Diversion of `safer supply' drugs: Urban myth or growing danger?
“A nightmare every day” is how Greg Sword describes the agony of losing his 14-year-old daughter Kamilah to a drug overdose last August.
“She took a pill in the middle of the night and never woke up.”
The B.C. Coroners Service told the grieving father that Kamilah had three drugs in her system: cocaine, MDMA and hydromorphone, also known as Dilaudid or “dillys.”
“I had never heard of hydromorphone,” said Sword.
Now he can't think about anything else.
Kamilah had always been fun-loving and outgoing, but during COVID-19, the isolation hit her hard. She began dabbling with drugs.
Sword said someone his daughter knew had purchased the hydromorphone for her in Vancouver's Downtown Eastside, where “dillys” go for a dollar or two.
Although he has no way of knowing for sure, he believes the hydromorphone pill his daughter ingested could have been diverted from Vancouver's so-called safer supply.
While his theory about safer-supply drugs being diverted has been raised by others since the inception of the program, it's difficult to prove where the drug in his daughter's system originated.
Pharmaceutical-grade hydromorphone is one of a range of medications prescribed as part of the safer-supply program, designed to provide a safer alternative to the toxic illegal drug supply that puts users at high risk of death by overdose.
In April, B.C. Chief Coroner Lisa Lapointe said the idea that patients are selling their safer-supply drugs to youth, creating new addicts and causing death, is an urban myth.
“It is not true,” said Lapointe in her keynote address at the B.C. Centre on Substance Use conference. “We are monitoring obviously very, very closely the results of those who die of the toxic drug supply. Youth are not dying from diverted supply.”
According to a spokesperson for the coroner's service, the most recent reporting by drug type shows that hydromorphone was present in just five per cent of drug toxicity deaths between July 2020 and December 2022. The report also showed that fentanyl was present in 88 per cent of drug toxicity deaths during that time.
Nearly all deaths in the province are the result of mixed-drug toxicity.
Jennifer Whiteside, B.C.'s minister of mental health and addictions, said she takes the issue of diversion of safer supply “very seriously,” and is waiting for the results of the coroner's investigation into Kamilah's death “to understand the circumstances and inform our ongoing work to prevent such deaths from happening.”
Eighty-four per cent of hydromorphone prescribed in B.C. is for pain relief, while 16 per cent is dispensed through prescribed safer supply.
In March 2023, 5,044 people in B.C. were prescribed pharmaceutical opioids — including hydromorphone — under the program.
“Oversight, monitoring, risk management and mitigation strategies” are in place and continuously adjusted, according to the Mental Health and Addictions Ministry.
This includes monitoring for “unintended consequences of prescribed safe supply, including diversion.”
Elenore Sturko, a Surrey South MLA with the B.C. United party, told Postmedia News she doesn't believe adequate safeguards or monitoring are in place.
Sturko wants a review of the program, and for the provincial government to consider imposing stricter controls, including “witnessed” supply. For example, methadone, an opioid agonist that is used to treat opioid use disorder, is usually dispensed at a pharmacy under the watch of a pharmacist.
“These eight-milligram tablets that are diverted from safe supply are widely available on the street,” said Dr. Alan Brookstone, a Surrey addictions medicines' specialist.
Brookstone is currently treating several opioid-addicted patients who report that their suppliers provided them with hydromorphone tablets obtained through a B.C. safer-supply prescription.
One couple he is treating, in their mid-50s, had no history of substance abuse. In 2021, friends suggested they try the tablets at a social gathering.
“They both ended up trying a hydromorphone eight-milligram tablet that night,” Brookstone said.
The couple quickly became dependent, using five-to-10, eight-milligram tablets a day each, and spending about $700 every two weeks on the tablets.
“My sense of this is that we are seeing an acceleration of individuals who are becoming addicted to pills coming from safe supply,” said Brookstone. “The program should be significantly reduced, or controlled and cut back.”
Mark Tyndall, University of B.C. professor and a founder of MySafe, a program that dispenses hydromorphone tablets to users at high risk of overdose through biometrics-controlled vending machines, said their tracking shows that the majority of pills stay with the user.
“We get the odd person who has sold or given them to people,” said Tyndall. “I don't think it's a common thing.”
However, Tyndall said hydromorphone diverted from pain prescriptions has always been available on the black market, and fake hydromorphone, which may contain dangerous ingredients like fentanyl, is also widely available on the streets.
“We're trying to prevent people from dying,” said Tyndall. “We have an alternative safer supply, and it's the only ethical response that we have.”
A recent review of the program in the Canadian Medical Association Journal shows that MySafe participants report less use of illicit drugs, less dependence on crime, panhandling and sex work, and greater focus on building a healthier lifestyle.
A total of 596 people died due to illicit drugs in the first three months of 2023. Illicit drug deaths continue to be the leading cause of non-natural deaths in the province.
Sword is still seeking answers: “I'm speaking out so no one else has to go through this.”