Drugs provided under “safer supply” programs are produced by companies who have been taken to court in relation to the opioid addiction crisis.
Highly potent opioids such as fentanyl are being produced by pharmaceutical companies, paid for by Canadian taxpayers, and given out as part of “safer supply” programs.
The merits and potential harms of such programs are the subject of ongoing debate, but in the meantime, the federal and B.C. governments are committing hundreds of millions to the purchase and distribution of these drugs.
The drugs include fentanyl buccal tablets produced by Teva Pharmaceutical Industries Ltd., which paid
a $4.25 billion settlement to U.S. states and local governments in 2022 for allegedly contributing to the nation’s opioid addiction crisis.
Another popular safe supply drug is hydromorphone, much of which is supplied by Purdue Pharma, accused of being among those largely
responsible for the
opioid crisis that safe supply is now aiming to address. In 2022, Purdue Pharma Canada paid $150 million to
settle a B.C.-led class-action lawsuit brought against it by all provinces and territories.
“We are committed to holding corporations and others accountable for acts of alleged wrongdoing committed in the manufacturing and distribution of opioid products,” then-B.C. Attorney General David Eby, who is now premier, said
in a statement at the time.
Neither Teva nor Purdue responded to Epoch Times inquiries regarding their participation in safe supply or the allegations about their role in the opioid addiction crisis.
Other safe supply drugs include fentanyl patches produced by Sandoz Canada Inc., which is also in a legal battle with British Columbia over its alleged contribution to the addiction crisis; sufentanil, which is up to 10 times stronger than fentanyl, produced by Sandoz Canada Inc. and SteriMax Inc.; and diacetylmorphine, a safe supply version of heroin, produced by Pharmascience Inc.
While the federal government has funded safe supply programs at a cost of
more than $100 million since 2017, Health Canada could not provide detailed information about how the funds are used, including quantities of various drugs purchased.
“The federal government does not routinely collect detailed information on drug treatment or safer supply programs that are run by provinces and territories,” Health Canada spokesperson Charlaine Sleiman said via email.
The vast majority of federally funded
safe supply programs are located in B.C. and Ontario. Ontario’s health ministry did not respond to a request for comment as of publication. B.C.’s health ministry referred The Epoch Times to its
PharmaCare search portal for drug prices, and noted that its spending on safe supply drugs alone (not including other safe supply program costs) was $8.87 million annually for both 2022 and 2023.
Drug Costs
Cost estimates for the drugs vary widely, depending on the kinds of drugs used and the frequency of use for each patient. While hydromorphone has been the most commonly supplied opioid over the past few years, use of safe supply fentanyl products is on the rise.
B.C. PharmaCare pays up to 38 cents for each hydromorphone tablet under the brand name Dilaudid, made by Purdue Pharma. If a patient receives
14 tablets per day, that could cost some $1,900 annually, assuming the patient uses every day. Dosages can go
beyond 20 tablets per day, which could bring estimated costs above $2,700 annually. B.C. Pharmacare covers up to 35 per day, which would be more than $4,800 annually.
At Ontario’s London InterCommunity Health Centre (LIHC), the cost of safe supply drugs per patient was about $1,600–$1,700 annually, according
to a 2022 study published in the Canadian Medical Association Journal. That includes hydromorphone, which has an immediate effect, as well as
long-acting opioids such as slow-release morphine. The two are paired together in prescriptions. Fentanyl buccal tablets under the brand name Fentora (made by Teva Pharmaceuticals Inc.) are covered by B.C. PharmaCare up to $13.17 daily.
The
protocols for the Victoria SAFER Initiative program includes an example of 400 mcg Fentora tablets prescribed to be ingested twice daily. At about $13 each, the cost would be $26 daily or $9,490 annually per patient. The province’s
protocol allows doses up to four times daily, which would bring the cost to about $19,000.
