A political battle is looming over safer-supply programs

For the Conservative Leader, a win in Parliament may not be the point. Instead, he’s using the platform to push his ‘Canada-is-broken’ message, an effective fear-stoking strategy that distracts from the lives at stake, experts say

Conservative Leader Pierre Poilievre will get another chance in Parliament next week to pursue his campaign against the federal government’s safer-supply approach to Canada’s toxic drug crisis, but he is unlikely to gain support from MPs of other parties.

MPs are expected to vote on a Conservative motion that denounces the government’s handling of the crisis, particularly its support for providing pharmaceutical-grade alternatives to toxic street drugs, the intervention commonly called safer supply.

Liberals, New Democrats and members of the Bloc Québécois spoke against the motion in debate earlier this month, suggesting it won’t pass. But for Mr. Poilievre, a win in Parliament may not have been the point. Instead, he is using the platform to reinforce his “Canada-is-broken” message, which has been key to his appeal for public support.

“He is looking to tap into and stoke a time for change movement to help him oust the government,” pollster Nik Nanos said in an e-mail. “It allows him to tap into voters beyond his Conservative base who might think things are not working and Canada needs change.”

The Conservative Leader was combative in remarks in the House on harm reduction. “We are told that giving out and decriminalizing hard drugs would reduce drug overdoses,” Mr. Poilievre said in introducing the motion.

“These so-called experts are typically pie-in-the sky theorists with no experience in getting people off drugs, or they are members of the ‘misery industry,’ those paid activists and public-health bureaucrats whose jobs depend on the crisis continuing.”

Mr. Poilievre has said Conservatives support scrapping safersupply programs, diverting resources into treatment and suing pharmaceutical companies to help provide additional financial resources for treatment. He has been making his case with videos on social media, and comments in news conferences. Mr. Poilievre declined comment for this story.

Ginny Roth, a volunteer communications director on Mr. Poilievre’s successful bid to win the Conservative leadership last year, has written about the efficacy of his strategy to appeal to “common sense” and says his stand on scrapping safer supply, and emphasizing treatment instead, is part of that effort.

“I think there is a message that is breaking through,” Ms. Roth said in an interview.

Safer supply is predicated on the idea that by providing people at high risk of overdose from illicit drugs with pharmaceutical alternatives, health care providers can reduce their risk of overdose as well as other related harms.

It is a direct response to a drug supply that has fundamentally changed over the past decade, and a recognition that Canada’s meteoric surge in drug deaths is being driven by the increasingly volatile supply. Close to 40,000 Canadians have died from illicit drugs since 2016, according to provincial and federal data.

Addictions physicians who spoke with The Globe and Mail said safer supply is showing promising benefits, but also comes with potential risks that must be carefully observed. They said the complexity of the intervention is being lost in the highly charged political discourse, and that they resent being used – along with people who use drugs – as political pawns.

Paxton Bach, an addiction medicine specialist at St. Paul’s Hospital in Vancouver and comedical director at the BC Centre on Substance Use, said he is “deeply frustrated” by the weaponization of safer supply. “The increased politicization of this as an issue, with a complete lack of nuance to the discussion, is doing everyone a huge disservice,” he said.

“This needs to be left up to the experts to determine clinical guidance, to conduct the research, to evaluate the research and adjust clinical guidance accordingly. Having this discussion in Question Period, it’s performance, it’s distracting, it’s distressing, it’s non-productive.”

Dr. Bach said the current crisis is being driven not by addiction but by poisoned street drugs, and prescribers have been put in the distressing position of acting as gate-keepers to a safer supply when he believes it should come from government regulation.

“That being said, when I’m doing this, I’m trying to weigh benefits to an individual versus potential public-safety implications,” he said. “We don’t have a great assessment of either of those ... but we have increasing evidence from qualitative work and quantitative studies, from program evaluations, consistently suggesting that, at least in some people, access to a safe supply does result in significant health benefits.”

Leslie McBain, who lost her adult son to an overdose eight years ago, says the parliamentary debate provided a helpful platform for discussion of harm-reduction issues, but that she is concerned about the Conservative position.

“The way they are framing this is so dangerous to people who use drugs,” said Ms. McBain, who co-founded the Moms Stop the Harm advocacy group. “What he keeps ignoring is that people who are dead are never going to access treatment.”

Garth Mullins, an organizer with the Vancouver Area Network of Drug Users, said he believes the Conservative strategy of stoking fear and moral panic is effective, and he is worried because lives are at stake.

