Issue #41 November 2024
Safe supply is a difficult drug policy challenge for at least two reasons. First, it is complex. Be wary of anyone who tells you differently or declares that they have the solution. Secondly, safe supply is now highly politicized and divisive which means that motives and declarations can be as contaminated as the illegal drug supply itself. I do not possess the solution. But I have encountered some prominent declarations related to safe supply that can be dismissed as outright wrong. This issue of DPA addresses three of them.
Safe Injection Sites Represent an Absurd Inconsistency
The long-standing controversy that surrounds safe injection sites typically reflects a misunderstanding of public health strategies. One misinformed inquiry sought confirmation that a safe injection site was a place where you could inject heroin, but you could not smoke a cigarette – suggesting that this is an absurd inconsistency. It is not. The seeming inconsistency rests upon three misunderstandings. The first is the belief that heroin is a more dangerous drug than cigarettes. There are no acute overdoses from cigarettes as there are from heroin, but that is just one part of what’s relevant. Nicotine is just as addictive as heroin, and more importantly, cigarettes account for far more deaths than does heroin.
The second misunderstanding is the insinuation that the restriction on indoor smoking is frivolous compared to the allowance of heroin injection. The restriction on smoking is intended to prevent exposure to second-hand smoke which is a well-documented contributor to respiratory illness, various cancers, and premature death. This is especially important for staff who work at safe injection sites who would be exposed to this risk on a long-term daily basis – as were people who worked in bars, restaurants, and cafes before smoking bans were implemented.
The third misunderstanding is that safe injection sites are primarily about offering an opportunity to inject free heroin or other drugs, and thus enable drug use. They are not. They are primarily about lowering the prevalence of drug-related deaths and the spread of potentially life-threatening infectious disease.
Once you understand the operation of safe injection sites within the appropriate public health framework, the policies make perfect sense.
The Opioid Crisis Began with Illegal Fentanyl
In defence of safe supply, drug policy advocates will sometimes assert that the opioid crisis began with a supply of illegal dangerous fentanyl. It did not. The opioid crisis began with the hyper-commercialized promotion of legal oxycodone products and the ensuing irresponsible prescribing practices stimulated by corporate pharma largesse. Some poorly considered regulatory interventions by governments also contributed. It was only later that an opportunistic illegal trade in fentanyl piled on and the opioid crisis further spiralled out of control. Apart from the hyper-commercialization of legal oxycodone products, the release of these products to the market checked all the customary boxes for a “safe supply”. But that obviously did not work out so well. The revenue-obsessed commercialization of opioid products by legal pharma companies launched the opioid crisis and created a fertile breeding ground for the illegal trade to exploit. It could be argued that the legal pharma oxycodone debacle is now mostly a problem of the past and we need to focus on the present problem which is the trade in illegal fentanyl. However, this perspective assumes that there will never be another incursion on public health by the pharmaceutical industry. From an international, historical perspective, that would be a perilous assumption. Accordingly, we need to clearly and continually declare legal pharma’s role in the opioid crisis and to encourage preparation and pre-emptive policy to prevent pharma’s next revenue-driven incursion against humanity.
Alcohol, Tobacco, Cannabis Industries Provide a Model for a Regulated Drug Supply
I have heard seasoned, even internationally-acclaimed, academics assert that our existing legal drug industries provide acceptably safe models for the legalization of a new drug supply. They do not. This canard was a major strategic component of Canada’s fraudulent cannabis legalization campaign. It continues to be used to justify the establishment of a legal safe supply of other drugs.
The Canadian Substance Use Costs and Harms database clearly demonstrates that legal alcohol and tobacco products account for the very great majority of drug related morbidity, mortality, and economic costs – more than all other drugs combined. There is a voluminous literature on regulatory violations including corporate crime and a long history of blatant indifference to public health protection by these legal drug industries. We should not hold them up as acceptable models for a new legal, regulated drug supply. While it is early, it appears that the legal cannabis industry is adopting the same playbook as its elder drug industry siblings with numerous regulatory violations including corporate crime and a demonstrated indifference to public health protection. We have evidence from Institut National de Santé Publique du Québec, Daniel Myron at Ottawa Hospital and David Hammond at The University of Waterloo that it is not so much cannabis, but the legalized commercialization of cannabis that appears to be associated with increased harms. This includes admissions of both adults and children to hospital (including ER) for cannabis-related toxicity. At minimum, this is a yellow flag waving for our attention. It is not to be dismissed with a declaration of legal, regulated cannabis as a viable model of safe supply.
Some cannabis reform advocates have proposed the establishment of cannabis lounges as safe consumption sites. They would not be so safe for the staff who worked there and were exposed to daily high levels of smoke and vapor. I’ve seen the same advocates refer to bars as safe consumption sites. These advocates appear to be unaware of the elevated levels of neighbourhood property damage, impaired driving, and violence – at the bars, surrounding the bars, and at the homes of some patrons in the form of domestic violence. Let’s be clear on this – bars are not safe consumption sites.
I appreciate that in many academic and health/social care settings, there are subtle and not so subtle forces that can discourage candid criticism of the commercial world and its impact upon public health and welfare, including upon drug-related harms. However, with emerging literatures on the commercial and political determinants of health, and on regulatory capture by numerous industries, I believe it is strategically timely and important to resist those forces. It is time to join a choir whose voice has been effectively muzzled for far too long. The song that needs to be sung is that the major cause of drug problems is revenue-driven, legal drug industries enabled by permissive, and often conflicted, government regulation of those industries. That has profound implications for how we provide a safe supply of drugs.
Mike DeVillaer
Hamilton Ontario Canada
December 16 2024
This issue is based partly upon modified and updated content from my book, “Buzz Kill: The Corporatization of Cannabis”. You can order it from:
Black Rose Books: https://blackrosebooks.com/products/buzz-kill-michael-r-devillaer or
Distributors: Canada / USA: University of Toronto Press utpbooks@utpress.utoronto.ca
UK / International: Central Books contactus@centralbooks.com
Or your local bookstore. They will appreciate your support.