Sufentanil products made by Sandoz Canada Inc. and SteriMax Inc. are covered up to $12.44 per 50 mcg vial. The province’s
protocols state that it can be offered as needed up to 250 mcg every hour “up to participant’s desired dose and as hours of operation allow.” The
protocols for the Victoria SAFER Initiative program say standardized dosing is 100 mcg up to four times daily. At that dosage, the cost would come out at about $100 daily and $36,500 annually.
Sandoz Canada is also the sole producer of safe supply fentanyl patches, which B.C. PharmaCare covers up to $30.45 each at the highest potency. The lowest potency costs $2.40, but others cost from $9 to about $24. Nurses apply the patch for a patient three times weekly,
according to protocols. At the maximum dosage, that would be about $90 weekly or about $4,700 annually.
Sandoz Canada is among four pharmaceutical manufacturers trying to halt a proposed class-action lawsuit by the B.C. government.
According to
court documents, the government says it is seeking “the recovery of health care costs incurred as a consequence of those companies’ actions to market, promote and sell opioid products as less addictive, less subject to abuse and diversion and less likely to cause tolerance and withdrawal than other pain medications. The health care costs incurred by the province include those for treatment of problematic use and addiction, the cost of emergency services in response to overdose events, the cost of hospital treatment and other costs.”
Provincial courts upheld the B.C. government’s right to recover costs, but the companies have taken the matter to the Supreme Court of Canada, which said in November 2023 that it
would hear the appeal. Sandoz did not reply to a request for comment on the case and on its role in safe supply programs.
Sandoz also makes injectable hydromorphone, called Hydromorphone HP 50, which is covered up to $7.50 per 50 mg vial. If the dosage is similar to the amount of hydromorphone ingested in pill form, that’s some $6,100 annually.
The Epoch Times contacted safe supply providers to request detailed information about amount of drugs supplied to patients and costs, but they either did not reply or referred us back to the government for information.
Program Costs
The total costs of operating the safe supply programs go well beyond the drugs themselves. For example, federal funds of more than $4.5 million are allocated to one provider alone, AVI Health and Community Services Society, for its safe supply projects on Vancouver Island. AVI’s 2023
annual report says about $6 million went to salaries. It also receives
funding from other sources, such as the B.C. government.
The report says it provided safe supply to 250 people. It also handed out more than 326,000 harm-reduction kits and provided education sessions. AVI did not reply to requests for additional information about its programs.
In addition to safe supply, governments are funding various spaces for people to use illicit drugs.
The Island Health authority, a publicly funded health care provider,
recently opened an indoor illicit-drug inhalation centre in Victoria, B.C., which it says is the first of its kind in North America. Island Health told The Epoch Times via email that setting up the site cost $2 million and annual operating costs are $2.6 million.
A Vancouver-based study in the Harm Reduction Journal in 2014 conducted a cost-benefit analysis of operating such a facility. It estimated costs at about $97,000 annually, which would be $123,000 today if taking into account inflation since the study. That’s far short of the $2.6 million reported by Island Health.
That study concluded that the public health cost benefits of preventing HIV and hepatitis C transmission from sharing crack pipes would outweigh the costs of operating the facility. Multiple cost-benefit analyses of safe supply have similarly weighed public health costs, but have also noted it’s hard to say with certainty.
For example, the
LIHC study concluded its safe supply program has a net cost benefit, but noted that since its programs provide “comprehensive primary care and social supports to clients, it is difficult to separate the relative impact of safer supply prescribing from the impact of the wrap-around supports provided.”
Cost-benefit analyses are also limited when it comes to drug addiction, as ethical and social concerns are important to consider.
There’s large consensus in Canada that money should be spent to help solve the addiction crisis. The heated debate is over how much should be allocated to safe supply and how much to long-term treatment and recovery.
For example, B.C.’s 2023 budget
included about $184 million “to support safer substance use,” and about $586 million for addiction treatment and recovery beds. The budget had critics on both sides, with some calling for all funds to be directed toward treatment, while others argued the budget is too “treatment-heavy,”
according to the Vancouver Sun.
