Every time opioids have become more accessible, it's been accompanied by an addiction crisis. Opium in China, morphine in the 19th century, Bayer heroin in the early 20th century, oxycontin in the late 20th/early 21st century. Diversion of "safe supply" drugs exacerbating existing addiction problems and expanding the number of addicts is depressingly predictable.
It often seems like activists concerned with drug addiction miss the fact that the drug use *is* the problem. The homelessness, disease transmission, overdoses, social dysfunction, and crime all follow from the drug use. The fact that we talk about drug use instead drug *abuse* suggests another way we've lost the plot here: these are pharmacological substances with positive and negative effects. When used for pain management, particularly temporarily, the benefits outweigh the negatives. Using them for recreation or getting high is abusing them. When these drugs don't kill their users quickly with overdoses, any experienced medical professional can tell you stories about all the other nasty consequences that manifest with chronic use. Preventing overdoses with things like safe supply is at best a means of buying time to get people into recovery. If you can't get them into recovery, you're just prolonging the time it takes for drug abuse to kill them.
Thanks for all your work on this file, Adam. The gaslighting around safer supply is similar to the gaslighting around puberty blockers. Ideological capture makes evidence based decision making next to impossible. Aside from confirmation bias, too many people have invested too much personal credibility to walk back unfounded beliefs. (See also the general unwillingness of politicians and media to correct false claims of mass graves, and of prosecutors to own up to wrongful convictions.)
Allan Stratton was quicker than I, but it doesn’t hurt to thank Allan and to thank Adam and all the excellent commentators again. Nor does it hurt to strengthen Allan’s excellent comment regarding the drug file.
One of the, independent of government, think tanks with resources needs to put all of the evidence based clear eyedness on the drug issue together so that governments can’t possibly brush it aside. The federal Liberals refuse to abandon their damaging political culture of “policy based evidence seeking” when what every rational citizen wants is “evidence based policy making”. [The paraphrasing in quotations is to the credit of Dr. Christian Leuprecht who gave scathing testimony before the Senate Committee investigating Bill C-21. That it was brushed aside corroborates the difficulty of a culture change.|
Excellent work. However, the fact this needed to ever be so researched and proven to anybody, over such a predictably flawed policy in the onset, really speaks to the overall disconnect between this government’s policies and good decision-making practices generally. This piece is merely another head-shaking example of that disconnect.
I think part of the rationale for gov't supplied drugs is crime reduction. If crime is in fact reduced then this partially offsets the negative impacts described in Adam Zivo's article. Any data or anecdote on this? GG
Derek Finkle has done fantastic reporting on the terrible impact of a safe injection site in his Toronto community. Unfortunately it seemed to lead to a spike in theft and other property crimes and, ultimately, a fatal shooting of a mother of two by a couple of drug dealers.
One of the things that drives me bonkers about this topic is the lack of values discussion. Anyone wondering if this is a good policy or not is shut down as being "anti science" far too often as a way to avoid discussing the baked in ethical assumptions. So flooding the country with easily accessible opioids might or might not reduce deaths at the expense of possibly creating more addicts. Thats a question that in good faith might be able to be answered to some useful degree with rigorous and sincere scientific study. Lets say this policy creates 1 new addict for every life saved as a side effect. OK, I probably would be on board with that still. What if it creates 10 new addicts for every life saved ? What if the number is 100 ? The scientific method is not going to answer what the acceptable number is for everyone in the community. We as a community should be deciding what tradeoffs we are ok living with through our elected representatives, not unaccountable academics nor public heath bureaucrats. I am 100% pro science. What I dont want is some new self appointed priestly class telling us what is and is not morally good while they contort and abuse the word "science" to get their way and shutdown people who they dont agree with.
This, from Grizwald just below (or above), is absolutely true: "Good intentions count for nothing, we need to be clear-eyed about actual outcomes." Vancouver is full of performative good intentions, and sidewalk corpses.
There is an old South Park episode where religion is abolished in the future and Richard Dawkins is the new God. He has basically replaced mainstream religion with an equally dogmatic atheistic ideology which spawns its own warring factions that squabble over trivial things. The point being that you can see dogmatic ideologies that resemble religious fervor outside of actual religion. Clearly the advocates of safe supply are one of them.
Where is the actual evidence that providing addicts with "safer" supply is better than no drugs at all?
It stands to reason that to get out of an addiction one would certainly need help (social programs, therapy, etc), but it is dubious to think that drugs would solve the problem drugs caused in the first place...
Am I missing something?
Anecdotally, I'm currently taking hydromorphone to trait pain after a surgery. It doesn't even work on that particular pain as well as OTC drugs like advil and tylenol, though the pain is pretty mild, so it may be more effective on more intense pains.
The theory is fairly straightforward: illegal drug supplies often contain fentanyl with unpredictable composition, and this leads to a lot of unintended overdoses. Replacing those supplies with legal supplies with known composition addresses that problem. But yes - I don't know if there's evidence that this program is actually effective at reducing overdoses given the evidence that users are selling the safe supply drugs to obtain more potent illegal supplies anyway. If there isn't a measurable drop in overdoses overall, or at the very least among those in this program, it'd be strong evidence that the theory doesn't work in practice.
