Something May Be Broken in Canada, But It Isn’t Our Safe Supply Programs

Just before Christmas, Pierre Poilievre, the leader of the Canadian Conservative Party released an ad titled “Everything feels broken.” In this dramatic video, Poilievre is positioned in front of a tent city in Vancouver, British Columbia. As of January 13, the video has 139,000 views on YouTube and is remarkably popular among Poilievre’s online admirers. Although the video has clearly resonated with millions, Poilievre’s critics accuse him of manipulating the facts and misleading the public.

Pierre Poilievre has displayed that he is a master of utilizing social media as a means of promotion, and this video is no exception. In it, he is dressed casually, his posture is relaxed and his tone is concerned. He opens by explaining that the community of unhoused people that occupy the video’s background have lost their homes as the result of addiction. He continues to say that rampant substance use has threatened the lives of unhoused people while separating them from their friends and family. Addiction, he claims, is the driving force behind Canada’s devastating rates of overdose.

He goes on to say that these taxpayer-funded drugs, supplied by the Canadian government, are to be blamed for major increases in overdoses and violent crime, a practice he insists must be halted immediately. Poilievre claims that we need only to look to Alberta to see an example of how a focus on sobriety-based recovery programs, not harm reduction, can successfully stem the tide of overdoses. He says that if we are serious about saving lives we need to tighten border control and create harsher penalties for drug dealers. Therefore, it only makes sense that the rest of the country should follow suit and put their focus on border control, criminalization, and recovery, not harm reduction. To Poilievre, we need to put an end to safe supply.

That would make sense, if any of what he was claiming was true. The reality is that

Poilievre’s video is a creative mashup of artfully presented half-truths and blatant lies. The brief video contains so many falsehoods that it is difficult to address without dissecting it line by line. Vancouver-based opioid expert Garth Mullins describes Poilievre’s video as a “firehose of bullshit,” and he is not alone. Experts and politicians from both sides of the political divide have come forward to decry Poilievre’s approach.

Canada has indeed seen an escalation in the rate of fatal overdoses in the past 15 years. These are not, however, attributable to safe supply programs which are limited in size and a fairly recent arrival on the scene. If anything, they can be attributed to exactly the sort of misguided drug policy that Poilievre is advocating for in this video.

In recent years, Canada’s heroin market has increasingly become tainted with an increasingly unpredictable supply of fentanyl. The result is that even if an individual sticks with their usual dose, they have limited information about the actual content of the substance they’re consuming. Imagine buying a drink at a bar and not knowing whether the liquid you’re offered is beer or vodka - it would become difficult to predict the level of your intoxication. Thus, it is this unpredictability, more so than consumption per se, that is responsible for skyrocketing rates of overdose. In British Columbia, where Poilievre’s video was filmed, the number of drugrelated deaths per year has risen from 330 in 1993, (which at the time the chief coroner described as an “inordinately high number.”) to over 2000 in 2022. Safe supply programs were specifically developed as a response to the increased prevalence of fentanyl. Safe supply is a harm reduction term that describes programs that distribute pharmaceutical grade substances to people with an established history of substance dependence disorder. Their aim is to protect the lives of people who use substances from the toxic drug supply. In order to slow these staggering losses, Canadian activists and healthcare professionals organized a handful of safe supply pilot programs.

How is this related to Canada’s drug laws? The Iron Law of Prohibition, a term coined by Richard Cowan in 1986 to explain the emergence of crack cocaine, describes a phenomenon through which prohibition policies and increased law enforcement result in an illicit substance becoming more potent and therefore more dangerous over time. Simply put, “the harder the enforcement, the harder the drugs.” Heightened law enforcement puts pressure on suppliers to innovate, pushing penalties associated with the sale and possession of heroin, suppliers turned instead to the sale of fentanyl which is both far more potent (and like a flask of moonshine, easier to transport) and synthetic, meaning it can be conveniently produced in a lab.

It was this progression – and not safe supply programs –which created the toxic supply crisis which has claimed the lives of over 20,000 Canadians since 2016. Safe supply programs are extremely limited in their reach and capacity. Ontario’s longest running safe supply program has only 82 participants. Furthermore, the majority of safe supply programs in Canada were launched between 2020 and 2022.

It is therefore unreasonable - and in fact, dishonest - to assert that that addressing the extreme stress and instability caused by poverty and homelessness is a prerequisite to curtailing dependence. This is to say that if someone passes away due to having consumed a toxic illicit substance, then sobriety ceases to be an option altogether. This is why harm reduction advocates focus on the creation of services that extend life and improve health outcomes and contribute to stability, creating the opportunity for an individual to live long enough to choose either sobriety or to achieve a more stable relationship to substance use in the future. These programs therefore measure their success not in terms of how many people have stopped using substances, but how many deaths they have prevented. them towards products that are more potent (and therefore smaller in volume and easier to transport) that evade current detection methods. An increase in drug potency can mean an accompanying increase in risk upon consumption. An example of this occurred during early 20th century attempts to ban the sale of alcohol. Beer and wine were quickly replaced with the far more dangerous home brewed moonshine. A flask of moonshine that can be hidden in a coat pocket or under the seat of a car might produce the same level of intoxication as a much larger and harder to smuggle bottle of wine. This pattern repeats itself regardless of the substance in question and is what has shifted the opioid market in Canada from being composed primarily of opium to heroin, and from heroin to fentanyl. When opium was made illegal, some smugglers shifted to selling heroin which was both far more powerful than opium and had the added advantage of being odorless and therefore harder to detect.

