Saks ignoring ‘safer supply’ crisis: MDS

Agroup of leading addiction physicians who have spent months imploring the federal government to recognize the catastrophic side-effects of Canada’s experimental “safer supply” programs say Ya’ara Saks, the federal minister of mental health and addictions, is ignoring them and misrepresenting these programs to the Canadian public.

Safer supply refers to the practice of distributing free addictive drugs, typically through prescription, as an alternative to illicit substances. Advocates claim this reduces overdoses and deaths, but experts say there is no real evidence the programs work and users regularly sell (“divert”) their free drugs on the black market, causing new addictions.

Dozens of addiction physicians have said that rampant safer supply diversion, particularly with respect to hydromorphone (an opioid as strong as heroin), has been an open secret for years.

“I had several patients who were drug-free for a long time and just couldn’t resist the temptation of this very cheap hydromorphone that was now on the street,” said Dr. Michael Lester, a Toronto-based addiction physician. “Every addiction medicine doctor I’ve spoken to has told me that, on a daily basis in their offices, they’re dealing with diverted hydromorphone, either from new clients coming in addicted to it, or patients of theirs that are using it as a drug of abuse.”

But, according to Lester and many others, physicians have often been afraid to openly criticize safer supply because harm-reduction activists aggressively try to “cancel” such critics.

“We all heard these stories. One doctor even told me that his daughter was being harassed in her high school because her father had criticized safe supply,” Lester said.

It has become much harder to silence critics since public reports of safer supply diversion started to proliferate last year. Among those critics has been a group of 17 addiction experts, including Lester, who came together last September to write a public letter to Saks, which received significant media attention.

The letter explained why the physicians felt Canada’s current approach to safer supply is harmful and asked the federal government to either reform or abolish the programs. According to the doctors who signed the letter, it took Saks’ office more than three weeks to respond.

“I will add this to our list of our scheduling requests and hope to get back to you soon,” wrote the minister’s director of operations, who then went silent.

Frustrated by the lack of followup, the physicians wrote another open letter two weeks later — this time with 35 signatories. They included an extensive brief supporting their analysis and made recommendations on how to improve safer supply.

This letter was also apparently ignored, which led the physicians to send a third letter two weeks later, which finally elicited a response.

The minister’s office eventually agreed to a 30-minute online meeting in mid-january, almost four months after the first open letter had been published. The physicians were given only one week’s notice and their meeting time was changed the day before, which made it difficult for some to attend.

At that meeting, which ultimately lasted 45 minutes, three physicians presented their concerns to the minister. One, Dr. Robert Cooper, said it seemed as though Saks was finally listening. She even invited the physicians to present at an online roundtable discussion about safer supply, which was to occur the following week.

Along with his colleagues, Cooper attended the roundtable, which consisted of 10to 15-minute presentations made by various groups. Representatives from Health Canada were among those present. Cooper said roundtable organizers asked him to keep the discussions confidential. But while he was not at liberty to say what was discussed, he did offer that the experience was “not productive” and it seemed as if critical voices were a low priority.

The physicians did not hear back from the minister’s office after. But three weeks ago, in an article by The Canadian Press, Saks dismissed criticism of safer supply and said opponents were primarily driven by “fear and stigma.”

Lester said the minister’s comments came as a slap in the face to the experts who had meticulously explained their concerns to her after months of outreach.

“We weren’t talking about stigma and fear. We’re talking about the overwhelming evidence we’re seeing in our patients and practices of the enormous diversion that has been going on,” he said.

“The people criticizing the program are addiction physicians — so she’s basically saying that addiction medicine doctors have a stigma against their clientele, which makes no sense,” Lester added.

Saks’s disregard of medical expertise has not been without costs. The RCMP said last week it recently seized thousands of safer supply hydromorphone pills in B.C. after they were diverted to organized crime groups; that the groups are trafficking the drugs interprovincially; and that diverted hydromorphone could be ending up in the hands of teenagers. One wonders how much of these harms could have been avoided had the minister listened to the experts.

WE WEREN’T TALKING ABOUT STIGMA AND FEAR.