My response to Jason Luan’s opinion on safe supply

Yesterday, Jason Luan, the associate minister for mental health and addiction, wrote an opinion piece published in the Edmonton Journal. In it, he addressed the idea of the safe supply of drugs.

Naturally, his opinion is peppered with myth and half truths, so I thought I’d address them here.

Safe supply refers to the medical provision of legal, regulated substances of known potency. Traditionally, these substances have been available through the illicit drug market. Providing drugs through a safe supply reduces risks to the user because it improves product consistency, normalizes potency, and increases safety.

So, here we go.

Advocates for the liberal use of hard drugs have expressed their opinions in the media that illicit drugs “may” become more potent, and are campaigning for a taxpayer-funded supply.

Their claim that the illegal hard drug supply is more toxic than it has been in recent years is not grounded in evidence. Drug intelligence sources from both the Calgary Police Service and Edmonton Police Service confirm the drug supply is no more toxic now than it has been in the past.

I find it interesting that he uses uncited sources from two police services for the basis for this position. I hadn’t realized that police departments were in the habit of testing toxicity of every batch of drugs they confiscate. If they are, I’d love to take a look at their methodology.

How many batches have they tested? How long was their testing period? What are they measuring with their toxicity tests? Has their research been peer-reviewed and published?

Also, what does Luan mean by toxicity? Is he referring to the effect a drug has on the body (the common usage)? Or is he talking about the increased risk to a user because a drug is cut with more dangerous substances?

Because if it’s the latter, he’s wrong. Mixing heroine or cocaine with fentanyl, for example, makes the original heroine or cocaine more potent, which increases overdose risk and intensity, itself leading to higher death risk.

Take this chart from the 2019 Drug Enforcement Administration National Drug Threat Assessment, for example.

Clearly, fentanyl has been on the rise, at least in the United States, but so has other opioids mixed with fentanyl, heroin mixed with fentanyl, cocaine mixed with fentanyl, and meth mixed with fentanyl. For heroin–fentanyl alone, there was a 97% increase in the number of reports in the last year represented in that chart. For cocaine and meth mixtures, it was 74% and 173% respectively.

Mixing any of these drugs with fentanyl makes them more dangerous. Particularly if you don’t know they’ve been cut and you try taking your usual dose.

Drug distributors also produce fentanyl in pill form to mimic oxycodone, hydrocodone, alprazolam, and other drugs available in pill form. For people who think they’re taking oxy, it can be deadly to take the more potent fentanyl in the same dosage. And there’s no consistency in those pills.

For example, in 2018, the DEA examined 148 batches of tablets. They found that while the average dose of fentanyl in these pills was 1.5 mg (less than the lethal dose of over 2 mg), dosage ranged from as little as 0.02 mg to nearly 5 mg. In other words, some of those pills contained lethal levels of fentanyl.

The fact that the associate minister over addictions thinks that drugs today aren’t any more “toxic” is worrying.

Illicit drugs have always been and will always be deadly and dangerous. For people suffering from addiction, there is no safe supply of addictive narcotics.

First, yes, drugs have always carried negative health risks (including death), but that doesn’t mean that the risks are the same now as they used to be. The fact that more potent drugs exist, more people are addicted to them, and more people have died from them over the last 5 years than previously should tell us that the risks are greater today than they used to be.

Second, if we’re defining safe as having no risk at all, then sure, there’s no such thing as a safe supply of drugs. But it’s not binary. A spectrum of safety exists, with some solutions being safer than others.

Methadone, for example, is safer than fentanyl.

Likewise, drugs manufactured in a government licensed and regulated facility using quality control processes are safer than drugs manufactured in a trailer in New Mexico.

Addiction does not exist in drugs; it exists in people. Therefore, the solution exists in people and not in tinkering with the drug supply. Supplying these narcotics to addicts will not end the addiction crisis in which we find ourselves. Let us not forget this current crisis began with doctors freely prescribing opioids to the general population.

Of course addiction exists in drugs. It’s the drugs that possess the addictive qualities. I mean, I will give Luan the fact that without people, there’s no addiction; however, it’s also true that without drugs, there’s no addition.

The point of safe supply isn’t necessarily to eliminate addiction; it’s to reduce health risks. And creating a regulated, reliable, consistent drug supply reduces the risk of serious health effects of drug use, including death.

It also has the benefit of reducing drug-related crime.

Yes, it’s true that the opioid crisis began with doctors prescribing opioids, but they were originally hesitant about it—that is until a 1980 letter in the New England Journal of Medicine indicated that addiction was actually rare in patients treated with narcotics. Plus over promotion by opioid manufacturers didn’t help.

Even so, these drugs weren’t prescribed for addiction treatment; they were prescribed for pain management. Doctors prescribed them for pain under the impression that addiction risks were low.

