Amidst the unregulated toxic drug supply emergency in the province that has killed over 16,000 people since 2016, alongside the manufactured onslaught against harm reduction country-wide, the BC Health Minister announced on February 19th that people who use opioids from safe supply programs will now be forced to take their prescription under the supervision of a pharmacist, eliminating the possibility for people to take their regulated supply home. The decision will require patients of prescribed alternatives—who are most at risk of overdose— to attend clinics multiple times per day depending on their dosage requirements.
This is the second time in the past year that the BC NDP have implemented an anti-harm reduction policy under the guise of “compassion,” the first being the expansion of involuntary treatment in prisons for people with adverse mental health experiences and/or people who use drugs. The primary justification behind the decision is to combat the diversion of safe supply opioids that occur when they are shared, exchanged or sold outside a sanctioned medical setting. Such diversion, according to reactionary politicians and the media, is allegedly fueling drug use in communities.
Upon closer analysis however, it becomes clear that the policy has little to do with public safety or reducing drug use, but rather serves as a re-entrenchment of the punitive drug ideology that has dominated so-called Canada since the beginning of its drug legislation, further undermining the agency of people who use drugs and rendering their lives as disposable. The discourse around the diversion of safe supply is being used to reinforce this ideology, where people who contribute to harm reduction are automatically labelled by the media as “organized criminals” in order to further marginalize poor, disproportionately racialized and Indigenous populations with either misleading or no context as to why diversion occurs in the first place or how it is used as a means to prevent the use of the toxic supply.
Why does safe supply diversion happen?
Safe supply is a lifesaving intervention that has been empirically proven to reduce dependency on the toxic supply of drugs, therefore reducing drug toxicity death, improve people’s quality of life and provide the most vulnerable in society with a more established connection to life sustaining resources. There is no evidence that prescribed alternatives increase overdose mortality and the detection of alternatives such as hydromorphone has been present in only 3% of overdose deaths in BC. Public health expert Dr. Mark Tyndall, in response to the ending of take-home safe supply, stated that “the only logical or ethical response to people dying from buying poisoned drugs on the street is to offer them an alternative.” Despite this, the scope of prescribed alternative programs in BC remains severely limited. Only 3,892 people were prescribed alternative opioids in December 2024, a 25% decrease from the 5,189 individuals in March 2023. Considering that approximately 100,000 people in BC are estimated to have an opioid disorder, that means that just under 4% of the total number of people who use opioids currently have access to safe supply.
First implemented in 2020 during the beginning of the COVID-19 Pandemic, prescribed alternative programs mainly offer such opioids alternatives as hydromorphone, sustained-release oral morphine and injectable fentanyl, free of charge at community health centres, primary care clinics and pharmacies for eligible individuals. Even if one is considered eligible there are many barriers that come with accessing safe supply according to the Auditor General of BC, such as lack of prescribers due to stigma and the restrictive criteria that forces recipients to be at the pharmacy at specific times during the day. This results in people having to alter their job schedules and various responsibilities just to access prescribed alternatives. For those in rural and remote areas, such an obstacle is notably less bearable as they have even less options for clinics. Many of the 3,892 people eligible for safe supply are already part of witness-only programs where they are forced to attend the pharmacy multiple times a day.
Furthermore, while safe supply programs have been shown to reduce stigma around drug use, the stigmatization towards Indigenous people in a Western medical setting where these programs are located remains highly prevalent. Considering Indigenous people make up a disproportionate amount of the population of Vancouver’s Downtown Eastside, the neighbourhood primarily associated with addressing the overdose emergency, such stigmatization can be a major factor for Indigenous communities when it comes to accessing life sustaining supply even if they are considered eligible. A recent study determined that Indigenous women who have experienced incarceration are 81 times more likely than people with no experience of incarceration to die from an opioid overdose, and Indigenous men with experience of incarceration are 23.6 times more likely to die from an overdose when compared with the rest of the population. BC has one of the highest indigenous incarceration rates in the country, making the barriers to accessing safe supply for Indigenous individuals even more concerning.
Given the fact that access to prescribed opioid alternatives is limited, alongside the many barriers that come with being eligible, it is no wonder that the diversion of prescribed opioids exists as it is the only alternative from the toxic supply for many. Anyone remotely in tune with the reality of drug use would understand the clear solution to such diversion would be to significantly expand safe supply availability, not reduce it. While often perceived as an unintended consequence, when perceived in this context diversion becomes an intended consequence in that the deliberate underfunding of harm reduction initiatives is the variable that leads to the rerouting of prescriptions.
