EXPOSED – COVERUP AND MEDIA DISTORTIONS HELP HIDE THE LETHAL FAILURE OF OPIOID “SAFER SUPPLY”
Predictably, flawed research interpretations get by as conclusions that shield the powerful systems fueling epidemic while direct reporting of diversion and misuse of their gold standard treatments is buried
by Clark Miller
Published May 3, 2024
A recent post that dismantled unsupportable conclusions of benefit attributed to “safer supply” of opioid and other drugs of abuse started this way –
There is nothing new about “safer supply” or “risk mitigation” medical prescriber practices implemented in British Columbia and elsewhere in Canada in desperate attempts to reduce lethal opioid overdoses, apart from the opioids supplied – hydromorphone and morphine – being more potent and less controlled than their predecessors, buprenorphine and methadone.
Nor anything new, as we will see here, in the ways that the medical/media collusion uses deception and cultivated incompetence to distort and hide the ineffectiveness and lethality of the approach.
Two media reports – one on the same original research – since that post was published reinforce those points along with the inescapable conclusion that nothing has changed, nothing learned, over past decades since a confluence of America’s most trusted media, research, medical and public health institutions colluded to recklessly and incompetently fabricate the lie that opioid pain medication could be effective and safe for all pain, generating the increasingly lethal opioid crisis now perpetuated by the same pathological forces.
Here’s a major report in Canadian media, comparing the same two pieces of research examined in this post, in this case by a news reporter concluding that,
Two studies in international medical journals cast the strategy in a different light. One found the program was associated with a reduced risk of death from overdose and other causes among opioid-using participants, while the other concluded the strategy was associated with a significant increase in opioid overdose hospitalizations across the community.
In fact, analyzed by anyone with background and basic competence in the fields of problem substance use, research design and interpretation, and current practices, trends, social and psychosocial factors affecting the course of the opioid crisis, it is clear that the study attributing benefit to safer supply did not provide support for that conclusion, instead pointed to no benefit or harm.
From that recent post –
Here’s the “landmark study” in the British Medical Journal –
Some salient points from the study included that
– While there were fewer lethal opioid overdoses for RMG subjects, there were no differences in acute care visits for opioid overdose = high-risk use
– There was no reduction in lethal overdose for subjects receiving RMG for stimulant drugs
– While protocols varied and were unspecified, dosing and dispensing, as in other RMG programs in Canada, involved multi-weekly or daily contact with health care settings
From the CDC piece describing the research and outcomes –
The study did not confirm whether the drug users took the drugs as intended. Bach said a significant criticism of safe supply programs is the fear that prescription opioids will be diverted or shared with those for whom the drugs are prescribed.
“That remains a complicated question,” said Bach. “This study design cannot speak to that specific question.
Other investigations can, including the reporting discussed in this recent post, with findings including that –
A four-month investigation by columnist Adam Zivo with our sister paper, the National Post, suggests the federal government’s “safer supply” program meant to wean addicts off the deadly opioid fentanyl, is having the opposite effect.
In interviews with 20 health-care experts, including 14 specializing in addiction medicine, Zivo was told many addicts are selling on the black market the free drugs they are given to reduce their dependency on fentanyl, to buy more fentanyl.
Compounding the problem is that this has caused the street price of the opioid they are given as a substitute— mainly hydromorphone — another powerful opioid, although nowhere near as potent as fentanyl — to plummet down to a few dollars per tablet.
The lower street price for hydromorphone because of the increased supply, Zivo reports in, “Drug fail: The Liberal government’s ‘safer supply’ is fuelling a new opioid crisis” has led to a wave of hydromorphone addiction across the country, particularly among the young.
The problem is that while hydromorphone is five to 10 times more powerful than morphine, it doesn’t eliminate the craving for many addicted to fentanyl, which is 50 to 100 times more potent than morphine.
But hydromorphone can be deadly for novice drug users, particularly when hydromorphone tablets, intended for oral consumption, are crushed for intravenous injection, potentially leading to excruciating and disfiguring infections and in some cases, paralysis.
But an expert cited in the CDC piece claims that the reduced lethal opioid overdoses in B.C. must have been due to subjects using the dispensed opioids, to their benefit.
Dr. Thomas Brothers, a resident physician in general internal medicine at Dalhousie University who is not affiliated with the study, said the extent to which mortality was reduced suggests users were themselves using what was prescribed.
“Some of the community of researchers and addiction medicine physicians who are more skeptical of safer supply have particular concerns about the amount of medication that might be diverted to others beyond the person that it was prescribed to,” he said.
“I think this may reassure them because the evidence of a mortality benefit means that the patient who is prescribed the medication must be taking some of it.”
Benefitting from “taking some of it”?
Or from the obvious confounding factor that would have and has consistently accounted for reduced incidence of lethal opioid overdose in studies claiming benefit from the treatment effects – differential availability, monitored provision of, and use of lethal OD-reversing naloxone in a population with more frequent and intensive contact with care providers and settings, and identified higher risk?
Would naloxone have likely been differentially provisioned and dispensed to, with more regular interactions to assure possession and potential life-saving use in the RMG treatment population than in the comparison population not receiving safer supply services?
Let’s consider.