If a patient is on an addiction treatment protocol, however, the attending physicians would be specifically focused on potency and toxicity of the drugs they prescribe.

And while the crisis did start with legitimate prescriptions, other contributing factors—such as the illicit drug market, including production and distribution of stronger drugs—have eclipsed prescriptions as the cause.

The American Society of Addiction Medicine defines addiction as a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences. This illness causes social, spiritual, biological and psychosocial issues that may involve trauma — none of which is treated by the prescription of opioids.

Again, the point isn’t necessarily to eliminate addiction; it’s to reduce health risks. An unsafe supply of illicit drugs increases overdose and death risks. A safe supply of regulated drugs reduces overdose and death risks. That reduces strain on our health care system, lowers drug-related crime, and—most importantly—keeps people alive.

Addiction is highly treatable but often left untreated, which is why our government has committed $140 million to make treatment and recovery available to all Albertans struggling with addiction in every corner of our province.

The problem, however, is that your committed funds have been directed to abstinence-only programmes—such as Simon House and Fresh Start—which often require the person to already be off drugs. And not a single one of those programmes prevents the deaths of people who are still addicted to drugs.

Plus, according to Alberta Health Services, up to 91% of people who use a total abstinence approach in short-term detoxification will restart use.

Drug treatment is important, and has been at insufficient levels for years, but it can’t be the only approach.

Also, that $140 million is spread out over 4 years, so much of it has yet to be actualized.

It is why we have committed to the creation of 4,000 publicly funded spaces for Albertans to begin a healing journey — of which we have achieved more than 3,000 additional spaces in just one year. And it is why we are partnering with high-quality, nationally accredited service providers who address every aspect of addiction.

Those 4,000 spaces are the same as the $140 million. That’s just being redundant.

And every aspect of addiction? Including harm reduction? Because Kenney seems to differ on that.

It is our government’s priority to ensure people struggling with addiction have access to world-class care, even during times of natural disasters, global pandemics, and economic uncertainty.

Does that include harm reduction efforts, such as supervised consumption and safe supply? How about addressing poverty and homelessness, two predictors of drug usage and addiction? Or education and fully funded and accessible mental health care, to prevent addiction in the first place?

Never in Alberta’s history has it been easier for people with addiction to get treatment. Until recently, Albertans were lined up for months to get into treatment beds. Now, they can get into treatment within three to seven days.

I’d love to see a source for this. I spent an hour looking for it and couldn’t find it anywhere.

This is a significant change to the continuum of care in our province. It is an approach gaining recognition across the country for its comprehensive and thoughtful approach to treating the disease of addiction.

Except it’s not comprehensive. Supervised consumption sites still don’t even know if they have continuing funding this year.

This new Alberta model does not, and will not, include the unethical supply of taxpayer-funded hard drugs to support addiction.

That’s fine. We’re asking for the ethical supply of tax-funded drugs to keep people alive and reduce overdose risk.

I mean, if it’s okay to use potentially $7.5 billion of taxpayer funds for a single pipeline, then surely it’d be okay to use taxpayer funds for health care.

In the March 2020 edition of The Canadian Journal of Addiction, the board of the Canadian Society of Addiction Medicine shared their grave concerns about the flexible model of “safe supply” and encouraged other physicians to speak up when they see practices that are causing harm to patients and communities. We’ve heard their concerns, and we’re listening.

To be clear, The Canadian Journal of Addiction is published by the Canadian Society of Addiction Medicine. It’s not like they submitted their letter to the editor to an independent journal.

Anyhow, as you pointed out, their concern was with the flexible model of safe supply, not safe supply in general, so it seems abrupt to simply introduce this one delivery model out of the blue and right at the end of your opinion piece.

What do you mean that you’re listening to their concerns about the flexible delivery model of safe supply? Does that mean you’re fine with safe supply if it’s supervised?

Our government is committed to a high-quality and easily accessible system of care for both mental health and addiction. Albertans deserve no less.

Really? I have a hard time believing this. The health ministry spent $20.83 billion last year. They’ve budgeted $20.62 billion this year, $20.63 billion next year, and $20.67 billion during the election year.

In other words, the entire ministry budget is decreasing by $212 million this year, increasing by $16 million next year, and increasing by $40 million the following year, which is still more than $150 million short of last year’s spending.

Had we maintained that $20.83 billion for the next 3 years, we’d have ended up spending a cumulative $62.48 billion. Instead, we’re spending, $61.92 billion over the next 3 years. We’re spending $550 million less than we should be over the next 3 years.

So, I’m not sure how you can be committed to high-quality and easily accessible system of care for both mental health and addiction if the ministry that funds mental health and addiction care is sorely underfunded.

In fact, it’s underfunded by more than 4 times the amount you cited in your opinion piece that your government has allocated to treatment.

And that’s not even considering population growth or inflation.