As The National Safer Supply Community of Practice puts it, safe supply diversion is reflective of unmet community needs. A common reason given for diversion is the fact that people are financially unstable and the selling of prescribed opioids is necessary for their survival. Forced or coerced diversion also exists, where people give away their prescribed supply in response to threats. Such violence does not happen in a vacuum but is indictive of an inaccessible healthcare system and social safety net that in turn divides desperate people against each other.
Indeed, the population of the Downtown Eastside has for decades been subjected to organized abandonment from the state, in which individuals are increasingly more susceptible to homelessness, displacement, alienation, policing, drug seizures and colonial extraction in pursuit of fulfilling the private capital objectives of what has been termed the “Non-Profit Industrial Complex.” All these factors have compounded to form as the catalyst for the current overdose mortality rate.
Safe supply diversion as mutual aid
While either portrayed in negative discourse or outright denied that it is happening, status quo narratives ignore the benefits of external distribution amongst users, such as how the use of diversion of prescribed opioids can decrease the risk of unregulated drug use. This is exactly what happened in Vancouver where a study found that those who used diverted pharmaceutical opioids were 30% less likely to be exposed to toxic fentanyl compared to those who did not use diverted safe supply. As argued by many harm reduction-based researchers, the benefits of such diversion far outweigh the perceived harms.
Since only an average of 4777 individuals have access to safe supply a month in BC, diversion can act as a form of mutual aid in which people with access to prescribed alternatives assist others from being exposed to toxic fentanyl. Mutual aid that existed at encampments under threat of eviction in Toronto during the COVID-19 pandemic, where residents helped each other with their basic needs such as access to drugs. Safety, altruism and compassion for others’ wellbeing are consistent factors as to why people decide to divert their supply in their communities. Such recognition of cooperation amongst vulnerable populations can serve as an effective counter to the dehumanizing status quo narrative labeling people who use drugs as primarily selfish actors who are undeserving of empathy.
Understanding safe supply diversion through the lens of mutual aid aligns with the acknowledgment of drug use in capitalist society as a form of resistance against oppressive drug laws that aim to police what people can do with their bodies. People wanting to share their altered experience in a safe way by diverting their limited alternatives emulates what capitalism, despite all of its might and desire to, will never destroy, the intrinsic social bonds that connect us with each other and make us want to fight for a better world that accepts drug use for what it truly is, a liberating experience allowing us to transcend beyond our sober selves, that which we can experience together.
Compassion clubs as essential service
Vancouver-prescribed safer supply programs overall have shown to be severely restricted in their ability to combat the unregulated drug market, most notably due to their capability of what they offer in terms of alternatives. As noted earlier in the article, safe supply participation itself remains severely limited. People who are eligible emphasize how prescribed opioids are not nearly enough for their needs and a “real safe supply” is required to counter the potency of illicit fentanyl.
Only 9.4% of drug users surveyed in BC preferred prescribed opioids as their alternative substance of choice compared to 57.8% who preferred heroin, a drug only available outside a regulated medical setting. Frequently in the literature analyzing prescribed alternative programs is the notion that such alternatives will inevitably have poorer acceptability if the felt effects are insubstantial in comparison to the potency of the illicit supply.
These are the factors that led to the creation of the unsanctioned Compassion Club Drug User Liberation Front (DULF) in 2021, which, recognizing the barriers of state funded safe prescriptions, offered up to 14 g per week of tested cocaine, heroin and methamphetamine for eligible individuals with the objective of undercutting the illicit drug market. Emerging evidence suggests that DULF, before being raided by the police, was successful in reducing overdose risk alongside creating a more prosocial space for people who use drugs free from stigmatization often present in traditional health service facilities. Mutual aid was also essential at DULF, where friendship, lack of access and safety were cited as the primary reasons individuals diverted their supply.
What powerful people tell us
If the capitalist-aligned, state-sanctioned media reported more accurately on the harms that brings the most damage to society, deaths from toxic drug supply would constantly be on the front of every news site every single day.
Yet, it is the moral panic around prescribed opioid diversion that currently dominates CBC, the National Post and CTV News. All for the purpose of further dehumanizing those that exist on the margins of capitalist society—those who it has been embedded into us time and time again to render disposable. We must reject such dehumanization and fight to uphold the agency of people who use drugs. We must humanize safe supply diversion. A necessary step in achieving this is recognizing the recent policy to end take-home prescribed opioids not as a well-intended “compassionate” decision with public safety in mind, but as another deliberate instance of the state augmenting their power over the autonomy of people who use drugs. Less safe supply will now be in communities, increasing the presence of illicit toxic fentanyl. Cruelty is the point.
Did you like this article? Help us produce more like it by donating $1, $2, or $5. Donate
