Nearly a quarter of participants in BC’s safer supply program are diverting prescribed opioids, according to a recent Vancouver-based study. The findings also reveal ongoing reliance on toxic street drugs, raising urgent questions about the program’s effectiveness in addressing Canada’s overdose crisis. These troubling trends are forcing a reevaluation of harm reduction strategies and their role in combating the escalating epidemic.
Safer Supply’s Promise and the Opioid Crisis Reality
British Columbia’s overdose crisis, now in its seventh year as a public health emergency, remains unrelenting. Each year, the province records thousands of overdose deaths, primarily linked to a toxic, unregulated drug market dominated by fentanyl and other deadly contaminants. To confront this crisis, BC introduced safer supply programs in 2020, offering pharmaceutical-grade opioids like hydromorphone to individuals at high risk of overdose.
The program’s goal was straightforward: save lives by replacing dangerous street drugs with safer alternatives while reducing stigma and encouraging access to health services. Advocates positioned safer supply as a critical extension of the Four Pillars approach—prevention, treatment, enforcement, and harm reduction—that Vancouver pioneered decades ago. In theory, these programs could provide stability for users, reduce deaths, and pave pathways to treatment.
However, the findings of a new Vancouver-based study led by Dr. Brian Conway, director of Vancouver’s Infectious Disease Centre, suggest that this vision is falling short. While safer supply has undoubtedly saved lives by mitigating immediate overdose risks, the program has not curbed dependency on street drugs. The study paints a picture of a community still heavily reliant on unregulated substances, challenging the program’s broader goals of harm reduction and recovery.
Study Exposes Safer Supply’s Disconnect from Real-World Use
The recent study, which analyzed data from 50 participants enrolled in a safer supply program, has sparked debate. Researchers found that 100% of participants tested positive for substances not prescribed under the program, with 84% showing fentanyl use and 72% testing positive for amphetamines. Despite being provided with hydromorphone as a safer alternative, nearly a quarter of participants admitted to selling or trading their prescriptions.
This diversion of safer supply opioids reveals unintended consequences. For some participants, selling hydromorphone was a way to afford stronger street drugs like fentanyl, highlighting the program’s inability to meet the needs of certain users. Others traded their supply to supplement income, reflecting the socioeconomic instability prevalent in the community.
These findings raise significant concerns about safer supply’s role in combating the overdose crisis. If participants continue to rely on street drugs despite access to pharmaceutical-grade alternatives, can the program achieve its intended outcomes? Critics argue that these results point to the need for stricter oversight and improved integration with treatment services. Advocates, however, counter that the findings underscore the toxic drug market’s grip on vulnerable communities, emphasizing the need for complementary policies like safe supply expansion and housing support.
The Shadow of Diversion and Its Consequences
Perhaps the most contentious issue raised by the study is the diversion of hydromorphone, which creates ripple effects far beyond program participants. When pharmaceutical-grade opioids enter the street market, they can fall into the hands of individuals outside the program, including those at lower risk of overdose. Critics warn that diversion may inadvertently expand access to opioids for recreational use, creating new vulnerabilities in communities already struggling with addiction.
The tragic story of Kamilah Sword, a teenager who died after consuming diverted hydromorphone, has amplified calls for greater accountability. Her case is emblematic of the risks of diversion, with some questioning whether safer supply programs inadvertently create harm. These concerns complicate public perceptions of harm reduction, making it harder for policymakers to build support for such initiatives.
Yet, harm reduction advocates caution against overgeneralizing the risks of diversion. They argue that the primary driver of the overdose crisis remains the toxic street drug supply, not safer supply programs. “Diversion is a symptom of a broken system,” one expert noted. “The real problem is that people are forced to navigate an unregulated market for survival.” This perspective underscores the complexity of addressing addiction in a crisis shaped by socioeconomic inequities and systemic failures.
Systemic Gaps Undermining Harm Reduction Efforts
The study’s findings also shed light on the broader challenges facing safer supply participants. Most individuals in the program are living in precarious circumstances, with 82% reporting homelessness or unstable housing and 92% unemployed. These conditions not only exacerbate addiction but also limit the effectiveness of harm reduction initiatives. Without addressing these underlying issues, programs like safer supply are unlikely to achieve their full potential.
The Downtown Community Court (DTCC) offers a case study on how systemic gaps complicate harm reduction efforts. The DTCC, which integrates health and social services into the justice system, serves many clients struggling with addiction and homelessness. While the court’s holistic approach is innovative, its limited resources and high caseloads illustrate the difficulties of scaling such interventions.
For safer supply to succeed, it must be part of a broader strategy that includes housing, mental health care, and employment support. The findings of the study highlight the need for a more integrated approach, where harm reduction programs are complemented by systemic solutions that address the root causes of addiction.
The Future of Safer Supply in British Columbia
The safer supply program was never intended to be a silver bullet for the overdose crisis, but its current trajectory raises difficult questions about its design and implementation. Critics point to the study’s findings as evidence that the program fails to achieve its goals, while supporters argue that it is being judged prematurely. Both sides agree, however, that the program must evolve to meet the complex realities of addiction in communities like Vancouver’s Downtown Eastside.
Policymakers face a critical challenge: refining safer supply to address its shortcomings while maintaining its core mission of saving lives. This may involve stricter monitoring to prevent diversion, better participant education, and expanded access to complementary services like treatment and housing. The program’s future will depend on its ability to adapt to the evolving needs of users and the communities it serves.
For Canada, the lessons learned from safer supply in British Columbia could shape the national approach to harm reduction. The opioid crisis is a shared challenge, and the success—or failure—of BC’s initiatives will have implications for the entire country.
The Unvarnished Truth About Safer Supply
The findings of this study force a critical and uncomfortable reckoning with BC’s safer supply program. The evidence is clear: while the program has undoubtedly saved lives by mitigating immediate overdose risks, it is far from solving the deeper crisis. For every life safer supply saves, its limitations and unintended consequences ripple out, reshaping the communities it aims to protect. Diversion of pharmaceuticals is not a minor glitch—it is a glaring symptom of a system trying to play catch-up with a crisis spiralling far beyond its control.
The underlying issue remains the toxic street drug market, an unregulated force dictating life and death in British Columbia. Safer supply was meant to sever this dependency, but the continued dominance of fentanyl and other contaminants underscores just how little has changed at the root level. Harm reduction without systemic reform is not harm reduction—it’s harm management. Without significant recalibration, this program risks becoming a stopgap solution that prolongs the status quo rather than dismantling it.
The crisis demands more than isolated policies or well-meaning experiments. It demands a fundamental shift in how Canada approaches addiction—integrating safer supply with aggressive investment in housing, mental health care, and economic support. The harsh reality is this: programs like safer supply can only do so much when the very fabric of social support is fraying. The question is whether governments will accept these hard truths and act decisively or remain caught in half-measures and deferred accountability cycles. Canada cannot afford the latter. Neither can its most vulnerable citizens.
Lance has lived in the Downtown Eastside for years, staying closely connected to the neighbourhood and the people who call it home. He writes about the issues that matter—from housing and policy shifts to the everyday stories that shape the community—because DTES isn’t just where he lives, it’s a place he cares deeply about.
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