The opioid crisis is complex. Through a number of articles, the writer has clearly established his views on this issue and can be reliably be expected to write from a single perspective. Thus those who are against safe supply are “experts” while those who believe in the approach are “activists”. The information presented absolutely is concerning but I have no confidence that it adequately addresses the issue or the body of evidence.
anecdotally, this week I have heard about two elderly (-ish) patients being refused pain meds from their doctors - one told her to use Tylenol, and the other suggested meditation (!)
if doctors won't/don't provide pain relief, people will start doing as your neighbour
My assumption is this is also related to timing. My husband was prescribed dilaudid after a major surgery and he had to take it every 4 to 6 hours when he was taking it. It's not really possible to supervise that. (It also caused some health issues that we don't hear talked about - like urine retention, dizziness, and personality changes - and he didn't use it in an abusive way. He was off opioids within 4 days of surgery, but had these effects from the previous year of pain management before surgery. I can't help but wonder what additional health issues come up with long term use of "safer supply".)
I am of the belief that while addiction is tragic and individuals deserve support, they won't get that support as long as they're being provided with drugs. The most supportive thing is to give them wrap around supports to get clean and stay clean and make it so that these medications are not easy for anyone to access without a proper prescription. (And perhaps some sort of pre-assessment for addiction risk should be done before the prescription is given?)
Yes, there does seem to be a disconnect/refusal to acknowledge that addiction is an illness by those who support safe supply. Making it easy for youth to become addicted is a really big problem - and that alone should be enough to pump the brakes on the program. But I feel like we don't see the current Trudeau government self-reflect and change course when presented with evidence, they just double down initially.
Unfortunately they consider double down to mean "policy based evidence seeking" when any rational voter wants "evidence based policy making". [Credit Dr. Christian Leuprecht for the paraphrase please.]
Came here to ask almost the same question - why is on-the-spot ingestion of 'safe supply' drugs not the answer? I can only assume it's because it's not practical for understaffed centres or drug seekers. This is a complicated issue and I appreciate the insightful work in this piece. We need to try harder, and by that I mean devote considerably more resources and brainpower into fixing it.
It used to be the case in Ontario until the pandemic. Then it became fashionable to let them leave with the drugs to be ingested at their own discretion. After that, it became an ideological battle where the facts (that the drugs were being rerouted to schools) never mattered.
Every time opioids have become more accessible, it's been accompanied by an addiction crisis. Opium in China, morphine in the 19th century, Bayer heroin in the early 20th century, oxycontin in the late 20th/early 21st century. Diversion of "safe supply" drugs exacerbating existing addiction problems and expanding the number of addicts is depressingly predictable.
It often seems like activists concerned with drug addiction miss the fact that the drug use *is* the problem. The homelessness, disease transmission, overdoses, social dysfunction, and crime all follow from the drug use. The fact that we talk about drug use instead drug *abuse* suggests another way we've lost the plot here: these are pharmacological substances with positive and negative effects. When used for pain management, particularly temporarily, the benefits outweigh the negatives. Using them for recreation or getting high is abusing them. When these drugs don't kill their users quickly with overdoses, any experienced medical professional can tell you stories about all the other nasty consequences that manifest with chronic use. Preventing overdoses with things like safe supply is at best a means of buying time to get people into recovery. If you can't get them into recovery, you're just prolonging the time it takes for drug abuse to kill them.
Thanks for all your work on this file, Adam. The gaslighting around safer supply is similar to the gaslighting around puberty blockers. Ideological capture makes evidence based decision making next to impossible. Aside from confirmation bias, too many people have invested too much personal credibility to walk back unfounded beliefs. (See also the general unwillingness of politicians and media to correct false claims of mass graves, and of prosecutors to own up to wrongful convictions.)
Allan Stratton was quicker than I, but it doesn’t hurt to thank Allan and to thank Adam and all the excellent commentators again. Nor does it hurt to strengthen Allan’s excellent comment regarding the drug file.
One of the, independent of government, think tanks with resources needs to put all of the evidence based clear eyedness on the drug issue together so that governments can’t possibly brush it aside. The federal Liberals refuse to abandon their damaging political culture of “policy based evidence seeking” when what every rational citizen wants is “evidence based policy making”. [The paraphrasing in quotations is to the credit of Dr. Christian Leuprecht who gave scathing testimony before the Senate Committee investigating Bill C-21. That it was brushed aside corroborates the difficulty of a culture change.|
Excellent work. However, the fact this needed to ever be so researched and proven to anybody, over such a predictably flawed policy in the onset, really speaks to the overall disconnect between this government’s policies and good decision-making practices generally. This piece is merely another head-shaking example of that disconnect.
I think part of the rationale for gov't supplied drugs is crime reduction. If crime is in fact reduced then this partially offsets the negative impacts described in Adam Zivo's article. Any data or anecdote on this? GG
Derek Finkle has done fantastic reporting on the terrible impact of a safe injection site in his Toronto community. Unfortunately it seemed to lead to a spike in theft and other property crimes and, ultimately, a fatal shooting of a mother of two by a couple of drug dealers.
