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This article was published more than 2 years ago. Some information may no longer be current. People hold a banner reading 'safe supply saves lives' at an Aug. Vincent Lam is an addictions medicine physician and an author. DULF — a non-profit — is seeking legal permission to purchase heroin, cocaine and methamphetamine from the Dark Web, which it plans to test, label and distribute. In this, doctors prescribe high doses of hydromorphone for patients to use anywhere, and to swallow, crush, or inject as they prefer. When they learn that I will not fulfill their request for hydromorphone, some are disappointed, or angry. Patients of mine who were free of illicit opioids for years now struggle with hydromorphone, which they are buying from those to whom it is prescribed. One told me they prefer to sleep outside rather than in shelters, because they cannot avoid hydromorphone in the shelters. One who has never tried fentanyl — which hydromorphone is meant to protect them from — is injecting high doses of hydromorphone daily, struggling to get off, while their tolerance rapidly increases. Vincent Lam. In medicine we are taught primum non nocere , first do no harm. At this moment, both people who use drugs and the professionals who are trying to offer care feel that a tidal wave of harm is engulfing us. An amount that a person could tolerate on one day causes them to overdose the next. I routinely learn of the deaths of my patients who have been among the 22, apparent-opioid toxicity deaths in Canada between January, , and March, A national tragedy with complex origins demands a coherent response. Some patients feel it has helped them. It is not treatment and it is an unproven intervention. A French study showed that giving people morphine tablets to take home, rather than providing less easily injected methadone and buprenorphine, resulted in higher rates of unintentional overdose, bacterial infection, dangerous blood clots and overall rates of death. A front-line worker fills syringes with Narcan at a safe-injection site in the Downtown Eastside. A commitment to iOAT — which differs from supervised injection sites where users bring their own drugs, and also differs from standard OAT, where take-home options of prescribed medications exist — requires immense staffing and resources, and availability of iOAT remains limited. The cost to patients is that multiple daily visits to receive iOAT make it prohibitive to work or attend school. It was a brilliant move by the federal government to dodge responsibility for drug policy. Much depends on the frame of observation. Heaslip would prefer broader access to hydromorphone through public-health mechanisms, without prescribers like her acting as gatekeepers. Heaslip says. In some communities, the street value of hydromorphone tablets has dropped significantly since the beginning of COVID because they are more widely available. Heroin and cocaine from a safe supply are handed out in Vancouver on Aug. If you are a skeptic, it points to the futility of the effort. This conundrum results in varying conclusions. Some advocates, like DULF, conclude that what is needed is free access to tested, labelled drugs that people can use as they wish. If I want to use a substance, I want the ability to go buy it from someone whom I trust. Many prescribers feel there is little clinical judgment involved in any case — they simply fulfill the request for hydromorphone. These are at once so diffusely powerful and inadequately addressed, that those of us who wield prescription pads are easily seduced by the promise of a solution by prescription, just as opioids promise solace in the smooth form of a nice, safe pill. In the late s and s the pharmaceutical company Purdue made an earlier unfounded claim of safety — telling doctors that if oxycodone was prescribed for pain, patients would not become addicted. Within a Medicare system that funds physicians and often pills — but less often provides multidisciplinary management of chronic pain — oxycodone was the go-to for pain for almost a decade. Stingy sick leave policies make it difficult for injured workers to recover from painful injuries. Many who suffered in non-physical ways — from trauma to untreated mental illness — also discovered that opioids helped to ease their suffering temporarily. In addition to being swallowed, oxycodone tablets like Percocet were sometimes sold, chewed and snorted. At the time, these prescriptions were received with gratitude and thanks. I wonder how many would thank me today? We now know that 80 per cent of heroin users initially misused prescribed opioids. Many are unconvinced. Nick Mathew, an addictions psychiatrist in Vancouver. The downsides of increasing the amount of opioids in the population have a known harm. A woman injects hydromorphone at a clinic on Vancouver's Downtown Eastside in Kaminski tells me. Patients of mine are rightly angry when — as often occurs — they seek general medical care and are belittled, condescended to, or refused pain management because they are a person who uses drugs. Many Canadian hospitals do not provide addictions services. The result is that people who suffer from substance-use disorders who are admitted for other urgent medical reasons often leave because they are suffering the agony of withdrawal, and therefore do not receive other essential medical services. In this way, they are denied