On March 7, a judicial review began of Health Canada’s 2022 decision to deny the Drug User Liberation Front an exemption to the Controlled Drugs and Substances Act. This would have allowed DULF to operate a compassion club, distributing tested drugs at cost to participants in order to reduce their exposure to the adulterated street supply of unregulated drugs.
As researchers with Imagine Safe Supply, a community-driven academic exploration of safe supply experiences among people who use drugs across Canada, our findings point to significant barriers in prescribed safe supply programs, and a clear need for low-barrier programs like DULF’s. Relying exclusively on medical prescriptions for safe supply will not be sufficient to tackle the crisis of deaths involving unregulated drugs. We need compassion clubs to save lives.
The medicalized model involves serious obstacles that inhibit the full life-saving potential of safe supply.
Canada’s prescribed safe supply programs permit doctors (and nurses, in British Columbia) to prescribe controlled substances to patients at risk of overdose. Much evidence points to the effectiveness of these programs in reducing overdose deaths and increasing positive health outcomes more generally.
However, this medicalized model involves serious obstacles that inhibit the full life-saving potential of safe supply. Participants in our study described how strict eligibility criteria in prescribed programs exclude large swathes of people most at risk of drug poisoning. They further described how current restrictions on the types of substances offered, and insufficient dosages, limit the effectiveness of these programs.
In addition, despite the substantial and growing evidence of safe supply’s potential in reducing drug toxicity deaths, 2023 saw a political backlash against safe supply. This was accompanied by a 14 percent reduction in people accessing prescribed safe supply in BC in 2023. Today, only 4,212 of an estimated 225,000 people at risk in BC have access to a prescribed safe supply.
It was with these barriers in mind that DULF developed its compassion club, which it implemented despite the Health Canada decision. This is the second kind of existing safe supply program in Canada—based on community-led, not-for-profit distribution to members. Participants could access banned substances that had been rigorously tested and contained no contaminants.
This model offers significant potential to overcome many of the barriers in prescribed safe supply, therefore reducing the number of people at high risk of fatal overdose. In February, an evaluation of DULF’s program was published that supported this claim, finding a 50 percent reduction in non-fatal overdose risk. There were zero fatal overdoses in DULF’s program, which was halted by police raids in October 2023, with two cofounders arrested and potentially facing prosecution.
The reasonableness of Health Canada’s decision to not sanction DULF’s program is the main question the judicial review is now addressing.
When we asked participants to envision an ideal model of safe supply, many described programs which directly align with DULF’s compassion club.
Our findings strongly support the need to formalize and support compassion club programs such as DULF’s. Participants in our research repeatedly expressed the need for models of safe supply outside of the medical system. When we asked participants to envision an ideal model of safe supply, many described programs that could overcome the barriers of prescription-based models, protect the basic human rights of drug users, and enhance greater access and engagement among impacted communities.
Programs, in other words, which directly align with DULF’s compassion club, and which would save lives by meeting the expressed needs of people who use drugs.
Solutions to this crisis require bold action, and people who use drugs are stepping forward to sacrifice their time, energy and resources to developing life-saving solutions. They should be recognized by public health authorities as valuable allies, not criminals.
Drug-user groups have historically demonstrated a steadfast determination to keep their members safe, regardless of legality. History has shown that the law and policy will ultimately follow. But the speed at which they follow is critically important.
There are many parallels between DULF and the establishment of Insite, North America’s first sanctioned safe consumption site. Insite also operated unsanctioned in its early days before a judicial review provided the program with a permanent exemption.
The lesson from Insite is that government collaboration with community-led programs saves considerable time, resources, and most significantly, lives. Over eight years into a public health emergency, the evidence is clear: We need compassion clubs to have any chance of turning the tide of drug toxicity deaths.
Photograph via Drug User Liberation Front