You’ll find those articles in the National Post.
I'd like a response to that too. What outcomes were/are they measuring to evaluate the performance of this program?
One of the things that drives me bonkers about this topic is the lack of values discussion. Anyone wondering if this is a good policy or not is shut down as being "anti science" far too often as a way to avoid discussing the baked in ethical assumptions. So flooding the country with easily accessible opioids might or might not reduce deaths at the expense of possibly creating more addicts. Thats a question that in good faith might be able to be answered to some useful degree with rigorous and sincere scientific study. Lets say this policy creates 1 new addict for every life saved as a side effect. OK, I probably would be on board with that still. What if it creates 10 new addicts for every life saved ? What if the number is 100 ? The scientific method is not going to answer what the acceptable number is for everyone in the community. We as a community should be deciding what tradeoffs we are ok living with through our elected representatives, not unaccountable academics nor public heath bureaucrats. I am 100% pro science. What I dont want is some new self appointed priestly class telling us what is and is not morally good while they contort and abuse the word "science" to get their way and shutdown people who they dont agree with.
This, from Grizwald just below (or above), is absolutely true: "Good intentions count for nothing, we need to be clear-eyed about actual outcomes." Vancouver is full of performative good intentions, and sidewalk corpses.
Yup and crime is not rising either ask the AG
There is an old South Park episode where religion is abolished in the future and Richard Dawkins is the new God. He has basically replaced mainstream religion with an equally dogmatic atheistic ideology which spawns its own warring factions that squabble over trivial things. The point being that you can see dogmatic ideologies that resemble religious fervor outside of actual religion. Clearly the advocates of safe supply are one of them.
Just watched that one yesterday, coincidentally.
Where is the actual evidence that providing addicts with "safer" supply is better than no drugs at all?
It stands to reason that to get out of an addiction one would certainly need help (social programs, therapy, etc), but it is dubious to think that drugs would solve the problem drugs caused in the first place...
Am I missing something?
Anecdotally, I'm currently taking hydromorphone to trait pain after a surgery. It doesn't even work on that particular pain as well as OTC drugs like advil and tylenol, though the pain is pretty mild, so it may be more effective on more intense pains.
The theory is fairly straightforward: illegal drug supplies often contain fentanyl with unpredictable composition, and this leads to a lot of unintended overdoses. Replacing those supplies with legal supplies with known composition addresses that problem. But yes - I don't know if there's evidence that this program is actually effective at reducing overdoses given the evidence that users are selling the safe supply drugs to obtain more potent illegal supplies anyway. If there isn't a measurable drop in overdoses overall, or at the very least among those in this program, it'd be strong evidence that the theory doesn't work in practice.
Thanks for the clarification. Makes perfect sense.
The opioid crisis is complex. Through a number of articles, the writer has clearly established his views on this issue and can be reliably be expected to write from a single perspective. Thus those who are against safe supply are “experts” while those who believe in the approach are “activists”. The information presented absolutely is concerning but I have no confidence that it adequately addresses the issue or the body of evidence.
anecdotally, this week I have heard about two elderly (-ish) patients being refused pain meds from their doctors - one told her to use Tylenol, and the other suggested meditation (!)
if doctors won't/don't provide pain relief, people will start doing as your neighbour
This is basically what we do in Alberta, fwiw. JG.
My assumption is this is also related to timing. My husband was prescribed dilaudid after a major surgery and he had to take it every 4 to 6 hours when he was taking it. It's not really possible to supervise that. (It also caused some health issues that we don't hear talked about - like urine retention, dizziness, and personality changes - and he didn't use it in an abusive way. He was off opioids within 4 days of surgery, but had these effects from the previous year of pain management before surgery. I can't help but wonder what additional health issues come up with long term use of "safer supply".)
I am of the belief that while addiction is tragic and individuals deserve support, they won't get that support as long as they're being provided with drugs. The most supportive thing is to give them wrap around supports to get clean and stay clean and make it so that these medications are not easy for anyone to access without a proper prescription. (And perhaps some sort of pre-assessment for addiction risk should be done before the prescription is given?)
Yes, there does seem to be a disconnect/refusal to acknowledge that addiction is an illness by those who support safe supply. Making it easy for youth to become addicted is a really big problem - and that alone should be enough to pump the brakes on the program. But I feel like we don't see the current Trudeau government self-reflect and change course when presented with evidence, they just double down initially.
Unfortunately they consider double down to mean "policy based evidence seeking" when any rational voter wants "evidence based policy making". [Credit Dr. Christian Leuprecht for the paraphrase please.]
I couldn’t agree more with this statement. I absolutely want evidence based policy making.
Came here to ask almost the same question - why is on-the-spot ingestion of 'safe supply' drugs not the answer? I can only assume it's because it's not practical for understaffed centres or drug seekers. This is a complicated issue and I appreciate the insightful work in this piece. We need to try harder, and by that I mean devote considerably more resources and brainpower into fixing it.
It used to be the case in Ontario until the pandemic. Then it became fashionable to let them leave with the drugs to be ingested at their own discretion. After that, it became an ideological battle where the facts (that the drugs were being rerouted to schools) never mattered.