what is promised by the Canada Health Act — universal access to health care. What everyone seems to agree on is that the issue and the required solutions are broader than just the molecules on-hand. Since power can only be exercised upon, or taken from, those who can be reached, individual users of drugs are criminalized, and the health care system is asked to both provide solutions and relinquish its oversight. A distinction between the exercise of punitive powers, and limits based upon science and safety, is important. I have not yet met an addictions professional who does not support decriminalization of the possession of small amounts of drugs for personal use — as the revolving door of the criminal justice system destabilizes people who use drugs and makes their lives more dangerous. We must find a way as a society to give people agency and choice — without the widespread, uncontrolled distribution of the same molecules that got us here. This is the kind of leadership and commitment that provincial and federal governments need to show, rather than a contradictory and patchwork throw-away, telling doctors not to prescribe opioids — except when they are supposed to be prescribing far more than ever before. A protester gathers containers that look like OxyContin bottles in in front of the U. Those of us who practise addictions medicine need to ask ourselves hard questions about how we can be more patient-centred and responsive to the dangers our patients now face. Addictions medicine has too often been structured to suit the needs of regulators and care providers before the needs of patients. Inpatient rehabilitation facilities that do not offer OAT ignore three decades of science. Outpatient clinics that profit from insisting upon frequent mandatory urine testing, along with regulations which require patients to attend a pharmacy daily to obtain prescribed treatment, make it difficult for many patients to be in treatment programs and attend school or work. In some smaller communities often no addictions treatment is available. Methadone and buprenorphine are on the WHO list of essential medicines , and yet pharmacies can opt out of dispensing them: dispensing other opioids and not dispensing the treatments for opioid use disorder is akin to allowing people to build bonfires without having buckets of water. Addictions care is starting to change, with more rapid dosing protocols and combinations of medications to address the higher tolerance era of fentanyl. Virtual options are expanding access to care. Guidelines for prescribing medications are becoming more flexible. Some hospitals are beginning to expand addictions consult services. All of these changes are happening too slowly and inconsistently, and need to move forward with urgency. Ultimately, this divisive issue is one that hinges on questions of power, inclusion, agency, as well as science. People who use drugs have felt powerless, and excluded. More than ever, their lives are at stake. A meaningful response needs to take place in addictions medicine, the broad health care system, and government, and in our communities — with people who use drugs at the centre in such a way that they are served by institutions and by science. Prescribed opioids were an integral part of the creation of this crisis. We are not going to be able to prescribe our way out of it. The Dalke and Seibel families share a tragic connection: Each lost a child to opioids. Now they plead with others to steer clear of illicit drugs and get help for mental illness if possible. These are their stories. American-level bad. Port Alberni vs. The Timmins tag team: When opioids and official inaction were killing people, these doctors pushed for life-saving changes. Keep your Opinions sharp and informed. Get the Opinion newsletter. Sign up today. Report an editorial error. Report a technical issue. Editorial code of conduct. Authors and topics you follow will be added to your personal news feed in Following. An epidemic of drug overdoses has claimed more than 20, Canadians since — about the same number of victims as the coronavirus. In this interactive feature, Andrea Woo and Marcus Gee puts names and faces to those we lost. Since joining The Globe in , her coverage has included the telecommunications and cannabis industries, personal finance and real estate. Her enterprise reporting has resulted in an immediate impact to Canadians' access to public information as part of the Rogers-Shaw takeover. As well, it has has highlighted inequality in telecommunications service in Iqaluit; held companies to account for unfulfilled corporate commitments to hire Ukrainian refugees; and shed light on the lasting impact of century-old real estate policies. She is a frequent contributor to The Globe's Amplify newsletter, which highlights female voices. Irene has appeared as a guest on news boradcasts and The Globe's podcast to provide analysis of business stories, and as a moderator of live panel discussions. She is currently completing a Masters of Building History from the University of Cambridge, with a focus on medieval buildings and the evolution of Toronto's nineteenth-century bank architecture. He also compiles stock market updates throughout the trading day while editing other staff stories. With a passion for equity markets, he's always on the lookout for news big and small that will cause rumblings on Bay Street. 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