As law enforcement tightened border regulations and increased safe supply programs, mostly created in the last eighteen months and permitting such limited enrollment, could be to blame for the meteoric rise of overdose deaths, now numbering in the tens of thousands, which began nearly two decades ago.

Not only are safe supply programs not the source of the problem, they are also successful. A study conducted on the aforementioned program in Ontario showed that it reduced both ER visits and healthcare costs. Most of Canada’s programs are too new to have produced extensive data, but the Ontario study is consistent with a study conducted in Halifax as well as with research done in Switzerland in demonstrating that safe supply programs are effective in reducing the risk of fatal overdose and in promoting the overall health of people who use drugs.

Harm reductionists often repeat the phrase: “you can’t get a dead body into rehab.” By this, they mean that the primary focus of harm reduction is not to use the threat of death to scare people into sobriety, but to mitigate the health impacts of substance use. Advocates argue

Former senator and ex-Ottawa police chief Vernon White is a passionate advocate for safe supply that proposed that all supervised consumption sites in Canada should also be allowed to provide safe supply programs. Supervised consumption sites (SCS), a form of harm reduction more familiar to the general public than safe supply, are spaces where individuals can come consume substances under the supervision of healthcare professionals and/or community workers who can intervene in case the individual experiences adverse effects. SCS first became legal in Canada after a long battle led by the founders of Insite, the continent’s first supervised consumption site, that, in 2011, ultimately went all the way to the Supreme Court. Harper’s Conservative government had no choice but to allow SCSs to exist, although they severely limited their reach. Under the Trudeau government, consumption sites have been opened across the country and have since been responsible for reversing over 40 000 overdoses. To date, not a single person has died at a supervised consumption site in Canada. Those 40,000 reversed overdoses represent 40,000 lives saved that would not have been without the existence of harm reduction services.

The most obvious lie in Poilievre’s video is the claim that Alberta has reduced overdose deaths by half without relying on harm reduction services. Neither of those things are true. Alberta has been successful in reducing overdose deaths, though not by half. In addition, that 50 per cent reduction is directly attributable to the sorts of programs that Poilievre opposes.

Poilievre has the facts backwards; it is not addiction that is causing people to be unhoused, but rather a lack of affordable housing driving up rates of addiction. Community organizer and harm reduction advocate Karen Ward explains, “You’ve got this backwards. Homelessness leads to mental illness and compulsive use of unregulated substances.” The solution, she adds, is “homes for all,” not law enforcement. A growing number of Canadians are losing their housing amidst a cost of living crisis. Poilievre himself in other media acknowledges the crisis and its impact on “working Canadians.” However, he does not acknowledge that nearly a quarter of homeless people in Vancouver are, in fact, employed and therefore should be counted amongst “working Canadians.” Why then, in this video, does he attribute homelessness to addiction, when he is clearly aware of the role that the lack of affordable housing plays? It is also worth noting that more than half of all fatal overdoses in Canada happen indoors in private residences - yet another reason why homelessness and overdoses need to be addressed separately.

Given their different causes, conflating the toxic supply crisis and rising rates of homelessness is not likely to result in effective policy. The Conservative approach to reducing the overdose rate ignores the role of poverty altogether. It relies on the idea that the specter of overdose might be enough to scare people into sobriety via rehab programs. It further assumes that such programs are effective and accessible when there is little evidence that either are true.

Conservatives also assume that sobriety alone would be enough to ensure that rehab alumni were able to afford housing. Even if it were true that replacing harm reduction programs with rehabs would result in universal sobriety, said sobriety would do nothing to reduce the cost of rent in Vancouver. Furthermore, while a minority of substance users consume their drug of choice to a self-destructive degree, research has demonstrated that the vast majority of people are able to consume substances stably for years when they have access to a regulated supply. Returning to the example of Prohibition, the legalization of alcohol has not led to the unchecked destruction predicted by temperance advocates. What it has done is create opportunities for people who are concerned about their consumption levels to communicate about them openly without the fear of legal reprisal. Concurrently, the vast majority of the population is able to consume recreationally without encountering major problems. Does the consumption of any substance come with risks to health? Of course. But the government should not exacerbate these risks through prohibition. Instead, support and education must be offered to mitigate the risks in the same way it is with alcohol. If Poilievre were to become the next Prime Minister and follow through on his threat to replace evidence based practice with ideologically motivated policies, he would be putting thousands of lives unnecessarily at risk.

Poilievre has a history of leveraging controversy in order to boost his popularity. This video is merely the latest example of Poilievre playing fast and loose with the truth. He first came to the attention of the general public as an advocate for the so-called “freedom convoy”. By the time said convoy turned out to be less of a popular uprising and to have been funded by outside interests, Poilievre had moved on and was nowhere to be seen.

Poilievre’s popularity comes at a time when conservative governments are taking power across the Western world often by leveraging the same themes and tactics: culture war and a fear of outsiders.

It is important that Canadian health policy be built on a foundation of evidence, not ideology. Regardless of anyone’s personal stance on the question of sobriety, until there is evidence that rehab is a universally effective and accessible solution, it is absurd to propose replacing functional programs that are saving lives based on dubious evidence.

To once again quote Karen Ward, “If we’re going to turn this around, we need to replace the entire illicit drug supply and replace it with regulated substances that are available to all.”