“Substituting pharmaceutical drugs for the toxic drug supply is the only thing that can stop the deaths,” he said. “The toxic drug market does not stand still while we have political debates.”

“The longer we wait, the longer we dither and get caught in these backwaters of disinformation and lying, the more people die,” he added.

Mr. Poilievre has spoken of patients selling their safer supply and “flooding the streets” with hydromorphone, an opioid medication typically used to treat moderate to severe pain from surgery, broken bones or cancer. Addictions physicians and drug users who spoke with The Globe say this does happen for various reasons, including so that the patient can afford food or stronger drugs when hydromorphone is insufficient.

In B.C., both the BC Centre for Disease Control (BCCDC) and the BC Coroners Service monitor toxicology results and say prescribed safer supply has not contributed to drug deaths. Further, the BCCDC has found no connection to date between prescribed safer supply and new diagnoses of opioid-use disorder.

“To suggest that we’re not intimately aware of the evidence and the potential risks and benefits, and that we don’t have discussions on a daily basis about these things and try to weigh all these factors into our clinical decision-making, it’s so disrespectful,” Dr. Bach said.

Although Mr. Poilievre has frequently focused on the problems of Vancouver’s troubled Downtown Eastside, Health Canada’s Substance Use and Addictions Program has, since 2020, provided more than $100-million in funding to 31 safer-supply projects in B.C., Manitoba, Ontario, Quebec – a key electoral battleground where the Conservatives hope to make electoral gains – and New Brunswick.

Both Toronto Public Health, which sets public-health policy, and the Quebec health ministry offered supportive comments on safer supply when asked about the practice.

“This practice could help prevent overdoses and save lives. It also has the advantage of allowing people who use drugs to be in contact with various health and social services that meet their needs,” said a statement from Marie-Claude Lacasse of Quebec’s health ministry.

“The debate in Parliament is an opportunity to highlight that prescribed safer-supply programs are an important medical service, and that the federallyfunded programs are having an impact in our local communities,” said Clemente Angiolillo of Toronto Public Health in a statement.

The office of federal Addictions Minister Carolyn Bennett said the government takes reports of the diversion of safersupply drugs seriously, but is not aware of any substantive evidence that safer supply is “flooding the streets” with diverted hydromorphone prescriptions.

“For Pierre Poilievre to state untrue information about safer supply, and try to create barriers to accessing harm reduction services that are saving lives amid this ongoing crisis is incredibly irresponsible and dehumanizing to people who use drugs,” said the statement provided by press secretary Maja Staka.

Safer-supply programs vary, but most offer tablets of hydromorphone. Most require daily or weekly visits to a clinic and come with wrap-around supports such as HIV and Hepatitis C treatment, wound care and counselling.

Emerging evidence has shown a number of benefits to the programs, as well as potential risks. A 2022 study of a safer opioid program in London, Ont., that has offered hydromorphone along with wrap-around supports since 2016 found that participants had significantly fewer emergency department visits and admissions to inpatient hospital care, as well as lower health care costs (not related to primary care or outpatient medication) compared with a similar cohort not involved with the program. The study was published in the Canadian Medical Association Journal.

A 2023 evaluation report of a similar program in Toronto found that participants experienced fewer overdoses, either stopped using or used less illicit fentanyl, and had improved access to health care and housing supports. There was also a drop in participants’ involvement in criminalized activities such as sex work.

An evaluation of a safer-supply program in Vancouver, which uses ATM-like biometric machines to dispense prescribed hydromorphone, found that nearly every participant continued to use illicit drugs, but they used less, experienced fewer overdoses and reported improvements in health and well-being. Participants also spoke of the ability to stockpile medication, which researchers saw as both contingency planning and potential for selling or giving it away.

Donald Durban, an elder from the T’Sou-ke First Nation located on Vancouver Island, had abstained from drugs for 15 years when a bad breakup plunged him back into substance use. He spent several years numbed by cocaine, heroin and fentanyl, anchored by depression and a generous drug dealer friend, before finding himself hospitalized after a suicide attempt.

The pivotal moment served as a wake-up call. In hospital, Mr. Durban was treated by a psychiatrist and a health care team that helped stabilize him. He was released a month later and decided he would never again touch fentanyl. He was prescribed methadone and a safer supply of hydromorphone, a combination that he credits for stopping his cravings and saving his life.

“I can function as a regular citizen,” said Mr. Durban, 70. “I firmly believe in safe supply. It works, and it will save lives.”