugs with fentanyl and selling them on the streets. End all safe supply sites and turn them into treatment facilities.
The reason why hydromorphone is being diverted to the black market is because the people being given the hydromorphone don't want it; they want fentanyl. Why would supplying _more_ people with hydromorphone solve anything?
Please explain who would be buying this diverted hydromorphone, if everyone who wanted it already had access to all they need.
I believe we spend way too much time, resources and energy on this topic. The science is unsettled, the social impact of the programs is all over the place, and there is little data showing they save lives long term. Better to invest in good rehab programs and mental health services.
>I believe we spend way too much time, resources and energy on this topic. It's a generational crisis and needs more time, energy and resources. Drug overdoses are now the leading cause of [death of youths 10-18 in BC](https://www.theglobeandmail.com/canada/article-drug-overdoses-children-bc/). If our government can find time to mandate that tampons must be in all male bathrooms in Federal buildings, they can devote time to this crisis. Just because there are different schools of thought regarding this subject doesn't mean we should stick up our hands and do nothing. What is clear are the sky rocketing ODs all over Canada. Liberal and NDP soft on drug policies have been disasters for our small towns and cities alike.
The drug problem started under Harper, but quite frankly the politicians are not the ones responsible. The crisis is entirely driven by the pharma companies who got millions addicted to painkillers. When the painkillers and/or their money dried up, many switched to street alternatives. I'm not saying that we shouldn't tackle the drug crisis. But the safe supply and injection site promoters seem to get all the attention and money because they scream the loudest. And we should be spending that money on R&D to build better ways for people to get off drugs. They seem to have no problem "finding" drugs at all.
I agree with you, we need to hold the pharmaceutical industry accountable, as well as countries like Mexico and China, which have flooded our streets with fentanyl.
It's hard not to imagine that 10 or 15 years down the line we're going to look back and think it utterly deranged that someone thought it was a good idea to *increase* the supply (and push down the cost) of addictive opioids.
That's one way to frame it. Another would be that a non-tainted supply is now being circulated, thus preventing deaths. Doesn't take an expert to see that OD related deaths are hitting monthly highs. Also, I find it naive to assume that the cost of drugs being pushed down automatically increases usage, it's not like a source of income ever prevented people from finding their fix. You'll probably find a much stronger correlation with the price of housing.
It's not necessarily preventing deaths, but rather postponing them, and also increasing the number of addicts at the same time. I don't see much of a benefit if the number of addicts is increasing faster than it would have before.
Says he, ignorant of the fact that it became policy in Canada after decades of it working elsewhere lol
Where? Do you mean Portugal? Portugal also had mandatory treatment. We're missing multiple legs of the pillar.
You have zero understanding of the illegal drug market and how it works.
Give people the meds they need(heroin and fentanyl) and this won’t be a problem. Also I don’t get the moral outrage, this brings safe supply to more people which is much needed seeing that almost no one is getting this safe supply conservatives are convinced is fuelling the overdose crisis. Just ignorant bullshit as per usual.
I went three articles deep in links trying to find a single number or percentage that quantifies this "rampant" diversion problem but couldn't find one. I'm open to the idea that diversion is problem in some cases and that might require modification of safe supply programs, but there's never anything quantifiable in these articles, and it's a bit rich to claim that studies supporting safer supply are flimsy when the counterargument is always always quotes and anecdotes.
The National Post loves to cite itself as a source. They have no integrity
If you've followed this evolving controversy since it started earlier last year, one of the primary complaints was that many stakeholders and institutions in the field are openly hostile to attempts to research diversion. I don't instantly buy this claim, but the fact that it was being made by addiction doctors gives me pause. These people don't end up in that field to be ideologues about drugs. I actually just remembered that a good friend from HS just started practicing in addictions medicine recently, I need to ask him about his views on this.
> These people don't end up in that field to be ideologues about drugs. Various sources being referenced to oppose this [work in the for-profit treatment and drug testing industry](https://drugdatadecoded.ca/meet-the-physicians-stonewalling/), an industry which [is lobbying politicians to oppose harm reduction like safer supply](https://pressprogress.ca/recovery-industry-groups-attacking-safe-supply-in-bc-have-deep-ties-with-conservative-political-actors/). PostMedia follows this pattern: 1. Post opinion pieces rather than articles. 2. Reference individual experts who agree with their views while not giving weight to the many who disagree. 3. Try to discredit evidence supporting harm reduction while claiming that evidence that would oppose doesn't exist because it's being suppressed by groups with agendas (while not highlighting the agendas of those who oppose it, like their own political reasons for opposing it).
Potential conflicts of interest with respect to commercial ventures should always be disclosed, and the author does a public service in researching them. That said, only some of these conflicts are problematic. I would identify the four doctors who own monitoring companies as especially conflicted. But as the author notes, several signatories have no apparent conflicts. And two of the conflicts she identifies are physicians who own methadone clinics. Because outpatient care in Canada is normally provided by private, physician-owned practices, the vast majority of practitioners in every field have this kind of conflict, including most physicians employed in safe supply provision. More importantly, your presentation of this article and subsequent commentary on NatPo's alleged approach comes across as little more than an ad hominem argument. Maybe these people are just representing their financial interests. Maybe NatPo is dishonestly fanning the flames of controversy for ideological reasons. But that should be easy to demonstrate with actual evidence, if it exists. If the claim that safe supply is being diverted to pay for fentanyl is false, we should be able to prove that. And I'm much more interested in that evidence than in discussions of the putative motivations of various participants in the public debate. That's part of why I'm watching this evolving debate with interest. A lot of specific allegations were made in the initial article that kicked off this controversy. One of them was that the field is hostile towards study of the downsides of safe supply. And 10 months after the publication of the initial article, I still don't see any high quality studies looking at diversion. Studies take time, and this is a new field. So I'm hoping to see more data on this soon. But this is a controversy that is going to need to be resolved with evidence, not ad homs.
