Bonnie Larson, Ginetta Salvalaggio, based in Alberta, and Claire Bodkin in Ontario are family physicians who care for people who use drugs. Their practice spans a continuum of care that includes evidence-based prevention, harm reduction and treatment interventions.
Some physicians will sympathize with Vincent Lam’s recent opinion (Nov. 27) column, in which he argues that safe supply is harmful. Although taking this position might release a doctor from the discomfort of prescribing opioids at a time when physicians are encouraged to “deprescribe,” or take patients off their medicines, others understand that safe supply is a critical component of any strategy to end drug poisonings. Regardless of where a physician stands on this issue, the importance of getting it right has never been higher. It is truly a matter of life or death.
Dr. Lam’s critique of safe supply concentrates on prescribing hydromorphone – one of several opioid medications for severe pain that can be used this way – to patients with opioid-use disorder. “Safe supply” has many facets, however, only one of which is prescribing pharmaceuticals to replace tainted drugs. Compassion clubs, or co-ops where resources are pooled to purchase and check substances for contaminants, offer another model of safe supply that does not necessitate any doctors’ involvement.
Dr. Lam also assumes that provision of safe supply is meant to be a treatment for addictions. This is a mistake, because the primary outcome of ensuring access to drugs that are not poisoned is survival, not recovery. The first must precede the latter in any case.
The prescribing of opioids is misattributed by many, including Dr. Lam, as the cause of the current crisis. At best, this is only partly true historically and is now practically irrelevant. Nearly all opioid-related poisonings in Canada are currently caused by an adulterated supply, coupled with prohibitionist drug policy. Present-day mortality is not caused by prescriptions, nor a rise in substance-use disorders. In fact, many deaths have nothing at all to do with “addiction.”
People who use drugs do not want to be sickened or harmed, and – just like everyone else – they have the right to interventions that keep them alive. People consume substances for many reasons, even in the face of risk – particularly if abstaining causes intolerable effects such as suicidal thoughts, the surfacing of awful memories, being assaulted if you fall asleep on the streets, or the severe symptoms of opioid withdrawal.
To read more on this opinion piece, you can find the article here.