A Fentanyl User’s Dispiriting Search for Safe Supply in Toronto

    When I heard earlier this year that a safe supply of opioids would be made more widely available for people who use drugs in my hometown of Toronto, I was excited but hesitant. 

    In the midst of a global pandemic and the drug poisoning crisis, the Canadian federal government decided to move forward with a new exemption and additional funding for safe supply programs. Through the fog of the drug war, they were handing out an olive branch of sorts, at a time when it was desperately needed. 

    After my years of constant struggling with heroin addiction, numerous trips to rehab, attempts to control my use through methadone, and even trying to quit using the hallucinogenic drug treatment ibogaine, things had only been getting tougher. 

    The street heroin to which I was accustomed began slowly transitioning to fentanyl a few years back. Before I knew it, heroin alone—on those occasions when it was available—was no longer strong enough to hold off the withdrawals. 

    These consumption methods can reduce risks; ironically, they would turn out to be a barrier to my accessing safe supply. 

    Honestly, I didn’t really care that fentanyl was a more powerful drug; I am not trying to put myself on some kind of pedestal. But I am at the point now where I really just want to get by and live my life. About three years ago, after losing the use of basically every vein on my body that I could reach, I switched from injecting to inhalation or intranasally sniffing drugs. 

    These consumption methods can reduce risks; ironically, they would turn out to be a barrier to my accessing safe supply. 

    My initial hesitation was caused by other concerns, however. Safe supply programs, I read, were going to make hydromorphone available to people who use drugs. But from my own experience of using hydromorphone, and from what I have read and heard anecdotally, I know that some people might find it enough to ward off withdrawals for use of regular heroin, but not for fentanyl.

    Matthew Bonn recently wrote for Filter, as a fentanyl user, about the importance of having a real fentanyl safe supply. A pilot fentanyl patch program in Vancouver, as he described, is aimed at those for whom methadone, buprenorphine or hydromorphone have not been effective.

    To be clear, fentanylthat “poison” you hear about on the newshas actually been used safely for years in healthcare settings, where dosages can be controlled and adjusted to the patient’s needs. 

    Once I built a tolerance to fentanyl, I found that it simply held off the withdrawals. People who overdose on fentanyl do so due to a higher-than-expected dose or adulterants they get on the street; or due to combining fentanyl with other drugs; or because they do not have a high opioid tolerance. That last reason applies particularly to people who are new to the drug, perhaps using a substance that they didn’t expect to contain fentanylor to those just released from prison, rehab or living in an abstinence-based based homelessness shelter.

    There are no easy answers for those of us who depend on opioids. We are so accustomed to having impossible choices put to us: abstain, suffer and face high risks down the road; or try various other options that likely still involve suffering and risk. From my experience, anything but a medically supervised taper is going to be painful and difficult, with few people quitting without some form of medication. We just have to make the best of our options and continue to try not to die.

    And so, back in the spring, I began the process of seeking a safe pharmaceutical supply.


    How I Hit a Roadbock

    Living in Toronto, that meant following one of two options. I could either access safe supply from one of a handful of programs already operating, usually through Community Health Centres in the downtown core. Alternatively, I could take an advocacy packageconsisting of a letter from the Minister of Health and general information on safe supplyto try and find a family doctor who would be willing to prescribe hydromorphone to me. 

    I began by calling the locations which were in various stages of commencing their safe supply programs. Some had already begun provision, while others were still screening candidates. After calling around, and multiple follow-up calls, I finally got myself on one community health center waiting list. All the other programs were either full or unable to accept me. 

    While on that waiting list, I was being asked further questions about the nature of my use to see if I met the eligibility criteria. This is where I hit a roadblock. I was no longer an injection drug user, because I was now inhaling or sniffing fentanyl. I was told that this program was focusing primarily on the most at-risk users, specifically people injecting.

    I pleaded with the very kind worker on the phone for about 20 minutes, explaining that I had consumed drugs via hypodermic needle for most of my adult life, and that a small improvement in my situation should not preclude me from consideration. I still engaged in plenty of risky and downright dangerous behaviours, and was still at risk of overdose. Surely I shouldn’t be penalized and excluded for having taken some harm reduction steps to protect myself?

    The staff member on the other end of the phone listened, and eventually told me that my situation would be brought up to the board, which makes decisions on such matters, and I would be contacted with an answer. 

    I waited days, weeks, then months for that answer. During this time, I made several more phone calls to the center; staff explained that this was a new program with limited capacity and funding, and that the process would take time. 

    Think about that for a second: The three of us had to apply to get this service through what felt like a competitive process. 

    I should mention here that at the same time I enrolled myself, two other people very close to me also applied to get on the same program. Think about that for a second: The three of us had to apply to get this service through what felt like a competitive process. 

    This should not have been a job interview. We were applying for the right to access a medication approved by Health Canada—so we could function on a daily basis and stay alive. While we waited, we were living in ongoing fear of being arrested for merely possessing our drugs, or of overdosing as we were forced to consume them in their unregulated formulations. 

    When my two close friends and I got our screening phone calls, we all felt that honesty was the best option in answering questions about ourselves and our drug use. After years of being forced to bend the truth in methadone programs and in conversations with doctors just to get medical care, we held on to the faith that maybe this would be different. If we were to be given an honest shot, why taint the first steps into this program with lies? 

    A few weeks later, as our summer was coming to an end, we each got a phone call informing us that we had been denied access to the program. To be fair to the program, its hands were probably tied by funding restrictions and other factors. But it was a crushing disappointment.

    Then we were each given an advocacy package to take to doctors in order to try and convince them that they can now legally prescribe opioids to people for opioid use disorder. If you think that sounds like a long shot, you’re probably right. Since then, the three of us have been trying every avenue to get on a program that will give our lives some level of stability. We have not succeeded.

    In the end I think society is going to have to look deeper, to consider examples from Europe and other evidence-based strategies and profound structural changes when it comes to substance use issues. 

    Occam’s razor suggests that the simplest explanation is likely the right one. Take the tenets of safe supply and run with them to their logical conclusion. Give people who use drugs a safe supply of the drugs they are already using. And while we’re waiting, at least give people the basic tools—naloxone, drug checking services, safe consumption sites, decriminalization—to avoid the worst dangers of our current supply. Give us some dignity and a chance at lifeor is that too much to ask? 

    That’s my safe supply story so far; wish me luck.


    Photo by Berkay Gumustekin on Unsplash

    • Jerzy Sandino is a pseudonym for a busy member of the harm reduction community in Toronto. He has written elsewhere on issues related to drug policy and music. He is an active drug user.

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