Adam Zivo: Doctors fed up with activists gaslighting them over 'safer supply'

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Earlier this month, a group of 35 addiction experts released yet another public letter calling upon the federal government to fix Canada’s failing “safer supply” drug experiment. A year ago this would have been unthinkable — but it seems that the wall of silence around safer supply is crumbling, despite activist-led efforts to discredit critics.

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The new letter states that there is “accumulating evidence” that safer supply programs are being widely abused and that the taxpayer-funded opioids being distributed through them are being resold (“diverted”) on the black market.

These diverted drugs, which are as potent as heroin, are ending up in the hands of youth, recovering addicts and people who don’t normally use opioids. This has put Canadians at “grave risk for harm, including addiction, injection-related infections, transitioning to fentanyl and overdose death.”

The letter criticizes the federal government for failing to “recognize the negative public health impact of Safe Supply programs that we are seeing in our practices and communities.”

In an accompanying evidence brief, the authors note that the studies which support safer supply are “weak” and fail to meet normal research standards, such as the use of control groups. Despite the fact that the federal government has invested over $80 million into safer supply, it has sponsored no serious studies measuring the scale and harms of diversion.

“This is a troubling abdication of responsibility on Health Canada’s part. Health Canada has provided many millions of dollars to Safe Supply programs over the past five years without conducting even the most basic evaluation of the potential adverse public health impact of these programs,” write the authors.

The brief also notes that, as safer supply programs typically distribute oral-use hydromorphone tablets, they seem to be associated with debilitating infections. Users often crush and inject the tablets, which are not sterile and include materials that are not designed for intravenous use. This unsafe practice is nonetheless condoned by safer supply providers.

The signatories make several commonsense recommendations to fix safer supply. Among other things, they argue that programs should require supervised consumption to reduce diversion (this is currently very rare) and that oral-use tablets should be replaced with liquid hydromorphone, to reduce infections.

The open letter was spearheaded by Dr. Meldon Kahan, medical director of the substance use service at Women’s College Hospital in Toronto. Its signatories include a number of respected figures within Canada’s addiction medicine world, such as Dr. Jenn Brasch and Dr. Melanie Willows (both are past-presidents of the Canadian Society of Addiction Medicine (CSAM)) and Dr. Robert Cooper (recipient of CSAM’s 2022 Lifetime Achievement Award).

This is the second open letter published this fall criticizing safer supply. Another letter, which was released in late September, was also organized by Dr. Kahan but included only 17 signatories.

“We have heard of physicians being personally harassed and publicly vilified for voicing their concerns about ‘safer supply,’” said Dr. Michael Lester, a Toronto-based addiction physician who was among the first letter’s signatories. “We find it terrifying. A number of physicians told us they agreed with what we were doing but were afraid to speak out.”

As more addiction experts have “come out” against safer supply, it appears that the harassment campaigns used to silence them are proving less effective. In just one and a half months, the number of doctors willing to publicly join the fray has doubled — and, based on conversations I had with addiction experts at CSAM’s annual scientific conference last month, it’s certain that even more will come forward over the coming months.

One such expert who changed their mind is Dr. Lisa Bromely, an Ottawa-based addiction physician who was one of my first sources when I began investigating safer supply diversion last winter.

She agreed to speak on record in January, but changed her mind upon witnessing the online viciousness of safer supply activists (I ultimately gave her a pseudonym, “Dr. Indigo”). After laying low for months, Dr. Bromley recently “came out” and signed the most recent open letter.

In an email, she explained that she was tired of the “gaslighting” and “ad hominem” attacks used by safer supply activists, which had created a “chilling effect” on addiction discourse. Although she “expects to experience personal attacks,” she said she “owes it to the people who have been harmed by diverted safer supply, and who are seeking help in my addiction practice, to speak up.”

Dr. Bromley is right to be concerned about attacks. After the first open letter criticizing safer supply was published in September, activists started claiming that their opponents are corrupt and misrepresenting safer supply for profit.

In a recent Substack article, Euan Thomson, a harm reduction activist, claimed that doctors who “stonewall” safer supply have “financial interests” and “seem willing to cash in their integrity for political potshots.” Safer supply advocates, including prominent researchers, have since widely shared his article online.

In most cases the “conflicts of interest” identified by Thomson amount to doctors running addiction clinics or related services — in other words, safer supply advocates want to smear addiction doctors as corrupt simply because they work in, and thus earn a living from, their own field.

This is not an isolated incident. Zoe Dodd, one of Canada’s leading safer supply activists, has publicly stated that the field of addiction medicine is the “worst medicine of them all” and should be “dismantled,” and has asserted, without evidence, that addiction doctors who criticize safer supply do so because they have “skin in the game” and are afraid of becoming “obsolete.”

In reality, the only thing that needs to be dismantled is the ideological radicalism that whitewashes safer supply.

National Post