Everyone deserves access to health care. It should be unconditional. If you have diabetes and still enjoy the occasional unhealthy snack, a doctor will still prescribe you insulin—and yet equivalent humane treatment is often withheld from people who use drugs. This population is dying at alarming rates, leaving patients and advocates fighting for evidence-based responses including decriminalization, safe consumption sites and safe supply.
Here in Canada, the safe supply movement in particular—the push for a legal, federally regulated supply of drugs like heroin and meth so that people may consume them more safely, free of dangerous adulterants—has been led primarily by women. When it comes to research, prescribing and, crucially, sharing their experiences around drug use, women are driving this movement.
Many of these women were calling for safe supply long before it was a widely known concept. People who do this work are often criticized by the public, and even by a large majority of the addiction medicine field; most addiction medicine doctors have not yet been able to wrap their head around this new way of prescribing.
It’s time for more of us to acknowledge the women who are doing so much to make this life-saving movement possible.
“Abstinence is not a goal for everyone.”
Jessica Hales, for example, is a nurse practitioner with Toronto Street Health, prescribing a safe supply of pharmaceutical drugs as alternatives to toxic ones—like hydromorphone as a replacement for contaminated heroin. “People use drugs for a variety of reasons, and not all drug use is problematic,” she told Filter. “Abstinence is not a goal for everyone.”
By pretending that abstinence is the only “responsible” option, we put everyone who uses drugs at risk of being poisoned by the toxic supply. “We are currently amidst an overdose crisis and need to act quickly with whatever resources are available,” Hales said. “Prescribing a safer opioid supply may prevent overdose deaths.”
Meanwhile, Cheyenne Johnson is the interim executive director of the British Columbia Centre for Substance Use (BCCSU). A registered nurse with speciality training in addiction, Johnson is an educator, practitioner and advocate. She helped develop both the BCCSU Risk Mitigation Guidance Document and the BCCSU Heroin Compassion Club Paper development—two of the most widely cited safe supply documents to date.
Dr. Gillian Kolla is a Toronto-based post doctoral fellow at the Canadian Institute for Substance Use Research. She’s been one of the prominent academic voices, speaking out about how safe supply medications need to comprise a wide variety of drugs including stimulants.
“In order to reduce the amount of overdoses that are happening [we need] to get people on to a safer regulated known pharmaceutical source of opioids,” Kolla said, because our opioid supply in particular is completely saturated with fentanyl. “In a lot of cases, this is hydromorphone but … it can be oxycodone, different forms of morphine. And most importantly it could be diacetylmorphine, which we don’t have good access to in Canada.”
“Safe supply should include producing diacetylmorphine domestically in Canada.”
Diacetylmorphine—AKA heroin—has been proven to be an effective, safer option for some people who use illicit heroin. Some people do prefer to use fentanyl—once you start using a stronger substance like that, some people find it harder to go back—but they may want to try diacetylmorphine because we don’t yet have a safe supply of fentanyl.
“[Safe supply] should include producing diacetylmorphine domestically in Canada,” said Petra Schulz, co-founder of Moms Stop the Harm, an advocacy group for family members who have lost loved ones to overdose.
Schulz lost her son Danny because of a contaminated street supply; she has been a harm reduction advocate ever since. “There needs to be expanded research on alternatives to stimulants, as well as on the role of psychedelics in helping people deal with issues of trauma and mental health with substances that are less harmful.”
As a fentanyl user myself, I know we need more than just diacetylmorphine; we need a pharmaceutical grade source of fentanyl. There needs to be many options for a safe opioid supply—fentanyl patches, liquid fentanyl, heroin and hydromorphone. There is no one magic drug that is going to eliminate this overdose crisis. People need and deserve options.
“Ultimately, ‘safe supply’ must mean legal regulation,” Schulz said. “All other forms of safe supply have limitations, such as barriers to access [with] highly medicalized models and limitations on the types of substances.”
“We don’t question free flu shots—that also keeps people alive.”
One of the big critiques of safe supply has always been, “we can’t give people free drugs.” But why not?
“For me, safe supply is a public health approach during a public health crisis,” Schulz said. “We don’t question free flu shots—that also keeps people alive.”
“We should give people free drugs!” Hales said. “Unfortunately, safer opioid supply programs do not replace the need for a legal, regulated supply.”
We must continue to advocate for community-based safe supply options, Hales said, such as “compassion clubs,” in which people pool together their money to source a safe supply of heroin at a cheaper price. Clubs in Canada are frequently led by women, including moms wary of attracting the attention of child protective services if they were to try to access a sanctioned safe supply program.
Ashley Smoke is a member of the Canadian Association of People Who Use Drugs. After transitioning from a regular opioid agonist program, she has been using a safe supply of opioids for some time and is now advocating for expanded access.
“Before safe supply I was terrified to use but was constantly dopesick, even with 120 mgs of methadone,” Smoke said. “My life still revolved around not feeling sick.”
“Since being on a safe supply program, I no longer feel withdrawals.”
“Since being on a safe supply program, I no longer feel withdrawals,” she continued. “I can have an honest conversation about my drug use and what’s driving it with my doctor. I have time to focus on other things, like connecting to my Indigenous heritage and creativity. My drug use has become recreational and less problematic.”
Most importantly, Smoke is “no longer scared I am going to die when I take my meds like I was before safe supply … I feel safer, more comfortable and in less pain, and empowered to advocate for folks everywhere to be able to access safe supply programs.”
Smoke knows that advocating for safe supply has become more of a necessity than ever as the COVID-19 pandemic compounds the existing overdose crisis. “The drug use itself is not necessarily the issue,” she said. “The social structure of our society is to blame for problematic drug use. And when you fix [that], a person’s drug use then tends to become less problematic.”
There are countless more women doing vital work in this field. To name just a few: Dr. Jade Boyd, Dr. Sara Davidson, Zoë Dodd, Dr. Nadia Fairbarne, Dr. Leah Genge, Natalie Kaminski, Dr. Tiffany O’Donnell, Dr. Nanky Rai, Dr. Andrea Sereda, Dr. Christy Sutherland, Erica Thomson, Natasha Touesnard and Shanell Twan.
The drug poisoning crisis has contributed to more than 17,000 deaths in Canada since 2016. Even though some funding has now been allotted for safe supply programs, a lack of political will meant that it only came after thousands of lives had already been lost.
When systems fail us, we are forced to create new ones. These courageous women and their peers continue to work at the frontline of this overdose crisis in Canada. They persevere through all the pain and grief experienced in this field so others don’t fall victim to this crisis. They are fighting for a safe supply for all of us.