Canada Claims We Have “Safe Supply.” Here’s What That Actually Looks Like.

    I started injecting morphine in 2004. It made my face painfully flushed, and what people often experience as a prickling sensation felt, in my case, more like my bloodstream had been replaced by a cactus. But it would be another 15 years before I knew why.

    A year later I got on methadone. I tried to go to detox for my crack cocaine use, but got kicked out after two days. I remember the head of the program screaming at me, You smoked crack, I know you did! You can keep your bed if you just admit that you smoked crack! I finally screamed back that I took two puffs of a joint while I was out getting my methadone, but hadn’t smoked crack, which was the truth. She kicked me out because it’s a dry facility.

    My then-girlfriend and I started splitting a quarter-gram of heroin each day. I was still on methadone, and at 55 mg was nodding out all over the place; setting furniture on fire. But the program wanted to bring me up to a much higher dose, very quickly, telling me it would put an end to my crack use. I titrated down on my own, left the program, and by the end of 2006 had been sober for eight months. Then my mother died.

    This time around, the methadone felt different; less effective. Turns out it wasn’t methadone.

    I used my inheritance to go to university and to buy heroin. Over the next few years, as my tolerance went up to about 1 gram a day and my housing and my relationship became less stable, I kept studying and just putting one foot in front of the other each day. Eventually I got back on methadone, but it felt different this time; less effective. I went up to 130 milligrams, and managed to get by on that for a while.

    As it turned out, the methadone felt different this time around because it was no longer methadone. The clinics had switched to Methadose, a diluted and therefore cheaper version—not that the actual people taking it were told this. I didn’t learn that I’d been taking something else until 2019.

    When I needed to go up to 140 mg, I was told that required an EKG. Methadone and Methadose alike had been taking a toll on my body, and I was scared. I spent the next six months titrating myself down to 30 mg, in preparation for a switch to Suboxone.

    Unlike the United States system, where clinics dispense methadone one day at a time and pharmacies provide Suboxone one month at a time, in Canada you can access both medications for opioid use disorder (MOUD) from pharmacies. But you have to have to “earn” Suboxone carries (take-homes, as they’re called in the US) just like you do with methadone.

    You do this by pissing clean, and in the beginning I did exactly that. Suboxone was working decently for me, and I was allowed to pick up a few days’ worth at a time. Life becomes a bit more manageable when you don’t have to report to the pharmacy every day.

    Suboxone was switched from the brand version to generic. We weren’t told about this either.

    But soon the Suboxone started to feel different; less effective. The public insurance coverage had been switched from brand Suboxone to a generic version. Of course, we weren’t told this at the time, either.

    Within two months I was using dope again. My carries were revoked, and I spent the next few years reporting to the pharmacy every day. That’s just how it is.

    By 2012 my Suboxone prescription was at the max 24 mg, and my girlfriend and I were splitting three-quarters of a gram each day. I was supporting both of us while studying, busking, taking off-book labor jobs, putting one foot in front of the other, until my white blood cell count dropped so low that at the hospital they asked if I was on chemotherapy. Just exhaustion, it turned out. But my nursing school program had a policy of automatically failing students who missed too many classes, so I was forced to drop out.

    In 2016, fentanyl came into the province. The woman I loved overdosed next to me. We nodded off in the bathub, and I woke up and she didn’t. That same year, I was switched to another version of generic Suboxone that might as well have been sugar pills.

    Canada has spectrum of MOUD and medical safe supply with a few more options than exist in the US. I painstakingly weaned myself off Suboxone so I could switch to yet another one: slow-release oral morphine, AKA Kadian.

    Over the years I’d sometimes had to buy morphine when heroin wasn’t available, and from these experiences had learned that it’s morphine, specifically, that my body cannot tolerate. One time the swelling and irritation was so bad, I had to go to a hospital—where they gave me morphine, even though I’d told them not to. They then realized I’m allergic to it, which I already knew.

    I switched to from Kadian to Dilaudid—which made me far more ill than I’d ever been before.

    Kadian made me painfully ill. I switched to hydromorphone (Dilaudid), which made me far more ill than I’d ever been before. I couldn’t get out of bed for weeks. My doctor tried to alleviate this by upping the dose to 12 or 16 of the 8 mg pills per day, but I couldn’t physically choke down more than six.

    I’d known this would happen, and so had my doctor. But I had to go through it because it was the only way I could try fentanyl patches. I was one of the first people in the province to receive them, but there was a rule that they could only be prescribed to people who had tried every other option.

    When I finally got the patches, I found that they provided a foundation of relief, even if they didn’t exactly make me well. But the problem, as anyone who uses the patches will tell you, is that they sweat off. Sometimes you’re given a special plastic clingwrap to cover them, but not always, and it was too expensive to buy on my own.

    In 2022, I lost one for the third time. I’m now permanently banned from receiving them.

    My doctor really went to bat for me, but there was only so much she could do. I couldn’t stand the idea of going back to Methadose, or even methadone if I’d had the option. Eventually she put me back on Kadian. There were no other options left for me.

    The Canadian government likes to tout its progressive safe supply policies, but those of actually using it know it’s not real safe supply.

    This is what their drug war gave us: Every day, I take 900 mg of a drug to which I am severely allergic, but according to the government is supposed to make me well. I feel like crap. I’ve been muscling my dope because my veins are shot, and am constantly fighting infections that never quite get worse nor heal.

    My body is collapsing from the strain of panhandling every day. Medical abuse has ensured I stay well away from hospitals. Meanwhile, the dope has so much cut—it’s benzodope these days— that for $100 you can get 1.5 g. So now I’m dealing with benzo withdrawal, too. So much for “safe supply.”



    Photograph via Canadian Medication Appropriateness and Deprescribing Network

    • Meg is a writer in Toronto, where she’s trying to stay alive in a world that wants her dead.

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