REDUCTION OR PRODUCTION?

If you’re the chief coroner, hold an executive position in public health, or are the independent representative for children and youth or advocate of any kind, you’ve had one unified message for three years: there are no downsides to safe supply. That’s a message some of us were sure was dishonest and, regardless of intentions, could never pan out. But that assessment was just based on human behaviour and logic, not direct evidence.

Then in early March, the RCMP shared the results of a recent probe. They assured the public that "Organized crime groups are actively involved in the redistribution of safe supply and prescription drugs." Of course that was always virtually inevitable when the system was set up so folks can get up to 28 hydromorphone (Dilaudid) tablets per day — in a context in which users report that safe supply drugs are not what they want or in strengths they are accustomed to and where pills can be sold for $20 each on the street. Right. That's $560 per person per day, or $16,800 per month (which, of course, is in the earnings range of a Google engineer or a neurologist.)

During the RCMP investigation, they watched a woman in Prince George, BC stand outside a pharmacy each morning for two weeks, trading illicit drugs for safe supply medication. The 58-year-old made “dozens of ‘hand-to-hand’ transactions in that time — both buying and selling prescribed pills…” On the first day of surveillance they noted 15 people waiting for the pharmacy to open; and, in the 20 minutes following opening, nine of those people were observed leaving and immediately carrying out what appeared to be sales transactions. This same thing was repeated every day of the RCMP probe, with police observing a total of 84 brief ­transactions of this same character.

Sworn statements by the pharmacy owner, used by police to obtain a warrant for their surveillance, tell us that "Since the inception of the 'safe supply' program, he has observed vehicles and people loitering outside of the store trying to purchase safe supply drugs from patients." So that was the situation on the ground, from inception, according to the people who would know best. But, of course, we also don’t know whether the remaining six people police observed were simply more savvy and travelling farther afield (than the sidewalk outside the pharmacy) to sell their safe supply. It very well could be that 100% of the safe supply hydromorphone from this pharmacy was being sold rather than ingested and the proceeds used to purchase the still-ubiquitous unsafe supply. Or, at least, there’s no evidence suggesting otherwise. And I imagine if I were in their position I would think it bonkers NOT to sell JUST HALF of my free, annual Dilaudid allotment (that users tell us is both not what they're after and too weak if it were) for twice what a high school math teacher earns in a year.

THE MARKET

All of that begs us to ask what the situation could look like at scale. I mean, what are the chances that none of BC’s more than 1,400 other pharmacies are experiencing anything of this sort? The province tells us roughly 77,000 British Columbians have been diagnosed with opioid use disorders (which would amount to very few of the total numbers in reality.) They also tell us that 23,000 of those people receive some form of opioid assisted treatment, like methadone, and almost 5,000 more are on prescription hydromorphone. And we all know seemingly everyone involved only wants to see these prescription numbers grow very significantly.

So, if less than half of all pharmacies are experiencing this phenomenon, and those who do have less than half the customers reselling at less than half the rate of this Prince George example, that would be what? ([28 pills * 4 people] * 180 days) * 700 pharmacies; or just 14.1 million Dilaudid diverted annually? Oh yeah, and lets say $10-20 per pill on the street? That's what? Maybe a mere $250 million a year?

But wait, what if Prince George is representative and most folks with prescriptions are selling? That would be closer to ([28*9]*365)*1400. Which is what, merely $2.575 billion annually? Fuck me! And that still pretends half of prescribed hydromorphone is being used and not sold (just 9 of 15 people waiting outside the Prince George pharmacy). Though, is there any reason to believe that's the case? Not as far as I can tell.

And now remember there's room and the political will AND a gargantuan profit incentive to grow safe supply prescriptions significantly. We doubled the number in just a year and could be up from 5,000 to 10,000 or 25,000, or even 50,000 ($25B!!!) in no time as deaths and hospitalizations continue climbing with our definition-of-insanity, stay-the-course strategy. And that is the plan coming from those writing policy, forming drug companies, and calling the shots (all of whom are friends and colleagues; that is, of course, when they aren't all the same person — as appears to be the case in several instances.)

Well, as we ponder that, we should also keep at the fore of our consciousness that all of this was happening, and right in the open, at the same time authorities and activists alike exclaimed that diversion was a “myth” and a “fear-mongering” strategy concocted for political ends.

WHAT NOW?

Today, however, we have more information. Just a few weeks after the above investigation came out, Vancouver Police Department Deputy Chief Fiona Wilson has explained, in an address to a House of Commons committee, that there is “no question” safe supply is being diverted. And not a little. She offered that half of hydromorphone seizures were found to be drugs diverted from the publicly funded safe supply.

That means that, on diversion, in just a few months we went from something like:

• Effectively everyone: ‘There is no diversion. That’s a politically-motivated psyop aimed at nothing more than deliberately hurting people’; to 
  

• Nearly everyone: ‘There’s no widespread diversion and anyone who suggests there could be is engaged in regressive Conservative fear-mongering and police-state promotion’; to
  

• PHO: ‘It’s very minor, if its happening at all; but it’s true that we’ve done nothing to prevent diversion and we haven’t been looking so we just don’t have the data either’; to
  

• RCMP: ‘It’s quite possible the public has been subsidizing organized crime all this time. Oh and, if that is occurring, your kids are probably the ones on the demand side of this equation’; to
  

• VPD: ‘It’s bad, real bad.’

So, just as we rebranded "safe supply" to "safer supply" and then again more recently to "prescribed alternatives", I suggest we take "harm reduction" from euphemism to something that better reflects reality: harm production, which it has always been. From there, maybe another year from now, we can change it once again to what we are now sure that it is: expert-approved, government-sponsored, taxpayer-funded, for-profit harm production. Just a suggestion.