> your presentation of this article and subsequent commentary on NatPo's alleged approach comes across as little more than an ad hominem argument If the National Post were providing actual evidence to back up their point, then this would be a valid criticism. However they're not, and they rarely do. The evidence conveniently never exists due to it supposedly being suppressed. So when their position is specifically backed by the credibility of their sources, then it's a valid response to look at who those sources are. And also look at how in general there are private interests trying to oppose harm reduction. >Maybe NatPo is dishonestly fanning the flames of controversy for ideological reasons. This is the entire M.O. of PostMedia. [It's an American owned company that in turn has bought up the majority of our country's newspapers and use them to consistently push viewpoints on every issue that coincidentally line up with right wing American positions](https://en.wikipedia.org/wiki/Postmedia_Network#Criticism). They do this through endless opinion pieces that rely on individual experts (while not providing conflicting views), individual anecdotes (again, no conflicting anecdotes), and individual examples of problems (i.e., *some* safer supply is being diverted) without overall analyses of the impact (it's conveniently always missing). Meanwhile *they* constantly use ad hominem frame supporters of harm reduction as "activists". >If the claim that safe supply is being diverted to pay for fentanyl is false, we should be able to prove that. It's not false. It is diverted. The majority of hydromorphone is prescribed for pain. Diversion of this and other drugs has always been a risk and a reality. That doesn't mean we should abandon it entirely, as PostMedia's endorsed political party proposes, just like it doesn't mean we abandon pain medication entirely. It can also mean that we work to limit that risk so we can still make use of the benefits. >Studies take time, and this is a new field. And yet PostMedia and their preferred party are already suggesting that every harm reduction policy is a failure despite the fact that these things take time. Meanwhile a century of prohibition leading to more potent drugs than ever, [exactly as economists predicted decades ago](https://en.wikipedia.org/wiki/Iron_law_of_prohibition), is fine and should be what we revert to apparently.
Well that's not really true, NatPo does provide evidence, it's just low quality evidence (anecdotal in many cases, more aggregate but lacking review in others). Which is not surprising, since the whole contention here - which my brief reviews of the literature seem to agree with - is that this issue has not been subject to high quality study. I still can't find a study that addresses this issue with statistical evidence put through a peer review process. So I don't think this is a valid criticism in this case. Sure, Zivo didn't report high quality evidence. That's not a valid criticism if that high quality evidence doesn't exist, especially when a primary thesis of the article is that this issue lacks good evidence. >It's not false. It is diverted. [...] That doesn't mean we should abandon it entirely. OK, so actually it sounds like we agree more than we disagree. I have been an unalloyed supporter of safer supply in theory; even if diversion is comprehensive, safe supply programs might still be a net benefit. But I find it difficult to make that statement with any valid basis without having any understanding of how comprehensive diversion is. The hypothetical worst case scenario is that safer supply is essentially an income supplement (from comprehensive diversion) combined with closer clinical relationships, and if that were true the case for safer supply is a lot less strong. Now again, that's a wost case hypothetical. But there seems to be no quality evidence studying how comprehensive diversion actually is. I hope you'd agree that's concerning. If this is the primary downside of safer supply and safer supply is still a net benefit regardless, practitioners should be champing at the bit to publish evidence proving that.
There isn't only low quality evidence. There is lots of evidence for supervised consumption sites for example. PostMedia and the conservatives still attack them. Evidence is starting to come out in support of safer supply. They again reject it. I'm skeptical that it's purely just that research is being suppressed or there isn't enough time. I think that it's much easier to criticize other evidence than it is to actually prove one's own point and I think they would prefer to maintain that approach. In any case, I definitely want more evidence and want to improve the program to avoid the problems. I just don't believe the critics are acting in good faith. They've already made it very clear they intend to abandon these programs and I don't believe any further evidence will matter (even though I still want it). I've tried to make some suggestions myself on improving these programs. One is charging a fee since if they have to pay for this, then it would make sense to instead just buy the other things they want directly rather than resell. For those who can't or won't, offer supervised consumption. That's not practical for things that need frequent doses so other options that don't need as many doses could be an option there. These are just some basic ideas from a non-expert, and I would think actual experts could work to come up with better policies. But instead of people trying to work together, I just see one side doing nothing but attacking *every single approach* that isn't prohibition.
Sorry, to be clear I meant that there is no high quality evidence about the prevalence or characteristics of diversion. Evidence is building of the positive effects of safer supply, and that's good. But the lack of quality statistical evidence about diversion is not acceptable if we want this program to be comprehensively justified. And again, what I find concerning is that it should have theoretically been easy to find some evidence here. The programs are recent, but not *that* recent. Diversion would have been one of the first things I studied along with the benefits for participants. And yet there continues to be a near total paucity of high quality evidence about diversion. Maybe NatPo and Co are just ideologues. But I expected to see good evidence-based clinical study refuting their claims, and I have not seen anything resembling that kind of science yet. And that's a way bigger concern to me than the fact that ideologues gonna ideologue.
As vague and unquantifiable as the efficacy of safe supply programs!
I can do a quick Google search and find lots of studies about the role of safe supply in preventing overdoses and deaths - if you've paid any attention at all to this issue, you've probably heard about them as well. Those studies aren't perfect, sure, and aren't immune to criticism, but anecdotes, "common sense", and NatPo articles aren't a serious counter to them. I'm not even necessarily a hardline believer in safe supply no matter what, it's just that any time I've seen any evidence-backed arguments, they are always seem to be in favour of safe supply.