Generally, the development of safer supply programs in Canada has included integrated efforts to “provide access to harm reduction and overdose prevention supplies and education” [emphasis added]. In the current study, dispensing of the opioids – requiring contact with care providers and settings including pharmacy, safe use sites, other clinical or support settings – appears to have occurred multiple times weekly of not daily. Typical protocols and supports in safer supply may include community outreach and contact with diverse members of a care team including nurses, case managers, care facilitators, social workers, outreach workers and housing workers“. In B.C. daily contact for safer supply recipients may be the norm, where “Clients pick up their medications daily at community pharmacies; selected pharmacies offer a delivery service to the sheltering sites and other locations to support physical distancing and self-isolation.“
There is a picture emerging here, part of it a factor not recorded, nor available for analysis in the “landmark study”, not part of the reported results, conclusions or interpretations. The care team members, community supports, and settings for daily contact by clients receiving RMG would predictably involve persons carrying naloxone and trained on its use. As part of naloxone campaigns in B.C. as elsewhere, community saves would have become more frequent, and not part of any clinical record. As of 2021, one group estimated that naloxone saves in B.C. had reached 1,000 to 2,000 per month. The picture has high-risk opioid users buying fentanyl and other “real dope” with the free hydromorphone and morphine they are provided, continuing to engage in high-risk opioid use (hence the absence of any decrease in visits for opioid overdoses), and regularly revived by unrecorded instances of community or professional reversals, with significantly higher probability due to daily contact than the RMG non-exposed group.
There is no evidence – none – in the “landmark study” or elsewhere to disconfirm that all of the apparent decrease in lethal opioid overdoses are attributable to naloxone saves, differentially more probable for clients in the RMG group than in the non RMG group.
There is, however, additional relevant evidence – the lack of any protective effect, in our current study, against lethal overdose for illicit stimulant users provided RMG with pharmaceutical stimulants.
That’s a bit of a discrepancy.
And a no-brainer, isn’t it?
There is no naloxone and no naloxone campaigns for potentially lethal stimulants.
Back to our current post:
Here’s the new piece confirming and validating the reporting by Adam Zivo, noted above. The entire piece is well worth reading.
So it was fascinating to get a close-up, street-level view of what exactly is happening outside at least some clinics and pharmacies after the prescribed safer supply is handed directly to people struggling with addiction problems.
The glimpse comes courtesy of CBC reporter Jason Proctor, who obtained a search warrant filed by Prince George RCMP who were investigating a woman who kept showing up outside a downtown drug store most mornings.
The search warrant simply lists all the suspicions that police had to present to a judge in order to get permission to look inside her house. They are not yet proven in court. But they are enough to make you wonder if the mantra is valid.
The pharmacist told police his prescriptions were being traded for illegal drugs. Ever since safe supply started, people have been loitering outside the store buying prescribed drugs from his patients after they are dispensed, he said. The problem has gotten worse in the last year.
People can get 28 Dilaudid a day, and the pharmacist said patients have told him they are worth money and are sold or traded routinely on the sidewalk outside the store. He said his clients are accosted outside the store most mornings by buyers. “Vehicles would be observed idling with windows down in the middle of winter.”
On March 6, 15 people entered the store when doors opened at 9 a.m. In the next 20 minutes, nine of them left and had interactions with suspects that were believed to be drug transactions.
The next morning was the same. And the next day of surveillance, and the next.
There were 84 brief transactions in the minutes after the store opened, over the duration of the surveillance. . . .
The Northern Beat online news site cited several drug-squad officers around B.C. who said diversion is a problem.
But curiously, the senior ranks of the RCMP started de-emphasizing diversion.
Assistant Commissioner John Brewer said: “The presence of confirmed safer supply prescriptions are in the minority of drug seizures. There is currently no evidence to support a widespread diversion of safer supply drugs in the illicit market.”
The NDP cabinet has been relying on that view for the past month and provincial health officer Dr. Bonnie Henry downplays it as well.
This week, Northern Beat published a memo from RCMP brass telling detachments to refer all queries on “hot button” issues — like drug seizures — during the pre-election period to headquarters.
The idea that it is a gag order was indignantly denied by Solicitor General Mike Farnworth.
While public health officials defend their commitment to safe supply, opposition critics raise doubts and drug-squad cops get muted, a meticulous police account of what’s going on at street level, produced by way of a reporter combing through search warrant applications, is an interesting bit of evidence.
Given that there is currently no official mechanism for measuring the scale of diversion, it’s actually one of the few indicators available to go on.
Back to our current post –
Not so surprising really. The scope and terrible costs of the opioid crisis, the signs and indications all along, from the beginning, its perpetuation and worsening driven by the same forces generating it. Those are truths that would be too disruptive, too costly to the established order, too much to tolerate, exposing the core of our most esteemed and trusted institutions. Truths that simply cannot be allowed.
And from that recent post, again –
As investigative reporter Adam Zivo put it –
The problem is that while hydromorphone is five to 10 times more powerful than morphine, it doesn’t eliminate the craving for many addicted to fentanyl, which is 50 to 100 times more potent than morphine.
Yes, that’s the problem. The problem underlying the decades-long “safer supply” of buprenorphine and methadone driving an increasingly lethal crisis, now with the more potent opioids morphine and hydromorphone.
The opioids supplied, without there ever having been a body of research supporting safety and benefit from the begining, do not meet the untreated needs of users desperately compelled to experience the relief from psychic pain and anguish that their more potent street opioids provide them, opioids easily obtained with the currency of their free, medically dispensed opioids. Their publicly financed vouchers.
That desperately needed relief from the psychic pain that drove their dependene on opioids has never been treated, the effective psychological, mental health and psychosocial treatments and supports never offered to them. They don’t exist, displaced by cronyism employment systems and lethal medical interventions the entirely non-medical condition of compulsive substance use.
Opioid high-risk use and deaths in the U.S. and Canada continue to mount, year by year, as expert cures are increasingly dispensed.
Safer supply is the new safer supply, as lethal as ever.
